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Saudi Journal of Kidney Diseases and Transplantation
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RENAL DATA FROM ASIA - AFRICA  
Year : 2018  |  Volume : 29  |  Issue : 2  |  Page : 409-413
Etiological profile of chronic kidney disease: A single-center retrospective hospital-based study


Department of Nephrology, Guwahati Medical College and Hospital, Guwahati, Assam, India

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Date of Web Publication10-Apr-2018
 

   Abstract 

Chronic kidney disease (CKD) is one of the leading causes of chronic diseases globally, with rising incidence and prevalence. It is a major risk factor for cerebrovascular disease and coronary artery disease, which are the main causes of death in this population. The etiology of CKD is varied. This study was performed to evaluate the various etiologies of CKD among patients presenting to the Department of Nephrology, Guwahati Medical College, a tertiary referral center. A total of 5718 CKD patients were evaluated to identify the cause of CKD. The most common cause was found to be diabetes mellitus in 42.2%, followed by chronic glomerulonephritis in 21.4%, hypertension in 19.5%, obstructive uropathy in 6.9%, chronic interstitial nephritis in 3.6%, and autosomal dominant polycystic kidney disease in 1.5% of the patients. Nearly 2.7% of the patients had CKD of unknown etiology. Most of the common causes of CKD are potentially treatable and initiating appropriate treatment early may prevent the development of CKD or progression to end-stage renal disease.

How to cite this article:
Sharma M, Doley P, Das HJ. Etiological profile of chronic kidney disease: A single-center retrospective hospital-based study. Saudi J Kidney Dis Transpl 2018;29:409-13

How to cite this URL:
Sharma M, Doley P, Das HJ. Etiological profile of chronic kidney disease: A single-center retrospective hospital-based study. Saudi J Kidney Dis Transpl [serial online] 2018 [cited 2022 Nov 27];29:409-13. Available from: https://www.sjkdt.org/text.asp?2018/29/2/409/229297

   Introduction Top


Chronic kidney disease (CKD) is defined as kidney damage or glomerular filtration rate below 60 mL/min per 1.73 m2 for three months or more, irrespective of the cause. It is a worldwide public health problem and causes a huge burden both to the affected patients and health-care providers. The prevalence of CKD is estimated to be 8–16% worldwide.[1] Globally, CKD is the 12th major cause of death and the 17th cause of disability. This could be an underestimate since patients with CKD are more likely to die of cardiovascular disease (CVD) before reaching end-stage renal disease (ESRD). Diabetes mellitus (DM) is the most common cause of CKD worldwide and in India. Approximately 30% of the patients with DM have diabetic nephropathy, and with the growing number of DM patients and aging population, there is likely a parallel increase in the incidence of CKD. According to the Diabetes Atlas 2006, the number of patients with DM in India (currently around 40.9 million) is expected to rise to 69.9 million by 2025 unless urgent preventive measures are taken.[2] The importance of CKD and its risk factors has to be realized urgently due to its increasing prevalence, CKD-related CVD, ESRD, and the consequent financial burden of renal replacement therapy (RRT). The prevalence of ESRD and patients on RRT has increased over the last two decades.[3] Screening and intervention can prevent CKD, and management strategies can be implemented to reduce the incidence of ESRD.


   Aims Top


The purpose of this study is to evaluate the various causes of CKD in our hospital.


   Materials and Methods Top


This study was conducted in the Department of Nephrology, Guwahati Medical College, a tertiary referral center. It was a retrospective cohort study conducted from 2005 to 2015. This study was based on the record analysis of the patients admitted in our hospital during that period, which involved 5,718 CKD patients of either sex without any age bar. The diagnosis of CKD was made on the basis of clinical findings, biochemical parameters, and imaging studies and renal biopsy when required. Hypertension (HTN) was defined according to JNC–VII, and diagnosis of diabetes was made according to the American Diabetes Association criteria.

Diabetic nephropathy was diagnosed when a long history of DM was present, and the patient had diabetic retinopathy and a classical history of slow progression with HTN, albuminuria, and edema preceding the onset of renal failure. When DM had been present for <5 years, retinopathy was absent, or the presentation was not typical, renal biopsy was performed. HTN-related CKD was diagnosed when there was a long-standing history of HTN, and the fundus showed changes of hypertensive retinopathy. There should have been no evidence to support a positive diagnosis of one of the other renal diseases such as glomerulonephritis (GN). Renal biopsy was performed whenever the renal size and cortical width permitted. Chronic GN was diagnosed when there was a history of edema in the distant past, with proteinuria for many years before the development of renal failure. In many patients, the diagnosis had been established by renal biopsy in the past. Chronic interstitial nephritis (CIN) was diagnosed in patients who had an insidious onset of renal failure. Edema occurred in these patients only at a late stage of renal failure when they were on the verge of needing dialysis. The kidneys were usually contracted but were of normal size in some, and in these patients, renal biopsy was performed and the diagnosis was established. The diagnosis of autosomal dominant polycystic kidney disease (ADPKD) was easily made on ultrasound examination. Obstructive uropathy was diagnosed when longstanding, neglected obstruction was found.


   Results Top


The present study comprised 5,718 CKD patients who were admitted in our hospital during the study period. In 2005, the number of CKD patients admitted was low, but there was a steady increase in the number of patients from 3.79% in 2005 to 20.98% in 2015. The male-to-female ratio was 2.59:1.

[Figure 1] shows the sex distribution of the patients.
Figure 1: Pie diagram showing the sex distribution of the study patients.

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The mean age at presentation of CKD was 40.4 ± 17.3 years. For DM and HTN, the mean age at presentation was 54.5 years, and the maximum number of patients was seen in this age group. In contrast, CKD due to ADPKD was seen in the 60–69 years’ age group and GN as a cause of CKD was seen in the age group of 20-50 years [Figure 2].
Figure 2: Bar diagram showing the disease-specific age distribution of the study patients.
T2DM: Type 2 diabetes mellitus, CGN: Chronic glomerulonephritis, HTN: Hypertension, OBST: Obstructive uropathy, CIN: Chronic interstitial nephritis, MISC: Miscellaneous (unknown), ADPKD: Autosomal dominant polycystic kidney disease.


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The etiology of CKD was found to be DM in 42.2%, chronic GN in 21.4%, HTN in 19.5%, obstructive uropathy in 6.9%, CIN in 3.6%, and ADPKD in 1.5% of CKD patients. About 2.7% patients had CKD of unknown etiology [Figure 3].
Figure 3: Pie diagram showing the basic etiologies of chronic kidney disease in the study population.
T2DM: Type 2 diabetes mellitus, CGN: Chronic glomerulonephritis, HTN: Hypertension, OBST: Obstructive uropathy, CIN: Chronic interstitial nephritis, MISC: Miscellaneous (unknown), ADPKD: Autosomal dominant polycystic kidney disease.


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   Discussion Top


The incidence and prevalence of CKD are very much underreported worldwide, particularly in developing countries. Due to lack of renal registry in India, the exact disease burden cannot be assessed. The incidence and prevalence of CKD in India are approximately 0.16% and 0.78%, respectively.[4] In the US, the prevalence of CKD in 1999-2004 was higher than it was in 1988–1994. The prevalence of CKD Stages 1–4 increased from 10.0% in 1988–1994 to 13.3% in 1999–2004.[5] In our study, it is seen that the number of admitted patients with CKD increased from 3.79% in 2005 to 20.98% in 2015. The average age at presentation of CKD in our study was 40.4 ± 17.3 years with male-to-female ratio of 2.59:1. This result was similar to the study conducted by Sakhuja et al in a hospital-based study; the mean age of their patients at presentation was 40 years and 70% were male.[6] This result was different from a population-based study conducted by Agarwal et al, where the mean age of patients with CKD was 59 years with 48% being males.[7]

The main aim of our study was to identify the various causes of CKD among hospitalized patients. In our study, the leading cause of CKD was DM, seen in 44.2% cases. The results of our study were almost similar to study conducted by Agarwal et al[8] in which diabetes and HTN were the leading causes of CKD, seen in 41% and 22.8% of the cases, respectively. In our study, chronic GN was found in 21.4% of the cases whereas Barsoum reported an incidence of 10%–20% in Africa.[9] Afshar et al[10] in their study found that the most common etiology of CKD was DM, seen in 26.8% of patients, followed by HTN seen in 13.5%, obstructive uropathy in 12%, cystic and congenital disorders in 10.3%, GN in 6.5%, urinary tract infections in 4%, vasculitis in 2%, tubulointerstitial nephritis and pregnancy related in 0.8% each, and unknown causes in 29.5% of the patients. Awad et al[11] in their study found that the most common etiology of CKD was DM, seen in 33%, followed by HTN seen in 22.6%, obstructive uropathy in 17.3%, undetermined causes in 14%, pyelonephritis in 4.7%, GN in 4.3%, and polycystic kidney disease in 3.9% of the patients. Alam et al[12] in their study found that the most common etiology of CKD was DM in 40%, followed by HTN in 35%, chronic GN in 12%, obstructive uropathy in 3%, ADPKD in 2%, chronic pyelonephritis in 2%, chronic tubulointerstitial nephritis in 1%, rapidly progressive glome- rulonephritis in 2%, ischemic renal disease in 2%, and unexplained cause in 1% of their patients. All the above studies found DM to be the most common cause of CKD followed by HTN.

In our study, a significant percentage of CKD was due to obstructive uropathy and constituted 6.9% of all CKD patients. Multivariate analysis of the obstructive uropathy group revealed calculus renal disease, congenital pelvic-ureteric junction obstruction, cervical malignancy, and benign prostatic hyperplasia, which was related to age and sex of the patients, as the causes of obstruction.

In conclusion, the incidence of CKD is drastically increasing in Assam, a North Eastern state of India, in the recent past. Most of the common causes of CKD are treatable and initiating appropriate treatment early might prevent the development of CKD. The high percentage of obstructive uropathy, especially calculus renal disease in this part of the country, requires further evaluation. To establish the actual burden of the disease, larger prospective multicenter epidemiological based studies are needed.

Conflict of interest: None declared.

 
   References Top

1.
Jha V, Garcia-Garcia G, Iseki K, et al. Chronic kidney disease: Global dimension and perspectives. Lancet 2013;382:260-72.  Back to cited text no. 1
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2.
Sicree R, Shaw J, Zimmet P. Diabetes and impaired glucose tolerance. In: Gan D, editor. Diabetes Atlas. 3rd ed. Brussels: International Diabetes Federation; 2006. p. 15-109.  Back to cited text no. 2
    
3.
Grassmann A, Gioberge S, Moeller S, Brown G. ESRD patients in 2004: Global overview of patient numbers, treatment modalities and associated trends. Nephrol Dial Transplant 2005;20:2587-93.  Back to cited text no. 3
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4.
Agarwal SK. Chronic kidney disease and its prevention in India. Kidney Int Suppl 2005;98: S41-5.  Back to cited text no. 4
    
5.
Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis 2003;41:1-2.  Back to cited text no. 5
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6.
Sakhuja V, Jha V, Ghosh AK, Ahmed S, Saha TK. Chonic renal failure in India. Nephrol Dial Transplant 1994;9:871-2.  Back to cited text no. 6
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7.
Agarwal SK, Dash SC. Spectrum of renal diseases in Indian adults. J Assoc Physicians India 2000;48:594-600.  Back to cited text no. 7
[PUBMED]    
8.
Agarwal SK, Dash SC, Irshad M, et al. Prevalence of chronic renal failure in adults in Delhi, India. Nephrol Dial Transplant 2005;20:1638-42.  Back to cited text no. 8
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9.
Barsoum RS. Burden of chronic kidney disease: North Africa. Kidney Int Suppl (2011) 2013;3:164-6.  Back to cited text no. 9
    
10.
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;18:191-4.  Back to cited text no. 10
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11.
Awad SM. Chronic renal failure in Al-Anbar of Iraq. Saudi J Kidney Dis Transpl 2011;22: 1280-4.  Back to cited text no. 11
[PUBMED]  [Full text]  
12.
Alam V, Prasad BN, Vidyasagar, Gupta U. Study of etiology of chronic kidney disease in a tertiary care hospital in Kolar. EJPMR 2016; 3:351-4.  Back to cited text no. 12
    

Top
Correspondence Address:
Dr. Manjuri Sharma
Department of Nephrology, Guwahati Medical College and Hospital, Guwahati 781032, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-2442.229297

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    Figures

  [Figure 1], [Figure 2], [Figure 3]

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