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.