BMJ open · 2025
Prevalence, incidence and risk factors of chronic kidney disease in people with diabetes and hypertension, and the prognosis and kidney function decline in Indonesia: a multicentre cross-sectional study in primary care centres.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Hustrini Ni Made, Susalit Endang, Harimurti Kuntjoro, Haryoso Ira Susanti, Legrans Adriana Eunike, Damarjati Kirana, Minangsih Sitri, Nurhisan Lida, Zaini Ma'mun, Oktavianti Sendy, Pratiwi Sujie, Pradesa Muhammad Galih, Anthony Geby, Sari Dwi WIgati Ratna, Purnama Rosa Chandra, Puspitasari Woro Rengganis Maesya, Rajagukguk Monica Juwita, van Diepen Merel, Rotmans Joris
Аннотация
OBJECTIVES: To examine chronic kidney disease (CKD) prevalence, incidence, prognosis, kidney function decline and associated risk factors among people with diabetes and/or hypertension.
DESIGN: Cross-sectional multicentre study.
SETTING: 14 primary care centres across Jakarta.
PARTICIPANTS: Adults (≥18 years) with diabetes and/or hypertension were included. Exclusion criteria were receiving kidney replacement therapy, language barrier, cognitive impairments, refusal to consent and pregnancy. Participants were grouped into three categories: hypertension only, diabetes only and both.
INTERVENTIONS: None.
PRIMARY AND SECONDARY OUTCOMES: Primary outcomes included CKD prevalence, incidence, number-needed-to-screen, KDIGO-based prognosis and annual kidney function decline. Secondary outcomes were risk factors for CKD, uncontrolled blood glucose, blood pressure and albuminuria.
RESULTS: A total of 1263 participants were enrolled: 51% had hypertension, 17.6% diabetes and 31.4% both. Mean age: 57.1±10.2 years, 72.2% female and 76% obese. Renin angiotensin aldosterone system inhibitors were prescribed in 32.3%, and only 1.2% used insulin despite a median glycated haemoglobin of 7.5% (IQR: 6.5-9.1). CKD prevalence was 14.8%, with an incidence rate of 9.1 per 100 person-years; number-needed-to-screen was 7. Based on KDIGO criteria, 48.9% were at moderate-to-very high risk of adverse outcomes. Baseline estimated glomerular filtration rate was 80.9 (SE=10.1), declining by 4.7 (SE=9.9) mL/min/1.73 m2 annually. CKD incidence was higher with albuminuria (OR 3.6, p=0.007) in the combined group; older age (OR 4.5, p<0.001), male (OR 2.3, p=0.026) and haematuria (OR 2.5, p=0.034) in the hypertension group and cardiovascular disease (OR 14.9, p=0.004) in the diabetes group.
CONCLUSIONS: CKD burden is high among people with diabetes and hypertension. Nearly half were at elevated risk despite preserved kidney function, highlighting the need for targeted early screening.
DESIGN: Cross-sectional multicentre study.
SETTING: 14 primary care centres across Jakarta.
PARTICIPANTS: Adults (≥18 years) with diabetes and/or hypertension were included. Exclusion criteria were receiving kidney replacement therapy, language barrier, cognitive impairments, refusal to consent and pregnancy. Participants were grouped into three categories: hypertension only, diabetes only and both.
INTERVENTIONS: None.
PRIMARY AND SECONDARY OUTCOMES: Primary outcomes included CKD prevalence, incidence, number-needed-to-screen, KDIGO-based prognosis and annual kidney function decline. Secondary outcomes were risk factors for CKD, uncontrolled blood glucose, blood pressure and albuminuria.
RESULTS: A total of 1263 participants were enrolled: 51% had hypertension, 17.6% diabetes and 31.4% both. Mean age: 57.1±10.2 years, 72.2% female and 76% obese. Renin angiotensin aldosterone system inhibitors were prescribed in 32.3%, and only 1.2% used insulin despite a median glycated haemoglobin of 7.5% (IQR: 6.5-9.1). CKD prevalence was 14.8%, with an incidence rate of 9.1 per 100 person-years; number-needed-to-screen was 7. Based on KDIGO criteria, 48.9% were at moderate-to-very high risk of adverse outcomes. Baseline estimated glomerular filtration rate was 80.9 (SE=10.1), declining by 4.7 (SE=9.9) mL/min/1.73 m2 annually. CKD incidence was higher with albuminuria (OR 3.6, p=0.007) in the combined group; older age (OR 4.5, p<0.001), male (OR 2.3, p=0.026) and haematuria (OR 2.5, p=0.034) in the hypertension group and cardiovascular disease (OR 14.9, p=0.004) in the diabetes group.
CONCLUSIONS: CKD burden is high among people with diabetes and hypertension. Nearly half were at elevated risk despite preserved kidney function, highlighting the need for targeted early screening.