Prevalence and factors associated with late presentation of patients with chronic kidney Disease to nephrologists at Kenyatta national hospital renal clinic
Abstract
Background: Chronic kidney disease (CKD) is currently a global
problem. late presentation and referral of CKD patients for renal services
comes with deleterious economic and medical consequences due of the
substantial proportion of patients with end stage renal disease (ESRD)
requiring renal replacement therapy (RRT).
Objective: The aim of the study was to determine the prevalence of late
presentation of CKD patients to nephrologists at Kenyatta National
Hospital (KNH) and the factors associated with the late presentation.
Design and seHing: The study was a cross sectional descriptive survey
carried out at the KNHrenal clinic.
Patients and methods: Patients on first referral visit to the nephrologist
were screened for eligibility and recruited upon signing an informed
consent. Patients' socio-demographics, clinical information and physical
examination findings were captured in a study proforma. Investigations
done included serum urea, creatinine, dipstick urinalysis and microscopy
of urine. Glomerular filtration rate (GFR) estimated using the cockroft and
Gault formula. CKD patients were staged according to the Kidney
Disease Outcomes Quality Initiative (K/DOQI) staging criteria. A qualitative
interview of 2 0 CKD in stages 4 &5 was carried out to determine reason
contributing to the late presentation.
Results: 104 patients on first visit to the nephrologist were recruited. 97
patients had evidence of CKD and were therefore the subjects of the
study. 52 {53.6%Jwere males and 45 (46.4%) were females with an age
range of 18 to 88 years and a mean of 48.01 years (± 15.34). There was no
significant difference in the mean ages between early and late
presentation groups. The prevalence of late presentation of CKD patients
in stages 4 &5 was 43.3%. Patients residing outside Nairobi were much more likely to present late to
the nephrologist (OR 3.1, 95% CI 1.1-8.5, p=O.037). The likely reasons for late
presentation of CKD patients was lack of awareness of the presence of
kidney disease, lack of information on the seriousness of the disease prior
to referral, lack of money to meet their health needs and use of
alternative treatment. On average it took about 34 days for the patient to
be seen by a nephrologist from the time of referral by the primary care
provider. However this time lag was not significantly different between the
CKD patients who presented early and those that presented late. There
was no significant association between the late presentation of CKD
patients with either the referring heath care provider or health facility.
Conclusions: Similar to the current trend world wide, late presentation of
patients with CKD to nephrologists at KNH renal clinic is high. However,
majority of our patients presenting late are relatively young and came
from mainly the rural parts of the country. The lack of disease awareness
and financial difficulties due to poverty largely contribute to the late
presentation of CKD patients unlike in the West where late referral is
common among the elderly and those without adequate medical
insurance cover.