Evaluation of Pre-Tertiary Hospital Care of Patients with Chronic Kidney Disease Stage 5.

INTRODUCTION : Chronic kidney disease (CKD) is a worldwide public health problem with a rising incidence and prevalence of kidney failure, with poor outcomes and high cost. There is an even higher prevalence of earlier stages of CKD, which often goes unnoticed. Even in affluent western countries, despite the magnitude of the resources committed to the treatment of Chronic Kidney Disease stage 5 (CKD 5) and the substantial improvements in the quality of dialysis therapy; these patients continue to experience significant mortality and morbidity, and a reduced quality of life. Survival probabilities for dialysis patients at 1, 2, 5 and 10 years are approximately 80, 67, 40, and 18 percent, respectively. Moreover, 50 percent of dialysis patients have three or more comorbid conditions, the mean number of hospital days per year is approximately 14 per patient, and selfreported quality of life is far lower in dialysis patients than in the general population. In the past two decades, there has been increasing evidence that the adverse outcomes of CKD, such as kidney failure, cardiovascular disease, and premature death, can be prevented or delayed. Earlier stages of CKD can be detected only through periodic health check-ups and laboratory testing. Treatment of earlier stages of CKD is effective in slowing the progression toward stage 5. Initiation of treatment for cardiovascular risk factors at earlier stages of CKD should be effective in reducing cardiovascular disease events both before and after the onset of kidney failure1. Unfortunately, CKD is “underdiagnosed” and “under-treated” resulting in lost opportunities for prevention. There is therefore a need for uniform application of the current recommendations designed to retard the progression of CKD; to optimize the medical management of comorbid medical conditions, such as cardiovascular disease, diabetes mellitus and lipid disorders; and to decrease the complications secondary to progression of CKD, including hypertension, anemia, secondary hyperparathyroidism, and malnutrition. Once the disease has progressed to CKD 5, patients have decreased quality of life, high morbidity, and an annual mortality of about 22%. The high morbidity and mortality seen in dialysis patients may decrease significantly if patients were healthier at the time of initiating renal replacement therapy (RRT). Data from India is lacking on how patients with CKD 5 are treated in the community. Data obtained about the pre-tertiary hospital care of patients with CKD 5 would form the background to see the pitfalls in treatment and would allow us to address the problem better and provide better treatment to the patients who come to us for help. AIM : To evaluate patients with Chronic Kidney Disease Stage 5 [CKD 5] regarding: 1. Their pre-tertiary hospital care and 2. To assess their knowledge of the disease and its treatment OBJECTIVES : 1. To assess the pre-tertiary hospital care of consecutive patients with CKD 5 who presented themselves to the nephrology services of Christian Medical College, Vellore. 2. To describe the demographic profile, education, occupation, socio-economic status, previous treating personnel, referral pattern, native kidney disease (if known), previously done investigations, vaccination against Hepatitis B virus, treatment received, prior patient education and decision towards renal replacement therapy. 3. To determine if the care given prior to coming to a tertiary hospital was appropriate and whether early referral to a nephrologist improved the adequacy of treatment. Consecutive pts with CKD 5 presenting to Nephrology services (over an eight month period) were prospective enrolled upon making a diagnosis of CKD 5. Both the patient and his relatives were interviewed by the investigator with regard to the pretertiary hospital management. The data thus collected was then entered into an electronically compatible proforma