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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO EDITOR Table of Contents   
Year : 2003  |  Volume : 14  |  Issue : 1  |  Page : 77-80
Risk Factors for Developing End­-Stage-Renal-Failure among Diabetic Patients: A Retrospective Analysis


Department of Medicine, King Fahd Military Hospital, Jeddah, Saudi Arabia

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How to cite this article:
Al-Jiffri AY, Fadag RB, Ghabrah TM, Ibrahim A. Risk Factors for Developing End­-Stage-Renal-Failure among Diabetic Patients: A Retrospective Analysis. Saudi J Kidney Dis Transpl 2003;14:77-80

How to cite this URL:
Al-Jiffri AY, Fadag RB, Ghabrah TM, Ibrahim A. Risk Factors for Developing End­-Stage-Renal-Failure among Diabetic Patients: A Retrospective Analysis. Saudi J Kidney Dis Transpl [serial online] 2003 [cited 2020 Dec 4];14:77-80. Available from: https://www.sjkdt.org/text.asp?2003/14/1/77/33093
To the Editor:

End-stage renal disease (ESRD) causes significant morbidity and mortality world­wide, [1] and is one of the major medical problems in Saudi Arabia. [2] In countries such as the USA, Europe, and Japan, the leading cause of ESRD has become diabetic nephro­pathy, particularly in patients with type II diabetes. [3],[4] Between the years 1982 and 1992, patients with diabetes as the cause of their ESRD rose from 27% to 36% in the United States and from 11 to 17% in Europe. A high incidence of diabetic ESRD was also evident in Canada (24%), Australia (14%), Europe (17%), and Japan (28%). [5] In Saudi Arabia also, diabetes mellitus is becoming a major medical problem. [6] This has been more evident over the last decade or so as a result of dramatic changes in life-style of the Saudi population. [6] A study done at the King Fahd Hospital of the University, Al-Khobar, diabetic nephropathy accounted for 27.9% of cases of ESRD. [7] The patient study was performed to detect the risk factors of ESRD among diabetic patients on maintenance hemodialysis.

The study cases included all diabetic patients with ESRD registered and treated at the Jeddah Kidney Center at King Fahd General Hospital, which is a referral center for patients in the Western province and the controls include all diabetic patients without ESRD registered and treated a the Jeddah Center for Diabetic and Hypertensive Care.

Fifty-one diabetic patients on hemodialysis were randomly selected from the list of diabetic patients at the Jeddah Kidney Center, in Jeddah. As a control group, 102 non­dialysis diabetic patients were selected by simple random sampling from the daily appointment book at the Jeddah Center for Diabetic and Hypertensive Care. A patient questionnaire was developed to collect infor­mation from the sample. The questionnaire included the following items: a). Socio-demographic data, body mass index (BMI) and smoking habits. b). Data related to type of diabetes, age of the patients at the time of diagnosis, duration of the disease in years, family history of diabetes, type of treatment, history of hypertension, duration of hypertension in years, and other associated diseases (note: for feasibility reasons, risk factors such as proteinuria and dyslipidemia will not be considered in the study because these require investigations that are not routinely done).

The Statistical Package for Social Science (SPSS) computer package was used for data entry and statistical analysis. The statistical tests such as the student t test, chi-square test, and logistic regression analysis were used to identify the risk factors that can be considered as predictors for the occurrence of end-stage renal disease among patients with diabetes at the hemodialysis center. The level of significance was taken at p < 0.05.

The study showed a predominance of Saudi over non-Saudi patients among both cases and controls. There are no statistically significant differences between the two groups [Table - 1]. This reflects the prevailing demographics of the population in Saudi Arabia (Saudi 73%, non-Saudi 27%). [8]

There was a predominance of males over females among both cases and controls. There was no statistically significant difference between the two groups [Table - 2].

The risk factors studied in patients with ESRD and the controls are summarized in [Table - 3].

The mean BMI for was lower among the ESRD patients than that of controls, 25 kg/m 2 and 30 kg/m 2 respectively. The difference was statistically significant p<0.05 and this is attributed to the inevitable physiological changes that accompany ESRD and its complications.

Summarized data for smoking habits among both groups showed that smokers were more among the hemodialyzed cases (45.1%) than the controls (28.4%) The difference is statistically significant p<0.05 which is in agreement with the results of a study carried out in Japan [9] where again they found higher prevalence of smokers among hemodialyzed diabetics (48.4%) than non­hemodialyzed diabetics (36.4%). Smoking can be deleterious to the diabetic patient, and can be associated with ESRD progression. There were more rural residents among patients on dialysis (17.6%) than among controls (6.9%). The difference was statistically significant p<0.05. This may be attributed to the fact that there are health care facilities for diabetics in both rural and urban areas, while hemo­dialysis services are present only in urban areas. The deficiency of hemodialysis services in the rural areas forces the patients to shift to the urban areas for hemodialysis.

The majority of study patients were of type II diabetes among both cases (94.1%) and controls (92.2%). In a study carried out in Japan, [10] type II diabetes was found to be the most common type of diabetes, even among those on hemodialysis. Conversely, type I diabetes accounted for 61% of diabetic-ESRD in Australia. [5]

The mean age among cases was higher than controls, 56.4 and 41.4 years respectively.

This finding is in contrast to a Japanese study, [9] where they found that the mean ages for diabetic patients on hemodialysis (62 + 10 years) were less than non-hemodialyzed diabetics (65.5 + 11.6 years). This probably indicates that ESRD occurs at an older age among patients in Saudi Arabia as compared to those in Japan.

The mean duration of diabetes mellitus among cases (15 years) was higher than that for controls (8 years). Huraib et al [6] stated that the duration of diabetes is a very important factor in the development of diabetic nephro­pathy as it has been confirmed that longer the duration of diabetes, the higher the frequency of diabetic nephropathy.

The majority of patients had positive family history of diabetes mellitus among both cases (66.7%) and controls (62.7%). In a study carried out in the UK, [11] family history of diabetes was associated independently with the development of diabetic renal complications.

Most of the diabetic patients at the hemo­dialysis center (cases) were hypertensive (66.7%), compared to 29.4% of patients at the diabetic center (controls). This finding is in accordance with a Japanese study, where they found that hypertension among diabetic patients on hemodialysis (97.2%) was higher than that among non-hemodialyzed diabetics (58.3%). Huraib et al [6] showed that the degree of proteinuria correlated very well with hypertension among Saudi patients with type II diabetes, p<0.003. Also, the mean duration of hypertension among hemodialyzed diabetics (12.7 years) was higher than that among diabetics at the diabetic center (7.8 years). This finding is in accordance with a study carried out in the USA [5] where hyper­tension before the onset of diabetes among Pima Indians conferred a greater risk of diabetic renal disease. Similarly, hypertension prior to diagnosis of diabetes was associated with abnormal urinary albumin excretion. [5] Bivariate analysis between cases and controls for the most important risk factors for occurrence of ESRD revealed that these were: presence of hypertension, excessive smoking, older age of patients at the time of diagnosis and longer duration of diabetes mellitus. These factors were further analyzed by logistic regression [Table - 3]. The most clear differences between the two groups were hypertension (p=0.0001), BMI (p=0.0001), duration of diabetes (p=0.0003) and smoking habits (p=0.0157).


   Acknowledgment Top


I would like to express my thanks to the staff members at the Jeddah Kidney Center and the Jeddah Center for Diabetic and Hypertensive Care for their help and cooperation during the initial phases of this project.

 
   References Top

1.Al-Homrany M, Abolfotoh M. Incidence of treated end-stage renal disease in Asir region. Southern Saudi Arabia. Saudi J Kidney Dis Transplant 1998;9(4):425-9.  Back to cited text no. 1    
2.Akhtar M, Qunibi W, Saadi T, Furayh O, Sanjad S, Al-Sabban E. Spectrum of renal disease in Saudi Arabia. Ann Saudi Med 1990;10(1):37-44.  Back to cited text no. 2    
3.Odoni G, Ritz E. Diabetic nephropathy-what have we learned in the last three decades? J Nephrol 1999;12(Suppl 2): S120-4.  Back to cited text no. 3  [PUBMED]  
4.Rossing P. Risk factors in the progression of diabetic nephropathies. Ugeskr Laeger 2000;162(38):5057-61.  Back to cited text no. 4    
5.Ismail N, Becker B, Strzelczyk P, Ritz E. Renal disease and hypertension in non­insulin-dependent diabetes mellitus. Kidney Int 1999;55(1):1-28.  Back to cited text no. 5    
6.Huraib S, Abu-Aisha H, Sulimani R, et al. The pattern of diabetic nephropathy among Saudi patients with non-insulin-dependent diabetes mellitus. Ann Saudi Med 1995; 15(2):120-3.  Back to cited text no. 6    
7.Al-Muhanna FA, Saeed I, Al-Muelo S, Larbi E, Rubaish A. Disease profile, complications and outcome in patients on maintenance hemodialysis at King Faisal University Hospital, Saudi Arabia. East Afr Med J 1999; 76(12): 664-7.  Back to cited text no. 7    
8.Statistical Yearbook. Central Department of Statistics, Ministry of Finance and National Economy, Kingdom of Saudi Arabia 1992.  Back to cited text no. 8    
9.Takei I, Yamauchi A, Nakamoto S, Suzuki H, Saruta T. Retrospective analysis of hemodialyzed diabetic patients in Japan. Diabetes Res Clin Pract 1995; 29(3):173-7.  Back to cited text no. 9    
10.Yokoyama H, Okudaira M, Otani T, et al. Higher incidence of diabetic nephro-pathy in type 2 than in type 1 diabetes in early-onset diabetes in Japan. Kidney Int 2000; 58(1):302-11.  Back to cited text no. 10    
11.Ritz E. Nephropathy in type 2 diabetes. J Intern Med 1999;245(2):111-26.  Back to cited text no. 11    

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Correspondence Address:
Abdulla Mohammed Y Al-Jiffri
Department of Preventive Medicine, King Fahd Military Hospital, P.O. Box 40332, Jeddah 21499
Saudi Arabia
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PMID: 17657095

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