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Chronic kidney disease, exacerbation, deterioration, precipitants, Nigeria
Many patients with chronic kidney disease (CKD) are often admitted because of acute deterioration of kidney function from various precipitants. We review the record of CKD patients admitted in our hospital over 5 years period with the aim of determining the aetiology of CKD and identifying the common precipitants of acute exacerbation of CKD.
Methods: This is a retrospective study of patients with CKD that were admitted at the University College Hospital Ibadan between January 2008 and December 2012. The hospital records of all the patients were reviewed.
A total of 1113 patients with diagnosis of CKD were admitted during the period under review. The yearly average was 222.6 and there was a steady rise in CKD admissions. Among the 945 patients with CKD included in the analysis 882(93.3%) had acute deterioration of an existing CKD while 63(6.7%) had end stage renal disease (ESRD). Precipitants of acute exacerbation of CKD identified were sepsis 480(54.4%), uncontrolled hypertension 138(15.6%), heart failure 54 (6.1%), herbal consumption 4(5.1%), others 10(1.1%) while no precipitant was identified in 155 (17.6%). In patients with acute deterioration of CKD, 433(49.1%) had partial recovery, 243(27.5%) progressed to ESRD and 206 (23.4%) died. Age > 60years (OR 1.7) and co-morbidity (OR 1.3) were associated with progression to ESRD or death.
Acute exacerbation of CKD is a leading cause of nephrology admission while sepsis, uncontrolled hypertension and heart failure were the common precipitants of acute deterioration of CKD. Increasing age and co-morbidity are determinants of poor outcome among patients with acute deterioration of CKD.
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