Prevalence of chronic kidney disease and associated factors in hypertensive patients attending the hypertension clinic in Mulago Hospital

Abstract

Introduction/background: Chronic Kidney Disease (CKD) is becoming a major health problem worldwide. CKD is one o the devastating complications of Hypertension (HTN) and early detection of CKD can lead to reversal or slow progression. However, despite that, there is no data to justify routine screening for CKD among hypertensive patients Hypertension is the most common cause of cardiovascular disease in the world and is a major cause of mortality in sub-Saharan Africa. Uganda has a high burden of hypertension in both urban (34%) and rural areas (32%). To address this gap, we determined the prevalence of CKD and associated factors in hypertensive patients attending Mulago Hospital. Methods: We undertook a cross sectional study among patients aged 18 years and above between the November/2011 to the March/2012 .CKD was defined as eGFR less than 60ml/min/1.73m2 for atleast 3 months using both cockroft –gault (CKG) and modified renal diet (MDRD) formulae with kidney size less than 9.0 cm in length were identified as CKD patients. Information was also collected on smoking, anaemia, proteinuria, herbal medication, HIV, exercise, family history of disease, sex, age, employment, drugs and addition of raw salt in food and bivariate and multivariate analysis was done. Results: Out of 431 patients screened 360 completed the study with the prevalence of CKD of 17.2%. Eighty three percent (83.3%) were female, average age was 52 years and 96.1% were known hypertensive patients for more than 6 months. On bivariate analysis, factors that were significantly associated with CKD included age > 40 years, female sex, unemployment , hypertension for more than 6 months, known HIV positive status , smoking , staying with a smoker, lack of exercise , oedema , haemoglobin < 11.5g/dl, urine protein >30mg/dl (all p-values <0.037) On multivariate analysis, patients who smoked were 8 times more likely to have CKD(p; 0.02); patients with low Hb (< 11.5g/dl) were 4 times more likely to have CKD ( p; 0.003) , and those who had proteinuria >30mg/dl on dipstick were more likely to have CKD (p;0.001). Conclusions and recommendations: The prevalence of CKD among hypertensives in Mulago is high and associated with smoking, proteinuria and anaemia. Therefore there is a need for hypertensive patients with a history of smoking, anaemia and proteinuria to be screened routinely for CKD.