Diabetes mellitus affects approximately 422 million people worldwide, with patients from low and middle-income countries (LMICs) accounting for the majority of cases.1 However, the number of cases per year continues to rise, particularly for type 2 diabetes mellitus (T2DM), due to the increasing prevalence of risk factors like obesity, poor dietary habits, and sedentary lifestyles.2 The burden of T2DM is significant due to its long-term complications, which can be categorized as either macrovascular (such as stroke, coronary artery disease [CAD], and peripheral artery disease) or microvascular (including retinopathy, neuropathy, and nephropathy). Among these, diabetic nephropathy or diabetic kidney disease (DKD) is the most prevalent cause of chronic kidney disease (CKD) globally.3,4 The increasing prevalence and significant morbidity, mortality, and healthcare costs associated with this complication necessitates urgent research efforts.5

According to the 2012 kidney disease-Improving Global Outcomes (KDIGO) guidelines, CKD is diagnosed and staged based on the presence and severity of kidney damage, calculated using estimated glomerular filtration rate (eGFR) as a marker of decreased kidney function.6 If left untreated and uncontrolled, CKD can progress from stage 1, mild disease, to stage 5, end-stage renal disease (ESRD), for which the latter necessitates dialysis and/or kidney transplantation. As such, KDIGO risk categorization is very useful in clinical practice to help inform and determine appropriate management strategies to slow the patient's risk of progression to ESRD and improve their prognosis.6 Moreover, CKD staging is crucial in the setting of T2DM because of the increased risk of damage to renal blood vessels and structures resulting from persistently high or uncontrolled blood sugar levels, including impaired glomerular filtration, increased inflammation, and elevated levels of proteinuria and albuminuria, of which the latter two factors represent important components of KDIGO risk categorization.7,8

Numerous factors have been proposed in previous studies to evaluate potential determinants influencing DKD outcomes. These investigations aim to enhance our understanding of the underlying pathophysiology of the disease and improve patient management. However, the epidemiology of DKD and its influencing factors have not been adequately assessed in Middle Eastern countries with high prevalence rates of diabetes, including Jordan.9 As with other LMICs, the burden of T2DM in Jordan is considerably greater compared to higher-income nations, with predictions that this trend will continue to worsen over the next several decades.10,11 Furthermore, recent recommendations to remove race as a factor in the 2021 CKD-Epidemiology Collaboration (EPI) eGFR equation could potentially impact patient management and resulting outcomes, especially in non-Western populations.12,13 As such, this study aimed to explore risk factors linked to CKD progression across KDIGO risk categories in a Middle Eastern population with T2DM. Furthermore, it assessed whether the number of risk factors varied among the different CKD progression risk categories based on the KDIGO classification. These findings will hopefully enhance our understanding of CKD due to diabetes in the region and improve the delivery of appropriate management and care to affected individuals.