Estimated glomerular filtration rate at initiation of hemodialysis in a Nigerian Tertiary Centre

Abstract

Background: Renal replacement therapy is indicated for patients with end-stage renal disease (ESRD). The glomerular filtration rate (GFR) of ESRD patients at initiation of hemodialysis vary depending on several factors including comorbidities, physicians' practice and geographical region amongst others.

Aim: We determined the levels of estimated GFR of ESRD patients at initiation of hemodialysis in a single tertiary centre in Nigeria

Method: This was a retrospective study. Records of all ESRD patients dialysed over a 12 month period were collated. Patients with acute kidney injury (AKI) or acute-on-chronic kidney disease were excluded. GFR was estimated using CKD-EPI formula. Early dialysis was defined as dialysing at an estimated GFR of >10ml/min.

Results: A total of 78 patients initiated haemodialysis during the period of review. Mean age was 45±18 years while male to female ratio was 1.2: 1. Serum creatinine concentration ranged from 4.8-19.4mg/dl with a median of 10mg/dl while estimated GFR ranged from 2-12ml/min with a median of 5ml/min. Seventy-one out of 78 (91%) ESRD patients dialysed late while only 9% dialysed early; early initiation of dialysis was commoner in patients with human immuno-deficiency virusassociated nephropathy (HIVAN) and obstructive uropathy. Among the patients with HIVAN and obstructive nephropathy, 50% and 66% respectively dialysed early (p=0.003).

Conclusion: Majority of ESRD patients in the centre dialysed late. Patients with HIVAN and obstructive uropathy tend to dialyse early compared to ESRD due to other aetiologies. Further research geared towards identifying possible predictors of early dialysis among ESRD patients is required.

Keywords: estimated glomerular filtration rate, haemodialysis initiation, HIVAN, obstructive uropathy