part 2:What Are Predictors Of Diabetic Kidney Disease
Mar 22, 2023
Results
Socio-demographic characteristics
A total of 415 patients with type II diabetes were enrolled in the study, with 98.8% of patients responding. Over half (52%) of these participants were female. Slightly less than three-quarters (71.6%) were married. Their mean age was 56.13 (SD 10.2) years. Then, more than half (59%) of the study participants were between the ages of 51 and 70. In addition, less than three-quarters (72.5%) were urban residents. (Table 1).
Kaplan- Meier recovery estimate and smoothed hazard estimate
The median survival time for study participants was 9 years. The graph shows the probability of survival for patients with T2DM at each time interval (0, 2, 4, 6, 8, and 9 years) throughout the follow-up time. As time progresses, patients with T2DM become less likely to survive CKD. At year 4, the survival time for people with diabetes is 100%, while by year 8, the survival rate drops to 70%. (Fig 1).
Kaplan- Meier graphs for predictors
Patients with serum total cholesterol levels greater than or equal to 200 mg/dl and -à-vis less than 200 mg/dl had equal survival times for the first 5 years. However, at year 8 of follow-up, the survival time for participants with serum cholesterol levels greater than or equal to 200 mg/dl and less than 200 mg/dl was 60% and 75%, respectively (p = 0.010). The median survival time for patients with serum cholesterol levels greater than or equal to 200 mg/dl was 8 years, while the median survival time for patients with serum cholesterol levels less than 200 mg/dl was 9 years.
The probability of survival for those with CKD was lower than for their counterparts in the study population with CVD. At year 8 of follow-up, the probability of survival was approximately 40% for those who developed CKD compared to 80% for those who did not develop CKD.
Predictors of CKD among type II diabetic patients
However, in the multivariate shared frailty Weibull (Gamma) (taking into account hospital as a clustering effect) model, only cardiovascular disease and total cholesterol were significant predictors of CKD. Thus, the risk of CKD was more than three times higher in diabetic patients who developed cardiovascular disease than in study subjects who did not develop cardiovascular disease. Similarly, among patients with hypercholesterolemia, the risk of developing CKD was three times higher than among their counterparts.
Discussion
Chronic kidney disease is the most severe stage of kidney disease and can be irreversible, even resulting in death. The disease is more frequent in patients with predominantly diabetic non-communicable diseases and therefore, determining its incidence, the median time of onset and predictors is essential to take appropriate and timely measures to ensure patient survival. Therefore, this study investigated the incidence, and median time to onset of CKD and its predictors among type 2 diabetic patients attending referral hospitals in the Amhara region.
During the follow-up period, 45 of the 415 diabetic patients developed CKD, with a cumulative incidence of 10.8% [95%; confidence interval: 7.7--14.0). The incidence density was 0.0193 (193/10,000 person-years). The findings suggest that the observed problem is an important public health issue that deserves appropriate attention. Considering the rising trend of diabetics and the poor self-care practices among victims in the country, the problem may escalate unless serious measures are taken. The cumulative prevalence of CKD in this study is consistent with the findings in Italy (13.4%), China (12.7%), and Spain (10.23%). However, this was much lower than in studies conducted in Ethiopia (14.25%) and Sweden (20%). The observed discrepancy may be due to the fact that in the previous study conducted in Ethiopia, all participants were urban dwellers whose lifestyles may have distorted the metabolic system, which could have further contributed to kidney damage. However, in this study, 27% of the study participants were from rural areas. Differences in the methods applied in Sweden and in this study may account for the observed differences in morbidity. Similarly, the previous study used albumin to determine the outcome, whereas the present study used eGFR. in addition, Sweden is known to be a developed country where differences in patient-seeking behavior, the quality of professionals working in these settings, and the availability of advanced diagnostic equipment can help clients to be screened in advance.
Cistanche Tubulosa benefits
The median time to CKD in patients with type ii diabetes is 5 years, which is consistent with a North American study (4.4 ~ 4.7 years). It is however considered shorter than the results of studies in the capital city of Ethiopia (Addis Ababa) (5.9 years) [27], the UK (12 years) and Australia (5.7 years). This may be related to factors such as quality of service, patients' knowledge of diabetes complications, patients' access behavior, patients' place of residence (all urban), and patients' self-care behavior. Previous studies conducted in Addis Ababa, the UK, and Australia recruited participants who lived in civilized cities so that their awareness and health-seeking behaviors were expected to be better, thus enabling them to apply better self-care practices. The median time in this study was higher than in population-based studies conducted in Canada (3.8 years) and China (3.3 years). This difference may be due to methodological differences; for example, the Canadian study was a community-based study and may have included participants who may not have been followed up regularly at a healthcare facility, which may have accelerated the onset of complications (especially CKD).
Studies have shown that patients with hypercholesterolemia have a higher incidence of CKD than those with normal cholesterol levels. This finding is consistent with studies conducted in Spain, Australia, Taiwan, and China. This may be related to cholesterol plaque caused by high cholesterol, which can block blood flow through the renal arteries to the kidneys, impairing kidney function and increasing the likelihood of CKD [47]. Another mechanism may be that high cholesterol levels increase the reabsorption of phospholipids by renal tubular epithelial cells, leading to dyslipidemia; this phenomenon may raise LDL levels, thereby exacerbating the formation of pro-inflammatory cytokines that induce glomerulosclerosis. In addition, hypercholesterolemia can lead to other medical complications other than CKD, such as hypertension and stroke. Therefore, regular monitoring of cholesterol levels and taking appropriate measures are recommended, especially in patients with type II diabetes.
Cistanche supplement
In a similar way, cardiovascular disease is a significant predictor of the development of CKD in patients with type 2 diabetes. Patients with diabetes who have at least one form of cardiovascular disease have a 3-fold higher risk of developing CKD than those who do not have CKD. This finding is supported by the Spanish and UK studies.
The link between CKD and cardiovascular disease may be that the heart may not be able to pump enough blood when the function of the heart and/or supporting blood vessels begins to be abnormal. As a result, there may be too much blood in the heart, leading to pressure in the main veins connecting to the kidneys, which in turn gradually leads to blockage and reduction in the supply of oxygen-rich blood to the kidneys, which again provides a pathway for the development of CKD[50]. This association is also supported by different findings suggesting that reduced cardiac output and reduced effective circulating blood volume lead to pressure receptor stimulation, increased sympathetic activity, and renin secretion (contributing to increased sodium reabsorption), as well as glomerular tethered cell contraction (causing a reduction in glomerular filtration area). Overall, the findings of this study imply the need to reduce the risk of CKD through the prevention of cardiovascular disease. Overall, the findings of this study imply the need to reduce the risk of CKD through the prevention of cardiovascular disease.
The multicentre nature of this study helps to reflect the regional burden of CKD and to generalize. However, the study also has undeniable shortcomings. This study is a retrospective follow-up, based on the analysis of routinely collected data, thus avoiding the omission of certain types of data (e.g. laboratory results).
Echinacoside benefits the kidney
Conclusion
CKD occurs in 1 in 10 cases of diabetes and the median time to develop CKD is 5 years. In addition, hypercholesterolemia and cardiovascular disease accelerate the development of CKD. Therefore, it is recommended that diabetic patients prevent CKD and maintain their cholesterol levels. Clinicians are advised to educate their patients on the prevention of CVD and hypercholesterolemia and to focus on early screening and management of their patients. In addition, it is recommended that researchers in this field conduct prognostic studies using risk scores to identify predictors so that clinicians can accept the evidence and prioritize patients during treatment.
Cistanche Tubulosa extract is a herb that is extracted from Cistanche Tubulosa after a number of rigorous operations to benefit the kidney function of the human body. It contains a large number of active substances of Phenylethanoid total glycoside, Echinacoside, and Verbascoside, they can increase the proliferation rate of kidney cells up to 8-10 times; it can even improve the repair ability of damaged kidney cells and inhibit apoptosis of kidney cells.
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