Introduction:
Diabetic Kidney Disease (DKD) is a major complication of diabetes and a leading cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) globally. In Bangladesh, rising diabetes prevalence has led to an increased burden of DKD, yet data on its prevalence and management within primary healthcare settings remain limited. This study aimed to assess the prevalence of DKD and evaluate management practices among diabetic patients at Diabetic association of Bangladesh (BADAS)-affiliated healthcare centers.
Methods:
A cross-sectional study was conducted across eight BADAS-affiliated healthcare centers, enrolling 320 diabetic patients (40 per center) selected through multi-stage sampling. Data collection included socio-demographic details, clinical assessments (eGFR, uACR), blood pressure, HbA1c levels, comorbidities, medication use, and adherence to DKD management guidelines. Descriptive statistics were utilized to analyze DKD prevalence, staging, and management. Ethical approval was obtained, and informed consent was provided by all participants.
Results:
DKD prevalence was 34.1%, with 31.9% identified through elevated uACR and 7.5% through reduced eGFR. Notably, only 4.4% of participants were aware of their DKD status at screening. Staging showed 33.0% of cases in Stage 1, 45.0% in Stage 2, and 18.3% in Stage 3, indicating that most cases were in early stage of disease. Hypertension (37.8%) and diabetic retinopathy (35.6%) were the most common comorbidities. Glycemic control was suboptimal, with 66.1% of participants having HbA1c levels ≥8%, and 91.5% having levels ≥6.5%. Additionally, 82.1% had HbA1c levels ≥7%, reflecting poor diabetes management. Obesity was prevalent, with 47.5% classified as obese and 21.6% as overweight. Uncontrolled blood pressure was observed in 69.1% of participants. Tobacco use was reported by 9.4% of participants for smoking and 14.4% for smokeless forms. Screening for DKD was inadequate, with only 47.5% screened, while 52.5% had never been screened. Management was also suboptimal, with 65.0% on antidiabetic medications and only 30.0% using anti-proteinuric drugs. Knowledge assessment highlighted gaps in awareness of DKD symptoms and screening practices, with only 41.56% recognizing urine albumin testing as a diagnostic tool. Cost-related barriers and dissatisfaction with healthcare services were reported by 45.6% of participants.
Conclusions:
DKD is highly prevalent among diabetic patients attending BADAS-affiliated centers, with significant deficiencies in screening, management, and patient education. The findings emphasize the need for improved DKD management strategies, including better screening protocols, targeted patient education on DKD symptoms and risk factors, and greater adherence to guideline-recommended medications. Implementing comprehensive prevention and management programs at BADAS centers could enhance patient outcomes, prevent progression to ESRD, and reduce the healthcare burden of DKD in Bangladesh. Enhanced diabetes care focusing on patient education, optimized therapies, and regular monitoring is urgently needed to prevent DKD and improve overall patient health.
I have no potential conflict of interest to disclose.
I used generative AI and AI-assisted technologies in the writing process.
During the preparation of this work the author(s) used ChatGPT in order to improve readability. After using this tool/service, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the publication.