Authors (including presenting author) :
Xu S, Chen XR, Li YC
Affiliation :
Yau Ma Tei Jocky Club Clinic, Departement of FM and GOPC, Queen Elizabeth Hospital
Introduction :
Chronic kidney disease (CKD) is a worldwide public health problem. It is confirmed to be associated with an increased risk of cardiovascular comorbidities and mortality as well as progression to end stage renal disease (ESRD) that is dialysis dependent. In Hong Kong, a screening study showed the prevalence of positive (≥1+) urine dipstick for protein, glucose, blood, protein or blood, any urine abnormality was 3.2%, 1.7%, 13.8%, 16%, 17.4%, respectively in apparently “healthy” (asymptomatic and without history of DM, HT, or CKD) individuals. Hypertension (HT) is a well-recognized risk factor for CKD. According to the United States Renal Data System (USRDS) 2019 Annual Data Report, hypertension is the second leading cause of ESRD. As suggested by the Asian Forum for Chronic Kidney Disease Initiatives (AFCKDI), hypertensive patients are the target population for CKD screening. Various studies reported CKD prevalence in HT patients among 1.7-26.0% in different ethnic population in Europe, the US, and Taiwan. A recent study in Hong Kong reported 22.0 per 1000 person-years for the incidence rate of CKD in local hypertensive patients. However, the study of CKD prevalence in HT patients in Hong Kong is still lacking despite the fact that many hypertensive patients followed-up in primary care have renal impairment.
Objectives :
To identify the prevalence of Chronic Kidney Disease (CKD) in Chinese hypertensive population managed in a local public primary care clinic and to explore its associated risk factors.
Methodology :
Design: Cross-sectional study.
Subjects: Chinese adult hypertensive patients (> 18 years of age) who had been followed up in a public general outpatient clinic (GOPC) from 1 Jan 2018 to 30 Jun 2018 were recruited.
Main outcome measures: Demographic, clinical parameters including age, gender, smoking status, body weight, height, systolic and diastolic blood pressure, biochemical data, and comorbidities were collected from the Computer Management System (CMS). Estimated glomerular filtration rate (eGFR) was calculated by using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. CKD was defined as eGFR < 60 ml/min/1.73m2 and staged according to Kidney Disease Improving Global Outcomes (KDIGO) 2012 criteria. Student's t-test was used to analyze continuous variables and the Chi-squared test was used for categorical data. Multivariate Logistic regression was used to examine the association between CKD and variable associated factors. All statistical tests were two-sided, and a P-value of < 0.05 was considered significant.
Result & Outcome :
Among the 993 Chinese hypertensive patients included in the final analysis, 152 were found to have CKD, with overall prevalence being 15.3%. In addition, the prevalence of CKD increased with the ageing of the population. In multivariate analysis, associated factors for CKD included age (OR 4.3 for every 10 years increase), history of congestive heart failure (OR 7.2), diabetes mellitus (OR 1.8), gout (OR 3.2), number of anti-hypertensive medications (OR 1.6) and high-density lipoprotein cholesterol level (OR 0.38).
