#4674 CLINICAL PROFILE OF PATIENTS WITH DIABETIC KIDNEY DISEASE ATTENDING NEPHROLOGY CLINICS IN A LOW-MIDDLE INCOME COUNTRY
Authors: Yaqub Sonia , Saeed Marwah , Awan Safia , Bano Sanam 
Published: June 2023

Abstract

Background and Aims
Chronic kidney disease secondary to diabetes is a significant contributor to the global burden of disease, both financially and through a marked deterioration in the quality of life. Diabetic kidney disease (DKD) increases the likelihood of adverse outcomes such as infirmity, cardiovascular events, progressive multi-organ damage, impaired quality of life and reduced life expectancy. Pakistan, a low-middle income country, is ranked among the top 10 countries for absolute diabetes prevalence. Over 19 million Pakistani adults have diabetes, which amounts to 17.1% of the adult population in the country. There is a dearth of literature examining the quality of care of diabetic kidney disease (DKD) patients in Pakistan. The aim of the current study is to evaluate the clinical profile and the quality of care delivered to patients with DKD attending nephrology clinics at a large tertiary care hospital in Karachi, Pakistan.

Method
It was a cross-sectional observational study at Aga Khan University Hospital (AKUH), a private tertiary-care facility located in Karachi, Pakistan. The data used in the study was acquired from the Diabetic Kidney Disease outpatient-database, a registry of patients managed by AKUH. It was used to identify a cohort of patients, with DKD presenting to the nephrology clinic at AKUH from December 2018-January 2021 (n = 553).

Results
Mean age of the study participants was 61.7 + 11.0 years and 60.9% of the study participants were male. 80.5% (n = 445) were non-smokers and over three-quarters (n = 400) had a body mass index (BMI) &gt; 25 which according to the Asian-Pacific BMI cut-offs classified them as obese. These patients had been living with diabetes for an average of 15 years (median IQR = 10-21) and 99% had type 2 diabetes mellitus. A total of 519 study participants (93.9%) had hypertension while 34.2% and 30.9% had dyslipidemia and ischemic heart disease (IHD), respectively. Almost two third of the participants (68.4%) had advanced CKD (stages 3b, 4and 5) at the time of presentation. Less than half of the study population (43.6%) had HbA1c &lt; 7.0 percentage and only 34.9% attained systolic blood pressure (BP) target &lt;130mm Hg while optimal diastolic BP (&lt;80 mmHg) targets were achieved in 72.7%. Almost 70% of the study population were on insulin while 49.7% were receiving oral anti-diabetics. The most prescribed oral anti-diabetic was DPP4 followed by metformin and two thirds were on statins. Calcium channel blockers and beta-blockers were the most used antihypertensive drugs 53.5% and 52.6% respectively; half of the population was on diuretics, while 47.4% were taking Renin-angiotensin system (RAAS) blockers. Those who had eGFR&gt; 60, only 60% of them were receiving RAAS blockade therapy. Women were more likely to be obese and to have higher systolic BP compared to men. Diastolic BP and HbA1c were similar in men and women. The use of statins was higher in men and use of calcium channel blockers and RAAS blockers was significantly higher in women.

Conclusion
The basis for DKD management is multifactorial risk factor reduction which is achieved by optimizing care through modifiable risk factors. In our study we identified potential gaps in the quality of care related to risk factor control, optimal glycemic and/or blood pressure targets and pharmacotherapy to delay the progression of DKD and minimize cardiovascular events. This highlights a major treatment gap in DKD prevention and management calling for greater quality improvement effort in Pakistan, which now has the third highest number of people living with diabetes in the world.