Chronic kidney disease in rheumatoid arthritis at Kenyatta National Hospital

Abstract

Objective: To determine the prevalence of chronic kidney disease among patients with rheumatoid arthritis on follow up at the rheumatology outpatient clinic at Kenyatta National Hospital.
Design: Descriptive, cross-sectional study.
Setting: Rheumatology outpatient clinic at the Kenyatta National Hospital, a public national and referral hospital.
Subjects: Patients diagnosed to have rheumatoid arthritis who met the 2010 ACR-EULAR criteria.
Results: Out of 104 patients recruited, 93 (89.4%) were female with a female to male ratio of 8.5:1. Mean age of patients was 48.7(±15.6) years. Majority of the patients (90%) were on at least one Disease Modifying Anti-Rheumatic Drug (DMARD) with methotrexate being the commonest used. Other DMARDs were leflunomide, sulfasalazine and hydroxychloroquine. None of our patients was on a biologic agent. Use of NSAIDs and/or prednisone was very frequent (88.5%). Median duration of disease since time of diagnosis was 4 years. Majority of patients (60%) had active disease. We found the prevalence of chronic kidney disease to be 28.7% (95% CI 19.1- 37.2%) based on estimated glomerular filtration rate using the Cockroft-Gault formula. Majority (50%) of which was stage 3a disease and none with end stage renal disease. We found no patients with proteinuria using urinary dipstick.
Conclusion: Although we did not find any proteinuria in our study population, prevalence of chronic kidney disease based on estimated glomerular filtration rate was high with the majority having early stages of kidney disease. Use of urine strips alone is not an adequate screening tool.