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Epidemiology of chronic kidney disease in a Pakistani population

Saudi J Kidney Dis Transpl 2015;26(6):1307-1310
© 2015 Saudi Center for Organ Transplantation
Letter to the Editor
Epidemiology of Chronic Kidney Disease in a Pakistani Population
To the Editor,
Chronic kidney disease (CKD) is progres-
sively increasing in south Asian countries like
Pakistan, and the reason for this spread is
multi-factorial. Most of the people have inade-
quate health-care provision due to either lack
of health education, lack of primary health-
care, inadequate funding on the part of the
government and, most importantly, the increa-
sing prevalence of risk factors for CKD such
as diabetes and hypertension.1 In addition,
other causes like glomerulonephritis and renal
stones are prevalent due to infections and dry
weather conditions.
Lack of a central registry makes epidemio-
logical assessment extremely difficult and in-
adequate in Pakistan. Most of the data regarding
disease burden estimates are mostly center-
based. Our nephrology unit, which is part of a
large tertiary care hospital, the Pakistan
Institute of Medical Sciences, Islamabad caters
to a large population in the region. The ave-
rage population served by this center is large
and the catchment area includes a vast area of
Punjab, Khyber and Kashmir (the three pro-
vinces). We have a separate dedicated CKD
This study evaluates the etiology of CKD
among patients presenting at our center.
This was a cross-sectional study of four
months duration conducted in the Nephrology
Department of the Pakistan Institute of Medical
Sciences, Islamabad from September till
December of 2013.
A case record form was used to record demo-
graphic details, stage of renal disease and pos-
sible etiology of patients with established CKD.
The data was obtained from patient interviews,
diagnosis charts and case records, ultrasound
scan reports and renal biopsy findings.
We included all patients with a diagnosis of
established CKD who visited our outpatient
department or were admitted in our ward
during the study duration. The possible cause
of CKD was evaluated as follows. A diagnosis
of diabetic nephropathy was established based
on the presence of confirmed diabetes mellitus
and one of the following criteria: Long-
standing diabetes preceding CKD (minimum
of 10 years), normal-sized kidneys on ultra-
sound or presence of established diabetic
retinopathy by fundoscopy. CKD due to
hypertension was established based on history
of hypertension (minimum of five years) pre-
ceding renal dysfunction, evidence of hyper-
tension-related end-organ damage and exclu-
sion of other renal diseases.
A diagnosis of chronic tubulo-interstitial di-
sease was made based on history of polyuria,
nocturia with low-specific gravity of urine and
low or normal blood pressure associated with
small kidneys on ultrasound.
The other etiologies of CKD were determined
based on renal biopsy and ultrasound findings.
The stage of CKD was established by recor-
ding the most recent (within the last three
months) eGFR according to the (Modification
of Diet in Renal Disease (MDRD) equation.
Reports from Pakistan have shown that eGFR
measured by the Cockcroft Gault or MDRD
formula is a better predictor of reduced GFR
Saudi Journal
of Kidney Diseases
and Transplantation
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than serum creatinine alone in the Pakistani
population.1CKD staging was performed
according to the Kidney Disease Outcomes
Quality Initiative (K/DOQI) guidelines.
Informed consent was obtained from every
individual studied. Ethical approval was ob-
tained from the Ethics Review Committee of
the Pakistan Institute of Medical Sciences,
Study data were analyzed using SPSS version
A total of 520 patients were initially included
in the study, with a male to female ratio of 1:1
(100:100). A total of 500 patients were con-
sidered for final analysis based on data ade-
quacy. The mean age of the population was
46.3 years, with the minimum age being 20
years and the maximum being 83 years.
Common causes of CKD identified in these
patients included diabetic nephropathy (140,
28%), glomerulonephritis (110, 22%), hyper-
tension (73, 14.6%), tubulo-interstitial disease
(67, 13.4%) and renal stone disease (40, 8%).
The cause was unknown in a significant per-
centage of patients (53, 10.6%). Other causes
including post-partum renal failure, which
constituted 2% of the cases (Table 1).
The majority of patients were in end-stage
renal failure at presentation (93%). Stages 3
and 4 constituted a minority (2% and 5%, res-
pectively) (Table 2). In 20% of the patients, a
diagnosis of acute on CKD, mostly due to
drugs, was made.
A total of 268 patients were below the age of
50 years. The common etiology of CKD in this
age-group included glomerulonephritis (33.2%),
diabetic nephropathy (17.9%), tubulo-inters-
titial disease (10%) and renal stone disease
(13.8%). The patients who had CKD of un-
known cause comprised 12.31%.
Among the 232 patients who were ≥50 years,
the following causes of CKD were identified:
diabetic nephropathy (39.6%), hypertension
(19.8%), renal stone disease (12.9%), tubulo-
interstitial disease (5.6%) and adult polycystic
kidney disease (3%). Only 8.6% of patients in
this age-group had CKD of unknown etiology
(Table 3).
CKD is a worldwide public health issue, the
incidence and prevalence of which are increa-
sing, resulting in high cost and poor out-
comes.1In the United States, the prevalence of
earlier stages of CKD is approximately 100-
times greater than the prevalence of kidney
failure, affecting almost 11% of adults in the
United States.2,3 The situation is probably the
reverse in developing countries, where late
presentation is more common.4
CKD is defined as abnormalities of kidney
structure or function, present for at least three
Table 1. Etiology of chronic kidney disease in the study patients.
Number of subjects
Diabetic nephropathy
Tubulo-interstitial nephritis
Unknown cause
Renal stone disease
Adult polycystic kidney disease
Other causes
Table 2. Stages of chronic kidney disease at presentation.
Acute on chronic
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months,5 and representative estimates of the
burden of CKD in most developing countries
are lacking.3No data regarding the epidemio-
logical pattern have been reported from our
catchment area, and this justifies our study.
It is estimated that the annual incidence of
new cases of end-stage renal disease (ESRD)
is >100 per million population in Pakistan.3,6
In our study, diabetes was the leading cause of
CKD, confirming previous results from Pakis-
tan.4These results are also consistent with
those reported from Western countries. Accor-
ding to the United States Renal Data System
(USRDS), diabetes is the leading cause of
ESRD (42.9%).3The prevalence of diabetes in
countries of the Indian subcontinent is higher
than that reported in Western countries, and is
expected to multiply over the next two
Glomerulonephritis remains the second lea-
ding cause of CKD, which probably reflects
the high prevalence of infections in our
society. Studies from Karachi have reported
chronic glomerulonephritis as the leading
cause of ESRD in dialysis patients, indicating
the high prevalence of infections in the com-
Studies from India have shown that chronic
glomerulonephritis (37%) is the most common
cause of ESRD in their population, followed
by diabetic nephropathy (14%) and chronic
tubulo-interstitial disease.10 Another study from
India reported chronic glomerulonephritis as
the prime cause of CKD (49.4%), followed by
diabetic nephropathy (28.4%).11
Hypertension represents the third major
cause. In our setup, hypertension largely
remains unrecognized and untreated due to the
asymptomatic nature of the disease and lack of
regular health checkup thus leading to com-
plications like CKD.
Tubulo-interstitial disease remains one of the
leading causes (13.4%) in our study, probably
reflecting misuse of analgesics and herbal
In a significant number of patients (10.6%),
the cause of renal failure was not known.
These patients mostly included those who pre-
sented very late or those in whom multiple
disorders co-existed and thus the cause could
not be ascertained.
Limitations of the study
Because of the cross-sectional study design,
the results cannot be generalized to the whole
country. Furthermore, most of the patients pre-
sented with advanced stages of CKD and
biopsy was not possible. The cause was ascer-
tained from the remaining available data, and
this may result in misclassification of etiology
in a few patients.
Conflict of interest: None declared.
Dr. Kifayat Ullah,
Dr. Ghias Butt,
Dr. Imtiaz Masroor,
Dr. Kinza Kanwal,
Dr. Farina Kifayat
Department of Nephrology, Pakistan Institute
of Medical Sciences, Islamabad, Pakistan
Table 3. Age-related prevalence of chronic kidney disease in the study patients.
Age <50 years (total 268)
Age >50 years (total 232)
Diabetic nephropathy
48 (17.9%)
92 (39.6%)
27 (10.07%)
46 (19.8%)
89 (33.20%)
21 (9.05%)
Adult polycystic kidney disease
7 (3%)
Renal stone disease
37 (13.80%)
30 (12.9%)
Tubulo-interstitial disease
27 (10.07%)
13 (5.60)
Unknown cause
33 (12.31%)
20 (8.6%)
7 (2.6%)
3 (1.2%)
Letter to the Editor 1309
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1. Jafar TH. The growing burden of chronic
kidney disease in Pakistan. N Engl J Med
2. Kidney Disease Outcomes Quality Initiative
(K/DOQI). K/DOQI clinical practice guide-
lines on hypertension and antihyper-tensive
agents in chronic kidney disease. Am J Kidney
Dis 2004;43 5 Suppl 1:S1-290.
3. National Kidney Foundation. K/DOQI clinical
practice guidelines for chronic kidney disease:
Evaluation, classification, and stratification.
Am J Kidney Dis 2002; 39 2 Suppl 1:S1-266.
4. US Renal Data System: USRDS. 2000 Annual
Data Report. Bethesda, MD: National Insti-
tutes of Health, National Institute of Diabetes
and Digestive and Kidney Diseases; 2000.
5. Rizvi SA, Manzoor K. Causes of chronic renal
failure in Pakistan: A single large center
experience. Saudi J Kidney Dis Transpl
6. Jafar TH, Hatcher J, Chaturvedi N, Levey AS.
Prevalence of reduced estimated GFR (eGFR)
in Indo Asian population. J Am Soc Nephrol
7. Jafar TH, Schmid CH, Levey AS. Serum
creatinine as marker of kidney function in
South Asians: A study of reduced GFR in
adults in Pakistan. J Am Soc Nephrol 2005;16:
8. Rizvi SA, Anwar Naqvi SA. Renal replace-
ment therapy in Pakistan. Saudi J Kidney Dis
Transpl 1996;7:404-8.
9. Kumar H, Alam F, Naqvi SA. Experience of
haemodialysis at the kidney centre. J Pak Med
Assoc 1992;42:234-6.
10. Chugh KS. Renal disease in India. Am J
Kidney Dis 1998;31:Ivii-Iix.
11. Agarwal SK, Dash SC. Spectrum of renal
diseases in Indian adults. J Assoc Physicians
India 2000;48:594-600.
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... 5 Therefore patients suffering from T2DM should be actively searched for the presence of CKD and its risk factors. 6 Studies in Pakistan mostly focused on microalbuminuria as a manifestation of diabetic kidney disease. An estimated prevalence of diabetic nephropathy is 28% in our country. ...
... An estimated prevalence of diabetic nephropathy is 28% in our country. 6,7 However, data on the extent of this problem in our patients are still being determined. This study aimed to determine the frequency of CKD based on estimated GFR values in patients with T2DM and to determine associated risk factors in patients attending a tertiary care hospital in Pakistan. ...
Objective: To determine the frequency of chronic kidney disease and its associated risk factors in patients with type 2 Diabetes Mellitus. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital Malir Cantt, Karachi, from Jan to Jun 2019. Methodology: A total of 203 adult patients with Type 2 Diabetes Mellitus were included in the study after taking informed consent on the justification of inclusion/exclusion criteria. The estimated Glomerular filtration rate was calculated for each patient using Creatinine based chronic kidney disease epidemiology collaboration (CKD-EPI) equation. Chronic kidney disease was defined as decreased glomerular filtration rate of <60 mL/min per 1.73m2. In addition, risk factors for developing chronic kidney disease, including Body Mass Index and blood pressure, were clinically determined. Results: Out of 203 patients with type 2 diabetes mellitus, 65(32%) had Chronic kidney disease. Most of them, 34(52.30%), were in Chronic kidney disease stage 3, while 21(32.30%) were in stages 4 and 10(15.40%) were having stage 5. Increasing age, smoking, female gender and higher body mass index were positively correlated with the development of chronic kidney disease in diabetes patients. Conclusion: Chronic kidney disease is a frequently observed complication in diabetes patients. Early detection and appropriate treatment can help in retarding progression to advanced stages of chronic kidney disease. Regular screening of diabetes patients for chronic kidney disease and associated risk factors is therefore recommended.
... The study found kidney stone disease and CKDu to be the most prevalent cause of renal failure, which is somewhat similar to the studies done almost three decades ago. 17,18 However, recent urban data has reported different results, 10,18,19 suggesting that chronic glomerulonephritis, diabetic nephropathy (DNP) were the major causes of ESRD ahead of CKDu and kidney stone. DM has emerged as the leading cause of CKD in recent times which might be explained by the rapid urbanisation in the last few decades in Pakistan. ...
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Objective: To evaluate the epidemiology of chronic kidney disease in a rural setting. Methods: The retrospective study was conducted at Indus Hospital, Badin, Sindh, Pakistan, and comprised data of patients of either gender regardless of age who visited the nephrology clinic between July 2019 and July 2020. Data was retrieved from the institutional health management information system. Data was analysed using SPSS 21. Results: Of the 348 patients, 184(52.9%) were males and 164(47.1%) were females. The overall mean age was 40.4±19 years. Obstructive nephropathy was the most frequent cause of chronic kidney disease 108(31%), followed by chronic kidney disease of unknown aetiology 79(22.7%). The most prevalent comorbid was hypertension in 106(30.5%) patients, while 56(16.1%) were diabetic. The stone disease was found in 90(24.6%) patients. Age was strongly associated with chronic kidney disease (p<0.001). Among those with chronic kidney disease of unknown aetiology, 35(44.3%) patients were aged 31-50 years 35. The expected glomerular filtration rate in such patients was significantly associated with the cause of chronic kidney disease (p<0.001). Conclusion: Unknown aetiology and kidney stones were the leading causes of chronic kidney disease among the rural population studied.
... The annual incidence of new end-stage renal disease (ESRD) cases in Pakistan is estimated at >100 per million population. 1 Haemodialysis remains the most prevalent modality for renal replacement therapy, with only a small percentage getting a renal transplant and just a handful of patients treated with peritoneal dialysis. Hemodialysis techniques have continued to evolve. ...
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Objective: To compare the loss of proteins with high and low flux hemodialysis membranes. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Nephrology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Nov 2019 to Feb 2020. Methodology: This study was conducted on patients with end-stage renal disease on maintenance haemodialysis. We excluded patients on haemodialysis for less than one month, those with poor compliance to hemodialysis, those undergoing hemodialysis for less than four hours per session and unwilling patients. Patients were divided into two groups: one was dialyzed with high flux membranes, whereas low flux membranes were used for the other group. Dialysate samples were collected during the first hour and then during the last hour of each haemodialysis session to estimate protein losses in each group. Results: Data were recorded during 133 hemodialysis sessions, the patients underwent. There were 22 patients, including 12 (54.55%) males, having a mean age of 46.45±13.99 years. Most patients (17, 77.27%) were on twice-a-week dialysis, whereas the rest were dialyzed thrice weekly. Protein loss was 0.45± 0.23g/L with low flux membranes and 1.20±0.60g/L with high flux membranes. This difference was statistically significant (p
... [15] The use of olive oil has also improved renal histoarchitecture including glomerular fragmentation, enlargement of Bowman's space, hemorrhage, infiltration of leukocytes, and tubular dilation caused by acrylamide [16] based on its properties, olive oil may be effective in protecting kidneys from arsenic-induced histological changes. In Pakistan, epidemiological data show that CKD is progressively increasing due to arsenic use [17] while its awareness is very poor among common as well as medical officers and pg trainees. [18] The objective of our study is to determine the association of high levels of arsenic in the body with kidney damage and also find out the ameliorative effect of EVOO. ...
... The studies, which were done to evaluate the epidemiology of CKD in Pakistan Age-specific prevalence was only measured by Alam et al and their study showed the highest prevalence among elderly patients more than 50 years of age (43.6%) on the other hand the lowest prevalence among comparatively younger participants aged less than 30 years (10.5%).Table 1.Gender-specific prevalence was reported by all four studies. Jessani et al and Jafar et al reported a higher prevalence in females, contrary to it Alam et al and Imran et al found men suffered more from CKD.CKD causesAfter completing the search, we found five studies on the causes of CKD in Pakistan(15)(16)(17)(18)(19), we added one study under peer review done at District Badin an area of rural Sind(Table 1). All the studies were done in urban Sind except the study done by Shahnawaz et al which was done at District Badin (rural Sind) adjacent to the Thar Desert area. ...
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Background: CKD is spreading like an epidemic. There is a dire need to understand the true prevalence as well as the causes of CKD in both urban and rural areas of Pakistan in relevance to age and gender. In this background, there is a need to know what has been done so far to understand the status of CKD in Pakistan. Materials and Methods: We selected the articles published through PubMed and Google scholar and the following keyword were used, epidemiology, demography, prevalence, chronic kidney disease, chronic renal insufficiency, etiology, and causes of CKD, Pakistan. We found four articles that evaluated the prevalence and five articles that dealt with the causes of CKD. We included all articles in our analysis. Results: The overall prevalence among all age groups was found to be 21.2%. The highest CKD prevalence was reported as 29.9% and the lowest at 12.5%. The highest prevalence was found in patients more than 50 years of age (43.6%). Two studies showed male predominance (62% and 54.4%), while two showed a female majority (64%,52%). The most common cause of CKD was found to be Diabetic nephropathy (27.1%), followed by CKD of unknown etiology (16.6%) and renal stone disease (12.4%) Conclusion: The prevalence of CKD is high, especially in the older population. Similarly, the leading causes of CKD are also different in all studies due to center dependence, hospital-specific and urban locations. DM, CKDu, and renal stone disease are common causes of CKD Keywords: Pakistan, chronic kidney disease, prevalence, epidemiology
... KIOQI recommendations for targeted serum iPTH levels according to CKD stages are as follows: in stage 3, the serum iPTH level should be within the range of 35 to 70 pg/mL, in stage 4, serum iPTH lies between 70 and 110 pg/mL, and in stage 5 or ESRD, serum iPTH should be between 150 and 300 pg/mL [11,14]. In Pakistan, CKD afects 21.2% of the population [15], and a potential predictor >100 per million population of Pakistan annually undergoes ESRD [16]. Published studies have reported the association of anemia with hyperparathyroidism in MHD patients. ...
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End-stage renal disease (ESRD) patients are mostly managed with maintenance hemodialysis (MHD). ESRD patients on MHD also present with many complications, such as anemia, hyperparathyroidism, and hepatitis prevalence. This study depicts the real-world scenario of anemia among MHD and end-stage renal disease patients in the Pakistani population. A retrospective, multicentric, and real-world data analytical study was conducted at 4 dialysis centers in Pakistan. The study had a sample size of n = 342 patients on maintenance hemodialysis. The data were gathered from the medical records of patients. Data analysis was performed using STATA Version 16. Statistical significance was gauged at a 0.05 level of significance. According to our results, the mean age of the patients was 45 (±15) years. Most of the patients were male (n = 234, 68.4%), whereas 58.1% of the patients were maintained on twice-weekly hemodialysis. The most commonly reported comorbidities were hypertension and diabetes mellitus. The frequency of dialysis ( P < 0.01) and comorbidities ( P = 0.009) had a significant association with anemia in MHD patients. The majority of the patients had hyperparathyroidism (52%) with anemia. Upon performing binary logistic regression, multivariate analysis displayed a similar odds value for having anemia in patients with every additional month in the duration of hemodialysis (OR 1.01, P = 0.001), the odds of anemic patients having a positive antihepatitis-C antibody (OR 2.22, P = 0.013), and the odds of having anemia in patients in the age category below 45 years (OR 1.93, P = 0.013). In conclusion, the study results depict that every additional month in the duration of hemodialysis, age (<45 years), and positive anti-HCV antibody status, these variables were more likely to have anemia in our study MHD patients. While in our final multivariate model, no statistically significant association was observed between hyperparathyroidism and anemia.
... Kidney failure in Pakistan is a disease of the young; the mean age of individuals with advanced CKD is 42 years, compared with 63 years in the United States. 1 Much of the elevated CKD incidence has been attributed to the high prevalence of underlying comorbid conditions such as diabetes and hypertension and underdeveloped health care infrastructure as a result of low government budgetary allocations for health care, leading to underdeveloped primary health care facilities, limited access to subspeciality care, and high costs of kidney replacement therapy treatment for patients. 2,3 As a result, many people receive late or no CKD care and counseling. 4 Survey-based studies surrounding dialysis decision making in Pakistani individuals receiving dialysis have indicated that Pakistani individuals report inadequate predialysis conversations, and a majority regret their decision for dialysis. ...
Aim: To determine the quality of life (QOL) of renal failure patients on maintenance hemodialysis on the basis of their baseline characteristics in Lahore, Pakistan. Study design: A cross sectional study was carried out with two hundred and ten patients selected randomly from dialysis centers in General, Mayo and Jinnah hospitals, Lahore Pakistan, to measure and analyze the QOL of hemodialysis patients by pre-validated KDQOL-SFTM version 1.3 in English language. Methodology: Interviews of the patients were performed to collect data. SF-36 items mean and standard deviation were performed to analyze data on the basis of gender and age groups. Results: Among the eleven scales targeting End-Stage Renal Disease (ESRD), only the "Effects of Kidney Disease" scale demonstrates a greater impact on males than females. However, three scales including Symptom/Problem list, Quality of Social Interaction, and Dialysis Staff Encouragement show suboptimal results in young patients. Similarly, two of the seven health-related outcome scales, Physical Functioning and Energy Fatigue, exhibit poor outcomes in young patients. Conclusion: Major cause of their kidney disease was hypertension and diabetes. Overall, less number of prescribed medications, decreased hospitalization and reduced hospital visits are the factors showing overall better quality of life.This study helps us understand the impacts of kidney disease on different genders and age groups, guiding the development of personalized care plans. Keywords: Quality of life (QOL), End stage renal disease ESRD, hemodialysis, KDQOL-SFTM version 1.3
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Objective: To determine the frequency of skin manifestations found in end-stage renal disease (ESRD) patients undergoing dialysis, while assessing their effect on the quality of lives of the same patients. Study design: Descriptive cross-sectional study. Place and Duration of the Study: Benazir Bhutto Hospital, Holy Family Hospital, and Hussain Lakhani Hospital, from 12th December 2021 to 13th October 2022. Methodology: Seventy-three Patients undergoing hemodialysis were enrolled in the study. Skin manifestations were defined as "cutaneous signs and symptoms related to ESRD unrelated to the symptoms resulting from any primary dermatological disorder or other systemic diseases". Data on the skin manifestations of their disease and their effect on patients' quality of life were collected by using a 2-part questionnaire. The first part consisted of demographic details along with the type of skin disorders faced by the patient and the second part of the questionnaire comprised of the dermatology life quality index (DLQI). The data were entered and analysed using the statistical package for social sciences (SPSS) version 23.0. Results: Xerosis and pruritus were most commonly reported (83.7%), followed by nail changes (18.6%) and skin discolouration (16.3%). The median duration of dialysis was 36 (1-180) months and there was no significant increase in skin symptoms with the increase in the duration of dialysis (p=0.082). The median DLQI score was 3 (range:0-10) A significantly higher number of females (n=14) reported associated mental discomfort with their skin symptoms of pruritis as compared to males (n=5, p=0.008). Conclusion: Cutaneous manifestations have variable effects on the quality of life of ESRD patients. Adopting a multidisciplinary approach early in the management may help to minimise the mental discomfort of these patients and bring an improvement in their quality of life. Key words: End-stage renal disease (ESRD), Hemodialysis, Skin manifestations, Pruritus, Quality of life.
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OBJECTIVES Kidney transplantation is a surgical procedure and the best treatment choice for end-stage renal disease. This study aims to assess nurses’ level of knowledge regarding post-operative care of patients with kidney transplantation. METHODOLOGY This descriptive cross-sectional was carried out in Hayatabad Medical Complex (HMC) and Rehman Medical Institute (RMI) Peshawar from February 2019 to May 2019. These are tertiary care hospitals; the former is a public sector hospital while the latter is a private sector hospital. A convenient sampling technique was followed and included 109 participants. Data were collected using a structured questionnaire of 25 items related to the care of post-renal transplantation on a Likert Scale. Frequencies and percentages were calculated for demographic variables. The Mean and standard deviation were calculated for knowledge among nurses. A Chi-square test was applied to find an association between demographic variables and level of knowledge. Data were analyzed with SPSS 20. RESULTS Of the total number of participants 109, 23 (26.6%) were females, and 77 (73.3%) were male. The mean score of knowledge was 11.59±3.391 out of 25. Of the participants, 62(56.9%) fell into the poor score, and the average score was awarded by 44 (40.4%), while 3 participants (2.8%) scored good knowledge. CONCLUSION The nurses demonstrate poor knowledge regarding post-operative care of patients with kidney transplantation. Education and experience play an essential role in enhancing the education of nursing staff working in kidney transplantation units. Formal training needs to be imparted to provide quality care to renal transplantation patients.
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Migrant populations of South Asian origin have a higher risk for chronic kidney disease than the native whites. Several formulas have been developed to estimate kidney function from serum creatinine concentration. However, none of these has been validated in the South Asian population, which generally has different muscle mass composition than whites. A population-based cross-sectional study was performed on 262 individuals who were aged > or = 40 yr in Karachi, Pakistan. Reduced GFR was defined as creatinine clearance (Ccr) measured in 24-h urine collection of <60 ml/min per 1.73 m2. Creatinine excretion was compared with age- and gender-matched white individuals by comparison of observed versus expected results on the basis of a formula using t test. The agreement among Cockcroft Gault (CG) Ccr and Modification of Diet in Renal Disease (MDRD) Study GFR equations was assessed by regression analyses, and the degree of accuracy of estimated versus measured GFR was determined. Mean (95% confidence interval) creatinine excretion was 1.7 (1.0 to 2.4) mg/kg per d lower than expected for age- and gender-matched white individuals (P < 0.001). The coefficient of determination for measured Ccr on the logarithmic scale was 66.7 and 55.6% for the CG and MDRD Study equations, respectively. The proportion of estimates within 20, 30, and 50% of measured Ccr values was 47.7 versus 32.8% (P < 0.001), 64.9 versus 49.6% (P < 0.001), and 79.4 versus 72.9 (P = 0.07) for CG versus MDRD Study equations, respectively. Lower mean creatinine excretion in these individuals may explain, in part, suboptimal agreement between estimated versus measured GFR. Inclusion of terms for ethnic and racial groups other than white and black might improve the performance of GFR estimating equations.
Seventy-nine patients of end stage renal disease (ESRD) on maintenance haemodialysis were studied. Most of the cases were in their prime of life. The disease was equally common in both sexes and all ethnic groups. Chronic glomerulonephritis was the commonest cause followed by diabetes mellitus. Hypertension was the commonest associated illness. All patients were screened for hepatitis B surface antigen and antibody and those found negative were vaccinated. A-V fistula in the upper extremity was used as the vascular access in 93% cases. In 68% cases dialyzer was reused without any ill effect. Amongst the complications observed, hypotension was seen in 65%, psychological disorders in 52%, followed by nausea, vomiting, itching and cramps. Technical complications were related to A-V fistula in 45% cases. Forty three percent patients were maintained without blood transfusion and 88% showed improvement in their quality of life.
Inspite of nephrology as a specialty since seventies, there is still paucity of data regarding the spectrum of renal diseases in India. Available literature from few hospitals shows data on specific clinical syndrome of renal diseases or specific renal diseases rather than the overall spectrum as a whole. This information will be useful for better resource management. We studied spectrum of renal diseases among 14,796 patients presenting for the first time to nephrology outpatients between January 1987 to Oct. 1998. Majority of patients in our clinic were adults. Patients 14 years or below who mostly attend pediatric renal unit of the hospital were excluded from the analysis. Till 1991, the study was retrospective but after 1991, patients were followed prospectively. Patients were grouped according to classical renal syndrome. After the initial presentation, patients were followed subsequently till their last follow-up in the clinic or till the time of reporting the present data. Mean age of patients was 38.69 +/- 15.5 years with male predominance in majority of presentations. Chronic renal failure (CRF), nephrotic syndrome (NS), nephritic syndrome and hypertension were the four common presentations seen in 47.8%, 15.03%, 4.6% and 4.9% cases respectively. Other presentations were acute renal failure (1.9%), urinary tract infection (2.9%), stone disease (4.6%), obstructive uropathy (2.1%), isolated haematuria (1.2%) and asymptomatic urinary abnormalities (0.3%). Chronic glomerulonephritis was seen in 49.4% cases of CRF followed by diabetic nephropathy in 28.4% cases. Of the nephrotic syndrome cases, primary glomerulonephritis was seen 58.5% cases, of which minimal change disease was the commonest cause in 38% cases. Of the secondary glomerular diseases, diabetic nephropathy was commonest cause of NS (53%) followed by amyloidosis (16.4%) and lupus (8.3%). Tuberculosis was the commonest cause of renal amyloidosis seen in 50% cases. Of the nephritic syndrome, post-infective glomerulonephritis was commonest cause followed by rapidly progressive glomerulonephritis being the second commonest cause. In the hypertensive group, essential hypertension was the commonest cause followed by renovascular hypertension. It is the first large study of its kind presenting the spectrum of renal diseases in the tertiary-care government hospital of the country and we expect the disease pattern to be reasonably similar in other similar government hospital of the country. Chronic renal failure, nephrotic syndrome and diabetes are three major diseases, with which we have to deal maximum. As CRF in young male patients is the largest load, with its wide social and economical implications in the Indian context, we must gear up to organise ourselves for providing the best possible care to these patients with the limited resources.
Many developing countries are facing a silent epidemic of chronic kidney disease — one facet of the health transition associated with industrialization. Dr. Tazeen Jafar writes that data from community-based studies reveal an alarmingly high burden of chronic kidney disease in Pakistan.
Prevalence of reduced estimated GFR (eGFR) in Indo Asian population
  • T H Jafar
  • J Hatcher
  • N Chaturvedi
  • A S Levey
Jafar TH, Hatcher J, Chaturvedi N, Levey AS. Prevalence of reduced estimated GFR (eGFR) in Indo Asian population. J Am Soc Nephrol 2005;16:323A.
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