Evaluation of Serum Electrolyte Abnormalities and Kidney Function to Assess Risk of Kidney Disease in Hypertensive Patients at Kenyatta National Hospital
Retrospective Research Article
DOI:
https://doi.org/10.37506/5zdj8565Keywords:
systolic, diastolic, hypertensive, serum electrolytes, urea, creatinine, proteinuriaAbstract
HTN is a known leading cause of kidney disease with over 20% of the population aged 20 years or older with HTN developing CKD. Complications from HTN and kidney disease contribute significantly to global mortality. In Kenya, data from WHO shows that about 4 million individuals suffer from CKD, with many progressing to kidney failure. The aim was to assess serum electrolyte abnormalities and kidney function among hypertensive patients at KNH. The study utilized cross-sectional retrospective data from KNH patient records. The CKD-EPI equation was used to calculate eGFR. Fisher et al.’s equation determined sample size. Data were stratified by variables such as DBP, age, sex, SBP, proteinuria, serum creatinine, urea levels, serum electrolytes, and eGFR. Data collection involved 189 patients: 82 males (43.4%) and 107 females (56.6%), with a median age of 54.00 years. 93 patients (49.20%) were <54 years and 96 (50.80%) were ≥54 years. 78.84% of HTN patients had abnormal serum creatinine levels, and 54.5% had abnormal serum urea levels. 58.7% showed proteinuria. Elevated sodium levels (>145 mmol/l) affected 39.68% of patients, while reduced potassium levels (<3.5 mmol/l) were found in 15.34%. 41.27% had elevated chloride levels above 106 mmol/l. CKD stages varied: 3.2% had G1, 17.5% had G2, 14.8% had G3a, 29.1% had G3b, 16.4% had G4, and 19.0% had G5. Reduced renal function, estimated using GFR, was prevalent among hypertensive patients (79.4%) (95% CI:72.9-82.9), notably those ≥54 years. In conclusion, the risk of progressive kidney disease was high amongst hypertensive patients and this was evident from the proportion of patients who have abnormal kidney function including proteinuria. Early screening and implementation of therapeutic strategies can improve patient’s quality of life.
References
Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Himmelfarb CD, et al. Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on
Clinical Pr. Hypertension. 2018;71(6): e13–115.
Andrew Levey, MD F. What’s New About the New CKD Guideline? [Internet]. NATIONAL KIDNEY FOUNDATION. 2021 [cited 2021 Jun 4]. Available from: https://www.kidney.org/professionals/CKDGuideline#:~:text=The KDIGO definition for CKD, of kidney damage%2C including albuminuria.
Makris K, Spanou L. Acute Kidney Injury: Definition, Pathophysiology and Clinical Phenotypes. Clin Biochem Rev. 2016 May;37(2):85–98.
Ogobuiro I FTuma. NCBI [Internet]. Physiology, Renal. [Updated 2020 Aug 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538339/
Suzanne R. Steinbaum D. High blood pressure and kidney disease. [Internet]. Hypertension. 2019. Available from: Suzanne R. Steinbaum, DO
AKF. Kidney failure (ESRD) causes, symptoms and Treatment. [Internet]. American Kidney Fund. 2021 [cited 2021 Jul 14]. Available from: https://www.kidneyfund.org/kidney-disease/kidney-failure/
Abd El Hafeez S, Bolignano D, D’Arrigo G, Dounousi E, Tripepi G, Zoccali C. Prevalence and burden of chronic kidney disease among the general population and high-risk groups in Africa: a systematic review. BMJ Open. 2018 Jan;8(1): e015069.
Suzanne R. Steinbaum D. High blood pressure and kidney disease. [Internet]. Hypertension. 2019. Available from: Suzanne R. Steinbaum, DO
Abdalrahim AK and M. Knowledge, attitudes, and practices towards prevention and early detection of chronic kidney diseases. Int Nurs Rev. 2014;61(2):237–45.
Molla MD, Degef M, Bekele A, Geto Z, Challa F, Lejisa T, et al. Assessment of serum electrolytes and kidney function test for screening of chronic kidney disease among Ethiopian Public Health Institute staff members, Addis Ababa, Ethiopia. BMC Nephrol. 2020;21(1):494.
American Kidney Fund. Kidney Disease Causes and Risk Factors. [Internet]. American Kidney Fund. 2021. Available from: https://www.kidneyfund.org/prevention/are-you-at-risk/
A.S. Levey et al. chronic kidney disease as a global public health problem: Approaches and initiatives – a position statement from Kidney Disease Improving Global Outcomes. Kidney Int. 2017;72(3):247–59.
Muiru AN, Charlebois ED, Balzer LB, Kwarisiima D, Elly A, Black D, et al. The epidemiology of chronic kidney disease (CKD) in rural East Africa: A population-based study. PLoS One. 2020 Mar 4;15(3): e0229649.
Mohamed SF, Mutua MK, Wamai R, Wekesah F, Haregu T, Juma P, et al. Prevalence, awareness, treatment and control of hypertension and their determinants: results from a national survey in Kenya. BMC Public Health. 2018 Nov 7;18(Suppl 3):1219.
Irene Labuschagne JN. Chronic kidney disease is still a major health challenge in Africa [Internet]. HEALTH+MEDICINE. 2017. Available from: https://theconversation.com/chronic-kidney-disease-is-still-a-major-health-challenge-in-africa-73977#:~:text=There are three main
challenges, thirdly%2C there are treatment failures.
Iqbal S, Klammer N, Ekmekcioglu C. The Effect of Electrolytes on Blood Pressure: A Brief Summary of Meta-Analyses. Nutrients [Internet]. 2019 Jun 17;11(6):1362. Available from: https://pubmed.ncbi.nlm.nih.gov/31212974
Montford JR, Linas S. How Dangerous Is Hyperkalemia? J Am Soc Nephrol [Internet]. 2017/08/04. 2017 Nov;28(11):3155–65. Available from:
https://pubmed.ncbi.nlm.nih.gov/28778861
Martínez-Rueda AJ, Olivas-Martínez A, Vega-Vega O, Fonseca-Correa JI, Correa-Rotter R. New 2017 American College of Cardiology/American Heart Association High Blood Pressure Guideline. Hypertension. 2019 Jan 1;73(1):142–7.
Horowitz B, Miskulin D, Zager P. Epidemiology of hypertension in CKD. Adv Chronic Kidney Dis. 2015 Mar;22(2):88–95.
Tedla FM, Brar A, Browne R, Brown C. Hypertension in Chronic Kidney Disease: Navigating the Evidence. Whaley-Connell AT, editor. Int J Hypertens. 2011;2011:132405.
Leticia Buffet CR. Chronic Kidney Disease and Hypertension: A Destructive Combination. Pharmacists Resource for Clinical Excellence. 2021;
Ku E, Lee BJ, Wei J, Weir MR. Hypertension in CKD: Core Curriculum 2019. American Journal of Kidney Diseases. 2019 Jul 1;74(1):120–31.
American Heart Association. How high blood pressure can lead to kidney damage or failure. High Blood Pressure. 2016;
Hamrahian SM, Falkner B. Hypertension in Chronic Kidney Disease. Adv Exp Med Biol. 2017;956:307–25.
Ku E, Lee BJ, Wei J, Weir MR. Hypertension in CKD: Core Curriculum 2019. American Journal of Kidney Diseases [Internet]. 2019 Jul 1;74(1):120–31. Available from: https://doi.org/10.1053/j.ajkd.2018.12.044
American Heart Association. How high blood pressure can lead to kidney damage or failure. High Blood Pressure [Internet]. 2016; Available from: https://www.heart.org/en/health-topics/high-blood-pressure/health-threats-from-high-blood-pressure/how-high-blood-pressure-can-lead-to-kidney-damage-or-failure
Lv JC, Zhang LX. Prevalence and Disease Burden of Chronic Kidney Disease. Adv Exp Med Biol. 2019;1165:3–15.
Mills KT, Stefanescu A, He J. The global epidemiology of hypertension. Nat Rev Nephrol. 2020;16(4):223–37.
Matsha TE, Erasmus RT. Chronic kidney disease in sub-Saharan Africa. Lancet Glob Health [Internet]. 2019 Dec 1;7(12):e1587–8. Available from: https://doi.org/10.1016/S2214-109X(19)30467-X
George JA, Brandenburg JT, Fabian J, Crowther NJ, Agongo G, Alberts M, et al. Kidney damage and associated risk factors in rural and urban sub-Saharan Africa (AWI-Gen): a cross-sectional population study. Lancet Glob Health. 2019;7(12):e1632–43.
Norberto Perico GR. Chronic kidney disease in sub-Saharan Africa: a public health priority.Lancet Glob Health [Internet]. 2014;2(3). Available from:https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(14)70014-2/fulltext
Mkuu RS, Gilreath TD, Wekullo C, Reyes GA, Harvey IS. Social determinants of hypertension and type-2 diabetes in Kenya: A latent class analysis of a nationally representative sample. Barengo NC, editor. PLoS One. 2019 Aug 19;14(8):e0221257.
Mwenda V, Githuku J, Gathecha G, Wambugu BM, Roka ZG, Ong’or WO. Prevalence and factors associated with chronic kidney disease among medical inpatients at the Kenyatta National Hospital, Kenya, 2018: a cross-sectional study. Pan Afr Med J. 2019 Aug 23;33:321.
Damasceno A. Noncommunicable Disease. Heart of Africa: Clinical Profile of an Evolving Burden of Heart Disease in Africa. 2016. 155–157 p.
Rotich Joyce Cherono. The Prevalence and Risk Factors for Chronic Kidney Disease in Kericho County, Kenya. INTERNATIONAL JOURNAL OF NURSING. 2017;4(2).
Ndege BW. Acute Kidney Injury And Electrolyte Abnormalities Among Patients Admitted With Cholera In Kenyatta National Hospital In Nairobi, Kenya, In The Year 2017. 2018 [cited 2021 Jul 24]; Available from: http://erepository.uonbi.ac.ke/handle/11295/109619#.YPvhBvPWepg.mendeley
Mwenda V, Githuku J, Gathecha G, Wambugu BM, Roka ZG, Ong’or WO. Prevalence and factors associated with chronic kidney disease among medical inpatients at the Kenyatta NationalHospital, Kenya, 2018: a cross-sectional study. Pan Afr Med J [Internet]. 2019 Aug 23;33:321.
Available from: https://pubmed.ncbi.nlm.nih.gov/31692795
Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med. 2013 Apr;35(2):121–6.
Kidney International Supplements. KDIGO K. Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (Ckd-Mbd). 2017. 1–59 p.
Beth L. Abramson, Kajenny Srivaratharajah LLD. Women and Hypertension: Beyond the 2017 Guideline for Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. AMERICAN COLLEGE of CARDIOLOGY. 2018;
Gatimu SM, John TW. Socioeconomic inequalities in hypertension in Kenya: a decomposition analysis of 2015 Kenya STEPwise survey on non-communicable diseases risk factors. Int J Equity Health. 2020;19(1):213.
Lunyera J, Stanifer JW, Ingabire P, Etolu W, Bagasha P, Egger JR, et al. Prevalence and correlates of proteinuria in Kampala, Uganda: a cross-sectional pilot study. BMC Res Notes. 2016;9(1):97.
Osafo C, Mate-Kole M, Affram K, Adu D. Prevalence of Chronic Kidney Disease in Hypertensive Patients in Ghana. Ren Fail. 2011 May 1;33(4):388–92.
Beddhu S, Shen J, Cheung AK, Kimmel PL, Chertow GM, Wei G, et al. Implications of early decline in eGFR due to intensive BP control for cardiovascular outcomes in SPRINT. Journal of the American Society of Nephrology. 2019;30(8):1523–33.
Shibata M, Sato KK, Uehara S, Koh H, Kinuhata S, Oue K, et al. Blood pressure components and the risk for proteinuria in Japanese men: The Kansai Healthcare Study. J Epidemiol [Internet]. 2017/07/11. 2017 Nov;27(11):505–10. Available from: https://pubmed.ncbi.nlm.nih.gov/28709559
National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda M. United States Renal Data System. 2016 USRDS annual data report: Epidemiology of kidney disease in the United States. NATIONAL KIDNEY FOUNDATION. 2016;
Osafo C, Mate-Kole M, Affram K, Adu D. Prevalence of Chronic Kidney Disease in Hypertensive Patients in Ghana. Ren Fail [Internet]. 2011 May 1;33(4):388–92. Available from: https://doi.org/10.3109/0886022X.2011.565140
Muyodi M. Prevalence and Risk Factors associated with Chronic Kidney Disease among Osteoarthritis patients at Kenyatta Nationa l Hospitaal. [Internet]. EREPOSITORY.UONBI.AC.KE. 2018. Available from: http://erepository.uonbi.ac.ke/bitstream/handle/11295/153674/ Muyodi_Prevalence of and factors associated with Chronic Kidney Disease in Osteoarthritis patientsyatta National Hospital.pdf?sequence=1
Iqbal S, Klammer N, Ekmekcioglu C. The Effect of Electrolytes on Blood Pressure: A Brief Summary of Meta-Analyses. Nutrients. 2019 Jun 17;11(6):1362.
Lakkis JI, Weir MR. Hyperkalemia in the Hypertensive Patient. Curr Cardiol Rep. 2018 Mar;20(2):12.
Toyama T, Kitagawa K, Oshima M, Kitajima S, Hara A, Iwata Y, et al. Age differences in the relationships between risk factors and loss of kidney function: a general population cohort study. BMC Nephrol. 2020;21(1):477.
Staff PONE. Longitudinal Study of the Decline in Renal Function in Healthy Subjects. PLoS One. 2015;10(8):e0135992.
Rayamajhi S, Wang L, Herzallah K. RELATIONSHIP BETWEEN BLOOD PRESSURE AND RENAL INDICES AMONG CHRONIC RENAL INSUFFICIENCY PATIENTS IN A LARGE COHORT STUDY. J Hypertens. 2019;37.
Eriksen BO, Stefansson VTN, Jenssen TG, Mathisen UD, Schei J, Solbu MD, et al. Blood pressure and age-related GFR decline in the general population. BMC Nephrol [Internet]. 2017;18(1):77. Available from: https://doi.org/10.1186/s12882-017-0496-7
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