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Chronic kidney disease currently affects approximately 1 in 11 adults in the world. It´s estimated that by 2040 it will be the 5th cause of worldwide death and the 4th in Latin America. The epidemiology of chronic kidney disease has been widely described but there are no specific reports from many regions in Latin America and specifically from Ecuador.
The main objective of this study was to know the epidemiology and evolution of kidney function in patients without health insurance.
A retrospective cohort study was done with patients who came in the Nephrology Outpatient Clinic of the Vicente Corral Moscoso Hospital between January and December 2021. Clinical and biochemical variables were collected for analysis from patients who met the inclusion criteria. The statistical analysis of the data was carried out with the SPSSv26 and Excel 2019 programs.
A total of 1121 patients were analyzed, only 446 met criteria of having a minimum of 2 measurement of serum creatinine with a period of 6 months between them, they were selected for the analysis. Of the total patients, 268 (60%) were women and 178 men (40%). The distribution by stages of kidney disease was Stage 1: 67 (15.8%), stage 2: 75 (17.6%), stage 3a: 79 (18.6%), stage 3b: 88 (20.7%), stage 4: 63 (14.8%) and stage 5: 52 (12.5%) at the beginning of study. The mean eGFR according to CKD-EPI 2021 at the beginning of study was 52.4 ± 32.7 ml/min/1.73m2. and at the end 51.7 ± 32.4 ml/min/1.73m2 with a follow-up time of 14.8 ± 7.1 months. In the analysis of risk factors, we found that the patients who had the lowest GFR were those who had Diabetes 45.3 ± 28.1 vs 55.8 ± 34.3 ml/min/1.73m2 p <0.05. The eGFR at the end of follow-up was 56.3 ± 35.1 ml/min in non-diabetics and 40.1 ± 29.2 ml/min in diabetics, p < 0.05. The change in GFR was analyzed by groups, finding a decrease in those with Diabetes 5.1 vs 0.5 ml/min compared with those who did not have Diabetes p <0.05.
The main risk factor for rapid decrease in GFR, defined as the loss of more than 10ml/min of eGFR or the doubling of creatinine value in the follow-up, was found to be the presence of diabetes mellitus 29% vs 42% p=0.02 and 28% vs 48% p= 0.001 respectively.
After adjusting the confounding factors like age, comorbidities, and proteinuria in a multiple regresion model, we found that the risk of accelerated loss of renal function was increased with the presence of Diabetes OR: 1.67 95%CI 1.03-2.7 p=0.03 and proteinuria greater than 50 mg/dl OR: 1.93 95%CI 1.2-3.2 p=0.01. (Figure 1)
In this retrospective cohort study with a representative population of the nephrology clinic in patients with risk factors for kidney disease, we found that having diabetes and proteinuria greater than 50 mg/dl are the most relevant risk factors for having lower GFR and to present an accelerated deterioration of kidney function. Variables likes hypertension, older age, or diagnosis of obstructive uropathy did not show to increase the risk of rapid deterioration of renal function in this cohort.
In patients without health insurance in Ecuador, new treatments that target diabetes and proteinuria cannot always be used due to their cost, so we expect in the future it can be reached by a larger population to improve outcomes.