|Year : 2021 | Volume
| Issue : 2 | Page : 488-496
|The awareness and perception of chronic kidney disease in Jeddah, Saudi Arabia
Faisal Al-Husayni1, Abdulaziz Al-Zahrani2, Mohammad Zwawy3, Samer Alamri4, Rakan Aljedaani5, Abdullah Almalki6
1 Department of Internal Medicine, National Guard Hospital, Jeddah, Saudi Arabia
2 Department of Family Medicine, Ministry of Health, Alkhobar, Saudi Arabia
3 Department of Family Medicine, National Guard Hospital, Jeddah, Saudi Arabia
4 Department of Dermatology, National Guard Hospital, Jeddah, Saudi Arabia
5 King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
6 King Saud Bin Abdulaziz University for Health Sciences; Department of Nephrology, National Guard Hospital; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
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|Date of Web Publication||11-Jan-2022|
| Abstract|| |
Chronic kidney disease (CKD) is a serious worldwide health problem with a rising incidence and prevalence. CKD can lead to end-stage renal failure that increases the risk of death and requires dialysis or kidney transplantation. Patients’ adherence, attitude, and knowledge are important to prevent and control CKD. The aim of this study was to investigate the awareness and knowledge about CKD and attitude toward kidney donation among the general population in Saudi Arabia. A cross-sectional study based on a questionnaire survey was conducted in Jeddah, Saudi Arabia. We surveyed the awareness about CKD among adult residents of Jeddah, Saudi Arabia. We used a self-administrated questionnaire that consisted of three sections; socio-demographic information, awareness about CKD, and attitude towards kidney donation. Simple descriptive statistics was employed using IBM SPSS Statistics version 24.0 software. The number of survey respondents was 268. More than half (53.7%) of the included participants knew that the use of non-steroidal anti-inflammatory drugs is a risk factor for CKD, whereas 54% thought that CKD could be diagnosed from a simple urine analysis, and 45% believed that lifestyle modifications can alter the course of the disease. Interestingly, most participants (57.4%) were ready to donate their kidney to a patient with end-stage renal disease, and 68.6% knew that patient can live with one kidney. The present study identifies a low rate of CKD awareness and calls for a need for awareness campaigns and other tools to strengthen knowledge dissemination. Improving public awareness about CKD needs to be addressed to help facilitate disease identification and prevention.
|How to cite this article:|
Al-Husayni F, Al-Zahrani A, Zwawy M, Alamri S, Aljedaani R, Almalki A. The awareness and perception of chronic kidney disease in Jeddah, Saudi Arabia. Saudi J Kidney Dis Transpl 2021;32:488-96
|How to cite this URL:|
Al-Husayni F, Al-Zahrani A, Zwawy M, Alamri S, Aljedaani R, Almalki A. The awareness and perception of chronic kidney disease in Jeddah, Saudi Arabia. Saudi J Kidney Dis Transpl [serial online] 2021 [cited 2022 May 16];32:488-96. Available from: https://www.sjkdt.org/text.asp?2021/32/2/488/335461
| Introduction|| |
Chronic kidney disease (CKD) is a serious worldwide health problem with a rising incidence and prevalence. The number of CKD patients is expected to increase as a consequence of aging populations and increased prevalence of type II diabetes mellitus (DM). Elderly patients with CKD are more likely than younger patients to have high rates of co-morbid conditions including cardiovascular diseases, DM, infection, and malignancy.,, Undoubtedly, CKD and associated comorbidities represent a financial burden on both the families and the health care systems.
CKD can lead to end-stage renal failure that increases the risk of death and requires kidney transplantation. Fortunately, progression of the disease can be prevented or delayed with timely diagnosis and treatment and by avoiding nephrotoxic drugs, especially non-steroidal anti-inflammatory drugs (NSAIDs), which constitute one of the most widely used class of drugs, with more than 70 million prescriptions and more than 30 billion over-the-counter purchases annually in the United States alone.,,,,,, Patients should also follow a strict diet, particularly protein intake.,
Because of the massive medical, social, and economic costs of CKD-related comorbidities and complications, there is a global challenge to slow the progression of the disease., Patients’ adherence and attitude are very important to control CKD progression. Many studies found that good patients’ knowledge was significantly associated with lower rates of peritonitis in patients on peritoneal dialysis since higher knowledge leads to better adherence to dialysis prescription and dietary recommendations.,,
Hence, the aim of the current study was to measure Saudis’ knowledge about CKD. The objectives were to study the level of knowledge about CKD risk factors, diagnostic and treatment strategies available to patients with CKD; estimate the prevalence of diagnosed chronic diseases including DM, hypertension (HTN), and CKD; and identify the attitude toward kidney donation and study its predictors.
| Subjects and Methods|| |
Study design and setting
A cross-sectional study based on a questionnairesurvey was conducted in Jeddah, Saudi Arabia. The study was approved by the Ethics Committee of King Abdullah International Medical Research Center (SP18/013/J).
We included adult (>18 years) residents of Jeddah, Saudi Arabia, and those who have end-stage renal disease were excluded in the study.
We used a self-administrated questionnaire that consisted of three sections: Socio-demographic information and existing diagnosis of chronic disease including DM, HTN, and CKD; knowledge about risk factors, diagnosis and treatment of CKD; and attitude towards kidney donation to patients with end-stage renal disease.
| Statistical Analysis|| |
Simple descriptive statistics were employed using IBM SPSS Statistics version 24.0 software (IBM Corp., Armonk, NY, USA). For the qualitative data, frequency and percentages were reported. For the quantitative data, the mean (standard deviation) was used. Chi-square was used to compare between two categories with a significance level of 0.05 two-sided.
| Results|| |
In this cross-sectional study, 268 responses were received. The mean age of the included participants was 33 years old. Most of the study participants (64.6%) were males, and 59.7% were single. More than half (55%) had a university education or higher and 25% of participants had a high school degree.
Participants with a history of DM, HTN, and dyslipidemia represented 8.9%, 10.4% and 6.7%, respectively, whereas 6.7% had established CKD. Only 50% of the patients with CKD performed kidney function test last year. [Table 1] shows the distribution and baseline characteristics of the respondents.
|Table 1: Socio-demographic characteristics of the study participants (n = 268).|
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[Table 2] presents data related to knowledge and attitude. In summary, nearly one-third of the included participants knew that diabetes and HTN are risk factors for CKD. Nearly half of the respondents defined the use of NSAIDs as an important risk factor and reported that CKD can be diagnosed by a simple urine analysis. Only three participants knew that soft drinks are risk factor if CKD and 14% of the participants did not know the methods of diagnosis of CKD. A good number of participants believed that lifestyle modifications and medications can alter the course of CKD (45% and 32.4%, respectively). While 11% of the participants thought that herbs can be used for the treatment of CKD.
|Table 2: Knowledge about chronic kidney disease among the study participants (n=268).|
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[Table 3] demonstrates that a personal history DM, occupation, and income increase the knowledge of DM as a risk factor with a P-value of <0.001, 0.041, and 0.042, respectively. A personal history of HTN did not show any significance in acknowledging DM as a risk factor. On the other hand, participants affected by DM (P = 0.007) had recognized HTN to be a risk factor for CKD. Gender and marital status did not show an influence on knowledge of DM and HTN as risk factors.
Interestingly, 57.4% of the participants were ready to donate their kidney after death to a patient with end-stage renal failure, and 68.6% knew that humans can live with one kidney. Campaigns were the most commonly preferred way for awareness about CKD, followed by media (59% and 48.5%, respectively) [Figure 1].
Our analysis showed a significant relationship between income and source of information. High-income level participants were more likely to choose clinics, campaigns, and media as the best ways to educate about CKD with P = 0.04, 0.03, and 0.01, respectively. Participants with an income of 3000–10000 SAR were more likely to know that it is possible to live with one kidney (P = 0.01) [Table 4].
University-educated persons were more likely to choose media (P = 0.001). Kidney donation after death was also significantly associated with higher educational level (P = 0.05) [Table 5].
| Discussion|| |
CKD is a leading public health problem, which is associated with high morbidity and mortality and low quality of life. There is an urgent need to define and increase awareness about CKD, especially among those with less severe disease status, in order to reduce its associated comorbidities and complications.
The current study shows a low level of awareness and poor knowledge of kidney disease in the community. This might be because almost one-third of our sample only had a high school certificate or lower. Similarly, Hsu et al reported low awareness rates of CKD in its earlier stages. These results are consistent with several reports showing that CKD is under-diagnosed and under-treated in a variety of populations.,,, These reports emphasize the importance of health education concerning CKD for patients, to adopt lifestyle and risk-factor modifications necessary to prevent progression of the disease and to minimize complications and early death.
Nearly 9% of our participants had DM, and 10.4% had HTN. Metabolic diseases such as DM, obesity, and HTN may be associated with kidney injury, and they are important predisposing factors for the development of CKD. Several studies showed that approximately half of diabetic patients have some degree of CKD.,
Thirty-eight percent said that DM is a risk factor, 29% and 25% knew that smoking and HTN are risk factors, respectively. The study participants were more aware of the hazard of NSAID intake as 53% recognized it as a risk factor. Patients with diabetes and HTN have a greater prevalence as well as a higher progression of CKD than subjects without these conditions., In addition, some population studies reported cardiovascular diseases, high blood cholesterol and triglycerides levels, and increasing age as factors that are strongly associated with CKD.
As expected, the level of knowledge was related to income level. Participants with monthly income over 10000 SAR were more likely to know that it is possible to live with one kidney (P = 0.01), and they chose clinics, campaigns, and media as the best way to educate about CKD (P = 0.04, 0.03, 0.01 respectively). A higher rank of monthly income is usually associated with better social standards and superior educational and awareness levels.
In the current study, participants with high educational level were more likely to be open to donating after death (P = 0.05). Furthermore, they were more likely to choose media as the best way to educate about CKD (P = 0.001). This could be explained in light of the continuous increase in media impact on our daily life. It is crucial that new approaches be implemented to increase patients’ education. These efforts should be coupled with localized campaigns to enhance screening and awareness in high-risk populations.
Numerous studies have shown that various factors, such as gender, race and educational level, might cause differences in the prevalence of CKD. Moreover, the prevalence of CKD may vary greatly between different geographical regions, which could be due to variability in socioeconomic features including lifestyles and family income.,,,
Conflict of interest: None declared.
| References|| |
Drey N, Roderick P, Mullee M, Rogerson M. A population-based study of the incidence and outcomes of diagnosed chronic kidney disease. Am J Kidney Dis 2003;42:677-84.
De Cosmo S, Viazzi F, Pacilli A, et al. Serum uric acid and risk of CKD in type 2 diabetes. Clin J Am Soc Nephrol 2015;10:1921-9.
Stevens LA, Levey AS. Chronic kidney disease in the elderly – How to assess risk. N Engl J Med 2005;352:2122-4.
James MT, Laupland KB, Tonelli M, et al. Risk of bloodstream infection in patients with chronic kidney disease not treated with dialysis. Arch Intern Med 2008;168:2333-9.
Wong G, Hayen A, Chapman JR, et al. Association of CKD and cancer risk in older people. J Am Soc Nephrol 2009;20:1341-50.
Kerr M, Bray B, Medcalf J, O’Donoghue DJ, Matthews B. Estimating the financial cost of chronic kidney disease to the NHS in England. Nephrol Dial Transplant 2012;27 Suppl 3:i73-80.
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:1296-305.
Bucher HC, Griffith LE, Guyatt GH. Systematic review on the risk and benefit of different cholesterol-lowering interventions. Arterioscler ThrombVasc Biol 1999;19:187- 95.
Parving H, Lehnert H, Brochner-Mortensen J, Gomis R, Andersen S, Arner P. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med 2001;345:870-78.
Sever P, Dahlöf B, Poulter NR, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial – Lipid Lowering Arm (ASCOT-LLA): A multi-centre randomized trial. Lancet 2003;361:1149-58.
de Zeeuw D, Lewis EJ, Remuzzi G, Brenner BM, Cooper ME. Renoprotective effects of renin-angiotensin-system inhibitors. Lancet 2006;367:899-900.
Harkonen S, Kjellstrand C. Contrast nephropathy. Am J Nephrol 1981;1:69-77.
Jang SM, Cerulli J, Grabe DW, et al. NSAID-avoidance education in community pharmacies for patients at high risk for acute kidney injury, upstate New York, 2011. Prev Chronic Dis 2014;11:220.
Wehling M. Non-steroidal anti-inflammatory drug use in chronic pain conditions with special emphasis on the elderly and patients with relevant comorbidities: Management and mitigation of risks and adverse effects. Eur J Clin Pharmacol 2014;70:1159-72.
Clinical practice guidelines for nutrition in chronic renal failure. K/DOQI, National Kidney Foundation. Am J Kidney Dis 2000; 35:S17-104.
Beto JA, Bansal VK. Medical nutrition therapy in chronic kidney failure: Integrating clinical practice guidelines. J Am Diet Assoc 2004; 104:404-9.
Bello AK, Nwankwo E, El Nahas AM. Prevention of chronic kidney disease: A global challenge. Kidney Int Suppl 2005;98:S11-7.
Schieppati A, Remuzzi G. Chronic renal diseases as a public health problem: Epidemiology, social, and economic implications. Kidney Int Suppl 2005;98:S7-10.
Kazancioglu R, Ozturk S, Ekiz S, Yucel L, Dogan S. Can using a questionnaire for assessment of home visits to peritoneal dialysis patients make a difference to the treatment outcome? J Ren Care 2008;34:59-63.
Thomas LK, Sargent RG, Michels PC, Richter DL, Valois RF, Moore CG. Identification of the factors associated with compliance to therapeutic diets in older adults with end stage renal disease. J Ren Nutr 2001;11:80-9.
Juergensen PH, Gorban-Brennan N, Finkelstein FO. Compliance with the dialysis regimen in chronic peritoneal dialysis patients: Utility of the pro card and impact of patient education. Adv Perit Dial 2004;20:90-2.
Hsu CC, Hwang SJ, Wen CP, et al. High prevalence and low awareness of CKD in Taiwan: A study on the relationship between serum creatinine and awareness from a nationally representative survey. Am J Kidney Dis 2006;48:727-38.
McClellan WM, Knight DF, Karp H, Brown WW. Early detection and treatment of renal disease in hospitalized diabetic and hypertensive patients: Important differences between practice and published guidelines. Am J Kidney Dis 1997;29:368-75.
Coresh J, Wei GL, McQuillan G, et al. Prevalence of high blood pressure and elevated serum creatinine level in the United States: Findings from the third National Health and Nutrition Examination Survey (1988-1994). Arch Intern Med 2001;161:1207-16.
McClellan WM, Langston RD, Presley R. Medicare patients with cardiovascular disease have a high prevalence of chronic kidney disease and a high rate of progression to end-stage renal disease. J Am Soc Nephrol 2004; 15:1912-9.
Lin B, Shao L, Luo Q, et al. Prevalence of chronic kidney disease and its association with metabolic diseases: A cross-sectional survey in Zhejiang province, Eastern China. BMC Nephrol 2014;15:36.
Costantini L, Beanlands H, McCay E, Cattran D, Hladunewich M, Francis D. The self-management experience of people with mild to moderate chronic kidney disease. Nephrol Nurs J 2008;35:147-55.
Nugent RA, Fathima SF, Feigl AB, Chyung D. The burden of chronic kidney disease on developing nations: A 21st century challenge in global health. Nephron Clin Pract 2011;118: c269-77.
Laliberté F, Bookhart BK, Vekeman F, et al. Direct all-cause health care costs associated with chronic kidney disease in patients with diabetes and hypertension: A managed care perspective. J Manag Care Pharm 2009;15: 312-22.
Ohta M, Babazono T, Uchigata Y, Iwamoto Y. Comparison of the prevalence of chronic kidney disease in Japanese patients with type 1 and type 2 diabetes. Diabet Med 2010;27: 1017-23.
Al-Aly Z, Zeringue A, Fu J, et al. Rate of kidney function decline associates with mortality. J Am Soc Nephrol 2010;21:1961-9.
Vinhas J, Gardete-Correia L, Boavida JM, et al. Prevalence of chronic kidney disease and associated risk factors, and risk of end-stage renal disease: Data from the PREVADIAB study. Nephron Clin Pract 2011;119:c35-40.
de Boer IH, Astor BC, Kramer H, et al. Lipoprotein abnormalities associated with mild impairment of kidney function in the multiethnic study of atherosclerosis. Clin J Am Soc Nephrol 2008;3:125-32.
Vicari S. Twitter and non-elites: Interpreting power dynamics in the life story of the (#)BRCA twitter stream. Soc Media Soc 2017; 3:2056305117733224.
Flessner MF, Wyatt SB, Akylbekova EL, et al. Prevalence and awareness of CKD among African Americans: The jackson heart study. Am J Kidney Dis 2009;53:238-47.
Hallan SI, Coresh J, Astor BC, et al. International comparison of the relationship of chronic kidney disease prevalence and ESRD risk. J Am Soc Nephrol 2006;17:2275-84.
Coresh J, Selvin E, Stevens LA, et al. Prevalence of chronic kidney disease in the United States. JAMA 2007;298:2038-47.
de Jong PE, van derVelde M, Gansevoort RT, Zoccali C. Screening for chronic kidney disease: Where does Europe go? Clin J Am Soc Nephrol 2008;3:616-23.
Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: A cross-sectional survey. Lancet 2012;379:815-22.
Department of Nephrology, National Guard Hospital, Jeddah
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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