Comparison of outcomes in diabetic and non-diabetic patients in the national low clearance clinic in Brunei Darussalam

Diabetes mellitus (DM) is the most common cause of chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Until recently, it was thought that CKD exhibit predominantly linear progression pattern. However, more recent studies suggested that renal function decline at later stages of CKD is not uniformly linear. This study aims to compare the progression of CKD towards adverse outcomes, defined as either death or needing dialysis, in patients with and without DM.

This was a retrospective cohort study of adult patients with CKD stages 4 or 5 and not on dialysis, at time of referral to the national low clearance clinic. All patients who were registered in the clinic from 1^st-January to 30^th-June 2017 were included. Patients who did not have at least 3 consecutive measurements of renal function in a follow up period of more than 6 months were excluded. Demographic and clinical data were obtained from electronic health records. Laboratory parameters were compared between DM and non-DM patients, using independent t-test, Mann-Whitney test, Pearson’s chi-square test and Fisher’s exact test. Categorical factors were analysed using the Kaplan-Meier method. The primary outcome was the progression to adverse outcomes.

A total of 69 patients were included (Table 1). Characteristics between DM and non-DM patients were shown in Table 2. There was a statistically significant association between presence of DM and adverse outcomes (p=0.015). The probability of survival (Figure 1) was 76% and 52% at 6-months, and 71.6% and 37.5% at 12-months after admission into the clinic registry, for patients without and with DM respectively (p=0.023).

CKD patients with DM have faster renal progression and should be given more focused attention and more regular follow-up. Further research is needed to determine whether early identification of modifiable risk factors and subsequent intervention could give better outcomes for this group of patients.