| Abstract|| |
Chronic kidney disease (CKD) has become a public health problem because of its increasing prevalence. The objective of this study was to describe the current profile of CKD in our working conditions. This is a descriptive retrospective study of patients admitted for CKD during the period from January 2010 to December 2014 in the Internal Medicine Department of the university hospital of Treichville in Abidjan. CKD was defined by a glomerular filtration rate below 60 mL/min lasting for at least three months. We collected 252 cases of CKD out of 3573 patients recorded during the study period, yielding a prevalence of 7%. The mean age was 39.6 ± 14 years (15–83 years). We observed a male predominance (sex ratio 1.2:1). Of the CKD patients studied, 67.1% were hypertensive, 7.9% were diabetic, and 8.7% were positive for human immunodeficiency (HIV) virus. The CKD was Stage 3 in 2.4%, Stage 4 in 3.2%, and Stage 5 in 94.4% of the patients. The etiology of CKD was hypertension in 59.9% of cases, followed by chronic glomerulonephritis (25%), HIV infection (9.1%), and diabetes (4.8%). On bivariate analysis, hypertension was the cause of CKD in 48.8% of patients under 35 years, 66.4% in patients between 35 and 64 years, and 85.4% in patients ≥65 years (P = 0.001). Chronic glomerulonephritis was the cause of CKD in 40.2% of patients under 35 years, in 14.3% between 35 and 64 years, and in 4.8% of patients ≥65 years (P = 0.0001). CKD is a common cause of hospitalization in our department. Patients generally consulted at the late stage of the disease. Risk factors are mainly hypertension, HIV infection, and diabetes.
|How to cite this article:|
Yao HK, Konan SD, Sanogo S, Diopoh SP, Diallo AD. Prevalence and risk factors of chronic kidney disease in Cote D'Ivoire: An analytic study conducted in the department of internal medicine. Saudi J Kidney Dis Transpl 2018;29:153-9
|How to cite this URL:|
Yao HK, Konan SD, Sanogo S, Diopoh SP, Diallo AD. Prevalence and risk factors of chronic kidney disease in Cote D'Ivoire: An analytic study conducted in the department of internal medicine. Saudi J Kidney Dis Transpl [serial online] 2018 [cited 2021 Oct 27];29:153-9. Available from: https://www.sjkdt.org/text.asp?2018/29/1/153/225201
| Introduction|| |
Chronic kidney disease (CKD) has become a major public health problem. Its prevalence varies from one region of the world to the other. In the US, it was 13.07% in a study carried out between 1999 and 2004. In France, the incidence of end-stage CKD was estimated between 100 and 150 per million inhabitants per year.,,
In Africa, the prevalence of CKD was 12% in the general population of the Demographic Republic of Congo. In Côte d’Ivoire, a study carried out from 2005 to 2009 in an Internal Medicine Department showed a prevalence of 7.5%. The risk factors for developing CKD also varied from one region to another in the world.
Some authors have claimed that the incidence of CKD has increased by 3%–7% in the past 10 years., This increase is related to rapid population growth, aging of the population with several known risk factors of CKD, and environmental factors. In addition, our country (Côte d’Ivoire) has experienced 10 years of socio-political crisis that has led to massive displacement of people and disruption of the health system. Thus, it seemed interesting to study the current profile of CKD in our working conditions.
| Patients and Methods|| |
This was a descriptive retrospective study carried out over a period of five years from January 2010 to December 2014. This study was carried out in the Internal Medicine Department of the University Hospital of Treichville. This department offers a consultation unit, an endoscopy unit, and a support unit for people living with the human immunodeficiency virus (HIV) and four hospitalization units with beds distributed equally between males and females.
Patients admitted had been informed that the results of their analysis would be used in the study and they accepted. Anonymity and confidentiality of information collected were preserved by assigning a number of anonymity to each survey form. Although this is a retrospective and observational study that was neither therapeutic nor interventional, the study was approved by the Ethics Committee of our hospital, according to institutional guidelines.
We included in the study, all patients hospitalized for CKD, older than 15 years on the date of admission. The exclusion criteria included patients hospitalized outside the department or those with acute renal failure or whose medical records were incomplete for the required parameters or those, who refused usage of these data.
The present survey focused on the medical records of hospitalized patients during the study period. For each patient included, the following data were collected using a survey form: epidemiological data (age, gender, and occupation); medical data (presence of edema, diabetes, heart disease, CKD, obesity, smoking, family illness, medical and surgical history, and lifestyle); clinical data (reason for admission, blood pressure (BP) on admission, presence of lower limb edema, acute pulmonary edema, fundus examination, neurological examination and, and pleuropulmonary examination); laboratory data (serum creatinine, calcium, glucose, 24 h proteinuria, hematuria, hemoglobin, mean corpuscular volume, reticulocyte count, and platelets); histological data (renal biopsy); and imaging data (renal ultrasound, electrocardiogram, and echocardiogram).
| Statistical Analysis|| |
Data were processed in an excel database and analyzed using the Statistical Package for the Social Sciences (SPSS) version 22.0 (SPSS Inc., Chicago, IL, USA). We first performed a univariate analysis. Quantitative variables were described in the form of average when their distribution was normal or otherwise, in the form of median. On bivariate analysis, proportions of qualitative variables were compared according to gender (male or female), and according to age groups (<35 years, between 35 and 64 years and >65 years) with a Chi-square test or Fisher’s exact test. Regarding quantitative variables, averages and medians were compared by the ANOVA test. Relative quantitative variables were converted into category variables according to pathological standards. Qualitative or categorical variables with Ρ <0.05 were included in a model of binary logistic regression (Wald backward stepwise method). The association between variables was evaluated by odds ratio (OR). The threshold Ρ <0.05 was considered statistically significant.
Definition of operational terms
Renal impairment was defined by a glomerular filtration rate (GFR) lower than 60 mL/ min/1.73 m2. The chronic nature was defined by the duration of renal failure (over 3 months) and/or presence of normochromic normocytic anemia and/or associated hypocalcemia. CKD was considered moderate (Stage 3) when the creatinine clearance was between 30 and 59 mL/min, severe (Stage 4) when it was between 15 and 29 mL/min, and terminal (Stage 5) when it was lower than 15 mL/min.
In the absence of renal biopsy, the etiological diagnosis of CKD was based on a set of clinical and laboratory tests as follows:
- Chronic glomerular nephropathy was suggested by the presence of CKD associated with proteinuria of 2 g/day or proteinuria associated with hematuria
- Chronic vascular nephropathy (nephroangiosclerosis) was diagnosed by the presence of hypertension, low-flow proteinuria (<1 g/day), and renal failure associated with hypertensive retinopathy
- Proteinuria was considered positive if it was ≥ 500 mg/24-h
- Nephropathy associated with HIV was diagnosed by the presence of proteinuria without hypertension or hematuria and progressive renal failure in any patient infected with HIV or on anti-retroviral therapy
- Diabetic nephropathy was diagnosed by the presence of proteinuria greater than 500 mg/24 h associated with diabetic retinopathy on examination of the fundus
- Chronic tubulointerstitial nephropathy was diagnosed by the presence of proteinuria (<1 g/24 h) associated with leukocyturia and negative urine culture and kidneys showing irregular contour on ultrasound.
Hypertension was defined as systolic BP ≥ 140 mm Hg and diastolic BP ≥ 90 mm Hg. Hypertension was divided into grades: Grade 1 or mild hypertension between 140 and 159 mm Hg (systolic) and/or 90–99 mm Hg (diastolic); Grade-2 or moderate hypertension between 160 and 179 mm Hg (systolic) and/or 100–109 mm Hg (diastolic); Grade-3 or severe hypertension ≥ 180 mm Hg for systolic and/or ≥ 110 mm Hg (diastolic).
Cardiac effect of hypertension was assessed by looking for left ventricular hypertrophy on electrocardiogram and/or echocardiogram. Ocular involvement and its severity were assessed by examination of the fundus. Neurological impact was assessed by looking for signs of brain damage (disorders of consciousness, seizures) and presence of neurological deficit.
Anemia was defined as a hemoglobin level <12 g/dL. It was considered severe when the hemoglobin level was <8 g/dL, and moderate, when it was between 8 and 12 g/dL.
| Results|| |
We collected during the study period, 252 cases of CKD out of 3573 patients recorded, yielding a prevalence of 7.05%.
There were in 134 males (54.8%) and 114 females (45.2%) with a sex ratio of 1.2:1. The mean age was 39.6 ± 14.3 y ranging from 15 to 83 years. The age-group most affected was 25–34 years (31.75%). The proportion of patients aged >65-years was 8.3%. Our patients were mostly housewives (15.8%) and traders (12.7%). Pupils and students accounted for 8.7%. In the other cases, they were without any employment.
Of the CKD patients studied, 67.1% were known to have hypertension, 7.9% were diabetic, and 8.7% were positive for HIV. 5.6% of cases were both hypertensive and diabetic. HIV infection was treated with antiretroviral therapy in 68.2% of infected patients, before they were hospitalized.
On clinical examination, hypertension was observed in 211 cases (83.7%). It was Grade-1 in 14.7%, Grade-2 in 16.3% of cases and Grade-3 in 52.8%.
According to the Modification of Diet in Renal Disease formula, CKD was Stage-3 in 2.4%, Stage-4 in 3.2% and Stage-5 in 94.4% of cases.
The etiology was dominated by hypertension, seen in 59.9% of cases, chronic glomerulonephritis in 25% of cases, HIV infection in 9.1% of cases, and diabetes in 4.8% of cases.
The mean age of male patients was 39.6 ± 14 years against 40.6 ± 15 years for female patients with a statistically insignificant difference (P = 0.28).
The proportion of patients, who were known to have CKD at admission was 13.8% for males against 23.7% for females with a statistically significant difference [P = 0.03; OR = 0.72 (from 0.53 to 0.96)]. The risk factors for CKD, grade of hypertension at admission, and the stage of CKD were compared between male and female subjects. No statistically significant difference was observed [Table 1].
The patients were compared according to the three age-groups. The proportion of patients with hypertension at admission was 54.5% for those under 35 years, 76.5% for those between 35 and 64 years and 81% for those ≥ 65 years with a statistically significant difference (P = 0.001). Diabetic patients were 2.7% among those under 35 years, 10.9% between 35 and 64 years, and 19% among those ≥ 65 years with a statistically significant difference (P = 0.01). HIV-infected patients were 5.4% among those under 35 years, 13.4% among those between 35 and 64 years, and 0% among those ≥ 65 years with a statistically significant difference (P = 0.03). Factors such as the grade of hypertension at admission and the stage of CKD were compared between age groups. No statistically significant difference was observed [Table 2].The etiology of CKD did not show any significant difference between the two genders [Table 3]. According to age groups, hypertension was the cause of CKD in 48.8% in patients under 35 years, 66.4% in those between 35 and 64 years, and in 85.4% in those ≥ 65 years with a statistically significant difference (P = 0.001).Chronic glomerulonephritis was the cause of CKD in 40.2% of patients under 35 years, in 14.3% between 35 and 64 years, and 4.8% in those ≥ 65 years with a statistically significant difference (P = 0.0001). Diabetes and HIV infection had varying proportions depending on age groups but without any significant difference [Table 4].
| Discussion|| |
CKD has become a public health problem in recent years with increasing prevalence worldwide. Indeed, the prevalence of this disease varies between 10% and 13% in the general population in Taiwan, Japan, China,, India, Canada, and the USA.
It was estimated to be 4.9% in the general population in Senegal and ranged between 2% and 12% depending on the hospital series, in sub-Saharan Africa.,
In Côte d’Ivoire, the hospital prevalence of CKD was 7.5% in 2009 in an Internal Medicine Department. Our results (7%) are slightly lower than the data of 2009. This difference is methodological. Indeed, in our study, we included patients who had a GFR <60 mL/min, while in the study of Ouattara et al, all patients who had a GFR <90 mL/min were included.
Male predominance has been observed in several studies like ours., Our patients were young (39 years on average). This young age has been observed in all African series,,,,, in contrast with the advanced age of patients in the Western countries. Indeed, according to the results of the 2011 Renal Epidemiology and Information Network registry, the average age of new patients on replacement therapy was 70.6 years.
Nine out of 10 patients in our study were at end-stage of CKD. This finding was observed in 82.4% of the patients by Ouattara et al, Vinay Sakhuja, and Naicker in South Africa also found similar results.
Etiologically, hypertension was the most common cause in our study, as seen in most African studies.,,, In Nigeria, the causes found were hypertension (17.2%), chronic glomerulonephritis (14.8%), and diabetes (11.8%). In South Africa, hypertension (24%), diabetes (18.9%), and HIV infection (10%) were the main etiologies of CKD. In Cameroon, the causes found were dominated by hypertension (30.9%), diabetes (15.9%), and HIV infection (6.6%).
While hypertension appears to be the leading cause of CKD in Sub-Saharan Africa, diabetes mellitus ranks first in North Africa.,
Hypertension was followed by HIV infection and diabetes in our series as in the study of Ouattara et al and that of Ackoundou. However, the proportion of hypertension is higher in our series than in the previous series. This higher proportion could be related to the socio-political crisis that occurred in our country between 1999 and 2011. The prevalence of chronic diseases increases during war, regardless of age, and the incidence is higher among populations directly exposed. Thus, hypertension, diabetes, and other cardiovascular diseases are frequently associated with traumatic psychological disorders.
On bivariate analysis, the proportion of hypertension as etiology of CKD increased with age. In a study carried out in China, hypertension was significantly associated with the outcome of CKD after adjustment for age and gender. We also observed that the proportion of chronic glomerulonephritis was higher in patients under 35 years and it decreased with age. The reasons given for the young age of these patients could be the high prevalence of infections, particularly in childhood leading to chronic glomerulonephritis. Emphasis must be added to the delay in starting appropriate management of patients, due to late consultation.
| Conclusion|| |
CKD is a common reason for consultation in our department. The affected patients were mostly unemployed and consulted at a late stage of the disease in most cases.
Risk factors are respectively hypertension, (the proportion has more than doubled), HIV infection, and diabetes. These results show the importance of early diagnosis and nephrology monitoring of the disease to slow down progression of CKD.
| Acknowledgment|| |
We thank the staff of department of nephrology, internal medicine in University Hospital of Treichville, for their participation in the study.
No funding was received for this study.
Conflict of interest: None declared.
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Dr. Hubert Kouame Yao
Department of Nephrology and Internal Medicine, University Hospital of Treichville, Abidjan 01
[Table 1], [Table 2], [Table 3], [Table 4]