The prevalence of chronic kidney disease and associated factors among patients admitted at Princess Marina Hospital, Gaborone, Botswana

Abstract

Background: Chronic kidney disease (CKD) has become a major public health problem worldwide. Due to the asymptomatic nature of CKD during earlier stages, patients tend to present late, missing opportunities for prevention. Aims: This study was conducted to determine the prevalence and assess the risk factors associated with CKD in patients admitted at Princes Marina Hospital. Settings and Design: Hospital inpatient setting. Subjects and Methods: A case-matched comparison study was done involving 86 cases and 86 matches by gender and age (± 5 years) from March 21, 2014, to May 31, 2014. Statistical Analysis Used: SPSS software version 20 (SPSS Inc. Chicago Illinois) was used for data entry, cleaning, and analysis. Frequency, percentage, mean, and standard deviation were used to describe the data. Chi-squared test and odds ratio (OR) with 95% confidence interval (CI) were employed to analyze the associations of categorical variables. Logistic regression analysis was done to control for possible confounding variables. A P < 0.05 was considered statistically significant. Results: In the study period, CKD prevalence was 74/550 (13.5%), and 23/99 (23.2%) of mortality occurred in patients with CKD. Over half of the 86 cases of CKD (53.5%) were not aware of their CKD status and were diagnosed during the index admission. Hypertension (HTN), diabetes mellitus, and HIV-positive status were significantly associated (P < 0.05) with CKD in the bivariate analysis, while HTN (adjusted OR [AOR] [95% CI]: 11.28 [4.56, 27.89]) and HIV-positive status (AOR [95% CI]: 8.68 [3.58, 20.99]) remained significant predictors of CKD in the multivariate analysis. CKD within the HIV-positive patients was significantly associated with duration of <3 years since HIV diagnosis and lower CD4 levels (P < 0.05). Conclusions: Significant admissions and mortality in medical wards are attributed to renal impairment. There is an urgent need to establish follow-up programs in high-risk populations (hypertensives, diabetes, and HIV) which aims to identify patients at early stages of CKD, and devise prevention mechanisms to reduce burden in terms of cost, morbidity, and mortality.