Saudi Journal of Kidney Diseases and Transplantation

CASE REPORT
Year
: 2007  |  Volume : 18  |  Issue : 2  |  Page : 191--194

Epidemiology of Chronic Renal Failure in Iran: A Four Year Single­ Center Experience


Reza Afshar1, Suzan Sanavi2, Javad Salimi3,  
1 Associate Professor of Nephrology, Nephrology Department, Mostafa Khomeini Hospital, Shahed University, Tehran, Iran
2 Internist. Fellowship of Nephrology. Mostafa Khomeini Hospital, Tehran, Iran
3 Assistant Professor of Vascular Surgery, Tehran University, Tehran, Iran

Correspondence Address:
Reza Afshar
Nephrology Department, Mostafa Khomeini Hospital Tehran
Iran

Abstract

Chronic renal failure (CRF) is a major public health problem. Early diagnosis and proper management have important roles in prevention of CRF progression to end-stage renal disease (ESRD). For this purpose, determining the etiology of CRF may be helpful. This study was conducted in the nephrology department at the Mostafa Khomeini Hospital in Tehran, Iran from March 2001 to March 2005, to determine the etiology of CRF in adult Iranian patients. A total of 1200 patients with a diagnosis of CRF were involved in the study. Relevant data were collected using a reliable questionnaire. All data analyses were carried out using SPSS and the χ2 test. Of the 1200 patients, 61% were males and 39% females. The most frequent age group was 61-75 years (38.3%) and the mean age of the study patients was 51.6 ± 17 years. The etiology of CRF in our series included: diabetes mellitus in 26.8%, hypertension in 13.5%, obstructive uropathy in 12%, cystic and congenital disorders in 10.3%, glomerulonephritis in 6.5%, urinary tract infections in 4%, vasculitis in 2%, tubulo-interstitial nephritis and pregnancy related in 0.8% each and unknown causes in 29.5% of the patients. Laboratory and ultrasonographic assessment at initiation of the study revealed blood urea nitrogen >100 mg/dl in 57.8% of the patients, serum creatinine >10 mg/dl in 40.3%, glomerular filtration rate (GFR) <10 ml/min in 61.3%, hemoglobin <10 g/dl in 65.8% and kidney size lesser than 8 cm in 46% of the cases. There was a significant statistical relationship between kidney size and duration of hypertension greater than five years (P = 0.017). The high frequency of CRF of unknown etiology in this study may be attributed to diagnostic limitations prevailing in our country. A GFR of <10 ml/min in 61.3% of the cases at presentation suggests late diagnosis and/or referral. Aggressive screening and treatment strategies to prevent ESRD are recommended.



How to cite this article:
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;18:191-194


How to cite this URL:
Afshar R, Sanavi S, Salimi J. Epidemiology of Chronic Renal Failure in Iran: A Four Year Single­ Center Experience. Saudi J Kidney Dis Transpl [serial online] 2007 [cited 2021 Oct 18 ];18:191-194
Available from: https://www.sjkdt.org/text.asp?2007/18/2/191/32308


Full Text

 Introduction



Chronic renal failure (CRF) is defined by a glomerular filtration rate (GFR) of 2 of body surface area (BSA).[1] It is a worldwide public health problem with enormous financial burden on health-care providers. The spending on dialysis in the United States of America (USA) in 2001 was 22.8 billion US dollars of which 15.4 billion was from the Medicare budget. This represents 6.4% of total Medicare spending.[1],[2]

Early diagnosis and proper management have important roles in prevention of progression of CRF to end-stage renal disease (ESRD).[2],[3] Following acute injury, the kidneys are capable of regaining function, but chronic injuries are usually irreversible, lead­ing to progressive reduction of the renal mass.[4] In fact, CRF is a pathophysiological process with multiple etiologies, resulting in the inexorable attrition of nephron number and function, frequently leading to ESRD. Many of the common causes of CRF including hypertension, urinary tract obstruction and infection are treatable, if diagnosed and managed early.[4] It is well recognized that CRF increases cardiovascular mortality and morbidity, patient disability and Medicare costs.[2],[5] Diabetic nephropathy and hyper­tension are emerging as the most common causes of CRF.[2],[6],[7],[8]

Unfortunately, there are no precise studies of the epidemiology and prevalence of CRF in Iran. Since determination of the etiology of CRF can help in exploring new screening and treatment strategies to prevent ESRD, we undertook this study.[9]

 Patients and Methods



This descriptive study included all patients above 15-years of age who presented to the nephrology department at the Mostafa Khomeini Hospital, Tehran, Iran with a diagnosis of CRF, during the period between March 2001 and March 2005. This center is a general hospital with various sub-specialties, and receives patients from all parts of Iran. A total of 1,200 patients (732 males and 468 females) were seen during the study period, and constituted the study group. Data were collected by using a questionnaire that included age, gender, weight, cause of CRF and its duration, any associated co-morbidity, serum creatinine (Se Cr), blood urea nitrogen (BUN), hemoglobin (Hb) at the diagnosis of CRF, as well as the ultrasonographic finding of the urinary tract. The creatinine clearance was calculated for each patient using the Cockroft-Gault equation, which is as under:

[INLINE:1] Correlation coefficients and the chi-square test were used to determine the statistical significance of the correlation between various variables.

 Results



There were 61% males and 39% females in the study. Their mean age was 51.6 ± 17.8 years. We divided our patients into five age­groups: 15-30 years, 31-45 years, 46-60 years, 61-75 years and 76-90 years and found these frequencies, respectively: 5.8%, 23%, 31.5%, 38.3% and 1.5%. Thus, the most frequent age group we encountered was the 61-75 year group (38.3%). A BUN level >100 mg/dl and Se Cr level >10 mg/dl were seen in 57.8 and 40.3% of patients, respectively. The creatinine clearance was The prevalence of diabetes as the cause of ESRD, as reported in some other studies, is depicted in [Table 1].[2]

[Table 2] shows the causes of renal failure in the dialysis population in the Kingdom of Saudi Arabia.[2] In our study, the causes of CRF were similar in comparison to other studies, although the frequencies varied. We noticed a higher percentage of unknown causes of CRF than others. This may be attributed to late diagnosis and referral as well as diagnostic limitations.

We found that 39.8% (38.3 + 1.5%) of the patients were over the age of 60 years. This finding is similar to other studies [10],[11],[12],[13]. In the USA for instance, the incidence is reported as 200 new cases per million population (PMP) for age range from 20-44 years and 1300 PMP for age range from 66-74 years.[2] In our study group, 61% of patients were male. This predominance of male gender has been well established by all investigators.[14]

 Conclusion



Our study suggests that the prevalence of CRF is high in Iran. Late referral for treatment compounded by delayed diagnosis may be major factors in causing morbidity. It is recommended that at-risk populations should be screened thoroughly and followed-up periodically with appropriate tests.

References

1Daugirdas JT, Blake PG Ing TS. Handbook of dialysis. 3 rd ed. Little Brown, 2001; 1:3-9.
2Shaheen FA, Al-Khader AA. Epidemiology and causes of end stage of renal disease (ESRD). Saudi J Kidney Dis Transpl. 2005; 16(3): 277: 82.
3McClellan WM, Ramirez SP, Jurkovitz C. Screening for chronic kidney disease. J Am Soc Nephrol 2003; 14:S81-7.
4Brenner B. Kidney disease. 7 th ed. Boston, Saunders, 2004, 43:1955-99.
5Go AS, Chertow Gm, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease & the risks of death, cardiovascular events and hospitalization. N Engl J Med 2004; 351:1296-305.
6McDonald SP, Russ GR, Kerr PG, et al. Australia & New Zealand Dialysis and transplant Registry. ESRD in Australia and New Zealand at the end of the millennium: a report from the ANZDATA registry. Am J Kidney Dis 2002; 40: 1122-31.
7Banton EN, Sageant LA, Samuels D, et al. A survey of chronic renal failure in Jamaica, West Indian Medi J 2004; 53:81- 4.
8McClellan WM. Epidemiology and risk factors for chronic kidney disease. Med Clin North Am 2005; 89:419-45.
9Kiberd BA, Clase CM. Cumulative risk for developing end-stage renal disease in the US population. J Am Soc nephrol 2002; 13:1635-44.
10Schrier R. Diseases of kidney & urinary tract. 7 th ed, lippincott williams & wilkins, 2001; 73:2084.
11Al-Rohani M. Renal failure in Yemen. Transplant proc 2004; 36:1777-9.
12Mircescu G. Nephrology and renal replacement therapy in Romania transition still continues. Nephrol Dial transplant 2004; 19:2971-80.
13Khan IH, Thereska N, Barbullushi M, Macleod AM. The epidemiology of CRF and provision of renal services in Albania, Nephrol Dial Transplant 1996;11:1751-4..
14USRDS: the United States Renal Date System. Am J Kidney Dis 2003;42(6) Suppl 5: 1-230.