Risk factors and their effect on the progression of Sri Lankan CKDu

MGIH Bandara1, SWMPWCIB Weerakoon1, HMDK Herath1, HPNS Hewapathirane1, HGN Erandika1, HPM Hewavitharana1, N Nanayakkara2
1Department of NEPHROLOGY, Centre For Research National Hospital Kandy, Sri Lanka
2Department of Nephrology, National Hospital Kandy, Sri Lanka

Objectives: We focused on risk factors like family history, social support for patients, alcoholic beverage consumption, tobacco use, etc. in CKDu to demonstrate critical causative agents in disease progression.

Methods: 293 patients were randomly recruited from Wilgamuwa, using KIDGO guidelines, and followed in consecutive renal clinics at Wilgamuwa Divisional hospital. Following a preliminary evaluation in the clinic, home visits were scheduled for a detailed interviewer-administered questionnaire with informed consent. A rapid progression in CKDu was defined as an annual decline of greater than 5 mL/min/1.73m2 in eGFR.

Results: Patients with CKDu who progressed rapidly had a lower prevalence [10.92%,n=32, p <0.05] than those who progressed slowly. A positive maternal history of CKDu reduced the risk of rapid progression by 5%(OR =0.95, 95% CI = 0.32 to 2.89), but having a father, mother, or both with kidney disease and a positive paternal history of renal disease increased the risk of rapid progression by 48%(OR =1.48, 95%CI = 0.68 to 3.49 and OR =1.48, 95%CI = 0.53 to 4.15, respectively). Among rapid CKDu progressors, the likelihood of having chronic kidney disease in at least one family member was 1.02(OR =1.02, 95%CI = 0.48 to 2.14). 65.87% of patients were involved in farming, and 71.48% had 30 years of history in farming. Although 36.52% of CKDu patients used alcohol, there was no correlation between alcohol use and rapid CKDu progression. A significant proportion of patients used at least one kind of tobacco (70.65%, p<0.05), and 10.14% indicated rapid progression. 92.78% (p<0.001)of patients received family support in relation to helping in medication adherence.

Conclusions: In light of the results, we showed that there is a contribution of family history to the disease progression. Moreover, factors like tobacco intake and patients who received family support to medication adherence had a significant effect on the disease progression.


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