Profile of Diabetic Nephropathy in Southern Morocco

Abstract

Diabetic nephropathy (DN) has a steadily increasing prevalence, particularly because of the increase in sedentary lifestyle and obesity. It is defined as persistent albuminuria and/or estimated Glomerular Filtration Rate (eGFR) <60 mL/min/1.73 m² for ≥3 months in a diabetic patient and requires early management to prevent progression to end-stage renal failure. The purpose of this work is to describe the epidemiologic profile and the progression of DN for the first time in a southern Moroccan region: Guelmim Oued noun - Moroccan Sahara. Patients and Methods: It is a retrospective study conducted at the 5th military hospital in Guelmim and including all diabetic patients seen in nephrology consultation between January 2015 and December 2018. We collected the following parameters of our patients: demographics, comorbidities, prescribed treatments and biological data (Albuminuria, renal function and glycated hemoglobin) during their nephrology follow-up. Résults: During the study period 267 diabetic patients were included among 1042 patients, which represented 25.9% of the nephrology consultation activity. Their average age was 64.3 ± 11.3 years with a slight male predominance (60%) and only two patients had type 1 diabetes.  At the first nephrology consultation the average duration of diabetes was 14 years, 15 (5.6%) patients were on diet alone, 94 (35.3%) on oral antidiabetic drugs (OADs), 93 (34.9%) on insulin and 34 (13%) on OAD and insulin. Half the patients were hypertensive and 146 (54%) already had a cardiovascular complication (arterial disease, coronary artery disease or stroke). Albuminuria was positive in 80,5% of patients and average of initial albuminuria was 207 [38;727] mg/g. The average eGFR was 58 [36 ; 89] ml/min/1,73m² and 115 (52%) patients already had renal failure. Forty-six (17%) patients had no renal function assessment during their previous follow-up and only 137 (50,9%) were on renin-angiotensin system inhibitors (RASIs). After a 24-month follow-up, the albuminuria tended to stabilize after RASI introduction in nephrology consultation. However, the eGFR decreased with an average which went from 58 to 50 ml/min/1.73m². Conclusion: Diabetic nephropathy accounts for at least a quarter of nephrology consultation activity in the region of Guelmim Oued Noun. It is characterized in this context by the delay in treatment using renin angiotensin system inhibitors and late nephrology referral hence the need to strengthen preventive strategies in this region especially continuous training.