Development of a tool for predicting the risk of chronic kidney stage 4 in type 2 diabetic patients

Abstract

Introduction: Diabetes is a major cause of chronic kidney disease (CKD) that will progress to end-stage renal disease (ESRD). Patients with CKD progression rates are faster and high mortality rates.  Objective: This study aimed to develop screening tool to assess risk factors for chronic kidney disease stage 4 in patients with type 2 diabetes. Materials and Methods: This research was retrospective study. The participants of the study were patients with type 2 diabetes, but non - CKD stage 4 by the CKD- EPI equation with the data on a computer database of the hospital since October 1, 2007 to September 30, 2009 (baseline) and trace ongoing average 4.85 years.  Results: There were 914 patients with type 2 diabetes participated in the study. Among those, 69 patients developed CKD stage 4 and the incidence of its occurred in patients was 7.5%. The risk factors associated with CKD stage 4 from binary logistic regression analysis including age (>60 years), gender (female), A1C (≥7%), triglyceride levels (≥150 mg/dl) and Low  Density Lipoprotein levels (≥100 mg/dl). When integrating risk factors into the screening tool, the cut-off point for CKD stage 4 prediction is equal to 12 (0-19). The sensitivity was 81.20 percent, specificity was 52 percent Conclusion: The screening tool for the risk of CKD stage 4 prediction should be performed by the medical staff in screening patients with type 2 diabetes. It is recommended that all patients with a score ranging from 12 to 19 points should be examined by nephrologist to prevent severe complications as a consequence.