An analysis of patients with chronic kidney disease newly referred to a specialized renal service in Sudan

Keywords: chronic kidney disease, primary health care, Sudan

Abstract

Background: Limited data are available regarding the management of chronic kidney disease (CKD) outside the specialized nephrology services in Sudan. Methods: A retrospective cohort study was conducted at Dr Salma Centre for Kidney Diseases (DSCKD) in Khartoum, Sudan. We aimed to determine the timing and reasons for referral of patients to specialized  nephrology services and to evaluate the management of CKD at primary care level. Newly referred adult patients with CKD were recruited between July and September 2018. Information was extracted from the referral notes, from follow-up records at DSCKD and via direct interview of patients. Data analysis was performed using SPSS. Results: A total of 244 patients were studied. Their mean age was 55 ± 13 years and 210 (86%) were on regular follow-up at primary care level. Hypertensive kidney disease and diabetic nephropathy were the leading causes of CKD. Most patients (78%) were timeously referred with CKD stage 3 or 4. Referrals were mostly due to elevated creatinine levels (35%), non-resolving nephrotic syndrome (27%) and upon patients’ request (28%). Most patients (60%) did not require significant m odifications to their ma nagement; 25 pa tients (1 1%) were late referrals and scheduled for urgent dialysis. Conclusions: The current study reflects a good level of awareness regarding the management of CKD at primary care level and appropriate timing of referrals in most cases.

References

Abu-Aisha H, Elhassan EAM, Khamis AH, Abu-Elmaali A. Chronic Kidney Disease in Police Forces Households in Khartoum, Sudan: Pilot Report. AJNT. 2009; 2(2):21-26. DOI: 10.4314/ajnt.v2i2.58852.

Sharif MU, Elsayed ME, Stack AG. The global nephrology workforce: Emerging threats and potential solutions! Clin Kidney J. 2016; 9(1):11-22. DOI: 10.1093/ckj/sfv111.

CARI LG. The CARI guidelines. Timing of referral of chronic kidney disease patients to nephrology services (adult). Nephrology (Carlton). 2010; 15(Suppl):S2-11. DOI: 10.1111/j.1440-1797.2010.01224.x.

Johnson DW, Atai E, Chan M, Phoon RKS, Scott C, Toussaint ND, et al. KHA-CARI Guidelines: Early chronic kidney disease: Detection, prevention and management. Nephrology (Carlton). 2013; 18(5):340-350. DOI: 10.111/nep.12052.

Martinez-Ramirez HR, Jalomo-Martinez B, Cortes-Sanabria L, Rojas-Campos E, Barragan G, Alfaro G, Cueto-Manzano AM. Renal function preservation in type 2 diabetes mellitus patients with early nephropathy: a comparative prospective cohort study between primary health care doctors and a nephrologist. Am J Kidney Dis. 2006; 47(1):78-87. DOI: 10.1053/j.ajkd.2005.09.015.

Fischer MJ, Ahya SN, Gordon EJ. Interventions to Reduce Late Referrals to Nephrologists. Am J Nephrol. 2011; 33:60-69. DOI. 10.1159/000322704.

Levin A, Stevens P, Bilous RW, Coresh J, de Francisco ALM, De Jong PE, et al. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013; 3(1):1-150. DOI: 10.1038/kisup.2012.73.

Gaitonde DY, Cook DL, Rivera IM. Chronic kidney disease: detection and evaluation. Am Fam Physician. 2017; 96(12):776-783. PMID: 29431364.

Levey AS, Stevens LA, Schmid CH, Zhang Y, Castro AF, Feldman HI, et al. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate [published correction appears in Ann Intern Med. 2011; 155(6): 408]. Ann Intern Med. 2009; 150(9):604-612. DOI: 10.7326/0003-4819-150-9-200905050-00006.

Smart NA, Dieberg GD, Ladhani M, Titus, T. Early referral to specialist nephrology services for preventing the progression to end‐stage kidney disease. Cochrane Database Syst Rev. 2014; 18:(6):CD007333. DOI. 10.1002/14651858.CD007333.pub2.

Baer G, Lameire N, Van Biesen W. Late referral of patients with end-stage renal disease: an in-depth review and suggestions for further actions. NDT Plus. 2010; 3(1):17-27. DOI:10.1093/ndtplus/sfp050.

Smart NA, Titus TT. Outcomes of early versus late nephrology referral in chronic kidney disease: a systematic review. Am J Med. 2011; 124(1):1073-1080.e2. DOI: 10.1016/j.amjmed.2011.04.026.

Chan MR, Dall AT, Fletcher KE, Lu N, Trivedi H. Outcomes in patients with chronic kidney diseases referred late to nephrologist: a meta-analysis. Am J Med. 2007; 120(12):1063-1070. DOI: 10.1016/j.amjmed.2007.04.024.

Tangri N, Grams ME, Levey AS, Coresh J, Appel L, Astor BC, et al. CKD Prognosis Consortium. Multinational assessment of accuracy of equations for predicting risk of kidney failure: a meta-analysis [published correction appears in JAMA. 2016; 315(8):822.] JAMA. 2016; 315(2):164-174. DOI: 10.1001/jama.2015.18202.

Lea JP, McClellan WM, Melcher C, Gladstone E, Hostetter T. CKD risk factors reported by primary care physicians: do guidelines make a difference? Am J Kidney Dis. 2006; 47(1):72-77. DOI: 10.1053/j.ajkd.2005.09.027.

Montgomery AJ, McGee HM, Shannon W, Donohoe J. Factors influencing general practitioner referral of patients developing end-stage renal failure: a standardized case-analysis study. BMC Health Services Research. 2006; 6:114. DOI: 10.1186/1472-6963-6-114.

Ouseph R, Hendricks P, Hollon JA, Bhimani BD, Lederer ED. Under-recognition of chronic kidney disease in elderly outpatients. Clin Nephrol. 2007; 68(6):373-378. DOI: 10.5414/cnp68373.

Kessler M, Frimat L, Panescu V, Briancon S. Impact of nephrology referral on early and midterm outcomes in ESRD: EPidemiologie de l’Insuffisance REnale chronique terminale en Lorraine (EPIREL): results of a 2-year, prospective, community-based study. Am J Kidney Dis. 2003; 42(3):474-485. DOI: 10.1016/s0272-6386(03)00805-9.

Ketteler M, Block GA, Evenepoel P, Fukagawa M, Herzog CA, McCann L, et al. Kidney Disease Improving Global Outcomes (KDIGO). (2017). Executive summary of the 2017 KDIGO Chronic Kidney Disease-Mineral Bone Disorder (CKD-MBD) Guideline Updates: what’s changed and why it matters. Kidney Int. 2017; 92:26-36. DOI: 10.1016/j.kint.2017.04.006.

Grapsa E, Kiousi E. The role of an out-patient renal clinic in renal disease management. Journal of Translational Internal Medicine 2015 3(1). Doi: 10.4103/2224-4018.154287.

Cass A, Cunningham J, Snelling P, Ayanian JZ. Late referral to a nephrologist reduces access to renal transplantation. Am J Kidney Dis. 2003; 42(5):1043-1049. DOI: 10.1016/j.ajkd.2003.07.006.

Rosenberg M, Kalda R , Kasiulevicius V, Lember M . Management of chronic kidney disease in primary health care: position paper of the European Forum for Primary Care. Quality in Primary Care. 2008;16(4):279-294. PMID: 18718165.

Published
2021-07-01
How to Cite
Shigidi, Mazin, Sahar Ebrahim, and Wieam Karrar. 2021. “An Analysis of Patients With Chronic Kidney Disease Newly Referred to a Specialized Renal Service in Sudan”. African Journal of Nephrology 24 (1), 12-18. https://doi.org/10.21804/24-1-4467.
Section
Original articles