Prevalence and Predictors of Diabetic Nephropathy among Patients with Type 2 Diabetes Mellitus in Al-Hussein Teaching Hospital in Al-Samawa, Iraq, 2024-2025

Background: Diabetic nephropathy (DN) is a leading cause of end-stage renal disease worldwide and a major microvascular complication of type 2 diabetes mellitus (T2DM). In Iraq, the burden of T2DM is substantial, yet region-specific data on the prevalence and predictors of DN are limited, particularly in smaller governorates like Al-Muthanna. This study aimed to determine the prevalence of DN and identify its key clinical and demographic predictors among patients with T2DM attending Al-Hussein Teaching Hospital in Al- Samawa, Iraq. Methods: A cross-sectional study was conducted at the outpatient diabetes clinic of Al-Hussein Teaching Hospital in Al- Samawa, Iraq, from January 2024 to January 2025. A total of 410 patients with established T2DM were enrolled using systematic random sampling. Data were collected through face-to-face interviews, clinical examinations, and review of medical records. Diabetic nephropathy was defined as the presence of albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g) and/or an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2, persisting for at least three months. Data on potential predictors including age, sex, duration of diabetes, body mass index (BMI), hypertension, glycemic control (HbA1c), and lipid profile were collected. Multivariate logistic regression analysis was performed to identify independent predictors of DN. Results: The prevalence of diabetic nephropathy among the study participants was 39.5% (n=162). Of these, 44.4% (n=72) had albuminuria with preserved eGFR, 29.6% (n=48) had reduced eGFR without albuminuria, and 25.9% (n=42) had both. The mean age of participants with DN was significantly higher than those without (58.7 ± 9.2 years vs. 52.1 ± 10.1 years, p<0.001). In the multivariate analysis, independent predictors of DN were longer duration of diabetes (OR = 1.12, 95% CI 1.06-1.18, p<0.001), presence of hypertension (OR = 3.45, 95% CI 2.01-5.92, p<0.001), poor glycemic control (HbA1c >8%) (OR = 2.89, 95% CI 1.68-4.97, p<0.001), and increasing age (OR = 1.05, 95% CI 1.02-1.08, p=0.002). Dyslipidemia, specifically elevated LDL-cholesterol, was also a significant predictor (OR = 1.85, 95% CI 1.10-3.11, p=0.02). Conclusion: The prevalence of diabetic nephropathy is alarmingly high in this cohort of T2DM patients in Al-Samawa, Iraq. Potentially modifiable factors, particularly hypertension, poor glycemic control, and dyslipidemia, are strong predictors of its development. These findings underscore the urgent need for intensive, multifaceted risk factor management strategies in this population to curb the progression of DN and reduce the future burden of kidney failure.