Prevalence, determinants, and management of chronic kidney disease in Karachi, Pakistan - A community based cross-sectional study
Jessani, S Bux, R Jafar, T.H
Jessani, S
Bux, R
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Alternative Title
Abstract
Background: Chronic kidney disease (CKD) is increasing being recognized as a global public health problem. However, there is dearth of information on the prevalence, determinants, and management of CKD from low- and middle-income countries. The objectives of the study were to determine the 1) prevalence of CKD; 2) socio-demographic and clinical factors associated with CKD; and 3) the existing management of these patients with regards to blood pressure control, and use of antihypertensive medications. Methods. We conducted a cross-sectional study on 2873 participants aged ≥40 years in 12 representative communities in Karachi, Pakistan. The primary outcome was clinically significant CKD defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 estimated by CKD-EPI (CKD Epidemiology Collaboration) Pakistan equation (0.686 × CKD-EPI1.059) or urinary albumin to creatinine ratio ≥3 mg/mmol (i.e. KDOQI CKD stage G3, A2 or worse). Results: The overall prevalence (95% CI) of CKD was 12.5% (11.4 - 13.8%). The factors independently associated with CKD were older age, hypertension, diabetes, elevated systolic blood pressure, raised fasting plasma glucose, raised triglycerides, and history of stroke (p < 0.05 for each). About 267 (74.4%, 69.5 - 78.8%) adults with CKD had concomitant hypertension. Of these, 130 (48.7%, 42.6 - 54.9%) were on antihypertensive medications, and less than 20% had their BP controlled to conventional target of ≤140/90 mm Hg, and only 16.9% (12.6 - 21.9%) were on blockers of renin-angiotensin system alone or in combination with other drugs. Conclusions: Clinically significant CKD is common among Pakistani adults. The conventional risk factors for CKD and poor control of blood pressure among patients with CKD highlight the need to integrate CKD prevention and management in the primary care infrastructure in Pakistan, and possibly neighbouring countries. © 2014 Jessani et al.; licensee BioMed Central Ltd.
Keywords
albumin, antihypertensive agent, beta adrenergic receptor blocking agent, creatinine, glucose, triacylglycerol, adult, age, albuminuria, article, blood pressure regulation, cerebrovascular accident, chronic kidney disease, creatinine blood level, creatinine urine level, cross-sectional study, diabetes mellitus, diet restriction, drug use, female, glomerulus filtration rate, glucose blood level, human, hypertension, ischemic heart disease, major clinical study, male, medical history, prevalence, systolic blood pressure, triacylglycerol blood level, urinalysis, age distribution, aged, clinical practice, comorbidity, epidemiology, hypertension, middle aged, Pakistan, Renal Insufficiency, Chronic, risk factor, sexism, socioeconomics, statistics and numerical data, treatment outcome, very elderly, Adult, Age Distribution, Aged, Aged, 80 and over, Antihypertensive Agents, Comorbidity, Cross-Sectional Studies, Female, Humans, Hypertension, Male, Middle Aged, Pakistan, Physician's Practice Patterns, Prevalence, Renal Insufficiency, Chronic, Risk Factors, Sexism, Socioeconomic Factors, Treatment Outcome
Source Title
BMC Nephrology
Publisher
Series/Report No.
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Rights
Attribution 4.0 International
Date
2014
DOI
10.1186/1471-2369-15-90
Type
Article