Chronic kidney disease in Nigeria: primary care physicians must intervene earlier

Abstract

Chronic Kidney disease (CKD) is one of the world's major public health problems and the prevalence of Kidney failure is rising steadily. Patients with early stages of CKD are primarily silent with long latent period, and may in fact be masked by other conditions. Progressive damage is invariable and progression to ESRD is the rule. Failure to recognize CKD early is a missed opportunity to prevent or delay the development of ESRD or other cardiovascular events complicating CKD. To evaluate the present practice of Medical officers within the primary and secondary health care centres in Kaduna State to see how this could help in early detection of CKD. Cross sectional descriptive study. Medical doctors working within Kaduna State of Nigeria both in the private and public sector excluding specialists and those in the university teaching hospital. Interview using self administered questionnaire. Percentage of patients tested for symptomless urinary abnormalities when seen by the doctor. A total of 96 completed and returned questionnaires were analysed. Sixty five percent (65%) of the doctors tested less than ten percent (10%) of their patients for proteinuria and eighty five percent (85%) of the doctors tested less than ten percent (10%) of their patients for haematuria. Only thirty percent (30%) of the doctors tested for proteinuria in thirty nine percent (39%) of those they were treating for Diabetes Mellitus and only thirty five percent (35%) of the doctors tested for proteinuria in twenty nine percent (29%) of those with hypertension. Screening for CKD is hardly considered in the routine practice of the primary and secondary care medical officers who have the first contact with patients and are in the best position to screen for CKD and provide opportunity for early detection, evaluation and prevention of progression to ESRD. Failure to recognize CKD early is a missed opportunity to improve patient outcome therefore the primary care physicians must intervene earlier to ensure early recognition of CKD.

Nigerian Medical Practitioner Vol. 49(1&2) 2006: 18-23