dc.description.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. |
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