letter to the editor

Ste´ phan Troyanov1, Daniel Cattran2 and Rosanna Coppo3 1 Hoˆpital du Sacre´-Coeur de Montre´al, Montreal, Quebec, Canada; 2University Health Network, Toronto General Hospital, Toronto, Ontario, Canada and 3 Hospital-University Agency Citta` della Salute e della Scienza, Regina Margherita Hospital, Turin, Italy Correspondence: Ste´phan Troyanov, Hopital du Sacre-Coeur de Montreal, 5400 Gouin Boulevard West, Montreal, Quebec, Canada, H4J 1C5. E-mail: [email protected] and [email protected].

Kidney International (2015) 87, 662–663; doi:10.1038/ki.2014.402

A 4-year survey of the spectrum of renal disease at a National Referral Hospital Outpatient Clinic in Uganda To the Editor: Recently, Radhakrishnan et al.1 reported on registries for early CKD detection in Europe, Japan, England, Australia, and the USA. Their report highlighted the need for unified health information systems to better measure the true burden of disease. Our experience shows that this need for robust data capture to determine disease burdens is even more urgent in low-income countries. We queried the files of patients 418 years old who attended the renal clinic in a 1500-bed National Referral Hospital in Uganda, between June 2007 and 2011, using a structured questionnaire. Eighty percent (2400/3000) of records over the 4-year period were missing, very poorly documented, or destroyed by poor storage and transport. The 600 records that were accessed and reviewed showed a patient population that was young (mean age of 37.5 years), lean (mean BMI, 17.74 kg/m2), hypertensive (mean BP 135/ 82 mm Hg), and 64.5% had stage 3–5 kidney disease (Table 1). The most prevalent diagnoses were hypertension

(17.7% (127/715) and the nephrotic syndrome 14.8% (105/715). Diabetes mellitus and HIV-associated nephropathy accounted for only 3.8 and 2.8%. This profile of young, thin, hypertensive, and HIVnegative patients is significantly different from that seen in similar hospital-based studies in the West.2–4 However, the incomplete data preclude any concrete conclusions about our population, further delaying knowledge-driven interventions by at least 2 years. We since attempted to institute structured paper-based forms to prospectively capture this data; however, adoption by over-worked providers is poor. Perhaps as a first step in addressing the broader question of disease burdens, the International Society of Nephrology could help drive more uniform documentation of hospital-based nephrology encounters in low-resourced settings. 1.

Radhakrishnan J, Remuzzi G, Saran R et al. Taming the chronic kidney disease epidemic: a global view of surveillance efforts. Kidney Int 2014; 86: 246–250. Keith DS, Nichols GA, Gullion CM et al. Longitudinal follow-up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med 2004; 164: 659–663. Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis 2002; 39: 930–936. O’Hare AM, Choi AI, Bertenthal D et al. Age affects outcomes in chronic kidney disease. J Am Soc Nephrol 2007; 18: 2758–2765.

2.

3. 4.

Robert Kalyesubula1,2, Joseph Lunyera1, Gyavira Makanga1,2, Bruce Kirenga1 and Timothy K. Amukele3,4 1

Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda; 2Department of Physiology, Mulago National Referral Hospital, Kampala, Uganda; 3Makerere University–Johns Hopkins University Clinical Core Laboratory at Infectious Diseases Institute, Kampala, Uganda and 4Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Correspondence: Timothy K. Amukele, Department of Pathology, Johns Hopkins School of Medicine, Meyer Building B-125D, 600 North Wolfe Street, Baltimore, Maryland 21287, USA. E-mail: [email protected] Kidney International (2015) 87, 663; doi:10.1038/ki.2014.411

Table 1 | Characteristics and demographics of the study population Men, n ¼ 321

Age (years) Height (cm) Weight (kg) Weight (kg)b BMI (kg/m2)c Systolic BP (mm/Hg) Diastolic BP (mm/Hg) Serum creatinine (mmol/l) Estimated GFR (ml/min/1.73 m2) Cockcroft–Gault

Women, n ¼ 273

All, n ¼ 594

na

Mean

s.d.

Mean

s.d.

Mean

s.d.

P-values

426 72 533 317 67 563 561 318

39.0 160.0 53.3 47.9 14.0 132.5 80.0 609.3

16.6 19.9 52.7 26.1 11.2 132.5 21.0 1241.9

35.7 149.7 52.7 52.3 22.4 137.9 82.2 507.0

14.6 19.2 36.5 25.5 14.3 79.0 36.7 867.7

37.5 155.2 53.1 48.3 17.7 135.4 81.4 557.5

15.9 20.4 30.4 22.9 14.3 59.9 29.7 1077.7

0.14594 0.03742 0.99124 0.14975 0.01192 0.30893 0.11546 0.39190

293

49.3

49.7

61.8

495.1

55.2

81.2

0.20926

Abbreviations: BMI, body mass index; BP, blood pressure; GFR, glomerular filtration rate. a The number of records that documented each characteristic. For example, 563 records had a documented systolic BP, whereas only 72 records had a documented height. b This excludes patients with documented edema. c Calculated by the study team on the basis of weight and height in chart.

Kidney International (2015) 87, 660–664

663

A 4-year survey of the spectrum of renal disease at a National Referral Hospital Outpatient Clinic in Uganda.

A 4-year survey of the spectrum of renal disease at a National Referral Hospital Outpatient Clinic in Uganda. - PDF Download Free
67KB Sizes 1 Downloads 7 Views