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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
ORIGINAL ARTICLE  
Year : 2020  |  Volume : 31  |  Issue : 2  |  Page : 440-447
Risk factors for kidney disease among civil servants: Report of annual screening and medical evaluation


1 Department of Medicine, Nephrology Unit, Ekiti State University Teaching Hospital, Ado Ekiti, Ekiti State, Nigeria
2 Department of Medical Laboratory, Ekiti State University Teaching Hospital, Ado Ekiti, Ekiti State, Nigeria
3 Department of Medicine, Endocrine Unit, Ekiti State University Teaching Hospital, Ado Ekiti, Ekiti State, Nigeria
4 Department of Radiodiagnostic, Ekiti State University Teaching Hospital, Ado Ekiti, Ekiti State, Nigeria
5 Department of Medicine, Cardiology Unit, Ekiti State University Teaching Hospital, Ado Ekiti, Ekiti State, Nigeria

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Date of Submission22-Oct-2018
Date of Acceptance24-Nov-2018
Date of Web Publication09-May-2020
 

   Abstract 


The outlook of chronic kidney disease (CKD) is worse among the poor sub-Saharan Africa populace due to limited and unaffordable renal replacement therapy. Regular screening of at-risk population can contribute to delaying or even preventing the progression of the disease. This study was designed to evaluate prevalent risk factors for CKD among the urban dwelling civil servants in Ado Ekiti. This is a cross-sectional observational study involving healthy adults above 18 years old. Data on sociodemographic and relevant lifestyle pattern such as smoking, alcohol intake, personal and family history of hypertension, diabetes, and kidney disease were obtained. Clinical variables such as anthropometric measurements, blood pressure (BP), and blood samples for laboratory investigations were taken. There were 122 participants with a mean age of 47.26 ± 5.62 years. About half of them earn <$140/month. Fifty-two (42.6%) individuals admitted taking local herbs and/or Chinese medicines and about a third (36.1%) use unprescribed medi-cations including nonsteroidal anti-inflammatory drugs. Family history of high BP and diabetes mellitus was present in 15.6% and 11.5% of individuals, respectively. We found 45 (32.6%) individuals with body mass index ≥30 kg/m2, while 13.3% and 3.3% have at least 1+ of dipstick and microalbuminuria, respectively. About one-third (25.4%) were either found to be hypertensive or were on antihypertensives, while 12 (9.8%) were either diabetic or had hyperglycemia during the screening. There is a high prevalence of risk factors for CKD among these apparently well individuals. Regular screening, and treatment of the identified risk factors is recommended.

How to cite this article:
Dada SA, Ajayi DD, Raimi TH, Thomas AA, Dele-Ojo B. Risk factors for kidney disease among civil servants: Report of annual screening and medical evaluation. Saudi J Kidney Dis Transpl 2020;31:440-7

How to cite this URL:
Dada SA, Ajayi DD, Raimi TH, Thomas AA, Dele-Ojo B. Risk factors for kidney disease among civil servants: Report of annual screening and medical evaluation. Saudi J Kidney Dis Transpl [serial online] 2020 [cited 2020 Jul 13];31:440-7. Available from: http://www.sjkdt.org/text.asp?2020/31/2/440/284019



   Introduction Top


The kidney is an important organ in the body. Its roles include excretion of waste product of metabolism and regulation of body fluid. The overall body function is deranged in the presence of kidney disease. Chronic kidney disease (CKD) is an established major health challenge all over the world,[1] and its early screening is a key to prevent the development of end-stage renal failure.

The estimated global prevalence of CKD is between 11% and 13%, with the majority in stage three.[1] The prevalence of CKD is expected to increase rapidly in the poorest parts of the world where there is low level of economic development and reduced availability of renal replacement therapy (RRT).[2] Contributory factors for this dismal picture in the sub- Saharan Africa include late presentation, limited and unaffordable RRT, lack of kidney disease prevention programs, and low level of literacy.[2],[3]

A number of factors such as hypertension (HTN), diabetes mellitus (DM), obesity, dysli- pidemia, smoking, and aging have been shown to be associated with the development of CKD.[1],[2],[4]

CKD affects minorities and disadvantaged individuals to a greater extent.[4] In the USA, African-American people are reported to reach end-stage renal disease (ESRD) at younger ages than the White people.[5] In the sub-Saharan Africa, young adults aged 20–50 years are mainly affected with CKD due to HTN and nephritis.[3]

CKD is a major and growing challenge for health-care systems. The financial impact of CKD is enormous. The cost attributable to CKD between 2009 and 2010 in the English National Health Service is estimated at £1.44 to £1.45 billion.[6]

CKD causes premature morbidity and mortality and greatly reduces the quality of life.[7] It is now clear that CKD is a risk multiplier for cardiovascular disease and death in specific high-risk populations.[8] The outlook for individuals with CKD is poor in the sub-Saharan Africa due to the challenging economic burden of RRT for ESRD. As preventive nephrology is being practiced in the developed countries, it is therefore very important that developing countries whose income cannot match these requirements should also embark on these preventive measures.

The Kidney Early Evaluation Program[9] is a model of an effective community awareness program for identifying populations at high risk for CKD and support the fact that early detection and prompt treatment of modifiable risk factors for kidney disease is a strategy to reduce the prevalence as well as lower the economic burden associated with RRT.

This study was designed to evaluate the prevalence of risk factors for CKD among the urban dwelling civil servants and to have preliminary data in our practice environment.

We hypothesize that risk factors for CKD will be prevalent among this study cohort.


   Subjects and Methods Top


A cross-sectional observational study was conducted among the civil servants in Ado Ekiti, Ekiti State, Nigeria. A convenient sampling method was used for data collection.

Permission to conduct the screening was obtained from the Ministry of Health, and ethical approval was obtained from Ekiti State University Teaching Hospital. There was an initial visit to the Ministries, and the staff members were given health talk on non- communicable diseases. They were all given instructions to have overnight fast when coming for screening.

All consenting apparently healthy adults above 18 years of age provided written informed consent. A pretested questionnaire was used to document the sociodemographic status such as the gender, age, grade at work, education level, and income. Lifestyle history such as smoking, alcohol intake, personal and family health history of HTN, DM, and kidney disease was also obtained. The weight and height of every participant were taken. Weight was measured using a standardized bathroom scale, while the height was measured with a stadiometer.

Body mass index (BMI) (in kg/m2) was classified as adopted by the World Health Organization (WHO) into underweight (BMI <18.5 kg/m2), normal weight (BMI of ≥18.5- 24.9 kg/m2), overweight (BMI of 25-29.9 kg/m2), and obesity (BMI of ≥30 kg/m2) according to the WHO guidelines.

After a rest of about 5 min in a sitting and relaxed position, the blood pressure (BP) was measured twice in the left arm using an automatic machine (Omron M2 Basic; Omron Healthcare Co., Ltd., Yamanouchi Yamanoshita- cho, Japan) positioned at heart level. Participants with average BPs ≥140 mm Hg systolic and 90 mm Hg diastolic were considered as HTN.

Urine sample was analyzed with urinalysis strips (Multistix®10 SG Reagent Strip for Urinalysis, Bayer Corporation, Elkart, IN, USA). Menstruating women were excluded from this analysis. Proteinuria and glycosuria were defined as the presence of at least 1+ of protein and 1+ of glucose on dipstick, respectively. Fasting venous blood sample (5 mL) was drawn for biochemical analysis in the chemical pathology laboratory. Serum creatinine and urea concentration were measured by Jaffe’s reaction and Urease-Berthelotdi methods, respectively[10],[11] while serum glucose was measured by glucose oxidase method.[12]

Fasting blood glucose above 7 mmol/L was considered elevated, and diabetes was defined as fasting blood sugar (FBS) ≥7.0 mmol/L or taking antidiabetic medications

The re-expressed Modification of Diet in Renal Disease study equation with the standardized serum creatinine assay was used to determine the glomerular filtration rate (GFR) in mL/min/1.73 m2. GFR = 30,849 x standardized serum creatinine - 1.154 x age - 0.203 x 0.742 (if female) x 1.21 (if Black).[13] Data were analyzed with IBM SPSS Statistics version 20.0 (IBM Corp., Armonk, NY, USA). The sociodemographic variables such as gender, marital status, level of education, and grade at work were presented as proportions. Continuous variables were presented as percentages, means, standard deviation, median, and range as appropriate.


   Results Top


There were 122 participants, among which 41.8% were males. Their mean age was 47.26 ± 5.62 years, while 63.9% of the participants were within the age range of 40-49 years.

Ninety-four (77%) and 28 (23.0%) were senior and junior staff, respectively. About half of them earn <$140/month, while more than 90% were married as illustrated in [Table 1]. This showed that there is a likelihood of good social support as entrenched in the culture of the people in this environment, especially where there is no health insurance.
Table 1: Sociodemographic characteristics of the participants.

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As shown in [Table 2], 52 (42.6%) individuals admitted taking local herbals and Chinese medicines, while about a third (36.1%) frequently patronized patent medicine stores for unprescribed drugs and five (3.6%) ingested nonsteroidal anti-inflammatory drugs regularly. Nineteen (13.8%), 14 (10.1%), and four (2.9%) had a family history of high BP, DM, and kidney disease, respectively, while only two respondents (1.6%) were casual cigarette smokers.
Table 2: Risk factors for chronic kidney disease among the participants

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The level of education was found to be good as more than two-thirds of the participants had university degree, while only a few [6 (4.9%)] attended elementary staff training school.

The mean BMI was 26.60 ± 5.27 kg/m2, while the distribution of BMI among the participant was as follows: obese = 45 (32.6%), overweight = 40 (29.0%), normal weight = 51 (37.0%), and underweight = two (1.4%). Compared with males, females had a statistically significantly higher BMI [Table 3].
Table 3: Clinical and laboratory parameters of the participants.

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The mean serum creatinine was found to be 87.26 ± 15.12 mmol/L, while the estimated glomerular filtration rate (eGFR) was 86.10 ± 17.64 mL/min/1.73 m2. Five (4.1%) respondents had eGFR <60 mL/min/1.73 m2 and four respondents were found to have microalbu- minuria. The median albumin-creatinine ratio (ACR) was 6.22 mg/g with a range of 55.69 mg/g as illustrated in [Table 3].

As shown in [Table 3], only four (3.3%) participants had abnormal ACR, while at least 13.1% had at least 1+ of dipstick proteinuria. The mean FBS was 4.4 ± 1.44 mmol/L, however, glycosuria was present in six (4.9%) respondents. Nearly one-third (25.4%) of the respondents were either found to be hypertensive or on BP-lowering medications, while 12 (9.8%) were diabetic on treatment or found to have elevated blood sugar diagnostic of diabetes. The mean systolic and diastolic BP was 121.93 ± 14.67 mm Hg and 79.63 ± 11.61 mm Hg, respectively.


   Discussion Top


One of the strategies to reduce the economic burden of CKD is to identify individuals with increased risk with the aim of early intervention so as to slow the progression of CKD as far as possible.

High BP was the most prevalent risk factor identified in this study, with a prevalence of 25.4%. This figure is similar to but higher than what was reported from the Southern Nigeria (20.8%)[14] and in El Salvador (20.9%)[15] although lower than 29.8% reported in similar study in the northern part of the country and in Kinshasa, DRC.[16],[17] Akpan et al[18] in their analysis of risk factors for CKD in Uyo, South-South, Nigeria, found that 30.16% of their respondents had HTN. However, a much higher prevalence of high BP (37.7%) was documented in a study that involved predo-minantly market women in Ile-Ife Nigeria by Fatiu et al[19] and in Enugu, South-East Nigeria by Ulasi et al.[20] It has been reported that the prevalence of HTN is growing worldwide, particularly in the sub-Saharan Africa where most people with the disease remain undiagnosed, untreated, or inadequately treated.[21] HTN remains one of the top three causes of CKD in Nigeria and is also a common cause of CKD in the sub- Saharan Africa.

Globally, DM remains the leading cause of CKD[22] and in Nigeria, there has been an increasing trend in the number of patients with CKD secondary to DM.[23] Evidence from studies support that adults with high BP, diabetes, or both are at a higher risk for developing CKD than those without these diseases.[16],[24] Rwegerera et al[25] showed that high BP and DM are strongly associated with the development of CKD.[Figure 1]
Figure 1: Estimated glomerular filtration rate distribution among the participants.

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In this study, we found that 9.8% of the screened individuals had DM. Our finding is similar to 8.1% reported in a study in the Niger Delta area of the country[26] and in agreement to 9% among adults of Salvadoran agricultural communities,[15] although slightly lower than the figure (11.6%) from an urban community in El Salvador (11.6%)[27] but in sharp contrast to the 3.6% obtained in a screening done among similar cohorts in the Northern part of our country.[17] The impact of HTN and diabetes on the development and progression of CKD cannot be overemphasized as it increases the risk of cardiovascular morbidity and mortality in patients with these diseases. Family history of cardiovascular and kidney disease and ethnic and racial peculiarities are also important risk factors for the development of CKD.[28] We found family history of HTN and DM in 15.8% and 11.5%, respectively, while only four (3.3%) had a family history of kidney disease. This figure is lower than what was obtained in other reports. Akpan et al[18] documented higher prevalence of family history of HTN (27.8%), DM (12.5%), and kidney disease (4.3%) among their cohorts, while Okafor et al[26] documented 30.3% prevalence of family history of HTN among their respondents. Nalado et al[17] in their study found that 3% of their respondents had a family history of kidney disease, while Song et al showed that nearly 23% of incident dialysis patients had close relatives with CKD.[29] About one-quarter (23%) of our participants were obese, similar to the report of Orantes et al[15] and Okafor et al.[26] However, higher prevalence was documented by other studies.[18],[30]

Many studies have shown that obesity is associated with the development of CKD. Kramer et al[31] were able to demonstrate a higher incidence of CKD in association with increased BMI. Obesity is frequently accom-panied by HTN, dyslipidemia, metabolic syndrome,[32] and oxidative stress. These factors may collectively or individually influence the risk of CKD in an obese person.

The prevalence of proteinuria in our study (13.1%) was similar to 12.4% reported by Wachukwu et al[14] and 10.9% obtained from Southwest Nigeria as part of a nationwide survey of indices of kidney disease in Nigeria.[33] However, a higher prevalence (19.6%) was reported among civil servants in Kano, Nigeria,[17] 19.7% in Haiti,[34] 23.5% by Akpan et al,[18] and 29.7% among a market population in Ile Ife, Nigeria.[19] Proteinuria is an early marker of kidney disease and a strong predictor of CKD. Persistent proteinuria is known to be associated with the progression of kidney disease.

Medicinal plants are commonly prescribed in many parts of Africa because the plants are accessible and serve as a form of alternative health resource available to the local community. The use of herbal medicines and dietary supplements to treat various chronic diseases and ailments has increased globally. The kidney also suffers from the harmful effect resulting from the use of this remedy. We observed that nearly half (42.6%) of our respondents ingest local herbs and/or imported supplements. Herbal medicines were reportedly used by 66.8% of the respondents in a study done among urban residents in Lagos, Nigeria.[35] However, a higher prevalence was documented in India by Mukherjee and Wahile.[36]

More than two-third of our respondents had a university degree, while only 5.1% earns above $280 per month. Socioeconomic status such as income and level of education has been found to be related with the development of CKD.[37] A 2.4-fold increase in CKD was reported by Krop et al among individuals with annual income <$16,000 compared with income ≥$35,000.[38] The same study also documented that respondents with less than high school education had 1.7 times CKD risk in comparison with those with college education.[38] A higher educational level has been associated with lower prevalence of HTN, DM, and kidney disease.[39],[40] Poverty- related factors are important risk factors for the development of CKD in low-income countries.[2]

The health-seeking attitude of an educated individual would be quite different from someone who has less education. A literate individual is more likely to seek medical attention earlier than someone who is not.


   Conclusions Top


A good understanding of the pattern of risk factors for CKD is important for designing preventive strategies in most cost-effective ways. The high burden of risk factors observed in this study demands urgent attention. This would on the long term contribute to a reduction in CKD burden and its associated cardiovascular risk. As part of the preventive strategies, awareness education and promotion of healthy lifestyles are to be emphasized including control and treatment of identified risk factors to target.

Conflict of interest: None declared.



 
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Correspondence Address:
Samuel Ayokunle Dada
Nephrology Unit, Department of Medicine, Ekiti State University Teaching Hospital, Ado Ekiti, Ekiti State
Nigeria
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DOI: 10.4103/1319-2442.284019

PMID: 32394917

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