Chronic kidney disease (CKD) is a worldwide public health problem, with undesired outcomes of renal failure and premature death if not diagnosed and treated promptly. CKD is defined as kidney damage or glomerular filtration rate (GFR) <60 ml/min/1.73 m2 for 3 months. GFR can be calculated from standardized serum Creatinine and estimating equations, such as the Modification of Diet in Renal Disease (MDRD) Study equation or the Cockcroft-Gault formula. The severity of kidney disease can be classified into five stages according to the level of GFR which is resultant from age, race, sex, and serum Creatinine concentration. On the other hand, End-stage renal disease (ESRD) which is described as an eGFR of <15 ml/min/1.73 m2, initiation of maintenance dialysis or receipt of preventive renal transplantation is classified as CKD stage five (1).
CKD is a chronic disease that deteriorates over time. The final stage of CKD is Kidney failure or end-stage renal disease (ESRD) indicating that the kidney has stopped working permanently. The symptoms will not be seen in most cases until the kidneys are severely damaged because CKD typically worsens over time. Once the kidneys are starting to fail, whichever of symptoms like itchy skin, vomiting, nausea, not feeling hungry, too much or inadequate urine, trouble catching breath and trouble sleeping, edema of feet and ankles and muscle cramps will be manifested (2).
To reduce the detrimental effect of CKD, early intervention is crucial which included identifying individuals with higher risk of renal disease. Factors such as race, gender, older age, and family history need due consideration. Additionally, DM, hypertension, smoking and obesity are the risk factors of kidney disease. Particularly, uncontrolled diabetes and/or hypertension can easily and quickly progress to an end stage renal disease (ESRD). Globally, Diabetes mellitus is the principal cause of both ESRD and CKD (5). Screening clinical indicators of renal dysfunction is the best way for the early detection of patients at risk of developing CKD. It is vital to enhance patient’s awareness on the importance of life style modification in order to preventing the occurrence of the disease (3) .
The 2016 worldwide report indicated, there were more than 21 million new cases of CKD per year implying an increase of CKD by 88.76%, 276 million prevalent cases showing an increase of CKD by 86.95%, nearly 1.2 million deaths due to CKD indicating an increase of the disease by 98.02% from 1990. The upsurge in burden of CKD due to diabetes and hypertension happened at a much faster rate in third world countries than in developed countries (6). Globally, diabetes was reported among 415 million adult populations, hypertension among 1.4 billion, while 2.1 billion children and adults are overweight or obese. The magnitude of CKD amongst adults having type 2 diabetes is about 25% to 40%, depending on population factors. A prevalence of CKD was reported to be 30% and 70% among hypertension and obese adult of United States, respectively(4).
Africa is a continent where more than 1 billion populations reside. Among this, 961.5 million people live in sub Saharan Africa and 195 million are from Northern Africa. CKD complications impacted global healthcare resources significantly and only a handful of countries have sufficiently robust economies to meet the challenge posed by this disease(5) (8). Chronic kidney disease is a major public health issue globally and a principal predictor of poor health outcomes. In developed nations the burden of CKD is relatively well defined. However fewer studies had indicated greater CKD burden in developing countries(4).
In 2015, CKD is a most important cause of morbidity and mortality in both developed and developing countries, with an estimated 10% of the population worldwide having CKD. Studies have consistently shown that African descendants are at higher risk for CKD occurrence and progression to ESRD. A substantial rise in the number of people affected by CKD in Africa can be explained by the burden of this two problems(6). Factors such as increase in age, type 2 DM, hypertensive patients, poor awareness about the disease, and living with diabetes for longer duration, increased body mass index, and obesity are important contributing factors for the occurrence of CKD over the World. It is important to understand effect of renal disease on metabolism and safe utilization of medications in order to delay the complication of CKD (7).
Nearly a quarter (13.2%) of sub-Saharan population has CKD while its magnitude among diabetic and hypertensive and patients is 24.7% and 34.5% respectively. The magnitude of CKD is increasing among diabetic and hypertensive patients. Similarly in Ethiopia, the magnitude of chronic kidney disease in hypertensive and diabetic patients ranges from 18.2% to 26% (8).
The burden of CKD and its related risk factors remain understudied in developing countries even if such interventions are available. This would be due to low awareness of the public, health care workers, government and other funders and may lead to the false perception that CKD is not an important problem in sub-Saharan Africa (8).
In Ethiopia, even if different studies have shown that the burden of CKD among diabetes and hypertension is high and treatment options are expensive, their results have varied regarding its prevalence. For example, the prevalence of CKD among diabetes patients is 21.8 and 26% ((9, 10) in Northern and Southwestern part of Ethiopia. Nevertheless, studies reporting prevalence of CKD and risk factors are still insufficient especially in the study area. Efforts to update the prevalence and identify the early risk factors then understanding those risk factors for CKD particularly, among diabetic and hypertensive patients are needed and will be beneficial for developing effective strategies for the prevention and controlling CKD. Therefore, the aim of this study is to assess prevalence and associated factors of CKD among diabetic and hypertensive patients attending at Ambo University referral and general hospitals of West Shewa Zone, Oromia Region, Ethiopia.