THE PREVALENCE OF DIABETIC KIDNEY DISEASE, RISK FACTORS AND ATYPICAL FEATURES IN TYPE 1 DIABETES MELLITUS ADULTS SEEN AT UNIVERSITAS ACADEMIC HOSPITAL, FREE STATE, SOUTH AFRICA

Background: 
Diabetic kidney disease (DKD) is common, often associated with other microvascular complications, and is a leading cause of end-stage kidney disease and a risk factor for cardiovascular complications.  We aimed to evaluate the prevalence of DKD, atypical features, and associated risk factors in adults with type-1 diabetes mellitus (T1DM). 

Methods: 
This was a retrospective survey of 119 adult T1DM patients seen at the specialist endocrine clinic of Universitas Academic Hospital in the Free State Province, South Africa, between May 2017 and May 2019.  DKD was defined as a spot urine albumin-creatinine ratio (uACR) above 3 mg/mmol of creatinine or an estimated glomerular filtration rate (eGFR) below 60 ml/min/1.73m² in at least two clinic visits, or a spot urine protein-creatinine-ratio (uPCR) above 0.3 g/mmol on one or more visits during the survey period. 

Results. 
The prevalence of DKD was 40.3% (48/119; 95% CI, 31.8–49.5%), with that of microalbuminuria (uACR 3–30 mg/mmol), macroalbuminuria (uACR≥30 mg/mmol), and reduced eGFR being 30.2% (36/119; CI, 22.6–39.2%), 8.4% (CI, 4.6–15%) and 5.9% (CI, 2.8‒11.9%), respectively. The prevalence of atypical DKD features was 33.3%, with one-third of patients with microalbuminuria having a duration of T1DM less than five years (12/119; 10.1%; CI, 5.8–17%).  On logistic regression analysis, glycated haemoglobin A1c (odds ratio [OR] 1.22; CI, 1.06–1.41; p=0.007) and systolic blood pressure (OR 1.03; CI, 1.00–105; p=0.028) were independent predictors of DKD. Furthermore, the duration of diabetes and blood pressure (BP) were independent predictors of macroalbuminuria and reduced eGFR with albuminuria (OR 1.05; CI, 1.01‒1.08; p=0.009) itself an added risk factor for persistent eGFR<60. 

Conclusion. 
The prevalence of DKD was appreciable and was associated with an early onset of microalbuminuria after diagnosis of T1DM.  Glucose and BP control were significant predictors of DKD, highlighting their importance in the T1DM population.