Home About us Current issue Back issues Submission Instructions Advertise Contact Login   

Search Article 
  
Advanced search 
 
Saudi Journal of Kidney Diseases and Transplantation
Users online: 145 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
 

Table of Contents   
RENAL DATA FROM ASIA-AFRICA  
Year : 2011  |  Volume : 22  |  Issue : 2  |  Page : 373-376
Causes of end-stage renal disease in Sudan: A single-center experience


Nephrology Department, Gazira Hospital for Renal Diseases, Khartoum, North Sudan

Click here for correspondence address and email

Date of Web Publication18-Mar-2011
 

   Abstract 

Very limited data are available about the causes of renal diseases leading to chronic renal diseases in all states of Sudan, including Gezira state. Awareness of the cause of end-stage renal disease (ESRD) helps the nephrologists to anticipate problems during renal re­placement therapy and plan preventive measures for the community. Over 1.1 million patients are estimated to have ESRD worldwide, with an addition of 7% annually. This is a cross-sectional study designed to determine the etiology of ESRD among patients with ESRD on regular he­modialysis (HD) at Gezira Hospital for renal disease. This study was conducted in May 2009. The population examined here consisted of 224 patients on regular HD in Gezira Hospital for renal disease. We found that the etiologies were dominated by unknown causes (53.57%). The leading cause of ESRD for those who were younger than 40 years was glomerular disease, hypertension for those between 40 and 60 years and obstruction for those who were older than 60 years.

How to cite this article:
Elsharif ME, Elsharif EG. Causes of end-stage renal disease in Sudan: A single-center experience. Saudi J Kidney Dis Transpl 2011;22:373-6

How to cite this URL:
Elsharif ME, Elsharif EG. Causes of end-stage renal disease in Sudan: A single-center experience. Saudi J Kidney Dis Transpl [serial online] 2011 [cited 2020 Jun 6];22:373-6. Available from: http://www.sjkdt.org/text.asp?2011/22/2/373/77650

   Introduction Top


Gezira state is located in the central part of Sudan, with a population of 3,900,000. Very limited data are available about the causes of renal diseases leading to chronic renal diseases (CKD) in all states of Sudan, including Gezira state. End-stage renal disease (ESRD) is usually the result of slowly progressive kidney damage. Because of the asymptomatic nature of renal disease, kidney damage frequently remains un­detected until late in the course, at which stage therapeutic interventions are often ineffective. In contrast, early detection and intervention may slow or halt the decline toward ESRD. [1] Awareness of the causes of ESRD helps the nephrologists to anticipate problems during re­nal replacement therapy (RRT) and plan pre­ventive measures for the community. [2] Over 1.1 million patients are estimated to have ESRD worldwide, with an addition of 7% an­nually. In USA, the incidence and prevalence counts are expected to increase by 44 and 85%, respectively, from 2000 to 2015, and the incidence and prevalence rates per million po­pulations by 32 and 70%. [3] In the developing countries, growth of the ESRD population has similar trends. [4] An average incidence of ESRD in the Middle East countries with similar renal care systems is 93 per million population. [5] The estimated incidence for new cases in Sudan is about 70-140/million inhabitants/year. [6]


   Patients and Methods Top


This is a cross-sectional study designed to de­termine the etiology of ESRD among patients with ESRD on regular hemodialysis (HD) at the Gezira Hospital for renal disease. This study was conducted in May 2009. The po­pulation examined here consisted of ESRD pa­tients on regular HD at the Gezira hospital for renal disease.

Inclusion criteria

  • Patients with ESRD.
  • Patients on regular HD at the Gezira Hospital for renal disease.
  • Age 18 years old or higher.
Diagnosis of the cause of ESRD was ob­tained from the medical history, radiological images and renal biopsy reports, if available. Medical history was obtained from patients' medical records and by direct interview.

Data were analyzed using SPSS 9.05. Results were presented in number, percent, mean and standard deviation (SD).


   Results Top


Information was obtained on 224 ESRD pa­tients undergoing regular HD in the Gezira Hospital for renal disease. The results revealed that 67.76% (152) were male and 32.14% (72) were female and the mean of age was 45.78 (SD 17.16) years. [Table 1] shows the causes of ESRD in the different age groups.

The mean duration of HD was 31.29 ± 26.36 months.
Table 1: Causes for ESRD in different age groups.

Click here to view



   Discussion Top


The causes of ESRD in the present study were hypertension, obstructive nephropathy, chronic glomerulonephritis, analgesic nephro­pathy, polycystic kidney disease and renovas­cular disease in this order, while Osman et al [7] and Abboud et al [8] reported in 1987 and 1989, respectively, that the causes of most of the CKD in Sudan are chronic glomerulonephritis and renal calculi. Both studies were performed in Khartoum. Osman et al [9] reported that only one-fifth of the patients in Sudan have con­trolled blood pressure; this may explain, pos­sibly, our finding of hypertensive nephropathy as the leading cause of ESRD. In our study, we also found that obstructive nephropathy was the second most common cause of ESRD, ex­plained by the delay in the diagnosis and ma­nagement. The prevalence of infection with S. mansoni in endemic areas such as the Gezira regions may reach up to 70%. [10] Mustafa et al stated that the incidence of malaria in the Gezira regions (Elhosh) is 23.7 episodes per 1000 population. [11] The high incidence of schis­tosomiasis and malaria may contribute to the high prevalence of chronic glomerulonephritis.

A significant proportion of patients with un­certain etiology are reported in the literature; 16.2% of elderly Indian cases, [12] 5.9% in the US, 18% in the UK [13] and, similarly, 14.8% in Iran. [14] Because of the late presentation of pa­tients when ESRD has already developed re­sulting in the inability to diagnose the cause, we found 53.57% of the cases of unknown etiology; this may reflect the lack of awareness of medical problems, lack of medical facilities in rural areas and/or delay in referral before arriving to the specialist physician.

A study from Netherlands found renal vas­cular disease (20.4%) followed by diabetic nephropathy (16.7%) as the leading causes of ESRD, [15] whereas in Switzerland, hypertensive nephropathy was the leading cause of ESRD. [16] But, in contrast to these studies, a study was performed in southern India in 2006 that de­termined the etiology of CKD by analyzing renal biopsies, which showed that 70.5% had GN as the histological diagnosis, 12% had interstitial nephritis and 6.6% had hypertensive arteriosclerosis. [17] In our study, we found that the leading known cause of ESRD for those who are between 40 and 60 years old was hy­pertension, and obstruction for those who were older than 60 years.

Glomerular disease is reported to be the most common cause of ESRD among the black in Nigeria; [18] Saraladevi Naicker reported a si­milar finding in sub-Saharan, South Africa, India and Pakistan, where glomerulonephritis was recorded as the most common cause of ESRD. [19],[20] We found glomerular disease to be the leading known etiology of ESRD in those who are younger than 40 years.

In conclusion, our data show that hyperten­sion and obstructive nephropathy are the lea­ding causes of ESRD in Gazira state (Sudan). There is a need to establish a national registry of ESRD in Sudan and to perform further mul­ticenter studies with the inclusion of a larger number of patients, which is needed to clearly show the frequencies of various causes of ESRD in order to establish nationwide pre­vention and management protocols.

 
   References Top

1.Ruggenenti P, Schieppati A, Remuzzi G. Prog­ression, remission, regression of chronic renal diseases. Lancet 2001;357:1601-8.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Martins Castro MC, Luders C, Elias RM, Abensur H, Romao Junior JE. High-efficiency short daily haemodialysis-morbidity and mor­tality rate in a long-term study. Nephrol Dial Transplant 2006;21(8):2232-8.  Back to cited text no. 2
    
3.Gilbertson DT, Liu J, Xue JL, et al. Projecting the Number of Patients with End-Stage Renal Disease in the United States to the Year 2015. J Am Soc Nephrol 2005;16:3736-41.  Back to cited text no. 3
[PUBMED]    
4.Mahon A. Epidemiology and classification of chronic kidney disease and management of diabetic nephropathy. Eur Endocr Rev 2006;2:33-6.  Back to cited text no. 4
    
5.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(2):191-4.  Back to cited text no. 5
    
6.Suliman SM, Beliela MH, Hamza H. Dialysis and Transplantation in Sudan. Saudi J Kidney Dis Transpl 1995;6:312-4.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
7.Osman EM, Abboud OI, Danielson BG. Chronic renal failure in Khartoum, Sudan. Ups J Med Sci 1987;92(1):65-73.  Back to cited text no. 7
    
8.Abboud OL, Osman EM, Musa AR. The aetiology of chronic renal failure in adult Sudanese patients. Ann Trop Med Parasitol 1989;83(4):411-4.  Back to cited text no. 8
    
9.Osman EM, Suleiman I, Elzubair AG. Patients knowledge of hypertension and its control in Eastern Sudan. East Afr Med J 2007;84(7): 324-8.  Back to cited text no. 9
    
10.Mudawi H, Ali Y, El Tahir M. Prevalence of gastric varices and portal hypertensive gastro­pathy in patients with Symmers periportal fibrosis. Ann Saudi Med 2008;28:42-4.  Back to cited text no. 10
[PUBMED]  Medknow Journal  
11.Mustafa HS, Malik EM, Tuok HT, Mohamed AA, Julla AI, Bassili A. Malaria preventive measures, health care seeking behaviour and malaria burden in different epidemiological settings in Sudan. Trop Med Int Health 2009; 14(12):1488-95.  Back to cited text no. 11
    
12.Mittal S, Kher V, Gulati S, Agarwal LK, Arora P. Chronic renal failure in India. Ren Fail 1997;19(6):763-70.  Back to cited text no. 12
    
13.Thomas PP. Changing profile of causes of chro­nic renal failure. Saudi J Kidney Dis Transpl 2003;14(4):456-61.  Back to cited text no. 13
    
14.Malekmakan L, Haghpanah S, Pakfetrat M, Malekmakan A, Khajehdehi P. Causes of chro­nic renal failure among Iranian hemodialysis patients. Saudi J Kidney Dis Transpl 2009;20: 501-4.  Back to cited text no. 14
[PUBMED]  Medknow Journal  
15.Termorshuizen F, Korevaar JC, Dekker FW, et al. Time trends in initiation and dose of dia­lysis in end-stage renal disease patients in The Netherlands. Nephrol Dial Transplant 2003; 18:552-8.  Back to cited text no. 15
[PUBMED]  [FULLTEXT]  
16.Saudan P, Halabi G, Perneger T, et al. Varia­bility in quality of care among dialysis units in western Switzerland. Nephrol Dial Transplant 2005;20:1854-63.  Back to cited text no. 16
[PUBMED]  [FULLTEXT]  
17.Dharan KS, John GT, Neelakantan N, et al. Spectrum of severe chronic kidney disease in India: A clinicopathological study. Natl Med J India 2006;19(5):250-2.  Back to cited text no. 17
    
18.Chijioke A, Adeniyi AB. End stage renal disease: Racial differences. Orient J Med 2003; 15(1&2):24-31.  Back to cited text no. 18
    
19.Naicker S. End-stage renal disease in sub­Saharan and South Africa. Kidney Int 2003; 63:S119-22.  Back to cited text no. 19
    
20.Sakhuja V, Sud K. End-stage renal disease in India and Pakistan: Burden of disease and management issues. Kid Int 2003;63:S115-8.  Back to cited text no. 20
    

Top
Correspondence Address:
Mohamed Elhafiz Elsharif
Head of Nephrology Department, Gazira Hospital for Renal Diseases, P.O. Box 335 Khartoum
North Sudan
Login to access the Email id


PMID: 21422650

Rights and Permissions



 
 
    Tables

  [Table 1]



 

Top
   
 
 
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    Abstract
    Introduction
    Patients and Methods
    Results
    Discussion
    References
    Article Tables
 

 Article Access Statistics
    Viewed4161    
    Printed99    
    Emailed0    
    PDF Downloaded649    
    Comments [Add]    

Recommend this journal