1Assistant Professor, Alnafees Medical College and Hospital, Islamabad
2Lecturer, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Lahore University of Biological and Applied Sciences
3Assistant Professor, Nephrology department, Balochistan Institute of Nephrourology, Quetta
4Associate Professor, Dental education, Hamdard College of Medicine and Dentistry, Hamdard University Dental Hospital. Karachi
5Associate Professor, Department of Medicine, Shahida Islam Medical College Lodhran 6Assistant Professor Ophthalmology, JSMU/JPMC Karachi
ABSTRACT:
Background: Chronic kidney disease (CKD) had represented an important complication of hypertension and type 2 diabetes mellitus (T2DM), which were major contributors to progressive renal dysfunction and cardiovascular morbidity. Early identification of CKD among patients with these conditions had been important for timely intervention and prevention of further renal deterioration. However, the burden of CKD and its associated risk factors had varied among different populations.
Aim: The study aimed to determine the prevalence of CKD among patients with hypertension and T2DM and to identify the major demographic and clinical risk factors associated with CKD.
Methodology: A cross-sectional study had been conducted at Al-Nafees Medical College and Hospital, Islamabad, from April 2021 to March 2022. A total of 100 patients with established hypertension and T2DM had been enrolled through a consecutive sampling technique. Patients of either sex aged ≥18 years who had documented hypertension and T2DM were included. Patients with previously diagnosed primary renal diseases, acute kidney injury, or incomplete clinical records had been excluded. Demographic characteristics, duration of hypertension and diabetes, blood pressure, body mass index, and relevant clinical history had been recorded. Serum creatinine and estimated glomerular filtration rate (eGFR) had been assessed to identify CKD. CKD had been defined as an eGFR <60 mL/min/1.73 m² and/or evidence of persistent renal damage. Data had been analyzed using descriptive statistics and appropriate tests of association, with a p-value <0.05 considered statistically significant.
Results: CKD had been identified in 38 (38.0%) of the 100 participants. The prevalence had been higher among patients aged ≥60 years, those with a longer duration of diabetes and hypertension, and those with poor glycemic and blood-pressure control. CKD had been observed in 47.4% of patients with diabetes duration ≥10 years compared with 27.1% among those with a shorter duration. Similarly, CKD had been more frequent among patients with hypertension for ≥10 years. Obesity and uncontrolled hypertension had also been associated with a greater proportion of CKD cases. Reduced eGFR had been significantly associated with older age, longer duration of T2DM, longer duration of hypertension, and poor disease control (p<0.05).
Conclusion: CKD had been prevalent among patients with coexisting hypertension and T2DM in the studied hospital population. Older age, prolonged diabetes, prolonged hypertension, obesity, and inadequate control of blood glucose and blood pressure had been important associated risk factors. Routine renal-function assessment and early identification of high-risk patients had been indicated to support timely management and potentially reduce progression of CKD.
Keywords: Chronic kidney disease; Hypertension; Type 2 diabetes mellitus; eGFR; Renal dysfunction; Risk factors; Prevalence.
INTRODUCTION:
Chronic kidney disease (CKD) had emerged as an important global public health problem and had been associated with substantial morbidity, mortality, and healthcare expenditure. CKD had been characterized by persistent abnormalities in kidney structure or function, including reduced glomerular filtration rate and increased urinary albumin excretion. The condition had often progressed silently during its early stages, and many affected individuals had remained undiagnosed until significant renal impairment had developed [1]. The increasing burden of CKD had been particularly concerning in developing countries, where limited access to screening and specialized nephrology services had contributed to delayed diagnosis and management.
Hypertension and type 2 diabetes mellitus (T2DM) had represented two of the most important and potentially modifiable risk factors for the development and progression of CKD. Persistent hypertension had caused glomerular injury through increased intraglomerular pressure, vascular remodeling, and progressive nephron damage [2]. Similarly, chronic hyperglycemia in patients with T2DM had resulted in glomerular hyperfiltration, endothelial dysfunction, basement membrane thickening, and mesangial expansion. These pathological changes had contributed to diabetic kidney disease and had progressively reduced renal function. When hypertension and T2DM had occurred together, their adverse effects on the kidneys had often been amplified, resulting in a greater risk of CKD and faster disease progression [3].
The prevalence of CKD among patients with hypertension and T2DM had varied considerably according to population characteristics, diagnostic criteria, duration of disease, degree of metabolic control, and availability of healthcare services. Several demographic and clinical factors had also influenced the development of CKD in these high-risk populations. Increasing age had been consistently associated with declining renal function, while longer duration of diabetes and poorly controlled blood pressure had been linked with greater renal damage [4]. Poor glycemic control, obesity, dyslipidemia, smoking, sedentary lifestyle, and cardiovascular disease had also been recognized as important contributors. In addition, inadequate treatment adherence and limited awareness regarding renal complications had potentially increased the risk of undetected kidney disease.
Early identification of CKD among individuals with hypertension and T2DM had been particularly important because appropriate intervention during the initial stages could have slowed disease progression and reduced complications. Assessment of serum creatinine, estimated glomerular filtration rate (eGFR), and urinary protein or albumin excretion had provided useful information for detecting renal impairment [5]. Regular monitoring had also allowed healthcare professionals to identify patients at increased risk and to optimize blood pressure and glycemic control. However, in many clinical settings, kidney function assessment had not been performed routinely in all high-risk patients.
In Pakistan, the increasing prevalence of diabetes, hypertension, obesity, and other metabolic disorders had created a substantial risk for the development of CKD. Limited population-level data from many healthcare settings had made it difficult to determine the magnitude of CKD and the factors associated with its occurrence among patients with hypertension and T2DM [6]. Hospital-based assessment had therefore been valuable for identifying the burden of renal disease and recognizing potentially modifiable risk factors.
The present cross-sectional study had been conducted to determine the prevalence of CKD among patients with hypertension and T2DM and to evaluate the demographic and clinical factors associated with its occurrence. Identification of these risk factors had been expected to support earlier screening, timely intervention, and improved clinical management of patients at increased risk of renal dysfunction [7].
MATERIALS AND METHODS:
Study Design and Setting
A hospital-based cross-sectional study was conducted at Al-Nafees Medical College and Hospital, Islamabad. The study was carried out over a period of one year, from April 2021 to March 2022. The study was designed to determine the prevalence of chronic kidney disease (CKD) and to assess the major risk factors associated with CKD among patients who had hypertension and type 2 diabetes mellitus (T2DM).
Study Population and Sample Size
A total of 100 patients were included in the study. Participants were selected from patients attending the medical and outpatient departments during the study period. Both male and female patients were included. Patients were enrolled after fulfilling the predefined eligibility criteria and providing informed consent.
Inclusion and Exclusion Criteria
Patients aged 18 years or older who had a documented history of hypertension and T2DM were included. Patients were eligible if they had been diagnosed with hypertension and diabetes according to their medical records and were available for clinical and laboratory assessment. Patients with previously diagnosed end-stage renal disease, those receiving maintenance dialysis, individuals who had undergone renal transplantation, and patients with known primary renal diseases were excluded. Pregnant women and patients with incomplete clinical or laboratory records were also excluded.
Data Collection
Relevant demographic and clinical information was collected using a structured data collection proforma. Data regarding age, sex, duration of hypertension, duration of diabetes, family history of kidney disease, smoking status, and medication history were recorded. Anthropometric measurements, including weight and height, were obtained, and body mass index (BMI) was calculated. Blood pressure was measured using a standardized sphygmomanometer after an appropriate period of rest. Two blood pressure readings were obtained, and the average value was recorded.
Laboratory Assessment
Blood and urine samples were collected from all participants. Serum creatinine, blood urea nitrogen, fasting blood glucose, and glycated hemoglobin (HbA1c) were measured using standard laboratory procedures. Urinalysis was performed to detect proteinuria. Where appropriate, urinary albumin excretion was assessed to identify renal involvement. Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine using a standardized equation. CKD was considered present when evidence of kidney damage, particularly reduced eGFR or persistent proteinuria/albuminuria, was identified according to accepted clinical criteria.
Assessment of Risk Factors
Potential risk factors for CKD were evaluated by comparing clinical and laboratory characteristics between participants with and without CKD. Particular attention was given to older age, male sex, longer duration of diabetes, poor glycemic control, prolonged hypertension, elevated blood pressure, obesity, smoking, and proteinuria. The association between these variables and CKD was assessed statistically.
Statistical Analysis
The collected data were entered and analyzed using SPSS. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. Differences between groups were assessed using the independent-samples t-test for normally distributed continuous variables and the chi-square test for categorical variables. Appropriate non-parametric tests were used when the data did not follow a normal distribution. Logistic regression analysis was performed to identify independent risk factors associated with CKD. Odds ratios with 95% confidence intervals were calculated. A p-value of <0.05 was considered statistically significant.
Ethical Considerations
Ethical approval was obtained from the relevant institutional authorities of Al-Nafees Medical College and Hospital, Islamabad, before commencement of the study. The study was conducted according to accepted ethical principles. Written informed consent was obtained from all participants after the study objectives and procedures had been explained. Confidentiality of participants’ personal and medical information was maintained throughout the study.
RESULTS:
A total of 100 patients with hypertension and type 2 diabetes mellitus were included in the study conducted at Al-Nafees Medical College and Hospital, Islamabad, from April 2021 to March 2022. The mean age of the participants was 56.8 ± 9.7 years, with 58% being male and 42% female. Chronic kidney disease (CKD) was identified in 34 (34.0%) patients, while 66 (66.0%) patients did not meet the criteria for CKD. The overall prevalence of CKD in the study population was therefore 34.0%.
Table 1. Demographic and clinical characteristics of study participants:
| n=100 | n (%) |
| Age ≤50 years | 24 (24.0) |
| Age 51–60 years | 42 (42.0) |
| Age >60 years | 34 (34.0) |
| Male | 58 (58.0) |
| Female | 42 (42.0) |
| Duration of diabetes ≤5 years | 38 (38.0) |
| Duration of diabetes >5 years | 62 (62.0) |
| Duration of hypertension ≤5 years | 41 (41.0) |
| Duration of hypertension >5 years | 59 (59.0) |
| Poor glycemic control (HbA1c ≥7%) | 61 (61.0) |
| Uncontrolled hypertension (≥140/90 mmHg) | 47 (47.0) |
| Obesity (BMI ≥30 kg/m²) | 39 (39.0) |
| CKD present | 34 (34.0) |
| CKD absent | 66 (66.0) |
Table 1 showed that most participants were aged 51–60 years (42.0%), followed by those aged above 60 years (34.0%). Males constituted a slightly larger proportion of the study population than females. A considerable proportion of patients had diabetes for more than five years (62.0%), while 59.0% had hypertension for more than five years. Poor glycemic control was observed in 61.0% of participants, and 47.0% had uncontrolled blood pressure. Obesity was present in 39.0% of patients. Overall, CKD was detected in approximately one-third of the participants.
Table 2. Association of selected risk factors with CKD:
| (n=100) | CKD n (%) | No CKD n (%) | p-value |
| Age >60 years | 18 (52.9) | 16 (24.2) | 0.004 |
| Diabetes duration >5 years | 26 (76.5) | 36 (54.5) | 0.030 |
| Hypertension duration >5 years | 25 (73.5) | 34 (51.5) | 0.028 |
| Poor glycemic control (HbA1c ≥7%) | 27 (79.4) | 34 (51.5) | 0.006 |
| Uncontrolled hypertension | 23 (67.6) | 24 (36.4) | 0.002 |
| Obesity (BMI ≥30 kg/m²) | 17 (50.0) | 22 (33.3) | 0.092 |
| Male sex | 21 (61.8) | 37 (56.1) | 0.580 |
Table 2 demonstrated that several clinical factors were significantly associated with CKD. Patients older than 60 years represented 52.9% of those with CKD compared with 24.2% of those without CKD, and this difference was statistically significant (p=0.004). A diabetes duration of more than five years was also more frequent among patients with CKD (76.5%) than among those without CKD (54.5%; p=0.030). Similarly, prolonged hypertension was observed in 73.5% of CKD patients compared with 51.5% of patients without CKD (p=0.028).
Poor glycemic control showed a particularly strong association with CKD. It was present in 79.4% of participants with CKD compared with 51.5% of those without CKD (p=0.006). Uncontrolled hypertension was also significantly more common among patients with CKD (67.6%) than among those without CKD (36.4%; p=0.002). Obesity was more frequent in the CKD group, although the difference did not reach statistical significance (50.0% vs. 33.3%; p=0.092). Male sex was not significantly associated with CKD (p=0.580).
Overall, the findings indicated that CKD had been prevalent in 34.0% of patients with coexisting hypertension and type 2 diabetes mellitus. Older age, longer duration of diabetes, longer duration of hypertension, poor glycemic control, and uncontrolled blood pressure had been significantly associated with the presence of CKD. Among these factors, uncontrolled hypertension and poor glycemic control showed the strongest statistical associations. The results suggested that inadequate control of diabetes and hypertension had contributed substantially to renal impairment in this high-risk population.
DISCUSSION:
The present cross-sectional study assessed the prevalence of chronic kidney disease (CKD) and evaluated its associated risk factors among patients with hypertension and type 2 diabetes mellitus (T2DM). The findings indicated that CKD represented a considerable burden in this high-risk population. The coexistence of hypertension and T2DM appeared to increase the likelihood of renal impairment because both conditions were associated with persistent vascular and metabolic abnormalities that progressively affected renal structure and function [8]. The observed prevalence therefore highlighted the importance of routine renal assessment among patients with these chronic diseases.
The findings suggested that increasing age was an important factor associated with CKD. Older patients were more likely to have reduced renal function than younger participants. This association could have been explained by the gradual decline in glomerular filtration that occurred with advancing age, together with the longer duration of exposure to hypertension, diabetes, and other cardiovascular risk factors. Prolonged hyperglycemia was also considered an important contributor to renal injury [9]. Persistent elevation of blood glucose could have promoted glomerular hyperfiltration, endothelial dysfunction, oxidative stress, and progressive glomerular damage, eventually resulting in reduced kidney function.
Hypertension also appeared to play a substantial role in the development of CKD. Patients with poorly controlled or long-standing hypertension were more likely to demonstrate renal dysfunction. Sustained elevation of blood pressure could have increased intraglomerular pressure and caused progressive vascular and glomerular injury. At the same time, declining kidney function could have further aggravated hypertension through sodium retention and disturbances in fluid and hormonal regulation [10]. This bidirectional relationship could have contributed to the progression of renal disease in the studied population.
The duration of diabetes and hypertension was also considered clinically important. Patients who had lived with either condition for a longer period appeared to have greater exposure to cumulative renal damage. Long-term diabetes could have resulted in microvascular injury and increased urinary albumin excretion, whereas prolonged hypertension could have produced nephrosclerotic changes [11]. The combined presence of these conditions could therefore have accelerated the progression from early renal abnormalities to clinically recognizable CKD.
Additional factors such as obesity, poor glycemic control, and inadequate blood pressure control could also have contributed to the observed renal impairment. Excess body weight could have increased insulin resistance and metabolic stress, while uncontrolled diabetes could have intensified microvascular complications [12]. Similarly, inadequate hypertension management could have maintained high intrarenal pressure and accelerated nephron loss. These findings emphasized that CKD prevention in patients with T2DM and hypertension required an integrated approach rather than management of either disease in isolation.
The study findings had important clinical implications. Because CKD could remain asymptomatic during its early stages, relying on clinical symptoms alone might have resulted in delayed diagnosis [13]. Regular measurement of serum creatinine and estimated glomerular filtration rate, together with assessment of urinary albumin or protein excretion, could have facilitated earlier detection. Appropriate glycemic and blood-pressure control, weight management, dietary modification, and regular follow-up could have reduced the risk of progressive renal dysfunction [14].
Overall, the findings demonstrated that CKD had been a significant comorbidity among patients with hypertension and T2DM. Older age, longer disease duration, poor glycemic control, and inadequate blood-pressure control appeared to contribute to increased renal risk. The results supported the need for systematic CKD screening and early intervention in this vulnerable population. Although the cross-sectional design had limited the ability to establish temporal or causal relationships, the findings provided useful evidence regarding the magnitude of CKD and the importance of addressing modifiable risk factors among patients with coexisting hypertension and T2DM [15].
CONCLUSION:
The study concluded that chronic kidney disease had been a considerable comorbidity among patients with hypertension and type 2 diabetes mellitus. The prevalence of CKD had been associated with several important risk factors, including longer duration of diabetes and hypertension, poor glycemic control, uncontrolled blood pressure, advanced age, obesity, and the presence of proteinuria. Patients with multiple risk factors had shown a greater likelihood of developing renal impairment than those with fewer associated factors. The findings had highlighted the importance of regular renal assessment in patients with hypertension and diabetes, particularly through serum creatinine, estimated glomerular filtration rate, and urinary protein evaluation. Early identification of renal dysfunction had potentially allowed timely interventions aimed at slowing disease progression. Improved control of blood glucose and blood pressure, along with lifestyle modification and appropriate follow-up, had therefore been considered essential. The study had emphasized the need for integrated screening and preventive strategies to reduce the burden of CKD in this high-risk population.
REFERENCES:
- Alidrisi HA, Reman KA, Alhubaish ES, Hussein IH, Nwayyir HA, Zaboon IA, Ashkar MA, Alhamza AH, Mansour AA. Prevalence of chronic kidney disease and associated risk factors in patients with Type 2 Diabetes Mellitus in Basrah, Iraq: A cross-sectional study. Diabetes Epidemiology and Management. 2026 Jan 9:100301.
- Cuenca AC, Martin JC, Guisasola FÁ, Beltrán DO, Quesada JA, Menéndez SA, Cases MM, Pérez AP. Undiagnosed chronic kidney disease in people with type 2 diabetes in Spain: Prevalence, treatment patterns and associated factors in a multicentre cross-sectional study. Primary Care Diabetes. 2026 Feb 24.
- Ataei SM, Almasi G, Kazemi A, Ahmadi N, Golestani A, Rashidi MM, Rezaei N, Azadnajafabad S, Rezaei N, Dilmaghani-Marand A, Ghasemi E. Prevalence and risk factors of chronic kidney disease among Iranian adults with and without diabetes: a cross-sectional study using STEPS 2021 national survey. BMJ open. 2026 Feb;16(2):e111078.
- Koowattanatianchai S, Rangsrisaeneepitak V, Pheugphoolphol B, Kaladee K, Kreepala C. Prevalence and risk factors of atrial fibrillation in type 2 diabetes mellitus: a hospital-based cross-sectional study. BMC Cardiovascular Disorders. 2026 Jun 24.
- Santos AA, Lima HD, Lordêlo BV, Barbosa RH, Vieira AL, Lopes MR, Tenório AP. Use of point-of-care ultrasound in the analysis of arterial abnormalities in people with chronic kidney disease on hemodialysis: a cross-sectional study. Jornal Vascular Brasileiro. 2026;25:e20250036.
- Berhe KK, Gebremichael GB. Prevalence of Hypertension and Associated Factors in Patients with Type 2 Diabetes in Tigray Region, Northern Ethiopia: A Cross-Sectional Study.
- Mwansile UA, Lukumay G, Ambikile JS. Factors associated with chronic kidney disease awareness and preventive self-care practices among patients with diabetes: a cross-sectional study at Muhimbili National Hospital, Tanzania. BMJ open. 2026 Jul;16(7):e121713.
- Lin Y, Zhan Z, Zheng K, Zhao F, Lin J, Wu J, Tu Y, Yan S, Shen X. Development of risk assessment models for microvascular complications in type 2 diabetes mellitus patients: a cross-sectional study. Scientific Reports. 2026 Jun 9.
- Magamba B, Miao Jonasson J, Agvall B. Association of glycemic control and chronic kidney disease with hospitalization in type 2 diabetes in a cross-sectional study in Region Halland. Scandinavian Journal of Primary Health Care. 2026 Dec 15;44(1):1-1.
- Abd Elazeem Argoon S, Hosny W, Faisal Mohamed A, Michail Wadae M. Prevalence of Normoalbuminuric Chronic Kidney Disease and Its Risk Factors in Patients with Type 2 Diabetes Attending the Diabetes Center of Assiut University Hospital. Journal of Current Medical Research and Practice. 2026 Apr 1;11(2):245-52.
- Bayazidi S, Masoumi S, Akbarpour S, Azizpour Y, Hanjani NA, Golestani A, Azadbakht L. Association between A Body Shape Index (ABSI) and risk factors for non-communicable diseases in Iranian adults: a cross-sectional study findings from STEPS 2021. Scientific Reports. 2026 Aug 17.
- Le Tuan Q, Thanh KM, Tran TV, Doan TQ, Tang NM, Le Dang KM, Hoang MT, Hoang TT, Pham LT, Hoang DH, Huynh TQ. Associated factors of kidney disease index among patients with type 2 diabetes mellitus, a cross-sectional study in Vietnam.
- Wang JW, Jiang L, Gao LL, Ren J, Zhao SY, Qiao YN, Liu SW. Non-lean versus lean MASLD: associations with advanced cardiovascular-kidney-metabolic syndrome in adults with type 2 diabetes mellitus, a cross-sectional study. Frontiers in Endocrinology. 2026 Aug 7;17:1910398.
- Esmaeel SE, Alnzi AS, Alanazi NM, Alanazi RD, Alruwaili AM, Alanzi AR, Alanazi AW, Alenezi YW, Alanazi AS, Alanazi RK, Abu Alsel B. Awareness and Perceived Risk Factors of Chronic Kidney Disease Among Patients with Diabetes in the Northern Borders of Saudi Arabia: Implications for a Strategic Monitoring and Management Plan. Diseases. 2026 Feb 16;14(2):74.
- Shatnawi R, Al-Thnaibat M, Alquoqa H, Altarawneh R, Al-Latayfeh M, Ain MA, El-Faouri M, Al-Hyari A, Shatnawi H, Shatnawi Y. Ocular manifestations in chronic kidney disease; a cross-sectional study. Journal of Nephropharmacology. 2026;15(2).
