Prevalence of chronic kidney disease and related factors among diabetic patients in primary care, Bangkok, Thailand

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Suthee Saritsiri
Aroonsri Mongkolchati
Thunwadee Suksaroj


The purpose of this study was to define the prevalence and related factors of chronic kidney disease (CKD) among diabetes patients who received service from 1 October, 2017 to  30 September, 2018, at the 67th Public Health Center, Bangkok, Thailand, in order to understand the current situation in primary care, and to lead the development of service policy to slow CKD progression in the future. The data were collected by questionnaires and by reviewing medical records, including the urine albumin-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) to evaluate renal function. The diagnosis of CKD followed the 2012 KDIGO Clinical Practice Guideline. The data were analysed using number, percentage, mean + S.D., chi-square test and multiple logistic regression. The results indicated that out of 442 diabetic patients, 418 were enrolled. The mean age was 62.7+10.1 years. The prevalence of stage 1, 2, 3a, 3b, 4 and 5 (non-dialysis) CKD were 14.8%, 11.2%, 9.3%, 6.7%, 0.5% and 0.2%, respectively. About 32.3% of cases had UACR > 30 mg/g creatinine (26.1% microalbuminuria and 6.2% macroalbuminuria). Factors related with CKD significantly (p < 0.05)  included age > 70 years, financial support by the civil servant medical beneficiary scheme, duration with diabetes > 5 years, smoking, haemoglobin < 13 g/dl, serum triglyceride > 150 mg/dl, HDL < 40 mg/dl in male or  < 50 mg/dl in female), and receiving antihypertensive drugs. However, diabetes patients who received angiotensin-converting enzyme inhibitors (ACEI) or angiotensin-receptor blockers (ARBs) decreased their risk of CKD. This study  showed high prevalence of CKD among diabetes patients. Early identification and proper management in primary care are mandatory to delay kidney disease progression.


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Author Biographies

Suthee Saritsiri, ASEAN Institute for Health Development, Mahidol University , Nakhon Pathom, Thailand

ASEAN Institute for Health Development, Mahidol University, Bangkok, Thailand

The 67th Public Health Center, Health Department, Bangkok Metropolitan Administration, Bangkok, Thailand

Aroonsri Mongkolchati, ASEAN Institute for Health Development, Mahidol University , Nakhon Pathom, Thailand

ASEAN Institute for Health Development, Mahidol University , Nakhon Pathom, Thailand

Thunwadee Suksaroj, ASEAN Institute for Health Development, Mahidol University , Nakhon Pathom, Thailand

ASEAN Institute for Health Development, Mahidol University , Nakhon Pathom, Thailand


1. Couser WG, Remuzzi G, Mendis S, Tonelli M. The contribution of chronic kidney disease to the global burden of major noncommunicable diseases. Kidney international. 2011;80(12): 1258-70. DOI: 10.1038/ki.2011.368
2. Praditpornsilpa K, Sookruetai S, Premasathian N, Kingwatanakul P, Lumpaopong A, Gojaseni P, et al. Prevalence trend of renal replacement therapy in Thailand: impact of health economics policy. Journal of the Medical Association of Thailand. 2011;94(9):1.
3. Jagannathan R, Patzer RE. Urbanization and kidney function decline in low and middle income countries. BMC nephrology. 2017; 18(1):276. DOI 10.1186/s12882-017-0685-4
4. Hyodo T, Hirawa N, Hayashi M, Than KMM, Pattanasittangkur K, Hu LW, et al. Present status of renal replacement therapy at 2015 in Asian countries (Myanmar, Vietnam, Thailand, China, and Japan). Renal Replacement Therapy. 2017;3(1):11. DOI 10.1186/ s41100-016-0082-7
5. Naghavi M, Wang H, Lozano R, Davis A, Liang X, Zhou M. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015; 385(9963):117-71. DOI http:// dx.doi. org/10.1016/ S0140-6736(14) 61682-2
6. Liyanage T, Ninomiya T, Jha V, Neal B, Patrice HM, Okpechi I, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. The Lancet. 2015;385(9981): 1975-82. DOI: 10.1016/S0140-6736 (14)61601-9
7. Mehta RL, Cerdá J, Burdmann EA, Tonelli M, García-García G, Jha V, et al. International Society of Nephro-logy's 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephro-logy. The Lancet. 2015;385(9987): 2616-43. DOI: 10.1016/S0140-6736 (15)60126-X
8. Rawdaree P, Ngarmukos C, Dee-rochanawong C, Suwanwalaikorn S, Chetthakul T, Krittiyawong S, et al. Thailand diabetes registry (TDR) project: clinical status and long term vascular complications in diabetic patients. J Med Assoc Thai. 2006;89 (Suppl 1):S1-9.
9. Control CfD, Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: US department of health and human services, centers for disease control and prevention. 2011; 201(1):2568-9.
10. Laliberté F, Bookhart BK, Vekeman F, Corral M, Duh MS, Bailey RA, et al. Direct all-cause health care costs associated with chronic kidney disease in patients with diabetes and hyper-tension: a managed care perspective. Journal of Managed Care Pharmacy. 2009;15(4):312-22. DOI: 10.18553/ jmcp.2009.15.4.312
11. Perkovic V, Cass A, Patel A, Suriyawongpaisal P, Barzi F, Chadban S, et al. High prevalence of chronic kidney disease in Thailand. Kidney international. 2008;73(4):473-9. DOI: 10.1038/
12. Inker LA, Astor BC, Fox CH, Isakova T, Lash JP, Peralta CA, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. American Journal of Kidney Diseases. 2014;63(5):713-35. DOI: 10.1053/ j.ajkd.2014.01.416
13. Bailey RA, Wang Y, Zhu V, Rupnow MF. Chronic kidney disease in US adults with type 2 diabetes: an updated national estimate of prevalence based on Kidney Disease: Improving Global Outcomes (KDIGO) staging. BMC research notes. 2014;7(1):415. DOI: 10.1186/1756-0500-7-415
14. Afkarian M, Sachs MC, Kestenbaum B, Hirsch IB, Tuttle KR, Himmelfarb J, et al. Kidney disease and increased mortality risk in type 2 diabetes. Journal of the American Society of Nephrology. 2013;24(2):302-8. DOI:
15. Loza Munarriz C, Cieza Zevallos J, Núñez Barahona C, Blas Benites K. ¿ Llegan oportunamente los pacientes con nefropatía diabética al servicio de Nefrología del Hospital Nacional Cayetano Heredia durante el periodo enero 2011-enero 2012? Acta Médica Peruana. 2013;30(2):57-62.
16. van der Meer V, Wielders HPM, Grootendorst DC, de Kanter JS, Sijpkens YW, Assendelft WJ, et al. Chronic kidney disease in patients with diabetes mellitus type 2 or hyper-tension in general practice. Br J Gen Pract. 2010;60(581):884-90. DOI: 10.3399/bjgp10X544041
17. Damtie S, Biadgo B, Baynes HW, Ambachew S, Melak T, Asmelash D, et al. Chronic kidney disease and associated risk factors assessment among diabetes mellitus patients at A Tertiary Hospital, Northwest Ethiopia. Ethiopian journal of health sciences. 2018;28(6). DOI: 10.4314/ejhs.v28i6.3
18. Ohta M, Babazono T, Uchigata Y, Iwamoto Y. Comparison of the prevalence of chronic kidney disease in Japanese patients with Type 1 and Type 2 diabetes. Diabetic medicine. 2010;27(9):1017-23. DOI: 10.1111/ j.1464-5491.2010.03049.x
19. Sriwijitkamol A, Moungngern Y, Vannaseang S. Assessment and prevalences of diabetic complications in 722 Thai type 2 diabetes patients. Journal of the Medical Association of Thailand. 2011;94(2):168.
20. Narenpitak S, Narenpitak A. Prevalence of chronic kidney disease in type 2 diabetes in primary health care unit of Udon Thani province, Thailand. Medical journal of the Medical Association of Thailand. 2008;91 (10):1505.
21. Thomas MC, Weekes AJ, Broadley OJ, Cooper ME, Mathew TH. The burden of chronic kidney disease in Australian patients with type 2 diabetes (the NEFRON study). Medical journal of Australia. 2006;185(3):140-4. DOI : 10.5694/j.1326-5377.2006.tb00499.x
22. Jia W, Gao X, Pang C, Hou X, Bao Y, Liu W, et al. Prevalence and risk factors of albuminuria and chronic kidney disease in Chinese population with type 2 diabetes and impaired glucose regulation: Shanghai diabetic complications study (SHDCS). Nephrology Dialysis Transplantation. 2009;24(12):3724-31. DOI: 10.1093/ ndt/gfp349
23. Penno G, Solini A, Bonora E, Fondelli C, Orsi E, Zerbini G, et al. Clinical significance of nonalbuminuric renal impairment in type 2 diabetes. Journal of hypertension. 2011;29(9):1802-9. DOI: 10.1097/HJH.0b013e3283495 cd6
24. Krairittichai U, Potisat S, Jongsareejit A, Sattaputh C. Prevalence and risk factors of diabetic nephropathy among Thai patients with type 2 diabetes mellitus. Journal of the Medical Association of Thailand= Chotmaihet thangphaet. 2011;94:S1-5.
25. Süleymanlar G, Utaş C, Arinsoy T, Ateş K, Altun B, Altiparmak MR, et al. A population-based survey of Chronic REnal Disease In Turkey—the CREDIT study. Nephrology Dialysis Transplantation. 2011;26(6):1862-71. DOI: 10.1093/ndt/gfq656 DOI: 10.1093/ndt/gfq656
26. Lew QLJ, Allen JC, Nguyen F, Tan NC, Jafar TH. Factors associated with chronic kidney disease and their clinical utility in primary care clinics in a multi-ethnic southeast Asian population. Nephron. 2018;138(3): 202-13. DOI: 10.1159/000485110
27. Glassock RJ, Winearls C. Ageing and the glomerular filtration rate: truths and consequences. Transactions of the American Clinical and Climatological Association. 2009;120:419.
28. Cortés Sanabria L, Calderon Garcia C, Martínez Ramírez H, Rojas Campos E, Gómez García E, López Leal J, et al. MP138 RISK FACTORS ASSO-CIATED WITH THE PREVALENCE OF CHRONIC KIDNEY DISEASE IN TYPE 2 DIABETIC PATIENTS. Nephrology Dialysis Transplantation. 2017;32(suppl_3):iii478-iii9. DOI: 10.1016/j.arcmed.2014.06.007
29. Kumela Goro K, Desalegn Wolide A, Kerga Dibaba F, Gashe Fufa F, Wakjira Garedow A, Edilu Tufa B, et al. Patient Awareness, Prevalence, and Risk Factors of Chronic Kidney Disease among Diabetes Mellitus and Hypertensive Patients at Jimma University Medical Center, Ethiopia. BioMed Research International. 2019;2019. DOI: 10.1155/2019/2383 508
30. Yacoub R, Habib H, Lahdo A, Al Ali R, Varjabedian L, Atalla G, et al. Association between smoking and chronic kidney disease: a case control study. BMC public health. 2010; 10(1):731.
31. Xia J, Wang L, Ma Z, Zhong L, Wang Y, Gao Y, et al. Cigarette smoking and chronic kidney disease in the general population: a systematic review and meta-analysis of prospective cohort studies. Nephrology Dialysis Transplantation. 2017;32(3):475-87. DOI: 10.1093/ndt/gfw452
32. Yi S-W, Moon SJ, Yi J-J. Low-normal hemoglobin levels and anemia are associated with increased risk of end-stage renal disease in general populations: A prospective cohort study. PloS one. 2019;14(4). DOI: 10.1371/journal.pone.0215920
33. Mihardja L, Delima D, Massie RG, Karyana M, Nugroho P, Yunir E. Prevalence of kidney dysfunction in diabetes mellitus and associated risk factors among productive age Indonesian. Journal of Diabetes & Metabolic Disorders. 2018;17(1):53-61. DOI: 10.1007/s40200-018-0338-6
34. Russo GT, De Cosmo S, Viazzi F, Pacilli A, Ceriello A, Genovese S, et al. Plasma triglycerides and HDL-C levels predict the development of diabetic kidney disease in subjects with type 2 diabetes: the AMD annals initiative. Diabetes Care. 2016;39(12):2278-87. DOI: 10.2337/dc16-1246
35. Eknoyan G, Lameire N, Eckardt K, Kasiske B, Wheeler D, Levin A, et al. KDIGO 2012 clinical practice guideline for the evaluation and mana-gement of chronic kidney disease. Kidney Int. 2013;3(1):5-14.
36. Nah E-H, Cho S, Kim S, Cho H-I. Comparison of urine albumin-to-creatinine ratio (ACR) between ACR strip test and quantitative test in prediabetes and diabetes. Annals of laboratory medicine. 2017;37(1):28-33. DOI: 10.3343/alm.2017.37.1.28