Prevalence and determinants of poor glycemic control among diabetic chronic kidney disease patients on maintenance hemodialysis in Tanzania

Abstract

Background Poor glycemic control in diabetic chronic kidney disease (CKD) patients on maintenance hemodialysis is of great challenge, resulting in increased risk of morbidity and mortality. This study aimed to determine the prevalence and determinants of poor glycemic control among diabetic CKD patients on maintenance hemodialysis. Methodology A cross-sectional study was conducted in 12 dialysis centers located in four regions of Tanzania from March to June 2023. The study population was diabetic CKD patients above 18 years on maintenance hemodialysis for three months or more. A consecutive sampling technique was used for patient recruitment, and a semi-structured questionnaire was used to collect data. The primary outcome was poor glycemic control which was considered when glycated hemoglobin (HbA1c) levels were < 6% or >8%. Statistical Package for Social Sciences (SPSS) version 23 was used for data analysis. Univariate and multivariable regression models were used to evaluate the determinants of poor glycemic control. A p-value <0.05 was considered statistically significant. Results Out of 233 enrolled patients, the overall prevalence of poor glycemic control was 55.4%, whereby 27.0% had HbA1c <6% and 28.33% had HbA1c >8%. A high risk of HbA1c >8% was observed among patients who were on antidiabetic medication (2.16 (95% CI: 1.06– 4.41) p = 0.035) and those attending dialysis sessions less than 3 times a week (1.59 (95% CI: 1.02– 2.48) p = 0.04). While the predictor of HbA1c <6% was the type of dialyzer used (0.57 (95% CI 0.36 – 0.87) p = 0.020). Conclusion There is a high prevalence of poor glycemic control among diabetic CKD patients. Patients who were on antidiabetic medication and those who had less than three dialysis sessions had a high risk of HbA1c >8%. In contrast, those dialyzed using glucose-free dialysates had a high risk of HbA1c <6%.