Prevalence, determinants, and management of chronic kidney disease in Karachi, Pakistan - a community based cross-sectional study

Abstract

BackgroundChronic kidney disease (CKD) is increasing being recognized as a global public health problem. However, there is dearth of information on the prevalence, determinants, and management of CKD from low- and middle-income countries. The objectives of the study were to determine the 1) prevalence of CKD; 2) socio-demographic and clinical factors associated with CKD; and 3) the existing management of these patients with regards to blood pressure control, and use of antihypertensive medications.MethodsWe conducted a cross-sectional study on 2873 participants aged ≥40 years in 12 representative communities in Karachi, Pakistan. The primary outcome was clinically significant CKD defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 estimated by CKD-EPI (CKD Epidemiology Collaboration) Pakistan equation (0.686 × CKD-EPI1.059) or urinary albumin to creatinine ratio ≥3 mg/mmol (i.e. KDOQI CKD stage G3, A2 or worse).ResultsThe overall prevalence (95% CI) of CKD was 12.5% (11.4 – 13.8%). The factors independently associated with CKD were older age, hypertension, diabetes, elevated systolic blood pressure, raised fasting plasma glucose, raised triglycerides, and history of stroke (p < 0.05 for each). About 267 (74.4%, 69.5 – 78.8%) adults with CKD had concomitant hypertension. Of these, 130 (48.7%, 42.6 – 54.9%) were on antihypertensive medications, and less than 20% had their BP controlled to conventional target of ≤140/90 mm Hg, and only 16.9% (12.6 – 21.9%) were on blockers of renin-angiotensin system alone or in combination with other drugs.ConclusionsClinically significant CKD is common among Pakistani adults. The conventional risk factors for CKD and poor control of blood pressure among patients with CKD highlight the need to integrate CKD prevention and management in the primary care infrastructure in Pakistan, and possibly neighbouring countries.

Glomerulonephritis Contributing to Chronic Kidney Disease

“…It is reported to be around 10-15% worldwide, with a sharp increase in Asian countries [2][3][4][5]. CKD is associated with increased mortality, impaired quality of life, and most importantly, increased healthcare expenditures [6][7][8][9][10]. If left untreated, CKD will lead to end-stage renal disease (ESRD) necessitating chronic dialysis or renal transplantation.…”

“…As an example, in a survey of 874 patients with chronic renal failure requiring dialysis, unknown etiology (26.3%) was the most common group [17]. The two most common causes of CKD worldwide are the diabetes mellitus (DM) and hypertension [1][2][3][4][5][6][7][8][9][10]. Glomerular diseases also constitute an important cause of growing epidemic of CKD [17].…”

Doctors’ knowledge and practices regarding chronic kidney disease at a tertiary care hospital

“…According to the Global Burden of Disease Study, CKD was ranked 18 th in the list of causes of total number of global deaths in 2010 [3]. Approximately 12.5% of adults in Pakistan show some evidence of kidney damage and/or reduced kidney function [4]. Identification of CKD requires recognition of individual risk and appropriate laboratory testing [serum creatinine and/or urinary protein] [5], since symptoms generally do not manifest in the earlier stages of CKD.…”

Pill Burden, Drug Class Distribution and Financial Burden for Buying Medicines in Different Modalities of Chronic Kidney Disease Patients: Cross-Sectional Study

“…In India, the prevalence rate of CKD was estimated to be 12.5% [2]. As per global burden of disease study, CKD is estimated to be 12 th among all causes of death and men are more prominently affected.…”