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DIABETES MELLITUS (DM) IS THE MAIN CAUSE OF CHRONIC KIDNEY DISEASE (CKD) AND IN ELDERLY PEOPLE IT IS FREQUENTLY ASSOCIATED WITH SEVERAL RISK FACTORS. RENAL HEALTH PROGRAMS AIMED AT PEOPLE WITH RISK FACTORS ARE THE MOST USEFUL TOOL TO REDUCE MORBIDITY AND MORTALITY.
CROSS-SECTIONAL DESIGN IN A RANDOM SAMPLE OF 123 PEOPLE WITH DM OLDER THAN 60 YEARS. CLINICAL AND LABORATORY DATA WERE INCLUDED. DESCRIPTIVE ANALYSIS AND MULTIPLE LOGISTIC REGRESSION WERE PERFORMED, CONSIDERING THE PRESENCE OF ANY CKD PARAMETER (ACCORDING TO KDIGOS CRITERIA) AS DEPENDENT VARIABLE. CI95% WERE CALCULATED WITH A P VALUE <0.05.
50.4% (95%CI 41.2-59.5) WERE WOMEN. MEAN AGE WAS 70.8 YEARS (SD 5.3), BEING 70.3 YEARS (SD 5.9) IN WOMEN AND 71.4 YEARS (SD 4.6) IN MEN (P>0.05). THE PREVALENCE OF CKD WAS 48.8% (95%CI 39.7-58.0). 82.1% (CI95% 74.2-88.4) HAD A DIAGNOSIS OF HYPERTENSION AND 28.7% (CI95% 20.1-30.6) HAD HYPERTENSION AT THE TIME OF THE EXAMINATION. 59.4% (CI95% 50.1-68.1) HAD OBESITY, 39.8% (CI95% 31.1-49.1) A HISTORY OF CARDIOVASCULAR EVENTS, 29.3% (CI95% 21.4-38.1) EXPOSURE TO NEPHROTOXIC AGENTS, 26.8% (95%CI 19.2-35.6) HAD POORLY CONTROLLED DM, 14.6% (95%CI 8.9-22.1) HAD A HISTORY OF ACUTE KIDNEY INJURY IN THE LAST YEAR AND 3.3% (95%CI 1.0-8.1) WERE SMOKERS. AMONG MALES, 36.1% (95%CI 21.2-49.4) HAD UNRESOLVED URINARY OBSTRUCTION. FEMALES WERE EXPOSED TO NEPHROTOXIC AGENTS 2.2 TIMES RELATIVE TO MALES (P=0.05). MALE PATIENTS HAD 2.6 TIMES THE RISK OF GLYCOSYLATED HEMOGLOBIN >7% IN THE LAST MONTHS (P<0.05) AND HIGHER PREVALENCE OF CARDIOVASCULAR EVENTS (47.5% CI95% 34.6-60.7) THAN FEMALES (32.3% CI95% 20.9-45.3). THE REST OF THE FACTORS WERE PRESENT IN A SIMILAR WAY IN BOTH SEXES. IN THE MULTIPLE LOGISTIC REGRESSION ANALYSIS, AGE, HYPERTENSION, EXPOSURE TO NEPHROTOXIC AGENTS AND HISTORY OF ACUTE KIDNEY INJURY WERE INDEPENDENT FACTORS ASSOCIATED WITH CKD WITH AN ADJUSTED OR OF 1.1 (95%CI 1.0-1.2), 4.0 (95%CI 1.2-14.1), 3.8 (95%CI 1.5-9.7) AND 33.5 (95%CI 3.9-286.8) RESPECTIVELY IN RELATION TO THOSE WITHOUT THESE FACTORS.
THE RESULTS WERE CONSISTENT IN RELATION TO WHAT HAS BEEN PUBLISHED; HOWEVER, SOME PARAMETERS SHOULD BE INTERPRETED CAREFULLY DUE TO THE SAMPLE SIZE. CONSIDERING THE LARGE NUMBER OF DIABETICS WHO WILL PRESENT COMPLICATIONS, EVEN IN EARLY STAGES OF RENAL DAMAGE, IT IS PROPOSED TO IMPLEMENT ON A LARGER SCALE RENAL HEALTH PROGRAMS BASED ON THE SCREENING OF PEOPLE WITH RISK FACTORS. THIS WOULD ALLOW THE IMPLEMENTATION OF PERSONALIZED, TIMELY AND CONTINUOUS ACTIONS (ESPECIALLY IN THE EARLY STAGES OF CKD RISK), REDUCE MORBIDITY AND MORTALITY DUE TO COMPLICATIONS, AND REDUCE THE OVERCROWDING OF THE HEALTH SYSTEM. A USEFUL TOOL COULD BE THE APPROACH BASED ON DATA SCIENCE AND HEALTH SYSTEM LEARNING, WHICH WOULD ALLOW THE REAL-TIME IMPLEMENTATION OF PREVENTIVE ACTIONS, THE EFFICIENT ORGANIZATION OF A REFERRAL AND COUNTER-REFERRAL SYSTEM, AND A MORE EFFICIENT USE OF RESOURCES.