Doença renal crônica e fatores associados em hipertensos

Abstract

Chronic kidney disease (CKD) is considered a serious worldwide public health issue. Its increased incidence and prevalence stems from the increasing number of people with hypertension and diabetes, as well as the aging of the population on account of a greater life expectancy. The number of patients who are on renal replacement therapy such as hemodialysis has increased considerably. As a consequence, this has yielded great financial burden for the government, poor quality of life of the individuals involved and increased mortality, because kidney disease is a major risk factor in the sprouting of cardiovascular diseases. This piece of research is the answer to a need to understand more about this disease in order to consolidate knowledge that may support policies of care for the renal disease patients based on more rational guidelines and above all, policies that take the primary prevention as a basis to keep patients from starting hemodialysis or else to delay the need for such procedure. This study, a cross-sectional one, was carried out with hypertensive patients from the Health Center in the suburban district of Bela Vista, registered in Hiperdia, aged at least 35 and at most 98 years old through random sampling. 160 hypertensive patients took part in the survey out of a population of 340 hypertensive patients. The criteria of inclusion were: age above 35 years old and a previous history of hypertension of at least five years. The criteria of exclusion were: having no any preexisting renal disease. The objective was to study the early stages of CKD and associated factors in these individuals. In order to study the CKD, laboratory tests were made, both urine and serum types: serum creatinine, proteinuria (protein / creatinine ratio) in an isolated urine sample and the creatinine clearance was calculated as well, which corresponds to the degree of renal function, using the formula Cockcroft-Gault (CG). These tests were made in the clinical laboratory (LAC) of UEPB. In addition, data were collected from medical records, and a form for interview was prepared. Three months later the tests were repeated to define the diagnosis and classify, in stages, CKD according to the criteria of the Kidney Disease Outcomes Quality Iniciative (K/DOQI). We assessed sociodemographic, lifestyle, and clinical aspects, and adherence to antihypertensive drugs as well. After that the statistical analyses needed to assess the association of CKD with the factors studied were performed, and the chi-square test and the Fisher test were used for that purpose. All the tests took into consideration a significance level of < 0.05. A prevalence of CKD of 14.1% was observed in the present study. Patients detected to have CKD in this study were mostly of stage III CKD. There was a higher prevalence of this disease among females. There was a statistically significant association between CKD and aging with a p &#8804; of 0,001, also with the elevated systolic blood pressure (SBP) with a p &#8804; of 0.019, with increased body mass index (BMI) of old patients with a p &#8804; of 0.013, and with the use of antihypertensive drugs, class ACEI / ARB with p &#8804; of 0.005, as well as the lack of use of adrenergic inhibitors of p &#8804; 0,030. On account of the big picture we get from our analysis there is a pressing need for tracing CKD within risk groups so that the outrageously growing number of patients under replacement therapy is diminished. That can be achieved through strategic actions involving health workers and patients, who use low cost tests, so as to face the situation and which as a result cut down on government spending and which promote a better quality of life for the population as a whole and which effectively support public policies concerning renal patient care with a focus on primary prevention as a sustaining pilar.