Prevalence and factors associated with chronic kidney dysfunction among women attending antenatal clinic at Kawempe national referral hospital

Abstract

Introduction: Chronic kidney dysfunction (CKD) is currently estimated to affect 3% of women of child bearing age worldwide. Pregnant women with chronic kidney dysfunction adapt poorly to gestational changes in renal blood flow. This may accelerate their decline in renal function and lead to poor maternal or fetal pregnancy outcomes or both. No estimates of prevalence of CKD and its associated factors exists in our Ugandan setting. This has lowered its index of suspicion and diagnosis. CKD has been associated with adverse fetal complications. A knowledge gap existed on the prevalence of chronic renal dysfunction in pregnancy and its associated factors in our setting. This research therefore sought to estimate the prevalence of the disease among pregnant women and elucidate the factors associated with it. Methods: The study was a cross-sectional study among 714 women attending their antenatal care visits at Kawempe National Referral Hospital. A pretested questionnaire was administered and laboratory testing done to eligible women. Serum creatinine was obtained (measured at MBN labs Kampala) and used to calculate estimated GFR. CKD was then defined as eGFR of less than 90 mL/min/1.73 m2. Other tests performed included Random blood Sugar (RBS), Human Immunodeficiency virus (HIV) testing and Urinalysis for Glucose and proteins. Findings: The 714 women who participated in the study had a mean age± SD of 25.5±5.2 years. The median (IQR) BMI was 25.2 kg/m2 (22.9, 28.5), 5.6 % had Systolic hypertension (≥ 140mmHg) and 2.8 % diastolic hypertension (≥ 90mmHg). Other significant findings included 0.8% having DM, 1% having SCD, 3.2% having HIV and 65.2% of these not being virally suppressed. 2.7% had chronic hypertension and 3.2% had a history of preeclampsia/eclampsia in previous pregnancies. None of the participants was found to have CKD . It was however noted that there were lower estimated GFRs associated with increasing age, increasing diastolic pressure and increasing socioeconomic status. Conclusions and Recommendations: CKD is extremely rare in our setting due to young age at conception. The mean age ±SD in our study was 25.5±5.2years. Renal function testing should therefore be performed only on symptomatic women.