Risk factors associated with Indian type 2 diabetes patients with chronic kidney disease: CITE study, a cross-sectional, real-world, observational study

Abstract

Background: Type 2 diabetes (T2DM) is the leading cause of chronic kidney disease (CKD) worldwide. Identifying clinical and laboratory associations with chronic kidney disease (CKD) in type 2 diabetes (T2DM) can help physicians target modifiable risk factors. In light of limited data from India, the CITE (CKD in Indian T2DM Evaluation) study was conducted. Methods: The multicenter, cross-sectional CITE study included 3,325 patients from 28 centres across India over a three-month period. CKD was defined as a persistent decline in kidney function (eGFR < 60 ml/min/1.73 m² for ≥ 3 months) or an elevated urine albumin-to-creatinine ratio (UACR) in at least two samples. Descriptive statistics summarised patient characteristics, while logistic regression analyses identified significant risk factors for CKD. Results: The prevalence of CKD in T2DM was 32%, with a median patient age of 59.9 years and 60.72% having a T2DM duration > 10 years. Reduced eGFR (< 60 ml/min/1.73 m²) was associated with older age (OR: 2.47, 95% CI 2.11–2.88, P < 0.001), longer T2DM duration (OR: 2.28, 95% CI 1.77–2.93, P < 0.001), higher HbA1c (OR: 1.039, 95% CI 1.001–1.079, P = 0.046), and elevated SBP (OR: 1.005, 95% CI 1.002–1.009, P = 0.003). Macroalbuminuria (UACR > 300 mg/g) was linked to non-vegetarian diet (OR: 1.95, 95% CI: 1.59–2.40, P < 0.001) and tobacco use (OR: 1.42, 95% CI: 1.17–1.73, P < 0.001). CKD increased comorbidity odds. Conclusion: The CITE study highlights the prevalence of CKD (32%) in Indian patients with T2DM and identifies clinical and laboratory factors associated with CKD, including age ≥ 60 years, T2DM duration, SBP, HbA1c, tobacco use, non-vegetarian diet, and comorbidities. Longitudinal studies are needed to confirm these associations and evaluate causality.