Research Article: Time to acute kidney injury and its predictors among newly diagnosed Type 2 diabetic patients at government hospitals in Harari Region, East Ethiopia

Date Published: May 2, 2019

Publisher: Public Library of Science

Author(s): Lemma Demissie Regassa, Yigzaw Kebede Gete, Fantahun Ayenew Mekonnen, Giuseppe Remuzzi.


Incidence of Acute Kidney Injury (AKI) among Type 2 diabetic patients is significantly increasing. But, earlier studies has focused on the admitted patients which may hide the true nature of the Acute Kidney Injury among Type 2 Diabetic (T2D) patients. So, this study was conducted to determine the time to Acute Kidney Injury and its predictors among Type 2 Diabetic patients in Harari Region, East Ethiopia.

We conducted a retrospective cohort study among type 2 diabetic patients who had been receiving treatment at government hospitals of Harari region, Ethiopia from 2013 to 2017. We extracted data from patients’ medical records. We estimated incidence rate and compared survival curves between different exposure groups using Kaplan-Meier and log-rank test. Weibull regression model was fitted to the data to identify the predictor variables. Variables with p-value <0.05 were considered statistically significant. Overall, 14.5% (95%CI: 11.7–17.9) of the study population developed acute kidney injury, with median survival time of 57 months. The significant predictors were physical activity [Adjusted Time Ratio (ATR):95%CI; 0.6 (0.49–0.75)], congestive heart failure [ATR:95%CI; 0.84 (0.71–0.99)], chronic kidney disease [ATR:95%CI; 0.77(0.65–0.91)], hypertension [ATR:95%CI; 0.78(0.65–0.91)], obesity [ATR:95%CI; 0.84(0.74–0.96)], diabetic nephropathy [ATR:95%CI; 0.80(0.65–0.98)], diuretics & beta blockers [ATR:95%CI; 0.85(0.74–0.97)], and delay of follow-up [ATR:95%CI; 0.97(0.96–0.98)]. Incidence of acute kidney injury was high in our study area. Hence, identification and controlling of comorbidities along with regular monitoring of kidney function are needed to prevent or delay the risk of acute kidney injury in type 2 diabetic patients.

Partial Text

Diabetes mellitus (DM) is a chronic metabolic disorder that occurs when the body’s response to insulin is impaired because of the incapacity of pancreas to produce enough insulin or the body cannot effectively use the insulin produced [1,2]. Type 2 Diabetes is the most common form of DM known by the body’s progressive resistance to the normal actions of insulin and/or gradual loss of the capacity to produce enough insulin in the pancreas [2,3].

We included 502 T2D patients who met the inclusion criteria of which 254 (50.6%) were from Hiwot Fana specialized and teaching hospital, 129 (25.7%) from Jugal hospital and 119 (23.7%) from Federal Police hospital. The age of participants at baseline ranged from 12 to 86 years with the mean of 48.31± 14.85 (95% CI: 33.46–63.22) years. Females constituted 57.2% of the patients. Participants who were married accounted for 84.9% (436/ 502) and 193 (38.4%) participants were government employees. The majority, 368 (74.1%) of the participants were urban dwellers (Table 1).

This study has examined the time to develop acute kidney injury and its determinant factors in Type 2 Diabetic patients. A total of eight factors were identified to determine the time to develop AKI in T2D patients. These factors included, physically activity, hypertension, chronic kidney disease, congestive heart failure, diabetic nephropathy, diuretic anti-hypertension medication, delay to start DM follow-up and obesity.




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