CLINICAL PROFILE OF PATIENTS WITH DIABETIC KIDNEY DISEASE ATTENDING NEPHROLOGY CLINICS IN A LOW-MIDDLE INCOME COUNTRY

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CLINICAL PROFILE OF PATIENTS WITH DIABETIC KIDNEY DISEASE ATTENDING NEPHROLOGY CLINICS IN A LOW-MIDDLE INCOME COUNTRY

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Co-author 1

Sonia Yaqub sonia.yaqub@aku.edu Aga Khan University Medicine Karachi Pakistan *

Co-author 2

Sanam Bano sanam.bano@aku.edu Aga Khan University Medicine Karachi Pakistan -

Co-author 3

Safia Awan safia.awan@aku.edu Aga Khan University Medicine Karachi Pakistan -

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Introduction

Diabetes poses a major public health challenge in Pakistan, with an estimated prevalence exceeding 26% among adults—the highest in the Middle East and South Asia region. The growing burden is fueled by urbanization, sedentary lifestyles, and limited access to preventive care, leading to rising rates of complications and healthcare costs. 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.

Methods

It was a cross-sectional observational study at Aga Khan University of a cohort of patients, with DKD presenting to the nephrology clinic from over a period of two years(n=553).

Results

Mean age was 61.7 + 11.0 years and 60.9% were male. 93.9% had hypertension while 34.2% and 30.9% had dyslipidemia and ischemic heart disease, respectively. Almost 2/3rd of the participants (68.4%) had advanced CKD (stages 3b, 4and 5) at the time of presentation. Only 43.6% had HbA1c < 7.0 and only 34.9 % attained systolic blood pressure (BP) target <130mm Hg while optimal diastolic BP (<80 mmHg) targets were achieved in 72.7%. Majority of patients were on insulin. 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 RAAS blockers. Those who had eGFR> 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

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.

P.S. This abstract was presented at ERA 2023 in Milan, Italy.

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