Prevalence and Pattern of Diabetic Retinopathy Among Diabetic Patients With Chronic Kidney Disease Attending the Renal Outpatient Clinic in Kenyatta National Hospital

Abstract

Study Background Over the last several decades, there has been a global increase in the prevalence of diabetes mellitus. As the number of people living with diabetes is increasing, so is the number of people suffering from the complications of uncontrolled diabetes, which include macro-angiopathies and micro-angiopathies such as nephropathy, retinopathy and neuropathy. Whereas retinopathy is almost universal in patients with DM, only about 40% of diabetic patients have chronic kidney disease (CKD). Study Objective This study sought to determine the prevalence and pattern of diabetic retinopathy among patients with chronic renal disease attending the Kenyatta National Hospital renal outpatient clinic. Materials and methods This was a cross-sectional hospital-based study carried out among adult patients with diabetes and chronic kidney disease at the renal outpatient clinic. It was conducted between March and April 2023. Each participant gave informed consent, and a pre-designed data collection tool was filled. We recruited 102 participants; 47 were females, and 55 were male (F:M 1:1.2). The participants underwent a single-shot macula-centered non-mydriatic retina photo of each eye. The photos were graded using the ETDRS score for DR in their original form. The worse eye was taken as the diagnosis of the participant. The data was analysed using SPSS Version 26 in descriptive and inferential statistics and presented in tables and figures. Results The prevalence of DR among known DM-CKD patients at KNH ROPC was 56.7% (95 % CI, 49.7%-62.4%). DR was more prevalent among participants who had DM for more than ten years and HBA1c of more than 6%. Among the study participants, we found that mild NPDR was 22%, moderate NPDR 8%, severe NPDR 9% and PDR 18%. We did not find a statistically significant association between increasing severity of CKD and worsening ETDRS DR stage. Only 21.6% of diabetic patients with CKD at ROPC had undergone a retina exam within one year preceding the study. Recommendations There is a need to increase screening of diabetic patients at the ROPC