Chronic kidney disease in patients admitted to the medical ward of Mbarara Regional Referral Hospital in southwestern Uganda: Prevalence and associated factors

Abstract

Background: In tropical Africa, although chronic kidney disease (CKD) is common, there are few data about its’ prevalence among patients admitted to a general medical ward. Aim: We proposed to determine the prevalence of CKD among patients admitted to a general medical ward in Uganda. Methods: We conducted a cross sectional study consecutively enrolling adults admitted to the medical ward of Mbarara Regional Referral Hospital over three months. We collected socio-demographic and clinical data including presenting symptoms, history of diabetes, hypertension, and use of nephrotoxic medication. Consenting patients provided spot morning urine specimen for measurement of urine albumin and we also drew patients’ blood for measurement of markers of renal function, complete blood count, hepatitis B surface antigen, and HIV. We also performed renal sonography for all included patients. We defined CKD as a glomerular filtration rate (eGFR) less than 60ml/min/1.73m².We used logistic regression to assess for factors associated with CKD. Results: Of the 372 patients enrolled, 57 (15.3%) had CKD. Body swelling (OR=2.79, 95% CI 1.53-5.07; p=0.001), active urine sediment (OR=3.13, 95% CI 1.64-6.41; p=0.016), microalbuminuria (OR=1.92, 95% CI 1.07-3.43; p=0.028), history of hypertension (OR=3.65, 95% CI 1.69-7.90; p=0.001), and high blood pressure (OR=3.34, 95% CI 1.33-8.40; p=0.010) were independently associated with CKD. Conclusion: Chronic kidney disease is common with hypertension as the etiology and associated with body swelling, active urine sediment and microalbuminuria among patients admitted to a general medical ward in southwestern Uganda. Screening for CKD of patients at risk should be prioritized in general medical wards.

Key words: Chronic kidney disease, epidemiology, nephrotoxicity, poor resource setting, Uganda