|Year : 2012 | Volume
| Issue : 2 | Page : 70-74
Prevalence of risk factors for chronic kidney disease among civil servants in Kano
Aisha Muhammad Nalado, Aliyu Abdu, Hamza Muhammad, Alhaji Abdu, Aminu Muhammad Sakajiki, Bappa Adamu
Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
|Date of Web Publication||12-Mar-2013|
Aisha Muhammad Nalado
Department of Medicine, Aminu Kano Teaching Hospital/Bayero University, PMB 3452, Kano
Source of Support: We Acknowledge the support given to us by the
management of Aminu Kano Teaching Hospital towards the success of this
work., Conflict of Interest: None
Background: Data on the epidemiology of chronic kidney disease (CKD) from sub-Saharan Africa are still sparse. Preventive strategy through early detection and treatment has been advocated for CKD, especially in our environment where majority of patients present late and cannot afford the cost of renal replacement therapy which is not widely available. We investigated the prevalence of risk factors for CKD among the civil servants who volunteered after a public enlightenment campaign in Kano, northern Nigeria. Materials and Methods: We studied 225 apparently healthy civil servants who availed themselves of the opportunity to be screened for risk factors for CKD during the 2011 World Kidney Day activities. Relevant demographic and clinical data were obtained using a questionnaire. Weight, height, Body Mass Index (BMI), and blood pressure were measured. Spot urine samples were collected and tested for protein, sugar, and other parameters using a dipstick. Random blood sugar was measured with a glucometer. Results: The mean age of the study participants was 41.5 ± 9.68 years. Males constituted 83.6% of the respondents. Majority had a positive history of use of traditional medications, followed by the use of analgesic drugs, while very few (less than 5% each) admitted to alcohol ingestion or use of bleaching creams. While there was a significant family history of hypertension and diabetes, only about 3% had positive family history of kidney disease. Proteinuria was found to be present in 19.4%. Other risk factors found include hypertension (29.8%), obesity (11%), and diabetes mellitus (3.6%). Conclusion: Risk factors for CKD are common among civil servants in Kano. The most frequent CKD risk factors found among the study subjects were use of traditional medication, cigarette smoking, obesity, hypertension, and proteinuria.
Keywords: Chronic kidney disease, civil servants, Kano, prevalence, risk factors
|How to cite this article:|
Nalado AM, Abdu A, Muhammad H, Abdu A, Sakajiki AM, Adamu B. Prevalence of risk factors for chronic kidney disease among civil servants in Kano. Niger J Basic Clin Sci 2012;9:70-4
|How to cite this URL:|
Nalado AM, Abdu A, Muhammad H, Abdu A, Sakajiki AM, Adamu B. Prevalence of risk factors for chronic kidney disease among civil servants in Kano. Niger J Basic Clin Sci [serial online] 2012 [cited 2019 Sep 17];9:70-4. Available from: http://www.njbcs.net/text.asp?2012/9/2/70/108467
| Introduction|| |
The global rise in the number of patients with chronic kidney disease (CKD) who would ultimately require renal replacement therapy (RRT) is increasing at an alarming rate. , The number of patients with end-stage renal disease (ESRD) has increased by about 9% per year in the United States of America and by 4% per year in Japan.  In developing countries, the number varies from less than 100 per million population in sub-Saharan Africa and India to about 400 per million population in Latin America and more than 600 per million population in Saudi Arabia. 
The increase in growth of the population with ESRD is partially related to the underrecognition of earlier stages of CKD and the risk factors for its development. 
It was pointed out that over the next decade, even the industrialized nations will struggle to meet demands of expanding ESRD programs. In the USA, it has been estimated that the annual expenditure on ESRD will reach over 50 billion US dollars by 2030.  In the UK, renal services currently consume about 2% of the National Health Service (NHS) budget and this is said to be rising with the increasing number of individuals requiring RRT. 
Studies have shown that early intervention and treatment of the risk factors can slow progression of the disease, and thus prevent loss of kidney function, and this will be the focus in reducing its burden. , Hypertension and diabetes account for nearly 70% of all causes of CKD worldwide and these primary disease states also hasten the progression of kidney disease.  Both conditions are poorly detected and inadequately treated.
The objective of this study was to determine the prevalence of CKD risk factors in an unselected population of civil servants who volunteered following an initial public enlightenment campaign as a prelude to early intervention.
| Materials and Methods|| |
The study was conducted during the World Kidney Day 2011 activities in Kano, located in northwestern Nigeria, with an estimated population of more than 11 million inhabitants. Screening was conducted among civil servants at Audu Bako Secretariat. A semi-structured interviewer-administered questionnaire was used to collect basic demographic data, past and present medical history, and family and social history. Participants were offered free measurements of blood pressure (BP), blood sugar, urinalysis, weight, height, and Body Mass Index (BMI).
The BP of the respondents was measured twice 5 min apart using Accouson's Mercury Sphygmomanometer with an appropriate cuff size, in the right arm in the sitting position after 5 min rest by medical doctors in the team. Random blood sugar test was done using Accu-Check Active glucometer and urinalysis with Combi-screen 9 urine Dipstick (Biotechnologies AG, Lichtenfels, Germany). Weight was measured by a weighing scale and height by a Steotape.
Hypertension was classified using the Joint National Committee (JNC) VII criteria.  Individuals with BP more than 140/90 mmHg or on current use of antihypertensive medications were regarded as being hypertensive. The diagnosis of diabetes was based on random blood sugar of more than 200 mg/dl or current use of antidiabetic agents according to the World Health Organization (WHO) criteria.  Proteinuria was graded as 1+ (30 mg/dl), 2+ (100 mg/dl), and 3+ (500 mg/dl). Obesity was defined based on BMI according to the WHO criteria.  Individuals discovered to have overt proteinuria, hypertension, obesity, and diabetes were referred to the teaching hospital for further evaluation and treatment.
All data were entered into excel spreadsheet and analyzed using Epi Info 2002. Numerical data were reported as mean ± SD. Comparison of means of continuous variables was done using Student's t-test. Chi-square test was used for comparing proportions.
| Results|| |
A total of 225 respondents were screened during the exercise. They consisted of 188 (83.6%) males and 37 (16.4%) females. The mean age of the respondents was 41.5 ± 9.7 years (age range 25-70 years). Majority of the respondents [136 (60.4%)] were in the 25-44 years age range. The male respondents were older than the female respondents, with a mean age of 42.0 ± 9.7 years compared to 38.7 ± 10 years of the females, although this difference was not statistically significant. All the respondents were Muslims.
Among the CKD risk factors asked in the questionnaire, majority of the subjects (over 81.78%) had a positive history of use of traditional medications, followed by the use of analgesic drugs (49.78%), while very few (less than 5% each) admitted to alcohol ingestion or use of bleaching creams. While there was a significant family history of hypertension and diabetes, only about 3% had positive family history of kidney disease as shown in [Table 1].
|Table 1: Risk factors for chronic kidney disease according to response to the questionnaire|
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Hypertension was detected in 67 of the respondents, giving a prevalence of 29.8%. When the patients were classified according to BP class, 158 (70.2%) had normal blood pressure, 8 (3.5%) were in the pre-hypertension category, and 22 (9.8%) had stage 1 hypertension, while 37 (16.4%) had stage 2 hypertension. There was no significant difference in the prevalence of hypertension between males and females ( P = 0.9816).
The male respondents had higher systolic and diastolic BP (SBP and DBP, respectively) compared with the female respondents (mean SBP 128.6 ± 30 mmHg in male respondents vs. 126.7 ± 24 mmHg in females, P = 0.755; mean DBP of 83.2 ± 14 mmHg in male respondents vs. 81.1 ± 14 mmHg in females, P = 0.152) as shown in [Table 2].
|Table 2: Sex distribution of the parameters measured in the study population|
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Prevalence of hypertension was highest in the 45-54 year age group ( n = 33; 14.7%), while 21 (9.3%) of the respondents in the 25-44 year age group were hypertensive.
Eight respondents were diabetic giving a prevalence of 3.6%, and the age range of the diabetic respondents was between 35 and 50 years. There was no significant difference in the prevalence of diabetes between male and female respondents ( P = 0.7592). Five respondents (2.2%) had combined diabetes and hypertension.
Proteinuria was detected in 44 (19.6%) of the respondents. In terms of distribution, 37 (16.4%) had 30 mg/dl (1+) proteinuria, 3 (1.3%) had 100 mg/dl (2+), and 4 (1.8%) had 500 mg/dl (3+) proteinuria. Seventeen (25.4%) respondents with hypertension had overt proteinuria, while 2 (25%) of the diabetic respondents had proteinuria. There was no significant difference in the prevalence of proteinuria among the male and female respondents ( P = 0.729).
Twenty-six (11%) of the respondents were obese, while 60 (26.7%) were found to be overweight.
There was no statistically significant association between proteinuria and hypertension ( P = 0.1512), so also with diabetes ( P = 0.693); however, there was a trend when we compared proteinuria with obesity, though it did not attain statistical significance ( P = 0.07).
| Discussion|| |
In this study, prevalence of risk factors for CKD among civil servants in Kano has been reported. Positive history of use of traditional medicines was high among the respondents, and this is important as most of these herbal preparations were not studied and accurately characterized, hence the active ingredient is not known. Some of these herbal preparations in some parts of the country were actually reported to be nephrotoxic.  History of alcohol ingestion and cigarette smoking was low in the studied population. This is a good development and may be attributed to the socio-cultural and religious background of the respondents.
Hypertension, diabetes, proteinuria, and obesity are the common risk factors for development of CKD. Hypertension was quite high among our respondents. The prevalence was as high as 29.8% which was higher than that reported in a similar study in Abuja,  although lower than that reported in similar studies in Ile-Ife, southwestern Nigeria,  and Enugu, southeastern Nigeria,  The comparison of our findings with that of similar centers in Nigeria is presented in [Table 3]. The prevalence was however similar to that of 27.6% reported in Kinshasha.  Hypertension is reported to be a common cause of CKD in Nigeria and other parts of tropical Africa.  This increase in prevalence of hypertension could be explained by a sedentary lifestyle as most of them sit in one place most of the days (being civil servants), and may also be influenced by their food habits as many of them may be involved in patronizing food vendors for their meals.
|Table 3: Comparison of our results with those from similar screening programs in Nigeria|
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The prevalence of diabetes in the study was 3.6%, which is higher than the value of 2.8% reported in a non-communicable disease survey,  but lower than a prevalence of 5% reported in a screening exercise in Rivers state  and 7% reported in a similar screening exercise in Kinshasa.  Diabetes is the most common cause of CKD in western countries and America,  and similar trend of increasing prevalence of diabetes as a cause of CKD has been reported in Nigeria.  Since in our study we used glycosuria and two random blood sugar values rather than fasting blood sugar in the diagnosis of diabetes, the prevalence of diabetes could have been underestimated.
We found 11% of the respondents to be obese, while 26.7% were found to be overweight. This value was similar to the finding of 10% in a similar study in Abuja,  but lower than 22.6% reported in Enugu, 13.5% in Rivers state,  [Table 3] and 14.9% in DR Congo.  Our finding was also lower than the findings in Okinawa, Japan, where the prevalence was 32.9%.  Higher prevalence of obesity in our urban population may be due to lifestyle modification. The increasing prevalence of obesity will probably impact on the future rates of CKD and other cardiovascular morbidities in this part of Nigeria.
Prevalence of proteinuria among the respondents was 19.6%; this is similar to the rates of 19% reported from Abuja and 19.9% from Lagos,  but higher than 4.3% reported from Enugu,  although lower than 29.7% reported from Ile-Ife  and 29.7% from Rivers state.  as shown in [Table 3]. Our finding was higher than that reported from China (12.1%).  Proteinuria is not only a marker of kidney disease, but also a progression factor in CKD, heralding a further deterioration in renal function. Its detection is therefore very important as intervention at this stage has been shown to prevent or at least delay further renal damage.
The global burden of risk factors for CKD is increasing, and this is important from public health perspective for early prevention of ESRD, cardiovascular morbidity, and mortality associated with early CKD. These risk factors render CKD an important focus of health care planning even in the developed world, but the problems they cause in the developing world are far more challenging the cost of the treatment for the endpoints (including ESRD and cardiovascular diseases) are prohibitive and untenable by most developing nations. Since many people from this part of the world do not appreciate the significance of routine medical checkups, population screening for CKD and its risk factors becomes paramount, especially among those at higher risk of the disease.
Limitations in our study were: the study population was unselected, hence the selection bias. We conducted on the spot measurements of samples such as urine and blood which were not timely collected as well as the cross-sectional nature of the study.
| Conclusion|| |
Reports from this screening program show that risk factors for CKD are common in our environment; therefore, there is a need for preventive strategies such as public enlightenment to avert the rising burden of CKD.
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[Table 1], [Table 2], [Table 3]