ASSOCIATION BETWEEN DIABETES AND CHRONIC KIDNEY DISEASE IN MOROCCAN ADULT POPULATION

DOI: https://doi.org/10.26758/16.1.19

(1) Faculty of Sciences, Chouaib Doukkali University, Training and Research Unit on Nutrition & Food Sciences, LABS, El Jadida 24000, Morocco.

email:  rachi-84@hotmail.fr,  https://orcid.org/0000-0001-6980-3360

email: hajar.elhendaoui1995@gmail.com, https://orcid.org/0009-0003-3439-9320

email : frikifirdaous@gmail.com,  https://orcid.org/0000-0003-0535-2841

email : rekiabelahsen@gmail.com, https://orcid.org/0000-0002-5641-5809

(2) Laboratory of Bio-Geosciences and Materials Engineering, Higher Normal School of Hassan II University, Casablanca, Morocco, email: m.mziwira@enscasa.ma, https://orcid.org/0000-0002-9814-4867

(3) Higher Institute of Professions Nurses and Health Techniques of Marrakesh, Morocco,  email:  imanebarakat@hotmail.com, https://orcid.org/0000-0002-3070-3642

email: libatonhabiba@gmail.com, https://orcid.org/0000-0002-2258-1315

Address correspondence to: Rekia BELAHSEN, Faculty of Sciences, Chouaib Doukkali University, Training and Research Unit on Nutrition & Food Sciences, LABS, El Jadida 24000, Morocco. Phone: 212 523 34 2325/212 664 97 16 16 Fax: 212 523 34 21 87/449 Email: rekiabelahsen@gmail.com/rbelahsen@yahoo.com

Abstract

Objectives: Chronic kidney disease (CKD) is a public health problem and a factor of high cardiovascular morbidity, mortality, and low quality of life, with a known link to diabetes. The aim of this study was to estimate the prevalence of CKD and its association with diabetes in a sample of Moroccan adults from the Casablanca-Settat region.

Material and methods: A prospective cohort study was carried out involving 210 subjects aged 18 or older, randomly selected from provincial health care centers. Sociodemographic and clinical data, as well as information on the participants’ lifestyle, were collected using a structured questionnaire. Blood samples were collected in a subgroup of 205 subjects in order to analyse glycemia and lipid profile, and to determine serum creatinine. Subsequently, the glomerular filtration rate (GFR) was estimated by the Modification of Diet in Renal Disease formula, and the CKD was defined by an estimated GFR (eGFR) < 60mL/min/1.73m².

Results: The mean age of participants was 54.18 ± 13.45 years, and the prevalence of CKD was 4.4%. The results show a slight negative correlation between chronic kidney disease and type 2 diabetes (r = -0.131; p = 0.06). However, no statistically significant association was found between diabetes and kidney damage. On the other hand, type 1 diabetes was more prevalent in individuals with CKD (25%) than those without CKD (13.2%), but the difference was not statistically significant.

Conclusion: Data have shown no significant relationship between CKD and diabetes. Indeed, the study findings recommend monitoring of diabetes, which is considered as the main risk factor for this chronic disease. The present study findings emphasize that CKD should be an important consideration in any strategy to address non-communicable diseases (NCDs).

Suggested citation (APA):

Moustakim, R., El Hendaoui, H., Liba, H., Barakat, I., Friki, F., Mziwira, M., & Belahsen, R. (2026). Association between diabetes and chronic kidney disease in Moroccan adult population. Anthropological Researches and Studies, 16, 269-279. https://doi.org/10.26758/16.1.19

Introduction

Chronic kidney disease (CKD) is recognized as a serious public health problem, associated with high cardiovascular morbidity, mortality, and low quality of life (Moustakim et al., 2020). Available data indicate a high prevalence of CKD from 10% to 16% of the general population worldwide (Mahmoodnia & Tamadon, 2017). The main determinants of CKD include diabetes, hypertension, chronic glomerulonephritis, chronic pyelonephritis, polycystic kidney disease, and chronic use of anti-inflammatory or nephrotoxic medication, as well as other factors such as age, gender, race, smoking, and genetic predisposition (Jha et al., 2013).

Chronic kidney disease is defined by reduced estimated glomerular filtration rate, increased proteinuria, or both (Winocour, 2018). Hence, CKD is categorized  into 5 stages of increasing severity, with a decrease in glomerular filtration rate (GFR) lower than 60 ml/min/1.73m² leading to end stage kidney disease (ESKD) requiring renal replacement therapy, such as dialysis or transplantation, and contributing to poor clinical outcomes (Winocour, 2018). Unfortunately, this chronic disease remains asymptomatic, without obvious clinical symptoms in the early stage of the disease, until the appearance of damage, occurring only in more advanced stages in patients with this disease (Kiefer & Ryan, 2015).

Currently, diabetes is constantly increasing, affecting a number of patients in many countries including Morocco (Tazi et al., 2003; Kowalski et al., 2015). Indeed, the prevalence of diabetes in Morocco has risen from 6.6% in 2000 (national survey on cardiovascular risk factors) to 10.6% in 2018 (STEPS survey), with a continuing upward trend (Tazi et al., 2003; Moustakim et al., 2020). This progression has been associated with numerous risk factors, including poor glycemic control, uncontrolled hypertension, smoking, age of onset, obesity, family history of diabetes, and genetic predisposition (Stevens et al., 2024).

This disease is considered the most common etiology of chronic kidney disease (Winocour, 2018). CKD can be directly attributed to type 1 and type 2 diabetes mellitus and is thus called diabetic nephropathy (DN) (Kowalski et al., 2015; Winocour, 2018). However, even though end-stage renal disease (ESRD) is a feared complication of CKD, patients with this disease have a much higher risk of dying from cardiovascular disease than progressing to renal failure (Ammirati, 2020; Moustakim et al., 2021). Also, the role of glycemic control in delaying the progression of CKD to advanced stages and preventing cardiovascular complications has already been highlighted by numerous studies, and several epidemiological studies have revealed an association between diabetes and chronic kidney disease (Chen et al., 2019; Hauwanga et al., 2024).

The aim of this study was to estimate the prevalence and the association of CKD with diabetes among a group of Moroccan adults from the Casablanca-Settat region.

Material and methods

Study population

Figure 1

Mapping of Sidi Bennour, part of the Casablanca-Settat region (to see Figure 1, please click here)

Data collection

The data were collected through a questionnaire including information on sociodemographic status (age, sex, income, and education), personal and family health history (hypertension, diabetes, and kidney disease) and lifestyle (smoking, alcohol consumption, and physical activity), and use of nephrotoxic medication (non-steroidal anti-inflammatory drugs and natural remedies). Blood pressure and anthropometric parameters were measured (height, weight, waist and hip circumferences). Body mass index (BMI) was calculated as body weight (in kg) divided by the square of height (in m).

Laboratory measurements

Blood samples were collected by venipuncture after an overnight fast of at least 12 hours, and the analyses were done on the same day. The analysis of blood samples was performed using a semi-automatic spectrophotometer, type BTS 350. Fasting plasma glucose (FPG) was measured using an enzymatic colorimetric method with glucose oxidase. The triglycerides (TGs) and total cholesterol (TC) measurements were performed using an enzymatic colorimetric method with glycerol phosphate oxidase and cholesterol esterase and cholesterol oxidase, respectively.

Chronic kidney disease

Serum creatinine was measured according to the standard colorimetric Jaffe kinetic reaction method. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) formula as follows (Farhadnejad et al., 2016; Levey & Coresh, 2012; Nelson & Tuttle, 2007):

eGFR = 186 × (serum creatinine)^-1.154  × (age)^-0.203 × (0.742 if female) × (1.210 if African American)

Subjects were classified as having CKD if eGFR < 60 mL/min/1.73 m², according to the National Kidney Foundation guidelines.

Hypertension is defined as a systolic blood pressure (SBP) ≥ 140 mmHg, diastolic blood pressure (DBP) ≥ 90 mmHg, or current use of antihypertensive drugs.

Diabetes mellitus was defined, according to the criteria of the American Diabetes Association, as fasting plasma glucose level of ≥ 126 mg/dL, or current use of hypoglycaemic agents.

Dyslipidemia was defined by serum concentrations of total cholesterol ≥ 200 mg/dL and/or triglycerides ≥ 150 mg/dL or patients already being treated with lipid-lowering medication (Rguibi & Belahsen, 2004).

According to the World Health Organization (WHO) criteria, normal weight was defined as 18 ≤ BMI ≤ 24.9 kg/m2, overweight as 25 ≤ BMI ≤ 29.9 kg/m2 and overall obesity was defined as BMI ≥ 30 kg/m2.

Abdominal obesity was defined, according to the definition of the National Cholesterol Education Program (NCEP), by WC ≥ 88 cm in women and WC ≥102 cm in men.

Subjects engaging in less than 150 minutes of physical activity per week were considered to have low physical activity (Faye et al., 2017; Moustakim et al., 2020).

Statistical analyses

Results

Baseline characteristics of the population

Table 1 presents the different sociodemographic characteristics of the study sample population. The current study included 210 individuals with a predominance of women (n = 152, 72.4%) compared to men (n = 58, 27.6%), with a mean age of 54.18 ± 13.45 years.  Thirty-one percent of the participants resided in urban area, while 69% resided in rural area. The total illiteracy rate of the sample was 74.8% and about 58% of the participants had a low socioeconomic status.

Table 2 shows the clinical and anthropometric characteristics in both sexes of the participants. Thus, there was a significant difference between men and women regarding anthropometric characteristics, type 2 diabetes, family history of hypertension, creatinine, urea, and total cholesterol parameters. The serum concentrations of creatinine and urea were significantly higher in men than women, while the total cholesterol level was higher in women compared to men.

Table 1 

Baseline Characteristics of the Participants (n = 210) (to see Table 1, please click here)

The comparison of characteristics between subjects with and without CKD is summarized in Table 3. Subjects with CKD were more likely to be older, hypertensive, have  higher serum creatinine and urea levels, lower eGFR, engage in less physical activity, and use more nephrotoxic medications compared to those without CKD, with these differences reaching statistical significance.

However, no significant differences were found for others parameters, including gender, anthropometric characteristics, glycemia, and lipid profile (p > 0.05).

Table 2

Clinical, Anthropometric, and Biochemical Characteristics of the Study Population (to see Table 2, please click here)

Table 3

 Comparison of Characteristics Between Subjects With and Without CKD (n=205) (to see Table 3, please click here)

Discussion

Chronic kidney disease (CKD) is a growing public health problem that represents a significant economic and social burden. Therefore, prevention and early detection are key strategies to reduce it (Vupputuri et al., 2014). This study estimated the prevalence of CKD and examined its association with diabetes in a group of Moroccan adults from the Casablanca-Settat region. The rationale for this research is based on numerous epidemiological studies that have revealed the close association between CKD and certain metabolic disorders, including diabetes, hypertension, and obesity (Kiefer & Ryan, 2015; Zhang et al., 2012). Indeed, hypertension has been reported to be the main risk factor responsible for kidney function decline and represents the most common complication of CKD (Wang et al., 2019). In the current study, the results clearly illustrated a significant association of CKD with hypertension, which is consistent with the results found by other studies (Ong-ajyooth et al., 2009; Atkins, 2005; Zhang et al., 2012; Faye et al., 2017).

The present data show that ageing was also a risk factor for CKD in this population. Indeed, similarly to other studies (Winocour, 2018), subjects with CKD were older than those without CKD, with a significant association between both variables. This result highlights that age is related to physiological decline in kidney function and notably to the presence of cardiovascular risk factors, including hypertension, diabetes, and obesity (Kiefer & Ryan, 2015).

In this research, the use of nephrotoxic medications, namely nonsteroidal anti-inflammatory and analgesic drugs, among participants was also linked to CKD. Consistent with the results of other similar studies, the use of these medications was significantly more common among subjects with CKD than among those without CKD (Zhang et al., 2012).

Several recent studies have also demonstrated the impact of physical activity on the prevention of numerous chronic diseases, including CKD (Martens et al., 2018). Similarly, the results of the current study also highlighted a significant association between physical activity and CKD. Thus, subjects with CKD were less active than their counterparts. The biological mechanisms of physical activity have been shown to provide multiple metabolic benefits, including improved vascular health, better regulation of blood pressure and blood glucose, and reduced inflammation (Martens et al., 2018).

A strong relationship was also reported by several recent studies, between the coexistence of diabetes and chronic kidney disease and an increased risk of both microvascular and macrovascular complications leading to the end stage renal disease and cardiovascular mortality in these patients (Aikaeli et al., 2022; Hauwanga et al., 2024; Winocour, 2018). Additionally, a combination of poor glycemic control and microvascular complications has also been found to lead to both cardiovascular disease and renal outcomes (Hauwanga et al., 2024; Kowalski et al., 2015; Winocour, 2018). These findings demonstrated the pivotal role and need for a multidisciplinary approach involving endocrinologists, nephrologists, cardiologists, and dietitians for the management of chronic kidney disease and diabetes, and in improving patient outcomes and quality of life (Hauwanga et al., 2024; Moustakim et al., 2020).

Although the data from this study did not reveal a significant association between diabetes and CKD in this population, the results obtained indicated that type 1 diabetes was more prevalent among subjects with CKD than those without CKD, with no statistically significant association. This is mainly due to the small sample size, low statistical power, and the cross-sectional design, which limits causal inference.

The results of this study support the need for earlier interventions, including CKD screening, promoting lifestyle change, optimizing blood pressure and glycemia control, and patient education on nephrotoxic drug use and increased physical activity, in order to reduce disease progression, manage risk factors, and delay the incidence of ESRD.

Limitations and future directions

The present study has several limitations. First, the cross-sectional design and small sample size with convenience sampling limit causal inference and statistical power. Second, no interventions were tested, and certain early markers of CKD, such as proteinuria, were not measured. Third, creatinine was obtained from a single measurement to estimate chronic reduction in GFR using the MDRD equation, which may be less accurate in certain populations. Nevertheless, the observed associations with hypertension, aging, physical inactivity, and nephrotoxic medication use highlight the relevance of evidence-based interventions suggested in the literature, including CKD screening, lifestyle modification, blood pressure and glycemia control, and patient education. Future studies should focus on larger cohorts, longitudinal designs, and interventional trials to evaluate the effectiveness of these strategies in preventing CKD progression.

Conclusion

In Morocco, few studies have assessed the prevalence of chronic kidney disease. The study results highlight that this disease must be considered in any strategy to combat non-communicable diseases. Although diabetes was not significantly associated with CKD in this sample, it remains a well-established risk factor according to extensive literature. Additionally, the findings in this study cannot be generalized to the whole population of Morocco as they are descriptive and correlational rather than causal. The small sample size further limits generalizability, and a larger study is suggested to validate these findings. Many determinants of CKD, including aging, hypertension, nephrotoxic medication use, and low physical activity, were notably observed in this sample. Thus, these findings support the need for appropriate screening, diagnosis, and management by primary care clinicians, who therefore play a crucial role in preventing adverse outcomes associated with CKD and its several risk factors.

Competing interests

The authors declare no competing interests.

Ethics Committee Approval

The study was supported by the Moroccan Ministry of Higher Education, Scientific Research and Innovation and the Ministry of Health and Social Protection of Morocco and approved by the respective Ethics Committees of the Provincial hospital, affiliated to Chouaib Doukkali University (Approval No 1475/14).

Consent to participate

Written informed consent was obtained from all participants prior to their inclusion in the survey.

Acknowledgments

We would like to thank the medical delegation of Sidi Bennour Province, Ministry of Health and Social Protection of Morocco and also the medical staff of all primary health care centers in the province of Sidi Bennour for their cooperation and allowing us to collect data.

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