Patient perceptions of risk factors for chronic kidney disease and methods of delaying progression of the disease in a tertiary care setting in Sri Lanka

To the Editor: An increasing incidence of diabetes mellitus and hypertension and population ageing has led to a predicted global pandemic of chronic kidney disease (CKD) in the next 20 years (1). Sri Lanka has seen a steady rise in patients with renal diseases since the early 1980s (2). Early identification of CKD will facilitate interventions to delay death, improve quality of life and postpone or prevent progression to end stage renal failure (3). The rate of progression shows great inter-individual variability and depends on multiple factors (4). Educational interventions aimed at empowering patients are successful in chronic disease management including CKD (5). Disease-educated patients are more likely to follow proper treatment and cope more successfully with their diagnosis. A descriptive cross-sectional study design was used enrolling all patients above 18 years with CKD stage 3 or 4. Patients followed up in the specialist nephrology clinic in the University medical unit, National Hospital of Sri Lanka were recruited for the study. The study population (n = 162) was mainly male (63%) with a mean age of 49 years (SD – 15.39), while most had received a secondary education (40.7%) with a low income level (43.8%). Most participants identified diabetes mellitus (75%) as a risk factor for the development of CKD while hypertension (45.7%) was selected less frequently. Control of proteinuria (88%), blood pressure (67.9%), glycaemia (87.7%), lipids (66.7%) and quitting smoking (76%) were associated by participants as possible methods of reducing progression. Use of angiotensin converting enzyme inhibitors (ACE I) and angiotensin receptor blockers (ARB) for slowing progression (28%) was less known. Almost all (96.3%) of the study population were aware that they had CKD although 86.4% did not know their last serum creatinine value. Of 56.8% of diabetics with CKD, 72.8% were unaware of their last sugar value. Self-reported patient practices also deferred from their knowledge on methods of slowing progression of the disease; 67.9% of the study population was aware that control of blood pressure would help reduce progression of CKD. However, only 27.2% of patients checked their blood pressure regularly. Most admitted to adhering to a well-controlled diet (61.7%) and being compliant with drugs (97.5%) as advised by the medical practitioner. Nephrotic range proteinuria and systemic blood pressure greater than 140/90 mmHg are the most important progression factors that strongly predict renal function decline (6). The majority of our study population was aware of these methods of reducing disease progression while the importance of angiotensin converting enzymes and angiotensin receptor blockers was less well known. The fact that the self-reported practices varied vastly from that of the knowledge on disease progression also points that patients need constant education, advice and encouragement to reinforce healthy behaviour patterns. None.