Risk Factors, Prevalence, Severity, and Management of Chronic Kidney Disease among Outpatients in Selected Hospitals in Nairobi City County, Kenya.
Mbithi, Annastacia Nduku
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Chronic kidney disease (CKD) is a worldwide public health issue with high prevalence (8% and 16%) among adults. The risk factors, prevalence, severity and management of CKD are less characterized in Kenya. Therefore, the study aimed at determining risk factors, prevalence, severity and management of CKD among outpatient attendees in selected hospitals in Nairobi County. An analytical cross sectional study design was used. The study was conducted at Kenyatta National Hospital, Aga Khan University Hospital, Nairobi and Mater Misericordiae Hospital among 336 CKD patients and 27 key informants. The sample size in the selected hospitals was obtained proportionately. Adult CKD outpatients aged 18 years and above who attended nephrology clinics between January and July, 2020 were recruited using a simple random sampling. A self-administered questionnaire was used to collect data on social-demographic, risk factors and factors influencing the management of CKD while data on severity and clinical features were retrieved from patients’ files of those who had given an informed consent. Key informant interviews we also conducted among nephrologists and nephrology nurses. Descriptive and inferential statistics were performed using statistical package of social science version 26.0. The qualitative data was analyzed using content analysis. Notably, the study reported a CKD prevalence of 9% among outpatients of selected hospitals. Majority of CKD patients (61.9%) had severe disease. Diabetic nephropathy (OR 3.43, 95% CI; 1.72, 5.67), glomerulonephritis (OR 2.52, 95% CI; 2.07, 4.05), hypertensive nephrosclerosis (OR 1.95, 95% CI; 1.87, 3.11), polycystic kidney disease (OR 1.26, 95% CI; 1.12, 2.61) and systemic lupus erythematosus (OR 1.16, 95% CI; 1.06, 1.39) were independently associated with severe CKD. Also, age (OR 2.73, 95% CI; 1.12, 6.67), sex (OR 2.62, 95% CI; 1.97, 6.05), family history of diabetes (OR 2.52, 95% CI; 1.2,7, 4.30) and hypertension (OR 1.16, 95% CI; 1.04, 1.93), tobacco smoking (OR 2.52, 95% CI; 1.27, 4.30), alcohol use (OR 2.01 95% CI; 1.83, 3.95), herbal medicine use (OR 1.73, 95% CI; 1.32, 2.27), obesity (OR 2.11, 95% CI; 1.52, 3.63), irregular nephrology consultation (OR 1.42, 95% CI; 1.12, 2.01), physical inactivity (OR 2.62, 95% CI; 1.97, 5.73) and poor diet (OR 1.16, 95% CI; 1.09, 2.41) were confirmed as independently associated with severe CKD. Furthermore, social (87%), physical (52%), economic (77%), emotional (46%) and hospital based factors (32%) were identified as the factors that affected provision of care to patients with CKD. Therefore, the patients with these features need proper follow up and treatment to slow down progression of CKD to severe stages. Kenyan Ministry of Health should design policies for early CKD screening on high risk populations, include CKD among the prioritized non communicable diseases and train more nephrology workers.