Prevalence of and factors associated with Chronic Kidney Disease in Osteoarthritis patients at Kenyatta National Hospital

Abstract

Background:Chronic Kidney disease(CKD)is a global health problem with increasingprevalence especially in Sub-Saharan Africa. It has a high morbidity and mortality. CKD and Osteoarthritis (OA)are related as they both increase with age and are associated with comorbidities e.g. hypertension, obesity, dyslipidaemiaand diabetes. However,there is limited evidence on the prevalence of CKD and associated risk factorsamong OA patients.Objectives: Toassessthe prevalence and factors associated withchronic kidney disease in osteoarthritis patients attending rheumatology and orthopaedic clinics in Kenyatta National Hospital.Method: A cross-sectional studywas conducted between November 2019 and January 2020.Patients aged 18 years and above;being followed up in the rheumatology and orthopaedic clinics at KNH with a diagnosis of knee, hip, spine and hand osteoarthritis based on the American College of Rheumatology (ACR)criteriawere included. CKD wasdefined as an estimated Glomerular Filtration (eGFR)of less than or equal to 60ml/min/1.73m2and/or proteinuria of 30mg/dl detected on urinary dipstick for threemonths or more.Descriptivestatisticswereused to describe the participants. The association between participants’ characteristics and CKDprevalence wereassessed using chi-squaretest.Factors associated with CKD among osteoarthritis patientswere analysed using bivariate and multivariable logistic regressions.Findings:The overall prevalence of CKD among patients with osteoarthritis was 61.9%(95 %CI:56.4–66.3)as per eGFR using Cockcroft Gault (CG) formula.Most were in CKD stage 3 at 59.2% with 45.5% in G3a and 13.7% in G3b. 1.1% were in stage 1, 38.3% in stage 2 and1.4% were in CKD stage 4 and 5. Only 12.1% of the respondents had persistent proteinuria and thus most of the patients had low and moderate risk for CKD progression at 38% and 38.2% respectively.Only12.1% and 11.6% had high and very high risk for CKD progression. The CKD prevalence increased with age,being highest amongolder adults (65+ years). Theprevalence was higher among men than women (65.9%, 95% CI: 54.7–75.5vs.60.2%, 95% CI: 54.4–65.7).The factors associated with CKD in OA were old age, hypertension, poor and fairself-rated healthanduse of more than one medication(NSAID/ACEI/ARB)which xiiiincreased the odds of CKD whilemoderatephysical activityand overweight/obesityreducedthe odds of CKD. Conclusion: This study providesevidencethatosteoarthritis is associated with a high prevalence of CKD. However, most of the patients are asymptomatic and in low and moderate risk category based on KDIGO nomenclature. OA patients should be considered a high-risk group for CKD given their older age, chronic use of NSAIDs and high prevalence ofcomorbidities e.g.hypertension, overweight/obesity which are known risk factors for CKD. Screening for CKD in OA patients should therefore be done routinely as is thecase in other high-riskgroupse.g. diabetes