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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2013  |  Volume : 24  |  Issue : 4  |  Page : 807-809
The magnitude of chronic kidney diseases among primary health care attendees in Gezira state, Sudan


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

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Date of Web Publication24-Jun-2013
 

How to cite this article:
Elsharif ME, Abdullha SM, Abdalla SM, AllaElsharif EG. The magnitude of chronic kidney diseases among primary health care attendees in Gezira state, Sudan. Saudi J Kidney Dis Transpl 2013;24:807-9

How to cite this URL:
Elsharif ME, Abdullha SM, Abdalla SM, AllaElsharif EG. The magnitude of chronic kidney diseases among primary health care attendees in Gezira state, Sudan. Saudi J Kidney Dis Transpl [serial online] 2013 [cited 2019 Nov 21];24:807-9. Available from: http://www.sjkdt.org/text.asp?2013/24/4/807/113900
To the Editor,

Chronic kidney disease (CKD) is an increasing worldwide health problem, and its early detection and early institution of treatment may slow or prevent disease progression. [1],[2] CKD is defined as structural or functional abnormalities of the kidney for more than three months, with or without a decreased glomerular filtration rate (GFR) or the presence of GFR <60 mL/min/ 1.73 m 2 for ≥3 months, with or without other signs of kidney damage. [1],[3] Screening the general population may decrease the incidence of end-stage renal disease (ESRD), although it is resource demanding. Several organizations have made recommendations promoting routine screening for CKD. [5]

Very limited data is available regarding the incidence and prevalence of CKD in Sudan. The aim of the study is to assess the prevalence of CKD among patients attending the primary health care (PHC) facilities in Gezira state.

This prospective, cross-sectional study was performed at Gezira state (Sudan) in the city of Wad Madani between March 1, 2011 and April 30, 2011, involving three PHC centers. The study included 252 random patients attending those centers. Patients known to have CKD and/or proteinuria, recipients of renal transplantation, patients who were hemodynamically unstable and those with sepsis were excluded from the study. Informed consent was obtained from all patients included in this study.

Data were collected by interviewing patients using a standard questionnaire. The study variables included demographic data, medical history of hypertension, diabetes mellitus, height in meters and weight in kilograms. All study patients were tested for serum creatinine and urine for protein using dipsticks. The GFR was calculated using the Modification of Diet in Renal Disease (MDRD) equation. CKD was defined as an estimated GFR of less than 60 mL/min/ 1.73 m 2 , with or without proteinuria. Data were double entered and analyzed using the SPSS software (Statistical Package for the Social Sciences, version 17.0; SPSS Inc., Chicago, IL, USA).

Two hundred and fifty-two patients were included in this study, of whom 208 (82.54%) patients were female. Their mean age was 43.35 ± 12.80 years and the means of the height, weight and body mass index (BMI) were 158 ± 12.09 cm, 71.11 ± 13.33 kg and 28.67 ± 6.43, respectively. About 2.38% of the patients had a BMI below 18 and 71.83% had a BMI above 25.13. A total of 10% of the study group were known to be hypertensive, 5.95% were known to be diabetic and 1.59% were smokers; all the smokers were male. The mean duration of hypertension in the hypertensive group was 7.56 ± 8.43 years and the mean duration of diabetes among the diabetic group was 8 ± 7.09 years. The duration of smoking among the smokers was 11.50 ± 7.33 years. The mean serum creatinine was 0.83 ± 0.37 mg/mL and the mean of the calculated estimated glomerular filtration rate (eGFR) according to the MDRD equation was 118.54 ± 66.61 mL/min/1.73 m . Twenty-six patients of the study group (10.32%) had an eGFR below 60 mL/min and 61 patients (24.21%) had ≥1+ proteinuria.

In this study, we found that 10.32% of the patients who were attending the PHC centers were having CKD with eGFR less than 60 mL/min, and they were not aware of the same. 24.21% patients of the study group had proteinuria ≥1+. Makaraite et al studied 4082 individuals attending the PHC and reported CKD in 11.2% and proteinuria in 24.4% of all patients. [6] Vara-Gonzalez et al studied the prevalence of CKD in hypertensive patients on treatment at the PHC centers in Spain and reported that 25.7% patients had a reduced GFR. [7] Sharma et al reported a prevalence of eGFR less than 60 mL/min of 7.3-14% from a study conducted in China, Mongolia and Nepal, which is comparable to our findings; they also reported a prevalence of proteinuria in 2.4-10% of the subjects. [8] Singh reported a lower prevalence of proteinuria (2.25%) in India than our findings. [9] Sumaili et al reported a prevalence of proteinuria of 17.1% in Kinshasa, Congo. [10] Several studies have reported proteinuria as an independent risk factor of CKD, cardiovascular and cerebrovascular disease as well as mortality. [9],[11]

Obesity, which is considered as an independent risk factor for proteinuria and CKD, is increasing worldwide and is affecting all age groups. [12] In the present study, we found that more than 70% of the individuals attending the PHC centers were having a BMI above the normal range.

Smoking may cause kidney damage and proteinuria, and the reported prevalence of smoking in most parts of the world is higher than that of our findings. [13],[14]

The reported prevalence of hypertension in Riyadh, Saudi Arabia, is 15.4%; [15] in India, it was 20.8% [16] and in African-Americans, it was 62.9%. The kidney is unique among the target organs of hypertension as it suffers damage and still contributes to the pathophysiologic sustenance of hypertension through many ways. [17]

The development of proteinuria in diabetics is associated with a risk of renal and cardiovascular disease. [18] In this study, we found that 5.95% of the patients attending PHCs were diabetic.

In conclusion, CKD and proteinuria are common health problems. Patients attending PHCs should be screened for CKD as well as its risk factors to enable early detection and management.

 
   References Top

1.National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Am J Kidney Dis 2002;39(Suppl 1):S1-266.  Back to cited text no. 1
    
2.Pereira BJ. Optimization of pre-ESRD care: The key to improved dialysis outcomes. Kidney Int 2000;57:351-65.  Back to cited text no. 2
    
3.Levey AS, Eckardt KU, Tsukamoto Y, et al. Definition and classification of chronic kidney disease: A position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2005;67:2089-10.  Back to cited text no. 3
    
4.van der Velde M, Halbesma N, de Charro FT, et al. Screening for albuminuria identifies individuals at increased renal risk. J Am Soc Nephrol 2009;20:852-62.  Back to cited text no. 4
    
5.Li PK, Weening JJ, Dirks J, et al. Participants of ISN Consensus Workshop on prevention of progression of renal disease. A report with consensus statements of the International Society of Nephrology 2004 Consensus Workshop on Prevention of Progression of Renal Disease; Hong Kong. June 29, 2004; Kidney Int Suppl 2005;94:S2-7.  Back to cited text no. 5
    
6.Makaraite A, Bumblyte IA, Kuzminskis V, Valius L, Gofmanaite R, Bagdonaviciûte G. The prevalence of major risk factors for chronic kidney disease among patients in primary health care centers. Medicina (Kaunas) 2007 ;43 Suppl 1:40-5.  Back to cited text no. 6
    
7.Vara-González L, Martín Rioboó E, Ureña Fernández T, Dalfó Baqué A, Flor Becerra I, López Fernández V. Prevalence of chronic kidney disease in hypertensive patients under treatment at primary care health centres in Spain and the monitoring of their blood pressure: The DISEHTAE Study. Aten Primaria 2008;40:241-5.  Back to cited text no. 7
    
8.Sharma SK, Zou H, Togtokh A, et al. Burden of CKD, proteinuria, and cardiovascular risk among Chinese, Mongolian, and Nepalese participants in the International Society of Nephrology screening programs. Am J Kidney Dis 2010;56:915-27.  Back to cited text no. 8
    
9.Singh NP, Ingle GK, Saini VK, et al. Prevalence of low glomerular filtration rate, proteinuria and associated risk factors in North India using Cockcroft-Gault and Modification of Diet in Renal Disease equation: An observational, cross-sectional study. BMC Nephrol 2009;10:4.  Back to cited text no. 9
    
10.Sumaili EK, Nseka NM, Lepira FB, et al. Screening for proteinuria and chronic kidney disease risk factors in Kinshasa: A World Kidney Day 2007 study. Nephron Clin Pract 2008;110:c220-8.  Back to cited text no. 10
    
11.Ohashi Y, Sakai K, Tanaka Y, Mizuiri S, Aikawa A. Reappraisal of proteinuria and estimated GFR to predict progression to ESRD or death for hospitalized chronic kidney disease patients. Ren Fail 2011;33:31-9.  Back to cited text no. 11
    
12.Koch M, Beien A, FusshaLler A, Zitta S, Haastert B, Trapp R. Impact of age, body mass index, insulin resistance and proteinuria on the kidney function in obese patients with Type 2 diabetes and renal insufficiency. Clin Nephrol 2008;69:10-7.  Back to cited text no. 12
    
13.Briganti EM, Branley P, Chadban SJ, et al. Smoking is associated with renal impairment and proteinuria in the normal population: The AusDiab kidney study. Australian Diabetes, Obesity and Lifestyle Study. Am J Kidney Dis 2002;40:704-12.  Back to cited text no. 13
    
14.Tozawa M, Iseki K, Iseki C, Oshiro S, Ikemiya Y, Takishita S. Influence of smoking and obesity on the development of proteinuria. Kidney Int 2002;62:956-62.  Back to cited text no. 14
    
15.Wahid Saeed AA, al Shammary FJ, Khoja TA, Hashim TJ, Anokute CC, Khan SB. Prevalence of hypertension and sociodemographic characteristics of adult hypertensives in Riyadh City, Saudi Arabia. J Hum Hypertens 1996;10:583-7.  Back to cited text no. 15
    
16.Singh RB, Sharma JP, Rastogi V, Niaz MA, Singh NK. Prevalence and determinants of hypertension in the Indian social class and heart survey. J Hum Hypertens 1997;11:51-6.  Back to cited text no. 16
    
17.Jamerson KA, Townsend RR. The attributable burden of hypertension: Focus on CKD. Adv Chronic Kidney Dis 2011;18:6-10.  Back to cited text no. 17
    
18.Karalliedde J, Viberti G. Proteinuria in diabetes: Bystander or pathway to cardiorenal disease? J Am Soc Nephrol 2010;21:2020-7.  Back to cited text no. 18
    

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Correspondence Address:
Mohamed Elhafiz Elsharif
Department of Nephrology, Gazira Hospital for Renal Diseases, Khartoum
North Sudan
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DOI: 10.4103/1319-2442.113900

PMID: 23816738

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