Masters theses : Medicine
Permanent URI for this collectionhttps://repository.neelain.edu.sd/handle/123456789/493
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Item Epidemiological Pattern of Chronic Kidney Diseases among Children- Khartoum State-2015(Al-Neelain University, 2015) Hallah Musa hasanAbstract: Introduction: chronic kidney disease is a major public health problem worldwide, and chronic renal failure in Sudanese children have high mortality rate, more than half of the patient followed progress to end stage renal disease. End stage renal disease is a devastating disorder associated with excessive mortality and cardiovascular morbidity, and specific problems occur in children, such as impaired growth and psychosocial adjustment. Objectives: To study the epidemiological pattern of chronic kidney disease among children with End stage renal disease on regular haemodialysis. Methodology :This was a descriptive cross sectional multicenter study among children with end stage renal disease on regular haemodialysison dialysis pediatric nephrology unit, Gaffer Ibn auf Hospital, Nora Center and Omdurman Teaching Hospital dialysis center January -July 2015, Data were collected with standardized administrated questionnaire and were analyzed using SPSS (Statistical Package for the Social Science) version 21.Chi squared and p value calculated with value of 0.05 was set for statistical significance Results: among the 100 children with End stage renal disease on regular haemodialysis 69% had at least on risk factor for chronic kidney disease, male were 2.2 times more to have it compared to female (odd ratio 2.2, P value 0.1) and congenital anomaly of the kidney and urinary tract were found in 26% of children and male were 5.6 times more to have it. Family history of kidney disease was found in 25%, and 21% had perinatal risk factor. 37% had history of repeated urinary tract infection, 20% had history of proteinuria during childhood and 19% had history of hematuria. Mean age at diagnosis ( mean age at first presentation) was 10.07 year +_ 3.68SD (range 1year-18year)) and was strongly related to duration from diagnosis till initiation of hemodialysis (which was less than one month in 55% of patient) as An increase in age at diagnosis by one year decreased the time for progression to hemodialysis by approximately 3 month (p value, .000)., also an increase in age at the time of study by one year increased the time for progression to hemodialysis by approximately 2 month, (p value, .000). The presence of congenital anomalies of the kidney and urinary tract decreased time for progression to hemodialysis II by approximately 8 month (p value, .000). An association was found between duration from diagnosis till initiation of hemodialysis and mother education (Chi-Square., 38.59 p value .040)), and facility where first diagnosed (Chi-Square20.821 p value .001). Nonavailability of donor alone was the main barrier for transplantation (43%), were (9%) had financial barrier and (17%) had both barriers (donor non-availability and financial barrier). 11% were waiting for transplantation (waiting list) and 10% had clinical barrier. Conclusion: Most patients on dialysis at Khartoum state were from other Sudan state, and mostly they came from rural areas, seeking emergency care and half of the patient (55%) present with end stage renal disease that required emergency hemodialysis with in few week after diagnosis. The mean age at diagnosis was 10 year +- 3, (range 1-18), The duration from diagnosis till initiation of hemodialysis was associated with mother education (Chi-Square., 38.59 p value .040)), and facility where first diagnosed (ChiSquare20.821 p value .001) and The presence of congenital anomalies of the kidney and urinary tract decreased time for progression to hemodialysis by approximately 8 month (p value, .000) also An increase in age at diagnosis by one year decreased the time for progression to hemodialysis by approximately 3 month, (p value, .000). The late presentation associated with donor unavailability and financial difficulties was the main barrier for transplantation in those children Recommendations: Targeting rural areas with Preventive and curative services that address chronic kidney disease among children is more effective as most of the children were from these areas, early detection and intervention are the most cost effective strategies that target CKD. and as more than half of the patient present with end stage renal disease that rabidly progress to hemodialysis The need to activate surveillance program for CKD stages 4 and 5 to monitor the magnitude and the care of this high-risk, high-cost population, and possibly to reduce both the risk of progression to end stage renal disease and the cost of dialysis and transplantation. The need to notice the problem of children on hemodialysis to alleviate the barrier for transplantation should be addressed.