Kakoko, Consolata D.2025-01-302025-01-302024Kakoko, Consolata D., 2024. Clinic biochemical indicators of kidney disease among newly diagnosed diabetes mellitus type 2 adults attending diabetic clinics in Dar es Salaam. Kairuki Universityhttp://kuir.ku.ac.tz:4000/handle/123456789/1464A dissertation submitted in (partial) fulfillment of the requirements for the degree of Master of Medicine (Internal Medicine) at Kairuki UniversityBackground: Kidney disease affects the functionality and structure of the kidney or both. It is the highest cause of mortality among diabetic mellitus patients. Diabetes mellitus type 2, has a long asymptomatic period of hyperglycemia, whereby longstanding hyperglycemia leads to activation and changes of metabolic pathways, which causes dysfunction of renal and vascular cells. Kidney disease is present in about half of patients with DM type 2. Despite diabetes mellitus being discussed as the leading cause of kidney disease, there has been a paucity of information in Dar es Salaam on clinico-biochemical indicators of kidney disease among newly diagnosed DM 2 adults. These indicators include urine protein(albuminuria) as well as serum creatinine which is used in the estimation of glomerular filtration rate. The study findings are expected to show the burden of kidney disease among newly diagnosed DM 2 adult patients in Dar es Salaam, hence emphasizing early detection of kidney disease during diagnosis of DM 2 adults, to avoid poor renal outcomes at a later stage. Objective: To determine the pattern of clinical biochemical indicators of kidney disease among newly diagnosed diabetes mellitus type 2 adults in Dar es Salaam. Methodology: This cross-sectional design study was conducted among newly diagnosed type 2 patients in the public regional referral hospitals in Dar es Salaam city. Random sampling was used to select 380 newly diagnosed type 2 diabetic patients. The study's dependent variable was kidney disease, the composite variable of eGFR and UACR. Independent variables were social demographics such as age, gender, education level, and occupation. Also, risk factors such as history of smoking and drinking alcohol, family history of diabetes, and kidney disease. Data analysis was done using SPSS version 28. Continuous variables were summarized using mean and standard deviations, while categorical variables were summarized using absolute count and percentage. The categorical comparisons of predictors variables of kidney disease (eGFR and UACR) were made using the chi-square test of independence. The variables that achieved a statistical significance of 0.2 were collectively analyzed in a multivariable logistic regression. A significance level of 0.05 at 95% CI was considered statistically significantly associated with kidney disease (eGFR and UACR). Results: Of the 380 participants recruited, 203(53.4%) were females 177(46.6%) were males and the mean age was 57.2 ± 13.0 standard deviation years. The average serum creatinine level was 90.6 ± 35.5 standard deviation, with an eGFR of 71.6 ± 23.4 standard deviation. The median UACR was 14.0. Among the study participants, 110(28.9%), had an eGFR of less than 60. About 85 participants (22.4%) had a UACR of greater than 30. About 83 participants (21.8%), had both UACR of greater than 30 and eGFR of less than 60. Kidney disease increased with age, mostly observed among participants older than 60. The proportion of KD was most common among divorced and widowed marital groups. The occurrence of KD increased with BMI, with the majority being 25-29.9 and 30+, with relatively equal proportions. The distribution of KD diagnosis was similar between hyperglycemic and non-hyperglycemic patients and was typical among those with a history of alcohol and smoking. Females had a higher proportion of kidney disease compared to males, however, multivariable regression has shown that being female was associated with a lower risk of kidney disease (p<0.05). Conclusion: Clinico-biochemical indicators of kidney disease among newly diagnosed DM 2 adult patients included reduced estimated glomerular filtration rate to <60mL/min/1.73m2 and increased UACR> 30mg/g. In this study, there were more study participants with reduced estimated glomerular filtration rate to <60mL/min/1.73m2 than those with increased UACR> 30mg/g. Moreover, the study findings show that, despite females having a higher proportion of clinico-biochemical indicators of kidney disease than males, they have a lower risk of developing kidney disease. Recommendation: Healthcare providers are emphasized on early screening of clinico-biochemical indicators of kidney disease during the diagnosis of diabetes mellitus type 2 in adult patients. This includes screening both serum creatinine to obtain an estimated glomerular filtration rate and for albuminuria, since DM type 2 asymptomatic patients may develop both or one among the 2 clinico-biochemical indicators. Also regular monitoring of these clinico-biochemical indicators of kidney disease in short intervals during follow-up of the DM 2 patients attending diabetic clinics.enkidney diseaseDM 2 patientsadult patientsThesis