Saudi Journal of Kidney Diseases and Transplantation

RENAL DATA FROM THE ARAB WORLD
Year
: 2002  |  Volume : 13  |  Issue : 2  |  Page : 199--202

Profile of Diabetic Patients with End-stage Renal Failure Requiring Dialysis Treatment at the King Abdulaziz University Hospital, Jeddah


Faiza A Qari 
 King Abdulaziz University Hospital, Jeddah, Saudi Arabia

Correspondence Address:
Faiza A Qari
King Abdulaziz University Hospital, P.O. Box 13042, Jeddah 21943
Saudi Arabia

Abstract

The aim of this study was to know the characteristics and risk factors of 13 diabetic patients (8 males and 5 females) undergoing chronic hemodialysis (HD) at the King Abdulaziz University Hospital in Jeddah during the last one and half years. The 13 diabetic patients who were included in the study constituted 31% of the total patients on HD. The median age was 50.7 year (33-60 years) with M: F ratio of 1.6:1, and Saudi to non-Saudi ratio of 1:1.8. The mean duration of diabetes mellitus (DM) was 12.15 year (3­28 years). Almost half of these patients required HD within 10 years of diagnosis of diabetes. The mean age at starting HD was 46.9 year (33-59). All patients were hypertensive, and 46% were hyperlipidemic. History of smoking was present in 38.5% (5 patients, all men). Complications of diabetes were documented in almost all patients, proliferative retinopathy in 53.8%, bilateral cataract in 15.4%, while one patient had total blindness. There was clinical evidence of peripheral neuropathy and ischaemic heart disease in 30.4% of patients, whereas stroke and gangrenous foot were each seen in 7.7% of patients. Our brief report confirms that DM contributes significantly to end stage renal disease. This could be attributed to poor glycemic control, inadequate treatment of hypertension, high smoking rate and inadequate screening for micro-albuminuria.



How to cite this article:
Qari FA. Profile of Diabetic Patients with End-stage Renal Failure Requiring Dialysis Treatment at the King Abdulaziz University Hospital, Jeddah.Saudi J Kidney Dis Transpl 2002;13:199-202


How to cite this URL:
Qari FA. Profile of Diabetic Patients with End-stage Renal Failure Requiring Dialysis Treatment at the King Abdulaziz University Hospital, Jeddah. Saudi J Kidney Dis Transpl [serial online] 2002 [cited 2022 Sep 30 ];13:199-202
Available from: https://www.sjkdt.org/text.asp?2002/13/2/199/33136


Full Text

 Introduction



The prevalence of diabetes mellitus (DM) is increasing world-wide. [1] In Saudi Arabia, it has increased from 4.9% in 1985 to 7.4% in 1995. [2],[3] Diabetic nephropathy is a serious complication of DM, often leading to end- stage renal disease (ESRD). Although the development and progression of diabetic nephropathy may be retarded by normali­zation of the blood pressure with angio­tensin converting enzyme inhibitors, strict control of the plasma glucose concentration and hyperlipidemia, and avoidance of smoking, many patients still progress to ESRD, usually after 15 years from the onset of diabetes. Important determinants of progression include the severity of underlying disease and the degree of proteinuria. Diabetes is now the commonest cause of new patients requiring renal replacement therapy; accounting for about 40% of cases in the Unites States. [4] Survival of diabetic patients on maintenance dialysis is lower than in non-diabetics with ESRD. [4] There are limited data on the long-term outcome of diabetes and the burden of diabetic complications on the health care system in Saudi Arabia. We have studied the clinical profile of diabetic patients with ESRD undergoing hemodialysis (HD) at the King Abdulaziz University Hospital, Jeddah, Saudi Arabia with a view of identifying common clinical features and risk factors.

 Methods



The King Abdulaziz University Hospital (KAUH) is a teaching hospital in the Western Province of Saudi Arabia. The dialysis unit at this hospital was functionally established in January, 2000. Data for analysis was retrieved from medical and dialysis charts of diabetic patients attending chronic HD at the KAUH. The inclusion criterion was diabetes mellitus causing ESRD requiring HD. Medical charts were reviewed for relevant information: patient's age, sex, smoking habit, hyperlipidemia, duration of diabetes, anti-diabetic medications, and associated complications. Glycemic and blood pressure control were assessed. Blood glucose level greater than 11.1 mmol/L and blood pressure 160/100 mm Hg or above were indicative of poor glycemic control and inadequate blood pressure control, respectively. Presence of retinopathy, neuropathy, ischemic heart disease, stroke and peripheral vascular disease were assessed clinically.

Statistical analysis was performed using SPSS 7.5 (Statistically Package for Social Science).

 Results



A total of 42 patients with ESRD were enrolled for three sessions of HD per week in the KAUH during the period of the study covering 18 months. There were 13 diabetic patients (31%) in this group and all were included in the study. One male patient was withdrawn from the study as he died of septicemia. The mean age of the study patients was 50.7 (33-60 years), with male: female ratio of 8:5 (1.6:1). There were nine (69%) non-Saudis and four Saudis (30.8%). The mean duration of diabetes was 12.5 year (3-28 years) and the mean duration on HD was 7.38 months (1-36) [Table 1]. Six (46%) patients had been diagnosed and dialyzed for one month only. Six (46%) patients were on insulin, three on oral hypoglycemic medications, one on diet, and two on combination of insulin and oral hypo­glycemic drugs. Six (46%) were hyperlipi­demic, and five males (38.5%) were smokers for a long duration. Two patients (15.4%) had family history of diabetes and one had bilateral kidney stones in addition to his diabetes.

All patients (100%) were hypertensive and the mean duration of hypertension was 4.9 years (1-22). Antihypertensive medications used included captopril in 11 (84.6%) patients and nifedipine and beta-blockers in two (15.4%).

Clinical presentation with the nephrotic syndrome was documented in four patients; one patient underwent kidney biopsy, which showed sclerosing glomerulonephritis.

Micro-albuminuria or proteinuria in some patients could not be ascertained due to lack of adequate data.

Diabetic proliferative retinopathy was present in seven patients all of whom were treated with laser photocoagulation. One patient was totally blind, and two had bilateral cataract. Other complications of diabetes such as ischemic heart disease, clinical evidence of peripheral neuropathy, stroke and a gangrenous foot are listed in [Table 2].

 Discussion



This study highlights the following points:

Diabetes is an important cause of chronic renal failure in patients undergoing HD. Poor control of diabetes, hypertension, and history of smoking are common risk factors, and probably contribute to progression to ESRD.

It has been shown that a sizeable number of patients would have complications of diabetes at diagnosis of ESRD such as ishaemic heart disease, proliferative retino­pathy, stroke, peripheral neuropathy and gangrenous foot. [5] It was also noted that nearly half of the diabetic patients (46%) had already been on HD within 10 years of being diagnosed to have diabetes, suggesting either a delay in the diagnosis of the disease or the presence of other factors leading to acceleration of diabetic nephropathy like hyperlipidemia, hypertension and smoking. [6],[7]

All of the study patients were hypertensive and it is well known that hypertension is an important precipitating factor in diabetics leading to early outset of ESRD. [8]

The nephrotic syndrome preceded chronic renal failure in 30.8% of cases; however, not enough data on proteinuria or micro­albuminuria could be documented. [9] The proteinuria can be ameliorated to a very significant degree by several interventions, if instituted early. These include tight glycemic control, aggressive anti-hypertensive treat­ment, and the use of angiotensin converting enzyme-inhibitors. Thus, screening for micro­albuminuria should be done at the time of diagnosis of diabetes and in its absence, it should be performed annually. [10],[11],[12] Micro­ albuminuria measurement was not available at the hospital.

It has been suggested that smoking increases the risk of renal damage. Smoking habit was almost exclusively present in our male patients, who are also known to have higher risk of micro vascular complications. [13]

The number of Saudi patients on HD was fewer than expatriates, 80% of whom were Yemeni. This is because KAUH is the only teaching hospital in Jeddah, which accepts and treats non-Saudi patients. Also, most of the Saudis with ESRD are dialyzed at the Jeddah Kidney Center where they have the advantage of being enrolled for renal transplantation.

Women on HD in this study were less than men, the M:F ratio being 1.6:1, which is similar to other reports. [14]

In conclusion, diabetes is an important cause of ESRD in Saudi as well as non-Saudi patients undergoing chronic HD at the KAUH. This may be attributed to poor control of diabetes, hypertension as well as inadequate early screening for micro-albuminuria.

Improved care of diabetes and aggressive treatment of hypertension can reduce, or at least delay, the prevalence as well as improve the prognosis of diabetic nephropathy.

A well-equipped diabetic care center should be established for screening for micro-albuminuria and wherein glyco­sylated hemoglobin can be done routinely and maximum blood sugar control and hypertension can be achieved by free supply of medications and good diabetic education programmes. This combined effort is needed to reduce the incidence of ESRD in diabetics.

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