Abstract
Background and Aims
Chronic kidney disease (CKD) is on the rise worldwide. It is associated with increased morbidity and mortality and places a huge burden on cost constrained health systems in developing countries such as South Africa. ACE inhibition is well established as major factor of reduction of the decline of renal function. The aim of this study to evaluate carvedilol, non-dihydropyridine calcium channel blockers (NDCCB) as potential renal protection factor beside ACE inhibition.
Method
This is a retrospective cohort study using the medical records of 300 patients attending the outpatient renal clinic department at Inkosi Albert Luthuli Central Hospital for the period January 2007 – December 2009. The average patient age was 43 years. The patients were followed up for 24 months following their first clinic visit. Socio-demographic (age sex, residence) and clinical characteristics including eGFR, blood pressure, BMI (body mass index), proteinuria, haemoglobin, cholesterolemia, were recorded. Treatments received including ACE inhibitors, carvedilol, non-dihydropyridine calcium channel blockers (NDCCB), Beta blockers were also recorded. Patients were divided into 2 outcome categories, according to changes in eGFR (estimated glomerular filtration rate): patients with eGFR decline of 1ml/min/year or less and those with accelerated eGFR decline (>1ml/min/year). Data analysis using SPSS version 23 (IBM) comprised of descriptive tests and logistic regression analysis (expressed as OR (odd ratio) and confidence interval) for the study of the association of above characteristics with patients’ outcome.
Results
ACE inhibition was used by 92% of patients. The use of carvedilol and NDCCB was associated with a reduction of the decline of eGFR with OR: 0.144[0.207-0.953] p=0.037 and OR: 0.543[0.329-0.884], p=0.016 respectively. No significant association was found between eGFR change and daily proteinuria or cholesterolemia. The aetiology of the chronic kidney disease did not affect rate of progression of eGFR. In addition, the rate of progression was not dependent on eGFR.
Conclusion
These results suggest that beyond ACE inhibition, the control of BMI, and use of carvedilol and NDCCB further delay the progression of chronic kidney disease in KwaZulu-Natal.
Barriers to management of Chronic Kidney Disease (CKD) CKD in a renal clinic in KwaZulu-Natal Province, South Africa – A qualitative study
