อัตราการเกิดภาวะแทรกซ้อนทางไตและปัจจัยที่เกี่ยวข้องในผู้ป่วยโรคเบาหวานชนิดที่ 2 ในโรงพยาบาลราชวิถี

บทคัดย่อ

Background : Diabetic nephropathy is the most common cause of ESRD which received renal replacement therapy in Thailand. The epidemiology and factors associated with diabetic nephropathy has not been best studied in type 2 diabetic patients in Thailand.

objective : To study associating factors and rate of developed diabetic nephropathy in Rajavithi Hospital.

Methods : Type 2 diabetic patients were randomly selected to participate and enroll in the study. Their fasting blood and mid—stream clean void urine were collected monthly for 3 month. Diagnosis for Microalbuminuria can be performed by the albumin-to-creatinine ratio 30-300 mg/gm and persistent 2 of 3 random spot urine collections. Estimated GFR was calculated by abbreviated MDRD equation. Diabetic nephropathy was classified into microalbuminuria and ESRD. Diabetic retinophathy were examinated by retinal specialist.

Results : A total of 200 diabetic patients were enrolled. Their mean age and diabetes duration were 59.06 ±10.08 and 7.9 ±6.6 years respectively. The prevalence of diabetic nephropathy classified as microalbuminuria, macroalbuminuria and ESRD were 26%, 10% and 2.0% respectively. The prevalence of diabetic retinopathy in patients with normal albumin excretion, microalbuminuria and clinical proteinuria (macroabluminuria and ESRD) were 16.13%, 25% and 41.7% respectively. Single urine dipstick for microalbuminuria have high sensitivity of 86.84%, specificity 88.71%, positive predictive value 82.5%, negative predictive value 91.67%, accuracy 88% and positive likelihood ratio 7.7. Using two of three positive results to diagnose microalbuminuria increased sensitivity, accuracy rate and positive likelihood ratio.

conclusions : Type 2 diabetic patients have high risk of diabetic nephropathy. In diabetic patients with clinical proteinuria have high risk of diabetic retinopathy. Urine dipstick for microalbuminuria can be used to diagnose diabetic nephropathy.