Prevalence of hypertension and adequacy of its control in chronic kidney disease patients at the renal clinic at Kenyatta National Hospital

Abstract

BACKGROUND Chronic kidney disease (CKD) is a growing problem worldwide. The prevalence in developing world remains largely unknown, but is estimated at about 150 to 200 per million population. It is much higher in developed countries. Sequel of its progression includes end stage renal failure and markedly increased cardiovascular risk .. Control of one of the major risk factors i.e. hypertension has been shown to be feasible in several studies with marked reduction in cardiovascular risk. The adequacy of blood pressure control in CKD patients in our local set up is unknown. OBJECTIVES The broad objective was to determine the prevalence of hypertension and the adequacy of its control in patients with chronic kidney disease in our local set up. Specifically sought to determine the prevalence of hypertension in CKD (chronic kidney disease) patients and the percentage of hypertensive CKD patients who are adequately controlled. Secondary objectives included comparing patients with normal blood pressure vs. those with hypertension by stage or CKD, to determine whether socio demographic factors and patients understanding of their disease had an impact on blood pressure control .The study also sought to determine use of rennin angiotensin aldosterone sympathetic (RAAS) axis modifiers METHODOLOGY Patients were recruited over a 3 month period from January to March 2009. A maximum of 10 patients per clinic visit were seen, every alternate patient was selected. 'Previous urinalysis and creatinine clearance were assessed and potential CKD cases identified. Repeat urinalysis and creatinine was taken on the morning of the clinic. Once CKD criteria was satisfied informed consent was then obtained. Inclusion and exclusion criteria were then applied, patients satisfying inclusion criteria were then recruited. Blood pressures was recorded twice and the average taken. A study questionnaire was then filled. Results 'were recorded and interpreted using MS EXCEL and SPSS version RESULTS The overall prevalence of hypertension amongst patients with CKD was 76%. 16.6% of the patients had achieved target blood pressure. Majority or patients with normal blood pressure were in stage I to 3 of CKD while hypertensive patients were in stage 3 to 5. Socio demographic factors were not found to have a significant impact on blood pressure control. 86.5% of the patients were using RAAS axis modifiers. CONCLUSIONS The vast majority of patients with CKD are hypertensive. Very few achieve target control or their blood pressures.