Progression of diabetic nephropathy and associated factors in a cohort of sri lankan patients: a retrospective study

Kamani Wanigasuriya1*, Chinthana Galahitiyawa2, Pubudu de Silva3, Priyanga Ranasinghe4, Chula Herath2

Background and aims Previous studies have noted a marked racial/ethnic difference in epidemiology and progression of diabetic nephropathy (DN). The present study aims to examine the rate of decline in estimated GFR (eGFR) and factors associated with progression in a cohort of patients with DN in Sri Lanka. Methods A retrospective-cohort-study was conducted among patients with DN. Data were collected retrospectively for 2-years by perusal of clinic records, including socio-demographic details, co-morbidities, investigational results and details of medications. eGFR was calculated and staging was based on national kidney foundation kidney disease outcomes Quality Initiative criterion. Results One hundred and fifty five adults were included (Males 70.3%). Mean age was 66.5 ± 8.7 years. Mean duration of diabetes was 18.2 ± 8.9 years, while diabetes retinopathy was the commonest microvascular complication (>90.0%). Majority were in either stage-3 (36.8%) or stage-4 (40.6%) CKD at recruitment.During the two-year period eGFR declined in 93 patients (60.0%), with a mean decline in eGFR of 5.2 ml/min/1.73m2 per year. There were 31 patients (20.0%) with rapid decline in eGFR (>5 ml/min/ 1.73m2 per year).Those with declining eGFR were significantly older (p<0.001).Decline in renal function was significantly associated with presence of albuminuria (OR: 4.9; p<0.001). Conclusion A rapid decline in kidney function was observed in the present study population, with implications for negative long term consequences for both the individual patients and the health care system. Therefore, it is an important factor that should be taken into account when taking policy decisions in relation to future preventive and curative health care planning.