Diabetic kidney disease in Bangladesh: a cross-sectional study on screening, treatment and prevention practice

Background and objectives: Diabetic kidney disease (DKD) is a leading complication of diabetes, contributing significantly to global cases of end-stage renal disease (ESRD). In Bangladesh, the rising prevalence of diabetes has made DKD a growing public health concern. An estimated 21.3% of diabetic patients in Bangladesh have some form of kidney impairment. The Diabetic Association of Bangladesh (BADAS) operates a network of healthcare centers that provide diabetes management across the country. Despite these efforts, significant gaps exist in DKD screening, patient education, and the use of renoprotective medications. This study aims to evaluate DKD in BADAS-affiliated healthcare centers, focusing on screening practices, management and patient education. Materials and Methods: This cross-sectional study was conducted in 8 BADAS-affiliated healthcare centers, representing diverse regions of Bangladesh. A total of 320 type 2 diabetic patients were selected using multi-stage sampling methods. Data were collected using structured questionnaires which included socio-demographic characteristics, clinical histories, comorbidities, body mass index (BMI), glycemic control status, blood pressure levels, medication usage, and diagnostic criteria for DKD. Blood samples were obtained to determine serum creatinine and HbA1c levels, and spot urine samples were collected to measure the urine albumin-to-creatinine ratio (uACR). Results: The prevalence of DKD was found to be 34.1%, with most cases in the early stages (Stage1:33% and Stage2: 45%). Screening practices were inadequate, as 52.5% of participants had never been tested for uACR or eGFR. Only 21.1% of participants with DKD were receiving renoprotective medications like ACE inhibitors or ARBs, and 35.8% were using SGLT2 inhibitors. Glycemic and blood pressure control were also suboptimal, with 81.9% of total participants having HbA1c levels ≥7% and 69.1% having uncontrolled hypertension. Of the entire study population, only 0.3% met all six prevention targets. Conclusion: DKD is prevalent among diabetic patients in BADAS-affiliated healthcare centers, with poor screening practices and underutilization of renoprotective medications. Systematic improvements in DKD management, including enhanced screening, medication use, and patient education, are essential to prevent progression to ESRD. January 2025; Vol. 19(1):001. DOI: https://doi.org/10.55010/imcjms.19.001 *Correspondence: Wasim Md Mohosin Ul Haque, Department o