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Factors associated with end-stage renal disease in the Gaza Strip: a case-control study

2017; Elsevier BV; Volume: 390; Linguagem: Inglês

10.1016/s0140-6736(17)32085-8

1474-547X

Hammoda Abu‐Odah, Yehia Abed, Khawal El-Nems,

Healthcare Systems and Reforms

BackgroundEnd-stage renal disease (ESRD) is a major public health problem. Identification of risk factors for ESRD can inform intervention policies to minimise disease morbidity and mortality. The main objective of this study is to fill a gap in research literature by establishing baseline information for factors associated with ESRD among patients receiving haemodialysis.MethodsIn a hospital-based, case-control study, 132 patients with ESRD (cases) and 132 patients free from renal problems (controls) were interviewed by researcher using a structured questionnaire between January and August, 2013. Cases were patients who attended the four dialysis centres at Gaza governmental hospital; they were selected by use of proportional stratified random sampling. Inclusion criteria for cases were diagnosis of ESRD and age older than 18 years, and for controls any other diagnosis and age older than 18 years. Controls were every other patient attending four governmental hospitals as outpatients, matched to cases by age, sex, and location. We used SPSS (version 19.0) for logistic regression analyses with estimations of odds ratio and 95% CI. Approval to undertake the research was obtained from the ethics committee in the Gaza Strip and the Palestinian Ministry of Health. Written informed consent was obtained from all participants.FindingsThe most common modifiable factors associated with ESRD were hypertension (present in 56 cases, 42·4% vs 27 controls, 20·5%), obesity (55, 41·7% vs 45, 34·1%), diabetes mellitus (37, 28·0% vs 22, 16·7%), analgesic drug (29, 22·0% vs 12, 9·1%), kidney stone (28, 21·2% vs 6, 4·5%), glomerulonephritis (26, 19·7% vs 8, 6·1%), and stress (23, 17·4% vs 8, 6·1%). ESRD was significantly associated with low socioeconomic status, education, and employment. Multiple logistic analysis controlling for age, sex, and location showed that significant predictors of ESRD were hypertension (OR 42·5, 95% CI 8·26–218·5; p<0·0001), glomerulonephritis (26·19, 4·52–151·5; p<0·0001), obesity (3·99, 1·60–9·94; p=0·003), and low monthly income (4·02, 1·79–9·02; p=0·001).InterpretationIn our study, hypertension was the most common modifiable factor associated with ESRD. Obesity, diabetes mellitus, analgesic drug and kidney stone were other important associated factors. A programme of sociocultural, economic, and educational approaches is needed to improve public awareness regarding renal failure and its risk factors in the Gaza Strip. Consideration for more frequent monitoring of kidney function among patients with diabetes and hypertension who are older than 40 years might be warranted.FundingNone.