RISK FACTORS, NUTRITIONAL STATUS AND DIETARY INTAKE PATTERN OF CHRONIC KIDNEY DISEASE PATIENTS IN BANGLADESH

Abstract

Chronic kidney disease (CKD) is a progressive loss of kidney function, which results in deterioration of renal function. It is a devastating medical, social and economic problem of the country .It is an important component of chronic non-communicable disease (NCDs) that are now one of the major causes of morbidity and mortality worldwide. Nutrition is important non medicinal therapy in CKD patients, it can prevent the progression of CKD but in the literature the number of research on that subject is limited especially in Bangladesh. This study was conducted to explore the risk factors, nutritional status and dietary intake pattern of the chronic kidney disease patients in Bangladesh. A cross sectional study was carried out in the outpatient department of nephrology unit of National Institute of kidney Disease and Urology (NIKDU) hospital, Kidney Foundation Hospital of Bangladesh ( KFB), Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital, Dhaka Medical College Hospital (DMC), and Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM ) Hospital, Dhaka. In the study a total of 384 male and female CKD patients were selected. Study design was stratified simple random sampling with proportionate allocation. Stages of CKD was calculated based on estimated glomerular filtration rate (eGFR). CKD patients’ socio-demographic, food and nutritional information and weekly food intake pattern were collected through a standard questionnaire. Multiple logistic regression analysis was done to identify various risk factors for the advancement of CKD progression. Odds ratios were calculated to find various risk factors. Data were analyzed SPSS computer software version 22. In the study majority of CKD patients were male (57.6%) and most of the patients (53.7%) were above fifty years of age. Nearly 66% were from Dhaka division and their level of education ranges from >HSC to no formal education,34%of patients were less than SSC level, 29% were between SSC to HSC,17% were higher than SSC level and about 20% of the patients had no formal education. In the study, based on eGFR, patients with CKD stage 4 was found higher (38.5%) compared to other stages (stage 3, 30.7% and stage 5 30.7%).

In the study weakness and anorexia were the common general complain and more than half of the patients had anaemia, uncontrolled blood pressure and swelling of body. According to nutritional knowledge majority had poor knowledge (44%). Level of poor knowledge was significantly higher among the advanced stage group (stage 5, 66%.P value-0.04). In the study a lower number of patients (35%) consumed protein rich food in most of the days per week. Intake of fruits and vegetables was also found lower among all the patients in most of the days. According to food consumption score, 70% of CKD patients were found to be in acceptable consumption level which was comparatively lower among advanced stage groups(53% in stage 5).About 43% of patients were tobacco user and a huge number of patients (79%) were found to do no physical exercise. Regarding nutritional status, majority(38%) of patients were found to be overweight and obese (23%), which was going down according to stage of advancement. In the study, the significant risk factors of CKD progression included high blood pressure, diabetes, anaemia, proteinuria, and poor nutritional knowledge, low intake of vegetables and lack of physical exercise. The insignificant risk factors of CKD progression were rural residence, inadequate dietary intake, over weight and obesity.