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Saudi Journal of Kidney Diseases and Transplantation
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CASE REPORT Table of Contents   
Year : 2007  |  Volume : 18  |  Issue : 2  |  Page : 191-194
Epidemiology of Chronic Renal Failure in Iran: A Four Year Single­ Center Experience


1 Associate Professor of Nephrology, Nephrology Department, Mostafa Khomeini Hospital, Shahed University, Tehran, Iran
2 Internist. Fellowship of Nephrology. Mostafa Khomeini Hospital, Tehran, Iran
3 Assistant Professor of Vascular Surgery, Tehran University, Tehran, Iran

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   Abstract 

Chronic renal failure (CRF) is a major public health problem. Early diagnosis and proper management have important roles in prevention of CRF progression to end-stage renal disease (ESRD). For this purpose, determining the etiology of CRF may be helpful. This study was conducted in the nephrology department at the Mostafa Khomeini Hospital in Tehran, Iran from March 2001 to March 2005, to determine the etiology of CRF in adult Iranian patients. A total of 1200 patients with a diagnosis of CRF were involved in the study. Relevant data were collected using a reliable questionnaire. All data analyses were carried out using SPSS and the χ2 test. Of the 1200 patients, 61% were males and 39% females. The most frequent age group was 61-75 years (38.3%) and the mean age of the study patients was 51.6 ± 17 years. The etiology of CRF in our series included: diabetes mellitus in 26.8%, hypertension in 13.5%, obstructive uropathy in 12%, cystic and congenital disorders in 10.3%, glomerulonephritis in 6.5%, urinary tract infections in 4%, vasculitis in 2%, tubulo-interstitial nephritis and pregnancy related in 0.8% each and unknown causes in 29.5% of the patients. Laboratory and ultrasonographic assessment at initiation of the study revealed blood urea nitrogen >100 mg/dl in 57.8% of the patients, serum creatinine >10 mg/dl in 40.3%, glomerular filtration rate (GFR) <10 ml/min in 61.3%, hemoglobin <10 g/dl in 65.8% and kidney size lesser than 8 cm in 46% of the cases. There was a significant statistical relationship between kidney size and duration of hypertension greater than five years (P = 0.017). The high frequency of CRF of unknown etiology in this study may be attributed to diagnostic limitations prevailing in our country. A GFR of <10 ml/min in 61.3% of the cases at presentation suggests late diagnosis and/or referral. Aggressive screening and treatment strategies to prevent ESRD are recommended.

Keywords: Chronic renal failure, Hypertensive nephropathy, Diabetic nephropathy, ESRD

How to cite this article:
Afshar R, Sanavi S, Salimi J. Epidemiology of Chronic Renal Failure in Iran: A Four Year Single­ Center Experience. Saudi J Kidney Dis Transpl 2007;18:191-4

How to cite this URL:
Afshar R, Sanavi S, Salimi J. Epidemiology of Chronic Renal Failure in Iran: A Four Year Single­ Center Experience. Saudi J Kidney Dis Transpl [serial online] 2007 [cited 2019 Dec 14];18:191-4. Available from: http://www.sjkdt.org/text.asp?2007/18/2/191/32308

   Introduction Top


Chronic renal failure (CRF) is defined by a glomerular filtration rate (GFR) of <50 ml/min/1.73 m 2 of body surface area (BSA).[1] It is a worldwide public health problem with enormous financial burden on health-care providers. The spending on dialysis in the United States of America (USA) in 2001 was 22.8 billion US dollars of which 15.4 billion was from the Medicare budget. This represents 6.4% of total Medicare spending.[1],[2]

Early diagnosis and proper management have important roles in prevention of progression of CRF to end-stage renal disease (ESRD).[2],[3] Following acute injury, the kidneys are capable of regaining function, but chronic injuries are usually irreversible, lead­ing to progressive reduction of the renal mass.[4] In fact, CRF is a pathophysiological process with multiple etiologies, resulting in the inexorable attrition of nephron number and function, frequently leading to ESRD. Many of the common causes of CRF including hypertension, urinary tract obstruction and infection are treatable, if diagnosed and managed early.[4] It is well recognized that CRF increases cardiovascular mortality and morbidity, patient disability and Medicare costs.[2],[5] Diabetic nephropathy and hyper­tension are emerging as the most common causes of CRF.[2],[6],[7],[8]

Unfortunately, there are no precise studies of the epidemiology and prevalence of CRF in Iran. Since determination of the etiology of CRF can help in exploring new screening and treatment strategies to prevent ESRD, we undertook this study.[9]


   Patients and Methods Top


This descriptive study included all patients above 15-years of age who presented to the nephrology department at the Mostafa Khomeini Hospital, Tehran, Iran with a diagnosis of CRF, during the period between March 2001 and March 2005. This center is a general hospital with various sub-specialties, and receives patients from all parts of Iran. A total of 1,200 patients (732 males and 468 females) were seen during the study period, and constituted the study group. Data were collected by using a questionnaire that included age, gender, weight, cause of CRF and its duration, any associated co-morbidity, serum creatinine (Se Cr), blood urea nitrogen (BUN), hemoglobin (Hb) at the diagnosis of CRF, as well as the ultrasonographic finding of the urinary tract. The creatinine clearance was calculated for each patient using the Cockroft-Gault equation, which is as under:

Correlation coefficients and the chi-square test were used to determine the statistical significance of the correlation between various variables.


   Results Top


There were 61% males and 39% females in the study. Their mean age was 51.6 ± 17.8 years. We divided our patients into five age­groups: 15-30 years, 31-45 years, 46-60 years, 61-75 years and 76-90 years and found these frequencies, respectively: 5.8%, 23%, 31.5%, 38.3% and 1.5%. Thus, the most frequent age group we encountered was the 61-75 year group (38.3%). A BUN level >100 mg/dl and Se Cr level >10 mg/dl were seen in 57.8 and 40.3% of patients, respectively. The creatinine clearance was <10 ml/min and Hb <10 g/dl in 61.3 and 65.8% of the patients, respectively.

[Figure - 1] shows the major causes of CRF in the study patients.

The prevalence of various causes of CRF in the study patients included: diabetes mellitus in 26.8%, hypertension in 13.5% obstructive nephropathy (ON) in 12%, congenital dis­orders including cystic disease in 10.3%, glomerulonephritis in 6.5%, urinary tract infections in 4%, vasculitis in 2%, tubulo­interstitial nephritis and pregnancy related in 0.8% each and unknown causes in 29.5% of the patients.

The chi-square test showed a statistically significant correlation between duration of hypertension above five years and kidney size (P = 0.017).


   Discussion Top


In our study, diabetic and hypertensive nephropathies accounted for the majority of cases of CRF seen in 26.8 and 13.5% of patients, respectively. This percentage is lower than has been reported in other studies. In the USA, diabetes mellitus accounted for 44.4% of the causes of CRF while hypertension was the cause in 26.6%, glomerulonephritis (idiopathic) in 9.9%, secondary glomerulo­nephritis and vasculitis in 2.3%, interstitial nephritis and pyelonephritis in 3.9%, congenital and cystic disease in 3.3%, neoplasms in 2% and miscellaneous in 9% of the patients[10]. The prevalence of diabetes as the cause of ESRD, as reported in some other studies, is depicted in [Table - 1].[2]

[Table - 2] shows the causes of renal failure in the dialysis population in the Kingdom of Saudi Arabia.[2] In our study, the causes of CRF were similar in comparison to other studies, although the frequencies varied. We noticed a higher percentage of unknown causes of CRF than others. This may be attributed to late diagnosis and referral as well as diagnostic limitations.

We found that 39.8% (38.3 + 1.5%) of the patients were over the age of 60 years. This finding is similar to other studies [10],[11],[12],[13]. In the USA for instance, the incidence is reported as 200 new cases per million population (PMP) for age range from 20-44 years and 1300 PMP for age range from 66-74 years.[2] In our study group, 61% of patients were male. This predominance of male gender has been well established by all investigators.[14]


   Conclusion Top


Our study suggests that the prevalence of CRF is high in Iran. Late referral for treatment compounded by delayed diagnosis may be major factors in causing morbidity. It is recommended that at-risk populations should be screened thoroughly and followed-up periodically with appropriate tests.

 
   References Top

1.Daugirdas JT, Blake PG Ing TS. Handbook of dialysis. 3 rd ed. Little Brown, 2001; 1:3-9.  Back to cited text no. 1    
2.Shaheen FA, Al-Khader AA. Epidemiology and causes of end stage of renal disease (ESRD). Saudi J Kidney Dis Transpl. 2005; 16(3): 277: 82.  Back to cited text no. 2    
3.McClellan WM, Ramirez SP, Jurkovitz C. Screening for chronic kidney disease. J Am Soc Nephrol 2003; 14:S81-7.  Back to cited text no. 3    
4.Brenner B. Kidney disease. 7 th ed. Boston, Saunders, 2004, 43:1955-99.  Back to cited text no. 4    
5.Go AS, Chertow Gm, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease & the risks of death, cardiovascular events and hospitalization. N Engl J Med 2004; 351:1296-305.  Back to cited text no. 5    
6.McDonald SP, Russ GR, Kerr PG, et al. Australia & New Zealand Dialysis and transplant Registry. ESRD in Australia and New Zealand at the end of the millennium: a report from the ANZDATA registry. Am J Kidney Dis 2002; 40: 1122-31.  Back to cited text no. 6    
7.Banton EN, Sageant LA, Samuels D, et al. A survey of chronic renal failure in Jamaica, West Indian Medi J 2004; 53:81- 4.  Back to cited text no. 7    
8.McClellan WM. Epidemiology and risk factors for chronic kidney disease. Med Clin North Am 2005; 89:419-45.  Back to cited text no. 8    
9.Kiberd BA, Clase CM. Cumulative risk for developing end-stage renal disease in the US population. J Am Soc nephrol 2002; 13:1635-44.  Back to cited text no. 9    
10.Schrier R. Diseases of kidney & urinary tract. 7 th ed, lippincott williams & wilkins, 2001; 73:2084.  Back to cited text no. 10    
11.Al-Rohani M. Renal failure in Yemen. Transplant proc 2004; 36:1777-9.  Back to cited text no. 11    
12.Mircescu G. Nephrology and renal replacement therapy in Romania transition still continues. Nephrol Dial transplant 2004; 19:2971-80.  Back to cited text no. 12    
13.Khan IH, Thereska N, Barbullushi M, Macleod AM. The epidemiology of CRF and provision of renal services in Albania, Nephrol Dial Transplant 1996;11:1751-4..  Back to cited text no. 13    
14.USRDS: the United States Renal Date System. Am J Kidney Dis 2003;42(6) Suppl 5: 1-230.  Back to cited text no. 14    

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Correspondence Address:
Reza Afshar
Nephrology Department, Mostafa Khomeini Hospital Tehran
Iran
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PMID: 17496393

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    Figures

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    Tables

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    Abstract
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