Diabetic Kidney Disease: Evidence from Two Selected Cohorts of Patients from Low-Middle and High Income Countries

Objectives: Diabetic kidney disease (DKD) is the leading cause of kidney failure worldwide. Different phenotypes of DKD are emerging, partially attributable to a better glycemic control, partially to concomitant risk factors for kidney disease. Diabetes belongs to Non-Communicable Diseases (NCD), but poor data about DKD in Low-Middle Income Countries are currently available. In the present paper we compare two cohorts of patients affected by DKD from Tanzania and from Italy. Study design: Retrospective observational study conducted by NCDs Clinic of Tosamaganga Regional Referral Hospital (Tanzania) and from the Multidisciplinary Diabetological-Nephrological Clinic of Bologna (Italy) Methods: Included patients’data were analyzed for demographical features, diabetes complications, laboratory findings and pharmacological therapy at the time of enrollment and after 6-month follow up. Results: Tanzanian patients were younger (56.65 vs 67.66 years, p< 0.001), with a higher prevalence of women (66.9% vs 25.5%, p< 0.001) and showed lower level of BMI (26.39 vs 30.18 kg/m2, p< 0.001). A worsen glycemic control could be observed in Tanzanian cohort (HbA1c 83.71 vs 56.92 mmol/mol, p< 0.001) and higher eGFR (70.13±31.93 vs 52.31±23.37 ml/min, p< 0.001). A sharp reduction of albuminuria was observed in both cohorts with an increase in nephroprotective drugs a better glycemic control. Conclusions: Two phenotypes of diabetic patients have emerged from comparison between two cohorts. Tanzanian patients are mostly female, younger and with normal BMI; whereas Italian patients are mainly male, older and affected by metabolic syndrome and vascular complications. Therapy implementation is associated with a delayed decline of eGFR and downgrading of albuminuria at 6 months follow up.