Prevalence of ABO blood group in diabetic nephropathy in population of Punjab-Pakistan

The study was designed to find the association between ABO blood group and diabetic nephropathy (DN). This cross-sectional study was conducted at Endocrine Unit and Diabetes Management Centre, Services hospital of Lahore from January 2016 July 2016. The studied population included 540 subjects that were divided into two groups i) diabetic nephropathic group (n=337) and ii) control group (n=203). Questionnaire was designed to gather information concerning risk factors. The type of blood group was determined by standard agglutination test. Data was evaluated on SPSS software (Version 13). Prevalence was determined by percentages. It has been concluded that DN was more prevalent in females (54.8%) as compared to males (45.1%). It was found that risk factors such as hypertension (44.2%), family history of renal disease (28.1%) and smoking (22.2%) were more prevalent among the diabetic nephropathic group. In the control group, percentage distribution of blood groups A, B, AB and O were found to be 9.35%, 46.7%, 11.8% and 32% respectively. While in the DN group percentage distribution of blood groups A, B, O and AB were found to be 2.96%, 44.5%, 2.67% and 49.8% respectively. In this cross sectional survey, it was found that blood group O was more prevalent in Diabetic Nephropathy group. While in Control group, blood group B was found to be more common. In the control subjects, Rh+ve factor prevalence was 92.6% and among the DN group it was 94.9%. Subjects having blood group O type had greater risk of progressing diabetic nephropathy in comparison with other blood types.


Introduction 1n 2000, 177 million people in the world were affected with diabetes mellitus (DM).
There are 4 million people in Pakistan having diabetes.It acts as a primary basis of illness and mortality rate.It presents a terrific challenge to public fitness.There is an endemic proportion of it worldwide and is also a cause of great socioeconomic problem in the developing countries.During the past two decades, there was a strong increase in the prevalence of diabetes which has caused an alarming situation.It is a primary cause of kidney disease and is also taken as a risk factor for cardiovascular disease (CVD).The University of Washington estimates that 20-40% of people with diabetes will get diabetic nephropathy at some stage in their lives [1, 2].According to the International Diabetes Federation (IDF), persons who were suffering from diabetes has been estimated about 1 in 11adults and this ratio is estimated to reach 1 in 10 adults by the year 2040 [3].In Pakistan, the prevalence of diabetes was found to be high statistically, extending from 7.6% to 11% by the year 2011 and is likely to increase to 15% in 2030.Among the countries with the prevalence of DM Pakistan lie at number 7 and will probably move to 4 th position if the existing circumstances continues.High proportion of diabetes thus poses an enormous challenge in front of health care professionals and other policy makers in Pakistan [2].Type 1 diabetes mellitus patients constituting 30-40% and patients with type II diabetes mellitus constituting 10-20% develop nephropathy.It may develop in several patients regardless of having good glycemic control.In contrast, prolonged duration of high level of glucose may not trigger nephropathy.These interpretations suggest that factors such as environmental and hereditary factors other than hyperglycemia, also contribute for the progress of diabetic nephropathy [4].The current study was aimed to examine the blood groups distribution in DN patients in local population.

Study Population
The cross-sectional study was conducted at Endocrine Unit and Diabetes Management Centre of Services hospital, Lahore.Before carrying out this study, research consent was taken from the ethical committee of Services hospital Lahore.The studied population consists of 540 samples which were further divided into two groups:

Control group (n=203) subjects Diabetic nephropathic group (n=337) subjects
Sample size was calculated with the help of raosoft sample calculator with confidence level 95%, margin of error 3.86% and taking the expected percentage as 32% in subjects.A structured questionnaire was designed.It was filled by each selected patient and information regarding gender, age, family history, hypertension, smoking status and other symptoms related to the disease were recorded.Diabetic nephropathy was defined as renal dysfunction with serum creatinine level >1.4 mg/dL in diabetic subjects.Rh factor and blood group were determined through antiserum A, B and D with the help of agglutination method.

Statistical analysis
Data was scrutinized using SPSS version 13.0 (ILO, Chicago).Correlation between blood groups and diabetic nephropathy was examined by means of the chi-square (X 2 ) test.Prevalence of blood group was determined with the help of acquired percentages.

Results
This cross-sectional study was done on 540 patients that were divided into two groups (i)

Table 3 . Prevalence Percentage of Rh+ and Rh-among ABO blood groups Sr. No.
Frequency of ABO and Rhesus blood groups in district Swat, Pakistan.J Ayub Med Coll Abbottabad, 20: 127-129.