Demographic and clinical profile of chronic kidney disease in tertiary care center

Background: Chronic kidney disease (CKD) is major public health problem in Nepal. Common causes of end-stage renal disease (ESRD) in Nepal are Diabetes Mellitus (DM), Chronic Glomerulonephritis and Hypertension (HTN). Common clinical features of CKD are volume overload, shortness of breath, oliguria, proteinuria and elevated blood pressure. So if we detect all these features early, we can extend the quality life of CKD patients. Objectives: Primary objective-To study demographic profile of chronic kidney disease in tertiary care center. Secondary objective. To study clinical presentations in different stages of CKD. Methods: This study was a prospective observational study, done in Tribhuvan University Teaching Hospital (TUTH) from September 2017 to September 2018. Patients attending medical OPDs or admitted in medical wards and other wards of TUTH during this period, who were more than 18 years and diagnosed as having Chronic Kidney disease of stage III to IV were enrolled in the study. Patient having Chronic Kidney disease of stage I to II, on maintenance haemodialysis and post- transplantation patients were excluded from the study. A written consent was taken from each patient as per the format of the Institution Review Board. Patients who did not give consent were excluded from the study. Creatinine clearance and stage of CKD for each patient was calculated using Cockcroft-Gault formula once patient`s creatinine level stabilized. Data analysis was done using Statistical Package for Social Sciences (SPSS) software version 25. Results: In our study, total number of patients included were 138. Mean age was 48±17.08 years; 69% were male and remaining 31% female; 96% were Hindu, 3% Muslim and 1.4%, Buddhist; 64% were residing in hilly area, 32 % from tarai and remaining 4% from mountains. Most of the cases were of CKD stage V (103, 74.6%), followed by stage IV (23, 16.7%), and stage III (12, 8.7%), respectively. Most common clinical presentation was volume overload (111, 80.43%), followed by shortness of breath (90, 65.2%), oliguria (85, 61.59 %), gastritis (60, 43.47%) and (10, 7.24%) were asymptomatic. In our study, complication encountered in 78, 56.52 % patients which includes metabolic acidosis (45, 57.69%), hyperkalaemia (15, 19.2%), pulmonary oedema (9, 11.53%), uremic encephalopathy (5, 6.4%), uremic pericarditis (4, 5.12%) which were mainly seen CKD stage V(75, 96.15%).Most common aetiology of CKD was CGN (68, 49.3%) followed by DM (38, 27.5%), hypertension (23, 16.7%),ADPKD (3, 2.17%), Obstructive uropathy (5, 3.6%), RAS (1, 0.72%).There was significant and graded association between the stages of CKD and haemoglobin, Calcium, phosphorus, and iPTH (p value <0.05). Conclusion: Most common clinical presentation of CKD was volume overload followed by shortness of breath, oliguria, and gastritis.So any patient with these features needed to be evaluated thoroughly to detect presence of renal disease as early as possible to prevent complications and to improve the quality of life. Most common aetiology being chronic glomerulonephritis followed by diabetes mellitus, hypertension, ADPKD, obstructive sssssssssssuropathy, and RAS in decreasing order respectively. Early diagnosis and proper management have important roles in prevention of CKD progression to end-stage renal disease (ESRD). For this purpose, determining the aetiology of CKD is helpful.