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Awareness of Chronic Kidney Disease among Patients Attending Tertiary Care Hospital in Bangladesh

Authors:
  • Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka, Bangladesh

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Abstract Background: Patients with chronic kidney disease (CKD) are at increased risk of morbidity & mortality. Educational interventions aimed at empower-ing patients are successful in chronic disease management including CKD. Objective: To explore the awareness regarding CKD among patients attend-ing in a tertiary care hospital in Bangladesh. Methodology: This was a de-scriptive observational study, which includes 100 adult patients attending the department of Medicine in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2013 to June 2013. Data were collected on a pre-tested questionnaire by face-to-face interview to investigate awareness toward: 1) basic knowledge of personal health; 2) perceptions of factors increasing the risk of CKD; 3) knowledge of therapies to slow CKD progression; 4) perceptions of CKD increasing the risk of other medical con-ditions and 5) demographic information. Main outcome variables were de-mographic parameters, socio-economic status and awareness about chronic kidney disease. Data were analyzed and compared by statistical tests. Results: Almost one third (32.0%) respondents were in 3rd decade and male to female ratio was 1:1.5. Majority (43.0%) patients came from lower-middle income family. In all age groups, the majority (60%) respondents had low knowledge of CKD. Among the study population, 44.0% believe that smoking increases risk of CKD; 42.0% believe that restricting salt intake reduces the progression of CKD; 34.0% mention that CKD increases the risk for hypertension and 82.0% mention that renal transplantation is the treatment of choice in CKD. Among the participants, 32.8% had knowledge of increasing risk factor of CKD, 30.8% had knowledge of the method of slow progression of CKD, 30.3% had knowledge of conditions for increase risk of CKD and 41.7% re s-pondent had knowledge of treatment of CKD. Conclusion: Most of the study participants had inadequate knowledge of CKD. Lack of CKD screening and educational programs have contributed to the inadequate patient knowledge about the condition. Keywords Awareness, Chronic Kidney Disease, Patient Knowledge, Patient Perception.
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Journal of Biosciences and Medicines, 2019, 7, 106-118
http://www.scirp.org/journal/jbm
ISSN Online: 2327-509X
ISSN Print: 2327-5081
DOI:
10.4236/jbm.2019.78009 Aug. 30, 2019 106 Journal of Biosciences and Medicines
Awareness of Chronic Kidney Disease among
Patients Attending Tertiary Care Hospital in
Bangladesh
Ferdous Jahan1*, A. K. M. Shahidur Rahman1, Tania Mahbub2, Mesbah Uddin Noman3,
Yeasmin Akter4, Mohammed Mizanur Rahaman5, K. B. M. Hadiuzzaman1, M. A. Jalil Chowdhury6
1Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
2Department of Nephrology, United Hospital Limited, Dhaka, Bangladesh
3Department of Nephrology, M Abdur Rahim Medical College, Dinajpur, Bangladesh
4Department of Gynecology and Obstetrics, Combined Military Hospital (CMH), Dhaka, Bangladesh
5Department of Cardiology, Narail Sadar Hospital, Narail, Bangladesh
6Department of Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
Abstract
Background:
Patients with chronic kidney disease (CKD) are at increased
risk of morbidity & mortality. Educational interventions aimed at empower-
ing patients are successful in chronic disease management including CKD.
Objective:
To explore the awareness regarding CKD among patients attend-
ing in a tertiary care hospital in Bangladesh.
Methodology:
This was a de-
scriptive observational study, which includes 100 adult patients attending
the
department of Medicine in Bangabandhu Sheikh Mujib Medical University
(BSMMU), Dhaka, Bangladesh from January 2013 to June 2013. Data were
collected on a pre-tested questionnaire by face-to-face interview to investigate
awareness toward: 1) basic knowledge of personal health; 2) perceptions of
factors increasing the risk of CKD; 3) knowledge of therapies to slow CKD
progression; 4) perceptions of CKD increasing the risk of other medical con-
ditions and 5) demographic information. Main outcome variables were de-
mographic parameters, socio-economic status and awareness about chronic
kidney disease. Data were analyzed and compared by statistical tests.
Results:
Almost one third (32.0%) respondents were in 3rd decade and male to female
ratio was 1:1.5. Majority (43.0%) patients came from lower-middle income
family. In all age groups, the majority (60%) respondents had low knowledge
of CKD. Among the study population, 44.0% believe that smoking increases
risk of CKD; 42.0% believe that restricting salt intake reduces the progression
of CKD; 34.0% mention that CKD increases the risk for hypertension and
82.0% mention that renal transplantation is the treatment of choice in CKD.
How to cite this paper: Jahan, F., Rahman,
A.K.M.S., Mahbub, T., Noman, M.U., A
k-
ter, Y., Rahaman, M.M., Hadiuzzaman,
K.B.M. and Chowdhury, M.A.J.
(2019
)
Awareness of Chronic Kidney Disease
among
Patients Attending Tertiary Care Hospital
in Bangladesh
.
Journal of Biosciences and
Medicines
,
7
, 106-118.
https://doi.org/10.4236/jbm.2019.78009
Received:
July 22, 2019
Accepted:
August 27, 2019
Published:
August 30, 2019
Copyright © 201
9 by author(s) and
Scientific
Research Publishing Inc.
This work is licensed under the Creative
Commons Attribution International
License (CC BY
4.0).
http://creativecommons.org/licenses/by/4.0/
Open Access
F. Jahan et al.
DOI:
10.4236/jbm.2019.78009 107 Journal of Biosciences and Medicines
Among the participants, 32.8% had knowledge of increasing risk factor of
CKD, 30.8% had knowledge of the method of slow progression of CKD,
30.3% had knowledge of conditions for increase risk of CKD and 41.7% res-
pondent had knowledge of treatment of CKD.
Conclusion:
Most of the study
participants had inadequate knowledge of CKD. Lack of CKD screening and
educational programs have contributed to the inadequate patient knowledge
about the condition.
Keywords
Awareness, Chronic Kidney Disease, Patient Knowledge, Patient Perception
1. Introduction
Chronic kidney disease (CKD) is increasingly being recognized as a global public
health problem. The declaration of World Kidney Day and its annual observance
remained us that CKD is common and harmful for almost all cross section of
people [1]. There is some convincing evidence that CKD is treatable [2]. Preva-
lence of CKD has reached epidemic proportions with a range of 10% - 13% pop-
ulation of USA [3], Canada [4], Japan [5], China [6], Taiwan [7], Iran [8], and
India [9]. In some countries of Europe, the prevalence of CKD is 8% - 10% [10]
[11]. Recent data on the prevalence of early stage of CKD in India showed that
15% apparently healthy-looking Indian Central government employees are suf-
fering from kidney disease [9].
As CKD is a silent disease which is treated as one of the leading causes of
death worldwide, many developed countries have studied CKD awareness and
developed guidelines and educational programs accordingly. Education to im-
prove knowledge on CKD has been documented to play an important role in
reducing this particular problem regardless of whether it is primary, secondary
or tertiary prevention [12]. Varied risk factors have been reported in the aware-
ness study on chronic kidney disease in different countries.
Bangladesh being a densely populated developing country, its health care
budget is only 1.4% of gross national product (GNP) with the priority areas as
population control, provision of clean drinking water and eradication of comm-
unicable disease. The treatment of non-communicable disease like chronic kid-
ney disease (CKD) has low priority in Bangladesh because of government health
policy and high cost of treatment [13]. Development of awareness through
screening and educational programs is still in the stage of infancy. The impor-
tant causes of CKD leading to kidney failure in South Asian region are chronic
glomerulonephritis, diabetes and hypertension [13]. In Bangladesh, leading
causes of end-stage renal disease (ESRD) are chronic glomerulonephritis (40%),
diabetes (34%) and hypertension (15%) [14]. Patients are not aware of the im-
portance of good control of these risk factors. Survey in a few rural, urban, dis-
advantageous population suggested that 18 million people have been suffering
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from CKD as defined by kidney disease outcomes quality initiative (KDOQI) in
Bangladesh [14]. About 30,000 patients are reaching end-stage renal failure
every year in this country they need either dialysis or transplantation of kidney
[14]. Out of 18% kidney patient, 11% have milder to severe form of kidney fail-
ure [14]. Increased CKD awareness over time in different countries and a recent
increase in nephrology referrals suggested that these efforts may have some posi-
tive impact [15] [16] [17].
It has been observed that physicians other than nephrologists are less likely to
recognize CKD and sometimes differ in their clinical evaluation of CKD [18]. A
significant number of CKD patients are referred to nephrologists much later
than it would have been appropriate [19]. Late evaluation of CKD patients by
nephrologists, especially those presenting in end-stage renal disease (ESRD), is
associated with suboptimal pre-dialysis care and treatment which ultimately in-
crease mortality [19] [20] [21] [22].
Cancer screening studies have shown that patients with more knowledge and
awareness of their diseases are more likely to follow methods that slow progression
of the disease [23]. Disease educated patients are more likely to follow proper
treatment and cope more successfully with their diagnosis and participate in
health care decisions that affect their health [24].
Study on awareness and education of CKD is scarce in Bangladesh. Thus the
present study was conducted to explore the awareness regarding CKD among
patients attending in a tertiary care hospital in Bangladesh. The study was fo-
cused on the relationship between the awareness of CKD with age, occupation
and educational status. The information generated out of this study will be use-
ful in implying awareness program for CKD patients. The developed awareness
program of the present study is expected to reduce CKD through early adoption
of treatment and thereby will contribute to a considerable extent to prevent it
from progression towards ESRD.
2. Methodology
This descriptive observational study was conducted from January 2013 to June
2013 in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka,
Bangladesh. The study was approved by the Ethical Review Committee, Banga-
bandhu Sheikh Mujib Medical University (BSMMU) Dhaka, Bangladesh. Ac-
cording to the statistical calculation, a total of one hundred (100) patients were
selected as study population. Patients who came to the department of medicine,
BSMMU during six months of the study period were recruited for the study
purposively. All adult (Age > 18 years) patients without renal disease were in-
cluded in the study and patients under 18 years old, known as CKD patient,
CKD on dialysis or history of renal transplantation were excluded from the
study. Informed written consent was taken from each participant prior to enroll-
ment. Main outcome variables were demographic parameters, socio-economic
status and awareness about chronic kidney disease. Data were collected by
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face-to-face interview using a pre-tested questionnaire. The questionnaire con-
sisted of five sectors that included; demographic characteristics, patient’s know-
ledge on health, patient’s perceptions of factors increasing the risk of CKD, pa-
tient’s perception of practices that slow chronic kidney disease progression and
patient’s perception of CKD increasing the risk of other medical conditions.
Each of the patient’s correct answer was given a score of 1 and therefore the
maximum total score was 11. Knowledge scouring was leveled as; no knowledge
= 0 score, low knowledge = 1 - 5, moderate knowledge = 6 - 9 and high know-
ledge = 9 - 11 score. Those who answered 5 or fewer questions correctly were
considered to have low knowledge on chronic kidney disease while those who
answered 6-8 questions correctly were considered to have moderate knowledge
while those who answered 9 - 11 questions correctly were considered to have
high knowledge on CKD. After editing and coding, the coded data were directly
entered into the computer by using SPSS software release for Windows, version
16.0 (SPSS, Inc. Chicago. III). Data cleaning validation and analysis were per-
formed using the SPSS software. Categorical data were presented as frequency,
percentage and continuous variable were expressed as mean ± SD (standard
deviation). An independent sample student’s t-test was used for comparison of
means of continuous variables with normal or approximately normal distribu-
tions. The Chi-square test was used to analyze discrete variables. ANOVA test
was performed where appropriate. The statistical significance threshold was set
to p ≤ 0.05 (two-tailed).
3. Results
A total of one hundred (100) participants were included in this study. Of them,
forty (40) were male and sixty (60) were female, among females most of them
were housewives and male to female ratio was 1:1.5. Almost one third (32.0%)
respondents were in 3rd decade. Majority (43.0%) patients came from lower-
middle-income family. In all age groups, the majority (60%) respondents had
low knowledge of CKD.
About the association between knowledge score with different age group, it
was observed that majority patients (60%) had low knowledge score which was
9.0% in ≤20 years age group, 21.0% in 21 - 30 years age group, 16.0% in 31 - 40
years age group, 10.0% in 41 - 50 years age group and 4.0% in >50 years age
group patients. The mean knowledge score was found 4.75 ± 4.47 in ≤20 years
age group, 5.09 ± 5.93 in 21 - 30 years age group, 5.73 ± 5.65 in 31 - 40 years age
group, 8.62 ± 6.81 in 41 - 50 years age group and 7.11 ± 8.79 in >50 years age
group. The differences were not statistically significant (p = 0.240) among
knowledge scoring with different age groups (Table 1).
Among the participants no knowledge score was found 1 (2.5%) in male pa-
tients and 7 (11.7%) in female patients; Low knowledge score was found 25
(62.5%) in male patients, 35 (58.3%) in female patients; Moderate knowledge
score was found 9 (22.5%) in male patients and 12 (20.0%) in female patients;
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Table 1. Distribution of the study patients by knowledge score according to age group
(n = 100).
Knowledge score
Age (years)
≤20
(n = 12)
31 - 40
(n = 23)
>50
(n = 9)
n
%
n
%
N
%
N
%
No Knowledge 0 0.0 3 3.0 1 1.0 2 2.0 2 2.0
Low Knowledge 9 9.0 21 21.0 16 16.0 10 10.0 ³ 4.0
Moderate Knowledge 3 3.0 4 4.0 6 6.0 8 8.0 0 0.0
High Knowledge 0 0.0 4 4.0 0 0.0 ³ 4.0 3 3.0
Mean ± SD
4.75 ±4.47 5.09 ±5.93 5.73 ±5.65 8.62 ±6.81 7.11 ±8.79
P value
0.240ns
No knowledge = 0. Low knowledge = 1 - 5. Moderate knowledge = 6 - 9. High knowledge = 9 - 11. ns = not
significant. P value reached from ANOVA test.
High knowledge score was found 5 (12.5%) in male patients and 6 (10.0%) in
female patients respectively. The mean knowledge score was found 6.5 ± 6.7 in
male patients and 6.0 ± 5.9 in female patients. The mean score difference was
not statistically significant (p > 0.05) between two groups (Table 2).
In this study no knowledge score 4 (4%), 1 (1%), 1 (1%), 0 (0%), 1 (1%), 0
(0%); low knowledge score 17 (17%), 8 (8%), 5 (5%), 10 (10%), 4 (4%), 6 (6%);
moderate knowledge score 11 (11%), 9 (9%), 5 (5%), 5 (5%), 2 (2%), 0 (0%) and
high knowledge score 4 (4%), 0 (0%), 3 (3%), 2 (2%), 0 (0%), 2 (2%) were found
among housewives, small trader, student, service holder, private service and
other occupation’s patients respectively (Table 3). Among the occupations ma-
jority of the respondents were housewives (17%) and they had low knowledge
score.
Table 4 shows monthly income of the respondents. It was observed that more
than two third (67.0%) respondents belonged to lower-middle-income group
and rest one third (33.0%) came from low-income group (Table 4).
Low knowledge score was found in 10 (10.0%) of the respondents who had no
institutional education, in 17 (17.0%) had primary education, in 15 (15.0%) had
high school education and in 18 (18.0%) respondents who had college &
university-level education. Other knowledge scores and educational status are
displaying in the table. But the mean differences were not statistically significant
(p = 0.071) among knowledge scores with different education groups (Table 5).
It was observed that 31 (31.0%) respondents mention that they believe di-
abetes increases the risk of CKD, 32 (32.0%) hypertension, 12 (12.0%) family
history, 44 (44.0%) smoking 39 (39.0%) dyslipidemia and 39 (39.0%) believe ob-
esity increases the risk of CKD (Table 6).
It was observed that 35 (35.0%) respondents mention that they believe stop
smoking slows down the progression of CKD, 29 (29.0%) control of HTN 27
(27.0%) control of DM, 33 (33.0%) control of LIPID, 42 (42.0%) restricting salt
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Table 2. Distribution of the study patients by knowledge score according to sex (n = 100).
Knowledge score
Male (n = 40)
Female (n = 60)
P-value
N
%
N
%
No Knowledge 1 2.5 7 11.7
Low Knowledge 25 62.5 35 58.3
Moderate Knowledge 9 22.5 12 20.0
High Knowledge 5 12.5 6 10.0
Mean ± SD 6.5 ±6.7 6.0 ±5.9 0.704ns
ns = not significant. P value reached from unpaired t-test.
Table 3. Distribution of the study patients by knowledge score according to occupation
(n = 100).
Knowledge score
Occupational status
Housewife
Small trader
Student
Service
holder
Private
service
Others
N % n % n % N % n % N %
No Knowledge 3 4.0 1 1.0 1 1.0 0 0.0 1 1.0 0 0.0
Low Knowledge 17 17.0 8 8.0 5 5.0 10 10.0 4 4.0 6 6.0
Moderate
Knowledge 11 11.0 9 9.0 5 5.0 5 5.0 2 2.0 0 0.0
High Knowledge 3 4.0 0 0.0 3 3.0 2 2.0 0 0.0 2 2.0
Total 36 36.0 18 18.0 14 14.0 17 17.0 7 7.0 8 8.0
Table 4. Distribution of the respondents by monthly income (n = 100).
Monthly income
Number of respondents
Percentage
Low-income 33 33.0
Lower-middle 67 67.0
Upper-middle 0 0.0
Table 5. Distribution of the study patients by knowledge score according to education
(n = 100).
Knowledge score
Educational status
No education
(n = 17)
Primary
(n = 31)
High school
(n = 23)
College &
University
(n = 29)
N
%
N
%
N
%
N
%
No Knowledge 5 5.0 3 3.0 0 0.0 0 0.0
Low Knowledge 10 10.0 17 17.0 15 15.0 18 18.0
Moderate Knowledge 2 2.0 8 8.0 3 4.0 7 7.0
High Knowledge 0 0.0 3 3.0 3 4.0 3 4.0
Mean ± SD
2.81 ±4.02 6.03 ±6.00 7.56 ±6.89
7.48 ±6.64
P value
0.071ns
ns = not significant. P value reached from ANOVA test.
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intake and 19 (19.0%) respondents mention that they believe taking the drug re-
gimen always slows down the progression of CKD (Table 7).
This study reveals that 82.0% of the participants believe that renal transplan-
tation is the treatment of choice in CKD, 22.0% knows about dialysis is a treat-
ment option of CKD, and as 21.0% believe that CKD can be treated by drugs
(Table 8).
Table 9 shows that 32.8% respondents believe that there are some factors that
increase the risk of CKD, 30.8% know the issues that slow down the progression
of CKD, 30.3% are aware of the conditions for increase of CKD, and 41.7% have
knowledge about treatment of CKD.
Table 6. Participants believe that factor increases risk of CKD (n = 100).
Factors increasing risk
of CKD*
Yes
No
Don’t know
n
%
N
%
N
%
Diabetes 31 31.0 15 15.0 54 54.0
Hypertension 32 32.0 13 13.0 55 55.0
Family history of CKD 12 12.0 15 15.0 73 73.0
Smoking 44 44.0 9 9.0 47 47.0
Dyslipidemia 39 39.0 11 11.0 50 50.0
Obesity 39 39.0 14 14.0 47 47.0
*Multiple response.
Table 7. Knowledge regarding slow progression of CKD (n = 100).
Progression
of CKD*
Yes
No
Don’t know
n
%
N
%
N
%
Stopping smoking 35 35.0 9 9.0 56 56.0
Controlling of HTN 29 29.0 19 19.0 52 52.0
Controlling of DM 27 27.0 21 21.0 52 52.0
Controlling of LIPID 33 33.0 19 19.0 48 48.0
Restricting salt intake 42 42.0 13 13.0 45 45.0
Taking the drug
regimen 19 19.0 11 11.0 70 70.0
*Multiple response.
Table 8. Knowledge regarding treatment of CKD (n = 100).
Treatment knowledge*
Yes
No
Don’t know
n
%
N
%
N
%
Drugs 21 21.0 17 17.0 62 62.0
Dialysis 22 22.0 16 16.0 62 62.0
Renal Transplantation 82 82.0 1 1.0 17 17.0
*Multiple response.
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Table 9. Total level of knowledge about CKD.
Items of CKD
Total level of knowledge (%)
Factor increase risk of CKD 32.8
Methods slow progression of CKD 30.8
Condition for increase risk for CKD 30.3
About treatment knowledge of CKD 41.7
4. Discussion
This descriptive observational study was carried out with an aim to determine
the level of knowledge about chronic kidney disease among patients attending in
the department of medicine in Bangabandhu Sheikh Mujib Medical University
(BSMMU) and to finding out the relationship between awareness of chronic
kidney disease with age, occupation and educational status of the patients. A to-
tal of 100 patients who attended in the department of medicine in BSMMU from
January 2013 to June 2013 were included in this study accordingly.
About the association between knowledge score with different age group it
was observed that majority of the study patients (60%) had low knowledge score
which was 9.0% in ≤20 years age group, 21.0% in 21 - 30 years age group, 16.0%
in 31 - 40 years age group, 10.0% in 41 - 50 years age group and 4.0% in >50
years age group patients. The mean knowledge score differences were not statis-
tically significant (p = 0.240) among knowledge scores with different age groups
in this current study. Leng C.W.,
et al
. [25] showed majority of the respondents
answered 3 to 5 questions correctly giving a mean score of 3.44 ± 1.53 and a me-
dian score of 3; Eighty (5.6%) respondents had no knowledge of kidney disease;
Of these 80 respondents, most of them were > 40 years old (72.1%). Tan A.U.,
et
al
. [26] reported that only younger age was independent predictors of overall
knowledge score. The current study is consistent with these above studies.
In this present study, it was observed that majority (31.0%) respondents were
passed primary education level followed by 29.0% passed college & University
level, 23.0% passed high school and 16.0% respondents had no education level.
Tan A.U.,
et al
. [26] reported that nearly all participants (96%) in their study had
at least completed high school education. In another study, Leng C.W.,
et al
. [25]
observed that 40.7% and 37.6% had secondary level and above secondary level of
education respectively. Erick W. [27] obtained that 70% of the participants had
acquired formal education of less than high school level. This low level of educa-
tion could account for the inadequate patient’s knowledge. Studies documented
that a high correlation between educational attainment and health outcomes, as
educated patients are more likely to allow proper treatment and cope more suc-
cessfully with their diagnosis and participate in health care decisions that affect
their outcome.
In this present study, it was observed that 31.0% respondents mention that
they believe diabetes increases the risk of CKD, 32.0% hypertension, 12.0% fam-
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ily history of CKD, 44.0% smoking, 39.0% dyslipidemia and 39.0% believe obes-
ity increases the risk of CKD. Majority of the participants thought that a family
history of CKD increased the risk of CKD as reported by Erick W. [27]. The less
commonly identified risk factors of CKD were smoking mentioned in 10% and
32.0% mentioned about diabetes in his study. In current study, only 32% of the
participants believe that hypertension increases the risk of chronic kidney dis-
ease. This finding is especially relevant as prior survey which demonstrated that
black populations are less likely to perceive themselves as being susceptible to
end-stage renal disease yet hypertension is the leading cause of ESRD among
blacks obtained by Sanne S.
et al
. [28]. Most of the participants believed that a
family history of chronic kidney disease increases the risk for CKD but a pre-
vious study in the United States by Tan A.U.,
et al
. [26] showed that although
most chronic kidney disease patients had a family history of chronic renal fail-
ure, they did not believe that it predisposed to chronic kidney disease. Tan A.U.,
et al
. [26] found in their study that hypertension 92.1% and diabetes 86% were
the two risk factors that were perceived as increasing the risk of CKD for the
largest proportion of their study participants. Other risk factors like obesity
mentioned 79.9%, family history of CKD 75.1%, smoking 74.7%, African Amer-
ican race 71.6%, and male sex 59.0% were less commonly identified as CKD risk
factors [26].
In this current study it was observed that 35.0% respondents mention that
they believe stop smoking delay progression of CKD, 29.0% control of HTN,
27.0% control of DM, 33.0% control of LIPID, 42.0% restricting salt intake and
19.0% respondents mention that they believe taking the CKD drug regimen al-
ways delay progression of CKD. Erick W. [27] showed most participants thought
that drugs always slowed progression of the chronic kidney disease while the
least likely to be identified as effective in slowing progression of CKD was
smoking control (8.0%).
In this study, it was observed that 34.0% respondents mention that they be-
lieve CKD increases risk for the hypertension, 31.0% heart attack, 26.0% stroke
and 30.0% death. Erick W. [27] identified that 90% of the participants thought
that CKD increases the risk of death but few thought that CKD increases the risk
of hypertension, heart attack and stroke. The present study shows that the par-
ticipants have very poor knowledge about complications and outcome of CKD.
In this present study, it was observed that, 82.0% of the participants believe
that renal transplantation is the treatment of choice in CKD, 22.0% knows about
dialysis is a treatment option of CKD, and 21.0% believe that CKD can be
treated by drugs. Leng C.W.,
et al
. [25] found 79.4% respondent knew that kid-
ney transplant is the best treatment for end-stage renal disease. 61.7% knew that
dialysis treatment can be carried out either at home or at a dialysis centre. The
present study reveals that participants have very poor knowledge about treat-
ment options of CKD patients.
It was observed in this study that no knowledge score was found in 2.5% in
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male patients and in 11.7% in female patients; low knowledge score was found
62.5% in male patients, 58.3% in female patients; moderate knowledge score was
22.5% and 20.0% in male and female respectively and high knowledge score was
found 5 (12.5%) in male patients and 6 (10.0%) in female patients. The mean
knowledge score was found 6.5 ± 6.7 in male patients and 6.0 ± 5.9 in female pa-
tients. The mean score difference was almost similar between male and female
participants. This result differs from the findings of Turner S.
et al
. [29], who
had observed that younger and female participants had greater knowledge and
awareness of CKD.
Regarding the associations between knowledge score and educational status, it
was observed in this current study that low knowledge score was found in 10.0%
respondents who had no institutional education, in 17.0% had primary educa-
tion, in 15.0% had high school education and in 18.0% participants had college &
university level education. But the differences were not statistically significant
(p = 0.071) among knowledge scores with different education groups. Gheewala,
P.A
et al
. showed that CKD knowledge score increased with a higher level of
education; which is not consistent with this current study [30].
Among the respondents, 32.8% respondent had knowledge about increase risk
factor of CKD, 30.8% had knowledge about the method of slow progression of
CKD, 30.3% had knowledge about conditions for increase risk of CKD and
41.7% respondent had knowledge about treatment of CKD.
To summarize, the current study found that majority (60%) of the participant
patients had inadequate knowledge about chronic kidney disease. Most of the
patients did not know all the risk factors, methods to slow progression and the
complications of CKD. The inadequate knowledge about chronic kidney disease
among the patients may be due to several factors which include illiteracy, lack of
health screening program and inadequate education of patients about the condi-
tion. This could be due to inadequate mass media involvement.
5. Conclusion
This study was undertaken to explore the awareness regarding CKD among the
patients attending in a tertiary care hospital. Most of the respondents were in 3rd
decade and female predominant and they were mostly housewife. Majority of the
study participants had inadequate knowledge of CKD. Lack of CKD screening
and educational programs have contributed to the inadequate patient knowledge
about the condition.
Conflicts of Interest
The authors declare no conflicts of interest regarding the publication of this pa-
per.
Limitations of Study
It was a single centre study with relatively small sample size.
F. Jahan et al.
DOI:
10.4236/jbm.2019.78009 116 Journal of Biosciences and Medicines
Recommendations
In this study, most of the patients had insufficient knowledge of CKD. The
knowledge can be improved by arranging local and regional workshop, use of
aids like posters and leaflets displayed in hospitals and by the use of local and
national media (TV, newspapers, journals etc) to highlight the issues related to
factor increase risk of CKD, method of slow progression of CKD, and manage-
ment of chronic kidney disease.
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... The adult patients from age 20 years to 80 years attending medical OPD of UCMS-TH, Bhairahawa, Rupandehi, Nepal, who were willing to participate and can speak and understand Nepali language were included in the study. Sample size was 2 2,9 calculated by using formula N=Z pq/L with 95% level of confidence interval, 5% marginal error and 11% prevalence of 6 good knowledge. Initial sample size was 150. ...
... In a study conducted in Bangladesh 60% of the respondents had low knowledge and only 11% of the respondents had good 6 knowledge regarding CKD. Likewise in a study conducted in Saudi Arabia, the findings revealed a lack of awareness among 7 Saudi population regarding CKD. ...
... This difference in the findings might be due to difference in the inclusion criteria of the respondents. The findings of the study showed that 22.4% of respondents were aware that dialysis as a treatment option for chronic kidney diseases which filters the blood through 6 machine. The finding of the study is consistent with the study conducted in Dhaka, Bangladesh which shows that 22% of respondents were aware that dialysis as a treatment option for chronic kidney diseases. ...
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Chronic kidney disease (CKD) poses a serious public health problem worldwide. Population-based studies determining the prevalence of this disease in China have been limited in several large developed cities. In the present study, a population-based screening study in Henan, a representative province in Central China, was conducted in order to quantify the prevalence of CKD and identify the associated risk factors for this disease in a population of developing areas of China. Residents (n = 4156) over 40 years old in four major cities of Henan Province were interviewed and their albuminuria, reduced renal function, haematuria and blood pressure were measured. Associations between age, components of metabolism syndrome and indicators of CKD were examined. Among these subjects, the prevalence rates of albuminuria, haematuria and reduced renal function were 4.51%, 6.28% and 1.53%, respectively. Approximately 10.49% of the subjects had at least one indicator of kidney damage. The awareness rate of this disease in subjects with CKD was only 9.50%. Hypertension, diabetes and hyperuricaemia were three independent risk factors for CKD. The high prevalence and low awareness of CKD in the studied population suggest that CKD is a severe public health problem in Central China. Effectively preventive and therapeutic interventions are needed.
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We previously estimated the prevalence of chronic kidney disease (CKD) stages 3-5 at 19.1 million based on data from the Japanese annual health check program for 2000-2004 using the Modification of Diet in Renal Disease (MDRD) equation multiplied by the coefficient 0.881 for the Japanese population. However, this equation underestimates the GFR, particularly for glomerular filtration rates (GFRs) of over 60 ml/min/1.73 m(2). We did not classify the participants as CKD stages 1 and 2 because we did not obtain proteinuria data for all of the participants. We re-estimated the prevalence of CKD by measuring proteinuria using a dipstick test and by calculating the GFR using a new equation that estimates GFR based on data from the Japanese annual health check program in 2005. Data were obtained for 574,024 (male 240,594, female 333,430) participants over 20 years old taken from the general adult population, who were from 11 different prefectures in Japan (Hokkaido, Yamagata, Fukushima, Tochigi, Ibaraki, Tokyo, Kanazawa, Osaka, Fukuoka, Miyazaki and Okinawa) and took part in the annual health check program in 2005. The glomerular filtration rate (GFR) of each participant was computed from the serum creatinine value using a new equation: GFR (ml/min/1.73 m(2)) = 194 x Age(-0.287) x S-Cr(-1.094) (if female x 0.739). The CKD population nationwide was calculated using census data from 2005. We also recalculated the prevalence of CKD in Japan assuming that the age composition of the population was same as that in the USA. The prevalence of CKD stages 1, 2, 3, and 4 + 5 were 0.6, 1.7, 10.4 and 0.2% in the study population, which resulted in predictions of 0.6, 1.7, 10.7 and 0.2 million patients, respectively, nationwide. The prevalence of low GFR was significantly higher in the hypertensive and proteinuric populations than it was in the populations without proteinuria or hypertension. The prevalence rate of CKD in Japan was similar to that in the USA when the Japanese general population was age adjusted to the US 2005 population estimate. About 13% of the Japanese adult population-approximately 13.3 million people-were predicted to have CKD in 2005.
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The prevalence of chronic kidney disease (CKD) varies greatly between countries. In a community-based study, our aims were to determine the prevalence and associated risk factors of adult CKD in Iran. A total of 17,240 persons of either sex over 14 years old from 30 counties of Iran enrolled in the study. Data on demographic characteristics and medical history were recorded. Participant were asked to provide a midstream sample of urine, and a blood sample was drawn for measuring serum creatinine and glucose. Glomerular filtration rate was estimated (eGFR) using the simplified Modification of Diet in Renal Disease (MDRD) study equation. The CKD stages were those provided by the Kidney Disease Outcomes Quality Initiative. Of studied participants, 9,812 (60.0%), 5,184 (31.7%), 1,276 (7.8%), 49 (0.3%) and 33 (0.2%) had estimated GFR categories of >or=90, 60-89, 30-59, 15-29 and <15 ml/min per 1.73 m2, respectively. By CKD stages, 359 (2.2%) had stage 1, 351 (2.1%) had stage 2, 1,276 (7.8%) had stage 3, 49 (0.3%) had stage 4, and 33 (0.2%) had stage 5 CKD. In total, 2,068 (12.6%) (95% confidence interval, 10.2%-14.2%) of the studied population had CKD. Diabetes, glomerulonephritis and hypertension were the most common primary renal diseases. This study shows considerable disparities among counties of Iran. Early intervention strategies to reduce the burden of CKD are essential. Further studies are warranted to better determine the causes and prevalence of CKD in different regions and countries.