Knowledge, attitudes and practices on measures to retard disease progression among chronic kidney disease patients at Kenyatta National Hospital
Background: Chronic Kidney Disease (CKD) is a global public health problem and is considered a worldwide epidemic. There is an increase in the incidence and prevalence of CKD in developing countries. CKD is associated with significant morbidity and decreased life expectancy. Educational interventions aimed at empowering patients are successful in CKD management and they prolong time to end stage renal disease (ESRD) and impact on the choice of renal replacement therapy. There are evidence based measures that retard the progression of CKD and knowledge acquisition of these measures by patients prolongs time to renal replacement therapy. Objective: The aim of the study was to determine the knowledge, attitudes and practices on measures to retard disease progression among CKD patients at KNH. Design and setting: This was a cross sectional descriptive survey carried out at the KNH renal clinic. Patients and methods: Patients with CKD on follow up in the KNH renal clinic for 3 months or more and with an estimated glomerular filtration rate of < 60ml/minl1.73 m2 were screened for eligibility and recruited upon signing an informed consent. Patients' socio-demographics, clinical information and weight were captured in a study proforma. Investigations done included serum urea and creatinine. Glomerular filtration rate was estimated using the corrected Cockroft and Gault formula. CKD patients were staged according to the Kidney Disease Outcomes Quality Initiative (KlDOQI) staging criteria. A pretested and semi-structured knowledge, attitude and practice questionnaire containing open and closed ended questions was used to collect data. Results: 110 patients with CKD were recruited into the study. There were 66 males (60%) and 44 females (40%) with a male to female ratio of 1.5:1. The age range was 18 to 80 years with a mean of 54.75 years. When patients were asked to rate their level of knowledge on etiology, symptoms, progression and treatment of CKD, 70.9 % reported having very little! no knowledge. Regarding the measures that retard the progression of cm, 70'/0 had not been infonned of these measures by a health worker. Majority thought that compliance to medication (40%) and eating a healthy diet (37.3%) would retard the progression of CKD. Twenty four point five percent mentioned prayers and 19.1% mentioned leading a stress free life. Regarding the well studied measures 35.5% mentioned blood pressure control, 12.7% mentioned blood glucose control. Very few mentioned dietary protein restriction (5.5%), smoking cessation (2.7%) and proteinuria control (0.9%). None of the patients mentioned prevention of hyperphosphatemia and correction of anemia. Majority (75.5%) thought that CKD was likely to regress with most of the study Participants (70.0%) being courageous lunafraid about their illness. Majority (87.3%) had infonned their family members! friends about their kidney disease with most (84.5%) keeping their clinic appointments as required. More than half (55.5%) were not seeking explanation from the doctors about the blood and urine tests that are routinely done for all patients. Sixty four point five percent of the patients were adherent to medication with only 16.4% Using non-prescription medication. Regarding practices, majority of the study Participants (89.1 %) were not smoking. A significant proportion (82.7%) had reduced their saIt intake with a similar proportion doing regular exercises. Only half of the study participants had reduced their protein intake. Younger patients were knowledgeable compared to the older patients and the difference was statistically significant (P=O.004).Patients with medical insurance were also knowledgeable compared to those without (P=0.017).A longer duration of follow up was associated with knowledge on CKD (P=0.004). We did not find a significant association between the attitudes and practices sought for with age, gender, level of education, medical insurance status, duration of follow up and stage of CKD. From the qualitative data, the need for health education Was the main recurring theme mentioned by the study participants. Conclusion: This study demonstrated that the majority of the patients had limited knowledge on the etiology, symptoms, progression and measures to retard progression of CKD. The qualitative arm of the study demonstrated the need for a health education programme for CKD patients at the KNH renal clinic.