Non-dialysis-dependent chronic kidney disease in two tertiary referral centres in Sri Lanka: a renal registry based descriptive study

Abstract

INTRODUCTION: Chronic kidney disease (CKD) is becoming a major public health issue in Sri Lanka. There is a regional variation in CKD prevalence due to CKD of unknown aetiology (CKDu). Significant attention is paid to CKDu, while CKD due to known causes is somewhat understudied as a public health problem. The objective of this study was to identify the aetiology, clinical stage, and associated co-morbid diseases in patients with CKD referred to nephrology services in Gampaha district. METHODS: A cross-sectional descriptive study was conducted over 18 months from May 2018 at Colombo North Teaching Hospital, Ragama, and District General Hospital, Negombo. All data was obtained from the two renal registries of the hospitals. RESULTS: A total of 1644 patients were studied. The mean age was 61.7 (SD 22.6) years, and 995 (60.5%) were males. Majority [1415 (86.0%)] were residents of Gampaha district. Primary renal disease was type 2 diabetes mellitus (T2DM) in 985 (59.9%), hypertension in 450 (27.4%) and chronic glomerulo-nephritis in 40 (2.4%). Only 29(1.8%) patients had CKD of unknown aetiology. Majority [833(50.7%)] were in CKD stage 3, 470(28.6%) in stage 4, and 238 (14.5%) in stage 5, with no significant difference in mean age of patients in each CKD stage. The commonest co-morbidity was hypertension, in 410 (24.9%), with coronary artery disease in 253 (15.4%). CONCLUSIONS: The commonest cause of non-dialysis dependent CKD in Gampaha district was T2DM, followed by hypertension, with very few patients having CKD of unknown aetiology. Annual screening of patients with T2DM and hypertension for CKD and timely referral to tertiary care is recommended as CKD appears to be an emerging and under-appreciated public health problem in Sri Lanka.