Department of Medicine, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
BMC Nephrol. 2022 Oct 26;23(1):343. doi: 10.1186/s12882-022-02951-z.
The incidence of end stage kidney disease (ESKD) is increasing in Ghana as with the rest of the world. This study compared the sociodemographic, diagnostic characteristics (clinical, biochemical and imaging) and clinical outcomes of ESKD patients who chose either renal replacement therapy (RRT) or conservative therapy as well as the factors that influenced their choice.
We retrospectively reviewed the records of 382 ESKD patient from 2006 to 2018. The data was collected from the Nephrology Clinic at the Komfo Anokye Teaching Hospital (KATH). Sociodemographic, diagnostic (clinical, biochemical and imaging) and therapeutic data were obtained, organized and analyzed with Statistical Package for the Social Sciences (SPSS).
Of the 382 patients, 321 had conservative therapy whiles 61 had renal replacement therapy. The mean age of participants was 47.71 ± 16.10 years. Bipedal swelling (16.8%), fatigue (10.4%) and facial swelling (9.2%) were the major clinical features. Chronic glomerulonephritis (31.4%), hypertension (30.3%) and diabetes mellitus nephropathy (28.2%) were the most frequent predisposing conditions. Nifedipine (82.0%), bisoprolol (32.8%), aspirin (19.7%), ranitidine (26.2%), metformin (13.1%) and lasix (78.7%) were commonly used by the RRT patients than their conservative therapy counterparts. Compared to their RRT counterparts, patients on conservative therapy were more on irbesartan/lisinopril (57.9%) and sodium hydro carbonate (NaHCO) (52.0%). Diastolic blood pressure (DBP) (p = 0.047), uremic gastritis (p = 0.007), anaemia, uraemia, haematuria and hyperkalaemia (p < 0.001) were more common in conservative therapy patients than RRT patients with RRT patients showing better corticomedullary differentiation (38.1% vs. 27.7%, p < 0.001) and normal echotexture (15.0% vs. 11.6%, p = 0.005). Age, gender, occupation and duration of illness were significantly associated with the decision to opt for conservative therapy.
Patients on conservative therapy have worse clinical outcomes than their RRT counterparts. Early referrals to nephrologist as well as subsidized RRT should be targeted.
加纳与世界其他地区一样，终末期肾病 (ESKD) 的发病率正在上升。本研究比较了选择肾脏替代治疗 (RRT) 或保守治疗的 ESKD 患者的社会人口统计学、诊断特征（临床、生化和影像学）和临床结局，以及影响他们选择的因素。
我们回顾性分析了 2006 年至 2018 年期间在 Komfo Anokye 教学医院 (KATH) 肾病科就诊的 382 名 ESKD 患者的记录。收集了社会人口统计学、诊断（临床、生化和影像学）和治疗数据，并使用社会科学统计软件包 (SPSS) 进行组织和分析。
382 名患者中，321 名接受保守治疗，61 名接受肾脏替代治疗。参与者的平均年龄为 47.71±16.10 岁。双足肿胀（16.8%）、疲劳（10.4%）和面部肿胀（9.2%）是主要的临床特征。慢性肾小球肾炎（31.4%）、高血压（30.3%）和糖尿病肾病（28.2%）是最常见的诱发因素。硝苯地平（82.0%）、比索洛尔（32.8%）、阿司匹林（19.7%）、雷尼替丁（26.2%）、二甲双胍（13.1%）和速尿（78.7%）是 RRT 患者比保守治疗患者更常用的药物。与 RRT 患者相比，接受保守治疗的患者更常使用厄贝沙坦/赖诺普利（57.9%）和碳酸氢钠（52.0%）。与 RRT 患者相比，接受保守治疗的患者舒张压（DBP）（p=0.047）、尿毒症性胃炎（p=0.007）、贫血、尿毒症、血尿和高钾血症（p<0.001）更为常见，而 RRT 患者的皮质髓质分化更好（38.1%比 27.7%，p<0.001），回声均匀（15.0%比 11.6%，p=0.005）。年龄、性别、职业和病程与选择保守治疗有显著相关性。
接受保守治疗的患者的临床结局比接受 RRT 治疗的患者差。应尽早向肾病专家转诊，并提供补贴的肾脏替代治疗。
