Original Research Article
Year: 2021 | Month: October | Volume: 11 | Issue: 10 | Pages: 336-347
DOI: https://doi.org/10.52403/ijhsr.20211044
Chronic Kidney Disease: Socioeconomic Impact. Findings from a Two Center Study in Southwestern Nigeria
Uduagbamen PK1,2, Ogunkoya JO3, Alalade BA4, Oyelese AT5, Nwogbe IC1, Eigbe SO1, Timothy OR1
1Division of Nephrology and Hypertension, 3Pulmonology Unit, Department of Internal Medicine, Ben Carson (Snr) School of Medicine, Babcock University/ Babcock University Teaching Hospital, Ilishan-Remo, Nigeria
2Nephrology Unit, 4Diabetes and Metabolism Unit, Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria.
5Department of Hematology and Blood Transfusion, Ben Carson (Snr) School of Medicine, Babcock University/Babcock University Teaching Hospital, Ilishan-Remo, Nigeria
Corresponding Author: Peter Uduagbamen
ABSTRACT
Introduction: Despite the rising prevalence of chronic kidney disease (CKD), access to adequate renal care is still not available to a very large part of the populace, essentially due to inadequate funds and this has further heightened the burden of the disease on patients and the general society. Measures are therefore needed to highlight this health challenge and proffer solutions.
Methods: A comparative study in which consented 354 consented participants with CKD stage 3-5 gave history, were examined and had blood taken for serum biochemistry and hematocrit to access kidney function.
Results: Two hundred and thirty six males and 118 females participated. The mean age of the participants was 52.11 ± 6.04 yrs. A greater percentage (44.6%) of participants had hypertension as cause of CKD and earned a monthly income less than the national minimum wage (47.7%). A greater proportion of participants had tertiary education (51.4%), were married (64.1%) and travelled less than 50 kilometers (67.5%) to access renal care. The health insured were more likely to be males (P=0.002), aged (P<0.001) have higher hematocrit (P=0.002), albumin (P=0.06), bicarbonate (P=0.04) and GFR (P=0.01)..
The health insured had more frequent dialysis (P<0.001) and erythropoietin use (P<0.001. Forty percent of the health insured had renal transplant compared to 1.6% of the uninsured, P<0.001.
The insured were more associated with IDHT as the uninsured were more associated with IDH. The health insured had a mean dialysis dose (Kt/V 1.34 ± 0.9) compared to 1.13 ± 0.5 for the uninsured, P<0.001. The dialysis dose was positively correlated with frequency of dialysis (P<0.001), and erythropoietin (P<0.001) but was negatively correlated with age (P=0.01) and serum creatinine (P=0.004). Predictors of dialysis dose were insurance status, frequency of dialysis, and erythropoietin, hematocrit, serum albumin and bicarbonate.
Conclusion: Only 11.9% of the CKD cohorts had health insurance coverage and they were more likely to be males, aged, highly educated, with higher hematocrit, and albumin. The health insured had a mean dialysis dose of Kt/V 1.34±0.9 as against 1.13±0.5 for the uninsured. The uninsured had more metabolic acidosis, were younger and being the most active working population, their affectation only further worsens the burden associated with CKD.
Key words: health insured, intradialysis hypotension, intradialysis hypertension, dialysis dose.