Prevalence and Impact of Chronic Kidney Disease in Diabetic Patients Presenting to the Emergency Department: A Systematic Review

Abstract

Background: Chronic kidney disease (CKD) is a common and serious complication of diabetes mellitus, associated with increased morbidity, mortality, and healthcare utilization. While the burden of CKD among diabetic populations has been well documented in community and outpatient settings, its prevalence and clinical impact among diabetic patients presenting to emergency departments (EDs) remain unclear, despite the ED’s critical role as a point of acute care and hospital entry. Objective: To systematically review and synthesize available evidence on the prevalence of CKD among adult patients with diabetes presenting to EDs and to evaluate the reported impact of CKD on clinical outcomes in this population. Methods: A systematic search of PubMed/MEDLINE, EMBASE, and Scopus was conducted from inception to the most recent search date to identify observational studies reporting CKD prevalence or outcomes in diabetic patients presenting to EDs or admitted via the ED. Study selection, data extraction, and methodological quality assessment were performed independently by two reviewers using standardized procedures. Given substantial heterogeneity and limited ED-specific data, results were synthesized narratively. Results: No eligible studies were identified that directly reported the prevalence of CKD or CKD-related outcomes among diabetic patients presenting to EDs. Indirect evidence from non-ED settings consistently demonstrated a high burden of CKD among individuals with diabetes and an association with adverse clinical outcomes; however, these findings could not be extrapolated reliably to the ED context. Conclusion: Despite the high global burden of diabetic CKD, there is a striking absence of ED-specific evidence regarding its prevalence and impact. This critical knowledge gap highlights the need for well-designed ED-based observational studies to inform screening strategies, acute management, and health-system planning for diabetic patients with CKD.