| 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 2021 Nov 29];22:373-6. Available from: https://www.sjkdt.org/text.asp?2011/22/2/373/77650
| Introduction|| |
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.  Awareness of the causes of ESRD helps the nephrologists to anticipate problems during renal replacement therapy (RRT) and plan preventive measures for the community.  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%.  In the developing countries, growth of the ESRD population has similar trends.  An average incidence of ESRD in the Middle East countries with similar renal care systems is 93 per million population.  The estimated incidence for new cases in Sudan is about 70-140/million inhabitants/year. 
| Patients and Methods|| |
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.
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.
- Patients with ESRD.
- Patients on regular HD at the Gezira Hospital for renal disease.
- Age 18 years old or higher.
Data were analyzed using SPSS 9.05. Results were presented in number, percent, mean and standard deviation (SD).
| Results|| |
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.
| Discussion|| |
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  and Abboud et al  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  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%.  Mustafa et al stated that the incidence of malaria in the Gezira regions (Elhosh) is 23.7 episodes per 1000 population.  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,  5.9% in the US, 18% in the UK  and, similarly, 14.8% in Iran.  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,  whereas in Switzerland, hypertensive nephropathy was the leading cause of ESRD.  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.  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;  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. , 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|| |
|1.||Ruggenenti P, Schieppati A, Remuzzi G. Progression, remission, regression of chronic renal diseases. Lancet 2001;357:1601-8. |
|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. |
|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. |
|4.||Mahon A. Epidemiology and classification of chronic kidney disease and management of diabetic nephropathy. Eur Endocr Rev 2006;2:33-6. |
|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. |
|6.||Suliman SM, Beliela MH, Hamza H. Dialysis and Transplantation in Sudan. Saudi J Kidney Dis Transpl 1995;6:312-4. |
|7.||Osman EM, Abboud OI, Danielson BG. Chronic renal failure in Khartoum, Sudan. Ups J Med Sci 1987;92(1):65-73. |
|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. |
|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. |
|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. |
|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. |
|12.||Mittal S, Kher V, Gulati S, Agarwal LK, Arora P. Chronic renal failure in India. Ren Fail 1997;19(6):763-70. |
|13.||Thomas PP. Changing profile of causes of chronic renal failure. Saudi J Kidney Dis Transpl 2003;14(4):456-61. |
|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. |
|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. |
|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. |
|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. |
|18.||Chijioke A, Adeniyi AB. End stage renal disease: Racial differences. Orient J Med 2003; 15(1&2):24-31. |
|19.||Naicker S. End-stage renal disease in subSaharan and South Africa. Kidney Int 2003; 63:S119-22. |
|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. |
Mohamed Elhafiz Elsharif
Head of Nephrology Department, Gazira Hospital for Renal Diseases, P.O. Box 335 Khartoum