BACKGROUND Chronic Kidney Disease (CKD) in patients with type 2 diabetes enhances the cardiovascular risk profiles and disease, and is a strong predictor of progression to end-stage kidney disease. Early diagnosis is encouraged for referral to specialist kidney care to initiate active management that would optimize outcomes including forestalling progression to end-stage kidney disease. This study was conducted in a regional referral public health facility in Central Kenya with a high prevalence of type 2 diabetes. It was aimed at finding out the burden of undiagnosed chronic kidney disease in their clinic of ambulatory patients with type 2 diabetes who dwell mainly in the rural area. METHODS A cross-sectional study was conducted at the out-patient of Nyeri County hospital. A total of 385 patients were enrolled over 5 months. Informed consent was obtained and clinical evaluation was done, a spot sample of urine obtained for albuminuria and venous blood drawn for HbA1c, Lipids and serum creatinine. Estimated GFR (eGFR) was calculated using the Cockroft-Gault equation. Chronic kidney disease (CKD) was classified on KDIGO scale. Albuminuria was reported as either positive or negative. Descriptive statistics for data summary and regression analysis were employed on SPSS v23. RESULTS A total of 385 participants were included in the study, 252 (65.5%) were females. There were 39.0% (95%CI 34.3-44.2) patients in CKD/KDIGO stages 3, 4 and 5 and 32.7% (95%CI, 27.8-37.4) had Albuminuria. The risk factors that were significantly associated with chronic kidney disease/KDIGO stages 3, 4 and 5 were: age > 50 years, long duration with diabetes > 5 years and hypertension. Employment and paradoxically, obesity reduced the odds of having CKD, probably as markers of better socio-economic status. CONCLUSION Unrecognized CKD of KDIGO stages 3,4 and 5 occurred in over 30 % of the study patients. The risk factors of hypertension, age above 50, long duration of diabetes should help identify those at high risk of developing CKD, for screening and linkage to care. They are at high risk of progression to end-stage kidney disease and cardiovascular events. The imperative of screening for chronic kidney disease is availing care in publicly-funded hospitals.

中文翻译：

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肯尼亚一家县医院诊所的2型糖尿病患者无法识别的慢性肾脏疾病负担：对护理的影响和筛查的必要性。

背景技术患有2型糖尿病的患者的慢性肾脏疾病（CKD）增强了心血管疾病风险和疾病，并且是发展为终末期肾脏疾病的强有力的预测指标。鼓励早期诊断，转诊至专科肾脏护理，以开始积极治疗，以优化结果，包括阻止进展为终末期肾脏疾病。这项研究是在肯尼亚中部地区2型糖尿病高发地区的地方转诊公共卫生机构进行的。目的是在主要居住在农村地区的2型糖尿病门诊患者的门诊中找出未确诊的慢性肾脏疾病的负担。方法在奈里县医院的门诊进行横断面研究。在5个月内共有385例患者入组。获得知情同意并进行临床评估，从尿液中抽取白蛋白尿样本，从静脉血中抽取HbA1c，脂质和血清肌酐。使用Cockroft-Gault方程计算估计的GFR（eGFR）。慢性肾脏病（CKD）按KDIGO等级进行分类。据报道蛋白尿为阳性或阴性。在SPSS v23上使用描述性统计数据进行汇总和回归分析。结果共有385名参与者参加了研究，其中252名（65.5％）是女性。CKD / KDIGO 3、4和5期有39.0％（95％CI 34.3-44.2）患者，有32.7％（95％CI，27.8-37.4）患者患有白蛋白尿。与慢性肾脏疾病/ KDIGO 3、4和5期显着相关的危险因素是：年龄> 50岁，糖尿病持续时间> 5年，以及高血压。就业和矛盾的是，肥胖降低了患CKD的几率，这可能是社会经济地位改善的标志。结论在超过30％的研究患者中，KDIGO的3、4和5期CKD无法识别。高血压，年龄在50岁以上，糖尿病持续时间长的危险因素应有助于确定罹患CKD的高风险人群，以进行筛查和与护理的联系。他们处于发展为终末期肾脏疾病和心血管事件的高风险。慢性肾脏病筛查的当务之急是在公立医院获得治疗。糖尿病持续时间长，应有助于确定罹患CKD的高风险人群，以进行筛查和与护理的联系。他们处于发展为终末期肾脏疾病和心血管事件的高风险。慢性肾脏病筛查的当务之急是在公立医院获得治疗。糖尿病持续时间长，应有助于确定罹患CKD的高风险人群，以进行筛查和与护理的联系。他们处于发展为终末期肾脏疾病和心血管事件的高风险。慢性肾脏病筛查的当务之急是在公立医院获得治疗。