A study on hypertension among chronic kidney disease patients admitted in the nephrology department of GGH, Kurnool.
1. To study the association between hypertension and Chronic Kidney Disease.
2. To study the other known risk factors and complications associated with hypertension among CKD patients.
MATERIALS AND METHODS:
Study Design: Cross sectional descriptive study.
Study Period: June to November 2012,
Study Area: The Department of Nephrology, Government General Hospital, Kurnool.
Study Subjects: The chronic kidney disease patients admitted in the Nephrology ward from June to November 2012 were included in the study and were interviewed with a Pre-designed semi structured questionnaire. Three readings of blood pressure were obtained in the sitting position after at least 5 minutes of quite rest. A subject was considered hypertensive if one had systolic blood pressure (SBP) of [greater than or equal to] 140 mmHg or diastolic blood pressure (DBP) of [greater than or equal to] 90 mmHg (the average of two measures that were taken in the seated position), or if he or she was using antihypertensive medication. The diagnosis and classification of HTN was done according to the JNC-VII report on Hypertension. (4)
Statistical Analysis: Chi-square test and percentages.
Data analyzed by EPIINFO software version 7.
RESULTS: Total study subjects were 153 in number. Their age ranged from 13 to 75yrs and the Mean age was 47.96 [+ or -] 11.14 years. Hypertension was present in 126(82.35%) of the patients with CKD. Age had a significant association with the presence of hypertension (p<0.05) whereas gender, education, economic status had no difference (Table 1). 90.48% of the hypertensive patients were in stage 4 CKD when compared to 74.07% of the patients with normal blood pressure which was statistically significant (p<0.05) (Table 2). Of all the patients with hypertension 69(54.7%) were having hypertension before the diagnosis of CKD, 40(31.75) were simultaneously diagnosed along with CKD and 13.49% of the patients developed hypertension after the diagnosis of CKD (Figure 1) Family history of CKD was reported by 23.02% of the hypertensive patients whereas none of the patients with normal blood pressure had family history of Chronic Kidney Disease (p<0.05) (Table 3). Presence of Hypertension had an increased risk (15.87% vs. none, P<0.05) for Heart disease. (Table 4) Only 4.35% of the patients with blood pressure under control had heart disease when compared to 29.82% of the patients with inadequate control (p<0.05) (Table 5) Among 105 male CKD pts 88.24% of the smokers had hypertension compared to 70% of non-smokers which is statistically significant (P<0.05) (Table 6). Similarly alcoholics had increased risk (88. 89% vs. 70. 83%, P<0.05) compare to non-alcoholics for hypertension (Table 7).
DISCUSSION: This study revealed overall prevalence of hypertension among CKD patients admitted into the nephrology ward over a period of six months to be 82.35%, which corresponds to the figure of 80% noted by a study done by Dr. Ronald M, Goldin et al. (1) The prevalence of hypertension was progressively increasing with the severity of CKD; 9.52% of the hypertensive patients were in stage (3), and 90.48% in stage 4-5 CKD. Based on a national survey of representative sample of non-institutionalized adults in the USA, it is estimated that hypertension occurs in 23.3% of individuals without CKD, and 35.8% of stage 1, 48.1% of stage 2, 59.9% of stage 3, and 84.1% of stage 4-5 CKD patients. (6)
A study done by J. A. Whitworth et al showed that more than half the patients with CKD die from a cardiac or vascular event. (4) In a study done by He J et al it was found that adults using healthy lifestyle changes were six times more likely to have controlled hypertension. (7) Study done by Coresh et al. 2003 in their NHANES III Cross-sectional Survey revealed that 51.4% of those with Hypertension on no medication and 64. 4% of those with Hypertension on medication had reduced GFR. (8)
Segura et al. 2004 (83) in their Observational cohort study looking at relationship between blood pressure and CKD observed that among patients with essential hypertension and normal renal function at baseline and a mean follow-up of 13.2 years, 14.6% developed renal insufficiency. (9)
CONCLUSIONS: This study revealed prevalence of hypertension among CKD patients to be 82.35%. Increasing age (>40 yrs.) had a significant association with hypertension among CKD patients. Individuals with hypertension and family history of CKD had increased risk of developing CKD. Smoking and Alcohol consumption had a significant association with hypertension among CKD patients. Presence of hypertension had an increased risk for heart disease among CKD patients. Inadequately controlled hypertension had significant association with occurrence of heart disease.
RECOMMENDATIONS: All efforts should be made to detect and strictly control hypertension in prevention and management of CKD. As an initial step, individuals aged more than 40 years and with family history of CKD should be screened for hypertension and CKD. Increased efforts are needed to identify the reasons for inadequate control of hypertension and approaches to increase blood pressure control among patients with CKD. Changes in life style (smoking, alcohol) are also necessary for control of hypertension along with pharmacological treatment. CKD patients with hypertension should be regularly screened for cardiovascular disease.
ACKNOWLEDGEMENTS: The authors are grateful for the support given by Dr A. Sree Devi, Prof and HOD, Department of community medicine and Dr N. Jikki, Prof and HOD, Department of Nephrology, Kurnool Medical College.
(1.) Dr. Ronald M. Dr. Goldin MD at al. Hypertension and CKD. Issue of kidney beginnings: The magazine, 2005; 4: 1.
(2.) Modi GK, Jha V: The incidence of end-stage renal disease in India: a population-based study. Kidney Int 2006, 70 (12): 2131-3.
(3.) Leticia Buffet, PharmD, Charlotte Ricchetti, PharmD, BCPS, CDE Chronic Kidney Disease and Hypertension A Destructive Combination http://www.medscape.com/.
(4.) JA Whitworth et al. Progression of Renal Failure--The Role of Hypertension. Ann Acad Med Singapore: 2005; 34: 8-15.
(5.) US Department of Health and Human Services. National institute of health, USA. Seventh report of the Joint national committee on Hypertension (JNC-VII). December 2003.
(6.) U S Renal Data System, USRDS 2010 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Bethesda, Md, USA, 2010.
(7.) He J et al. Factors associated with hypertension control in the General population of the United States. Arch Intern Med. 2002; 162: 1051-1058.
(8.) Coresh J, Aster BC, Greene T, Eknoyan G, Levey A S Prevalence of Chronic Kidney Disease and Decreased Kidney Function in the adult U S population: Third national health and nutrition examination survey. Am J Kidney Dis (2003) 41: 1-12.
(9.) Segura J, Campo C, Gil P, Roldan C, Visi I L, Rodicio JL et al. Development of Chronic Kidney Disease and cardiovascular prognosis in essential Hypertensive patients. J Am Soc Nephrol. 2004; 15: 1616-1622.
Y. Padma Sri , T. Siva Kala 
[1.] Y. Padma Sri
[2.] T. Siva Kala
PARTICULARS OF CONTRIBUTORS:
[1.] Associate Professor, Department of Community Medicine, Kurnool Medical College, A. P.
[2.] Senior Resident, Department of Community Medicine, RIMS, Ongole, A. P.
FINANCIAL OR OTHER COMPETING INTERESTS: None
NAME ADDRESS EMAIL ID OF THE CORRESPONDING AUTHOR:
Dr. Y. Padma Sri, Associate Professor, Department of Community Medicine, Kurnool Medical College, Kurnool, Andhra Pradesh.
Date of Submission: 12/03/2015.
Date of Peer Review: 13/03/2015.
Date of Acceptance: 26/03/2015.
Date of Publishing: 08/04/2015.
Table 1: Hypertension and socio-demographic distribution of the study subjects Hypertension Hypertension Socio demographic factors present absent P-value Male 89 (84.76%) 16 (15.24%) Female 37 (77.08%) 11 (22.92%) >0.05 < 40y 17 (65.38%) 9 (34.62%) <0.05 [greater than or 109 (85.83%) 18 (14.17%) equal to] 40y < 12y of education 108 (81.20%) 25 (18.80%) >0.05 > 12y of education 18 (90%) 2 (10%) BPL 114 (82.01%) 25 (17.99%) >0.05 APL 12 (85.71%) 2 (14.29%) Table 2: Hypertension Vs Stage of Chronic kidney Disease [chi square] CKD stage 3 CKD stage 4 Total value: Hypertensives 12 (9.52%) 114 (90.48%) 126 (100%) 5. 5001 Normotensives 7 (25.93%) 20 (74.07%) 27 (100%) P-value: Total 19 (12.42%) 134 (87.58%) 153 (100%) < 0.05 Table 3: Hypertension and Family history of Chronic Kidney disease among CKD patients Family history of CKD Subjects Present Absent Total [chi square] value: Hypertensives 29 (23.02%) 97 (76.98%) 126 (100%) 6.2425 Normotensives 0 (0%) 27 (100%) 27 (100%) P-value: Total 29 (18.95%) 124 (81.05%) 153 (100%) < 0.05 Table 4: Hypertension vs Heart disease among Chronic kidney Disease patients Heart disease Subjects Present Absent Total [chis quare] value: Hypertensives 20 (15.87%) 106 (84.31%) 126 (100%) 4.9302 Normotensives 0 (0%) 27 (100%) 27 (100%) P-value: Total 20 (13.01%) 133 (86.93%) 153 (100%) < 0.05 Table 5: Control of Hypertension Vs Heart disease among CKD patients Heart disease Hypertension Present Absent Total [chi square] value: Under control 3 (4.35%) 66 (95.65%) 69 (100%) 15.1721 Inadequate 17 (29.82%) 40 (70.18%) 57 (100%) control P-value: Total 20 (15.87%) 106 (84.13%) 126 (100%) < 0.05 Table 6: Smoking Vs Hypertension among Male Chronic kidney Disease patients (n=105) Smoking Hypertensives Normotensives Total Present 75 (88.24%) 10 (11.76%) 85 (100%) Absent 14 (70%) 6 (30%) 20 (100%) Total 89 (84.57%) 16 (15.24%) 105 (100%) [chi square] 4. 1683 P = 0.04. Table 7: Alcohol vs. Hypertension among Male Chronic kidney Disease patients (n=105) Alcohol consumption Hypertensives Normotensives Total Yes 72 (88.89%) 9 (11.11%) 81 (100%) No 17 (70.83%) 7 (29.17%) 24 (100%) Total 89 (84.76%) 16 (15.24%) 105 (100%) [chi square] = 4.6730, P = 0.03. Figure 1: Hypertension and diagnosis of Chronic kidney disease Before diagnosis of CKD 69 (54.76%) At the time of diagnosis of CKD 40 (31.75%) After the diagnosis of CKD 17 (13.49%) Note: Table made from bar graph.
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|Title Annotation:||ORIGINAL ARTICLE; Government General Hospital, Kurnool, India|
|Author:||Sri, Y. Padma; Kala, T. Siva|
|Publication:||Journal of Evolution of Medical and Dental Sciences|
|Date:||Apr 9, 2015|
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