IFEMED Journal of the Obafemi Awolowo University Medical Students’ Association J. Ifemed | vol 27| issue 1|2023 https://ifemedjc.com Ifemed Journal of Medicine May be reproduced with permission and acknowledgement Copyright © 2023 Obafemi Awolowo University Medical Students’ Association. All rights reserved. Diabetic Kidney Disease in Africa: Epidemiology, Management, and Prevention Olaitan Komolafe 1 , Morenikeji Oluduro 2, Joyce Popoola 3 , Oluyomi Okunola 4 1 Clinical I, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria 2 Clinical III, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria 3 Consultant Nephrologist, St. George University Hospital, United Kingdom 4 Professor, Consultant Nephrologist, Obafemi Awolowo University Teaching Hospital Complex ABSTRACT Diabetes is a worldwide pandemic, with more than 75 percent of people with diabetes estimated to live in developing nations by 2025. This epidemic in developing countries has been attributed to urbanization and westernization, altered nutritional intake, increasing sedentary lifestyle, and established risk factors, including age, and gender. The management of diabetic kidney disease follows a multi-disciplinary approach, with blood glucose control, hypertension control, pharmacologic intervention, and lifestyle modification such as weight reduction and increased physical activity. In most of Sub-Saharan Africa, economic challenges pose a barrier to treating and preventing diabetes and its complications. This is due to a lack of screening, the rising cost of medications, and inadequate universal health coverage such as national insurance schemes, resulting in affected individuals seeking treatment late. This article elaborates on the risk factors, epidemiology, and treatment strategies of diabetic kidney disease and highlights strategies for its prevention in Africa. KEYWORDS: Diabetes, Diabetic Kidney Disease, Africa INTRODUCTION For centuries, communicable diseases and uncontrolled epidemics were the major cause of death worldwide. However, breakthroughs in medicine and research have curbed the deleterious effects of communicable diseases on society. In its stead, non-communicable diseases are at the forefront of mortality. 1 The World Health Organization (WHO) estimates that non-communicable diseases, including cardiovascular diseases, diabetes, cancers, and obesity-related conditions, account for 59% of global deaths worldwide and almost half (49.5%) of the global disease burden. 2 Diabetes is a worldwide pandemic, with more than 75 percent of people with diabetes estimated to live in developing nations by 2025. (Table 1) Poorly managed diabetes results in severe complications, including end-stage renal failure, blindness, amputation, and cardiovascular diseases 3 , that burden developing countries with limited resources, who still struggle to meet the challenges of infectious diseases. 2 Most cases of diabetes fall into one of two categories: Type 1, which is caused by severe insulin deficiency, occurs in <10% of all cases and tends to occur in younger subjects. Type 2 diabetes is usually seen in older adults but is diagnosed with increasing frequency in younger age groups. Insulin resistance and islet beta cell defect are the characteristic pathologic findings in type 2 diabetes. 3 Diabetes is the most common cause of chronic kidney disease (CKD) in developed countries and a major cause in developing countries. 4 Other predisposing factors to CKD include hyperglycemia, systemic hypertension, glomerular hyperfiltration, low nephron mass, genetic predisposition, proteinuria, lipid abnormalities, and Advanced Glycosylation End Products (AGEs). Diabetic kidney disease (DKD) is a heterogeneous clinical condition characterized by the presence of persistent overt proteinuria (urine albumin creatinine ratio or UACR ≥ 300 mg/g or 3 mg/mmol) and declining renal function reflected by an estimated glomerular filtration rate (e-GFR) of < 60 ml/min/1.73 m 2 . 5 Diabetic kidney disease (DKD) is a complication in 20- 40% of all people with diabetes. 6 It is a chronic complication of both type 1 diabetes mellitus (DM) and type 2 DM 6 ; however,