Prevalence and risk factors of diabetic kidney disease in Malagasy patients with diabetes mellitus: a cross-sectional study at a University Hospital Center in Antananarivo, Madagascar

Diabetic kidney disease (DKD) is the most serious microvascular complication of diabetes mellitus (DM), responsible for significant morbidity and mortality. Its incidence is increasing in parallel with the epidemiological evolution of DM. Its management is primarily preventive, with specific attention paid to the identification and management of associated risk factors. The study’s objectives were to determine the prevalences and risk factors of DKD and glomerular hyperfiltration (GHF) in Malagasy patients with DM. This cross-sectional study was conducted on 248 patients with DKD seen in the Cardiovascular Diseases and Internal Medicine departments of the Soavinandriana Hospital Center in Antananarivo over a 2-year period. The diagnosis of DKD was confirmed by an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m² and/or albuminuria ≥ 30 mg/24 h. GHF was defined as a value ≥ 100 mL/min/1.73 m². The prevalence of DKD was 36.3% and GHF was 31.0%. In bivariate analysis, risk factors for DKD included age ≥ 60 years (aOR 2.08 [1.14–3.88]), hypertension (aOR 2.21 [1.07–4.78]), dyslipidemia (aOR 2.91 [1.53–5.77]), smoking (aOR 1.94 [1.09–3.49]) and DM duration ≥ 10 years (aOR 2.99 [1.64–5.53]). After multivariate analysis, the independent risk factors for DKD were dyslipidemia (aOR 2.23 [1.11–4.46]) and duration of diabetes ≥ 10 years (aOR 2.82 [1.55–5.14]). Peripheral neuropathy (aOR 4.93 [2.67–9.11]), retinopathy (aOR 28.3 [12.0-66.8]) and carotid atherosclerosis (aOR 1.86 [1.00-3.51]) were significantly associated with DKD. Independent risk factors for GHF were age ≤ 50 years (aOR 5.48 [2.37–12.7]) and glycated hemoglobin ≥ 10% (aOR 1.89 [1.01–3.21]). DKD and GHF were common among Malagasy diabetics. Their management should primarily focus on prevention by achieving optimal control of blood glucose levels and other risk factors, using cardioprotective and renoprotective medications. The presence of DKD should prompt a search for other diabetic complications, and vice versa.