Prevalence and factors associated with chronic kidney disease among medical inpatients at the Kenyatta National Hospital, 2018

Abstract

The burden of chronic kidney disease (CKD) is increasing worldwide. Population surveys are the gold-standard for CKD burden determination; these are time and financial resourceintensive. Prevalence of CKD among medical inpatients in tertiary facilities has been used to estimate disease burden in resource-constrained settings. We aimed to describe prevalence and factors associated with CKD among medical inpatients at the largest referral hospital in Kenya. A cross-sectional study was conducted among medical inpatients at the Kenyatta National Hospital. Systematic sampling was used and data on demographic information, behavioural risk factors, medical history, underlying conditions, laboratory and imaging workup was collected using a structured questionnaire. Glomerular filtration rate (GFR) was estimated in ml/min/1.73m2 using serum creatinine levels and classified into 5 stages; G1 (≥90), G2 (60-89), G3a (45-59), G3b (30-44), G4 915-29) and G5 (<15, or treated by dialysis/renal transplant). Ethical approval was obtained from the Moi University Institutional Research and Ethics Committee (FAN: IREC 2088) and Kenyatta National Hospital/University of Nairobi ethics committee (P510/09/2017). Prevalence of CKD was estimated and logistic regression applied to identify factors independently associated with CKD diagnosis. A total of 306 inpatients were included; median age 40.0 years (IQR 24.0), 162 (52.9%) were male, 155 (50.7%) rural residents. Chronic Kidney Disease prevalence was 118 patients (38.6%, 95% CI 33.3-44.1); median age 42.5 years (IQR 28.0), 74 (62.7%) were male, 64 (54.2%) rural residents. Respondents with CKD were older than those without (difference 4.4 years, 95% CI 3.7-8.4 years, P=0.032). Fifty-six (47.4%) of the patients had stage G1 or G2, 17 (14.4%) had end-stage renal disease; 73 (61.9%) had haemoglobin <10g/dl while 33 (28.0%) had serum sodium levels below 135mmol/l. Male sex (aOR 2.63, 95% CI 1.49-4.63), prior history of anaemia (aOR 1.80, 95% CI 1.02-3.19), proteinuria (aOR 5.16, 95% CI 2.09-12.74), hematuria (aOR 7.68, 95% CI 2.37-24.86), history of hypertension (aOR 2.71, 95% CI 1.53-4.80) and herbal medications use (aOR 1.97, 95% CI 1.07-3.64) were independently associated with CKD. In conclusion, the burden of CKD was high among this inpatient population. Male sex and prior history of anaemia, hypertension, herbal medications use, proteinuria or hematuria were the associated factors. We recommend that dipstick urinalysis should form part of screening packages in primary care settings and detection of blood or proteins serve as referral criteria for further CKD diagnostic work-up. We also recommend creation of public awareness on health hazards of herbal medication use.