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Chronic Kidney Disease Stage 3B among Malaysian Diabetics in Primary Care and its Associated Factors: A Pilot 5-Year Case Control Study

Original article

Abstrak

Abstract

The present study aimed to determine the factors associated with CKD stage 3b among type 2 diabetics attending primary care follow-up, specifically the role of angiotensin blockade dosage. This was a pilot unmatched case-control study conducted in a teaching primary care centre. Clinical data of 25 cases of diabetic patients with CKD stage 3b (GFR 30-45ml/min/1.73m2) in 2012 were selected for this study, as well as 103 controls who were diabetic patients with GFR more than 45ml/min/1.73m2 in 2012. Systematic random sampling was employed. Data was obtained from patients’ diabetic records, computerised clinical medical information system and medical case notes. Univariate analysis was done using Chi-square, t-test, Fisher’s exact test and Mann-Whitney U-test. Multiple logistic regression was used to determine the associated factors for development of CKD stage 3b. Cases and controls were different in terms of age, duration of diabetes, use and dosage of angiotensin blockade medications, systolic blood pressure and baseline GFR. Multiple logistic regression revealed that systolic blood pressure (Adjusted OR= 1.08, 95% CI= 1.02-1.14, p=0.013) and baseline GFR (Adjusted OR= 0.90, 95% CI= 0.85-0.95, p<0.001) was significantly associated with the development of CKD stage 3b among diabetics. Maximizing the dose of angiotensin blockade had a protective effect (Adjusted OR= 0.14, 95% CI=0.85-0.95, p=0.025). The results of the present study supports the need for good control of systolic blood pressure among diabetic patients to reduce the risk of chronic kidney disease progression. Dose of angiotensin blockade medications should be optimised in these patients.