|Year : 2016 | Volume
| Issue : 4 | Page : 118-120
Etiological Survey of Chronic Kidney Disease Patients on Maintenance Hemodialysis in Different Centers of Chittagong, Bangladesh
Rajat Sanker Roy Biswas1, MA Kashem2
1 Department of Medicine, Chattagram Maa Shishu O General Hospital, Agrabad, Chittagong, Bangladesh
2 Department of Nephrology, Chattagram Maa Shishu O General Hospital, Agrabad, Chittagong, Bangladesh
|Date of Web Publication||7-Nov-2016|
Rajat Sanker Roy Biswas
Chattagram Maa Shishu O General Hospital, Agrabad, Chittagong
Source of Support: None, Conflict of Interest: None
Background and Objectives: Chronic kidney disease (CKD) is a common health problem in Bangladesh. Etiological factors of CKD are very vital for management but largely unknown in our setting. Hence, the main objective of the study is to identify etiology of CKD of patients who are on maintenance hemodialysis (MHD) at different dialysis units of Chittagong. Methods: This descriptive study was conducted on 107 patients of CKD who were on MHD in different dialysis centers of Chittagong town, Bangladesh. A pretested questionnaire was adopted from previous study addressing different etiology of the CKD. This study was based solely on history and previous health records. After collection of data, it was compiled and analyzed manually. Results: In the present study, there were 61.62% males and 38.31% females and male-female ratio was 1.61:1. Majority (42 [39.25%]) of the patients were in the age group of 50-60 years, next to which was 40-50 years (23 [21.49%]). Diabetes mellitus (DM) with or without hypertension (HTN) was found as the most common etiology (70 [65.45%]) of CKD in our study, next to which was HTN (53 [49.53%]), nonsteroidal anti-inflammatory drug (NSAID) (15 [14.1%]), chronic glomerulonephritis (7 [6.54%]), polycystic kidney disease (6 [5.60]), systemic lupus erythematosus (1 [0.93%]), contrast-induced (1 [0.93%]), and following acute kidney injury (1 [0.93%]). Only 4 (3.73%) cases were found to have biopsy-confirmed nephritis. Conclusion: DM was found the most common etiology of CKD among patients who are on MHD in Bangladesh, next to which was HTN. Maximum patients had no biopsy proof of CKD and NSAID constituting a significant segment of etiology which is a potentially preventable etiology, in our setting.
Keywords: Chronic kidney disease, etiology, maintenance hemodialysis
|How to cite this article:|
Biswas RS, Kashem M A. Etiological Survey of Chronic Kidney Disease Patients on Maintenance Hemodialysis in Different Centers of Chittagong, Bangladesh. J Integr Nephrol Androl 2016;3:118-20
|How to cite this URL:|
Biswas RS, Kashem M A. Etiological Survey of Chronic Kidney Disease Patients on Maintenance Hemodialysis in Different Centers of Chittagong, Bangladesh. J Integr Nephrol Androl [serial online] 2016 [cited 2018 Jan 17];3:118-20. Available from: http://www.journal-ina.com/text.asp?2016/3/4/118/193514
| Introduction|| |
Chronic kidney disease (CKD) is a major public health problem worldwide due to change of its underlying etiopathogenesis.  Infections are considered as less important regarding etiology of kidney disease, but hypertension (HTN) and diabetes are being considered as major contributor of it in western world as well as in developing countries. 
End-stage renal disease (ESRD) has reached epidemic proportion with more than 400,000 affected individuals in the United States and well over one million worldwide.  This staggering number represents only the tip of the iceberg as the incidence of CKD is at least 30-fold higher than that of ESRD.  CKD is a common health problem in Bangladesh and the number is increasing day by day. Only a small percentage of CKD patients can afford the maintenance hemodialysis (MHD) support. Majority of patients die without getting the costly dialysis. A cross-sectional survey  was carried out at certain selected slum areas of Mirpur in Dhaka city of Bangladesh over the period of 2 years, and a total of 1000 participants ranging from 15 to 65 years old were studied. The analysis discovered that 4.1% of the participants were diabetic, 11.6% were hypertensive, and 7.7% had proteinuria. Based on modification of diet in renal disease equation, 13.1% of the participants were detected as having CKD, while with Cockcroft-Gault equation, 16% had CKD.
To reduce the development of CKD, etiological factors assessment is very vital which is largely unknown in our setting. In a study  done in Bangladesh, 125 CKD patients (cases) and 125 age- and sex-matched healthy subjects (control) in Mymensingh Medical College, a tertiary hospital of Bangladesh, were compared for the presence of nonmodifiable (age, sex, family history of HTN, cardiovascular disease, family history of kidney disease, and socioeconomic condition) and modifiable (HTN, diabetes mellitus [DM], smoking habit, and obesity) risk factors. Glomerulonephritis (GN) was the dominant cause of CKD (67.2%), followed by diabetes (24%), HTN (4.8%), and others (4%). They did not do any biopsy.
Hence, the present study was aimed to see etiology of CKD on MHD at different dialysis units of Chittagong, Bangladesh.
| Methods|| |
This descriptive study was conducted on 107 patients of CKD who were on MHD in different dialysis centers of Chittagong town, Bangladesh. A pretested questionnaire was adopted to address different etiology of the CKD along with some baseline information. It was validated by a small pilot study with ten cases earlier. Our study was based solely on history and previous health records and no interventions or investigations were done. After data collection, it was compiled and analyzed manually. A total of 107 patients of CKD were included, of which the majority were from Center for Scientific and Clinical Research (50.40%) and Chittagong Kidney Foundation (23.30%). 13 (12.10%) patients were recruited from Chattagram Maa Shishu O General Hospital, and rest 15% were from Al-Arafah Dialysis Center and Chittagong Port Authority Hospital.
| Results|| |
In the present study, there are more male patients (61.62%) and male-female ratio was 1.61:1. Among all, 50-60 years old patients were the majority, i.e., 42 (39.25%) [Table 1]. DM with or without HTN was found the most common etiology, i.e., 70 (65.45%), of CKD in our study, next to which was HTN, i.e., 53 (49.53%). Nonsteroidal anti-inflammatory drug (NSAID), chronic GN (CGN), polycystic kidney disease, systemic lupus erythematosus, contrast-induced, and following acute kidney injury were some less common causes of CKD [Table 2]. A few cases were done biopsy to confirm nephritis [Table 3].
| Discussion|| |
Primary GN remains the most probable underlying cause of ESRD of uncertain etiology in many developing countries.  Glomerular disease is a common cause of ESRD and comprises 25-45% cases of ESRD in developing nations, including Bangladesh.  In Bangladesh, like most developing countries, the incidence and histological pattern of GN remain undetermined. The current study was performed to see the etiology CKD among Bangladeshi patients who are on MHD.
In the present study, male patients were more (61.2%) with male to female ratio 1.61:1. Bangladesh is a country of low educational level and male gets more preference than female. Hence, here, more males come under dialysis than female. The majority of patients in our study were at age group 50-60 years, i.e., 42 (39.25%), next which were 40-50 years, i.e., 23 (21.49%).
Studies , done in India analyzed their demographic data, socioeconomic profile, and etiologies of CKD from different zones. The overall age was 50.1 ± 14.6 years, and 36,745 (70.3%) of the subjects were males. Overall, females with CKD were 2½ years younger than males (50.9 ± 14.6 vs. 48.3 ± 14.4 years).  Comparison of data from different zones showed small but statistically significant differences in age distribution and sex ratio. As here, Indian data are near similar to Bangladesh in terms of demographic variables.
Regarding analysis of etiology, DM with or without the HTN was the dominant cause of ESRD found in our study which was 65.45%. Isolated HTN with CKD was found in 53(49.53%) cases. A study  done in Bangladesh found that GN was the dominant cause of CKD (67.2%), followed by diabetes (24%), HTN (4.8%), and others (4%). Among CKD, 86.4% participants had HTN and 26.4% had diabetes. Similar findings were also found in India.  However, in the present study, we found only 7 (6.54%) cases of CGN. None of the above etiology was biopsy proven, so still we are in darkness regarding the actual etiology of CKD in our context.
History of long-term NSAID was found in 15 (14.1%) cases. Drugs are sold here in Bangladesh without restriction as over the counter product. Hence, people can buy any drug which might be the hidden cause of such finding in the development of ESRD in our study.
Among all, only 4 (3.73%) cases were found to have biopsy proof of their ESRD. Bangladesh is a developing country with limited resources and workforce. Hence, still, scientific approach in treating ESRD patients is lacking. This study will provide us a view that we still need to go a long way to provide standard treatment of ESRD patients.
| Conclusion|| |
DM was found the most common cause of CKD found in our country, next to which was HTN. Biopsy proof of CKD is painfully lacking found in our study. CKD due to NSAID is also found as an important contributor of the etiology which is a potentially preventable.
We want to acknowledge the contributions of Dr. Sanjoy Datta from Thana Health Complex, Mirsharai, and Dr. Aparna Das, Chittagong Kidney Foundation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Zhang QL, Rothenbacher D. Prevalence of chronic kidney disease in population-based studies: Systematic review. BMC Public Health 2008;8:117.
Hasan MJ, Kashem MA, Rahaman MH, Quddush R, Rahaman M, Sharmeen A, et al
. Prevalence of chronic kidney disease (CKD) and identification of associated risk factors among rural population by mass screening. CBMJ 2012;1:20-6.
Satko SG, Freedman BI, Moossavi S. Genetic factors in end-stage renal disease. Kidney Int 2005;67:S46-9.
Jones CA, McQuillan GM, Kusek JW, Eberhardt MS, Herman WH, Coresh J, et al.
Serum creatinine levels in the US population: Third national health and nutrition examination survey. Am J Kidney Dis 1998;32:992-9.
Huda MN, Alam KS, Rashid HU. Prevalence of chronic kidney disease and its association with risk factors in disadvantageous population. Int J Nephrol 2012;2012:267329.
Kabir MS, Dutta PK, Islam MN, Hasan MJ, Mondol G. Prevalence of risk factors of chronic kidney disease in adults. Mymensingh Med J 2012;21:605-10.
Samad T, Huq WM, Rahim MA, Iqbal S. Histological pattern of primary glomerulonephritis in a tertiary care hospital of Bangladesh. Nephrol Dial Transplant 2015;30 Suppl 3:iii420-39.
Rajapurkar MM, John GT, Kirpalani AL, Abraham G, Agarwal SK, Almeida AF, et al.
What do we know about chronic kidney disease in India: First report of the Indian CKD registry. BMC Nephrol 2012;13:10.
Jha V. End-stage renal care in developing countries: The India experience. Ren Fail 2004;26:201-8.
Rajasekar P, Sameeraja V, Poornima B. Etiological spectrum of chronic kidney disease in young: A single center study from South India. J Integr Nephrol Androl 2015;2:54-60.
[Table 1], [Table 2], [Table 3]