Progression and Outcomes of Chronic Kidney Disease Patients in District Hospitals

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Pongpitak Mikkata
Denpong Patanasethanont
Supon Limwattananon


The objective of this retrospective study was to determine the progression and outcomes of chronic kidney disease (CKD). Participants were patients who had serum creatinine (SCr) measurement in two district hospitals of Amnat Charoen province between 1 January 2003 and 31 December 2007. Based on definitions of the Kidney Disease Outcome Quality Initiative guideline, patients who had glomerular filtration rate (GFR) less than 60 ml/min/1.73 m² in two separate SCr measurements for at least 3 months were included. GFR was estimated using the abbreviated Modification of Diet in Renal Disease study equation. Descriptive statistics and Kaplan-Meier plots were used for analysis. At baseline, mean age was 61.5±11.3 years and 68.6% were female. At the end of a four-year follow up, 143 of 749 (19.1%) CKD stage 3 patients developed stage 4, 56 of 162 (34.6%) stage 4 patients developed stage 5, and 63 of 103 (61.2%) stage 5 patients died. Among the 103 stage 5 patients, 83 patients (80.6%) were hospitalized 4.7 times for 3.5 days, on average. For stage 4 or 5 patients, 2.3% of all prescriptions were unadjusted dosage regimens based on renal function. In conclusion, disease progression was still rapid in this study population leading to high rates of death and hospitalization. Further implementations on intervention aiming to slow the progression of patients with CKD in district hospitals should be conducted.

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Alexander M, Bradbury BD, Kewalramani R, et al. Chronic kidney disease and US healthcare resource utilization in a nationally representative sample. Am J Nephrol 2009; 29(5): 473-82.

Aronoff GR, Berns JS, Brier ME. Drug prescribing in renal failure: dosing guidelines for adult. 4th ed. Philadelphia: American College of Physicians; 1999.

Khan SS, Kazmi WH, Abichandani R, et al. Healthcare utilization among patients with chronic kidney disease. Kidney Int 2002; 62(1):229-36.

National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratify cation. Am J Kidney Dis 2002; 39(2 Suppl 1): S1-266.

Nitiyanant W, Chetthakul T, Sang AkP, et al. A survey study on diabetes management and complication status in primary care setting inThailand. J Med Assoc Thai 2007; 90(1):65-71.

Perkovic V, Cass A, Patel AA, et al. High prevalence of chronic kidney disease in Thailand. Kidney Int 2008; 73(4): 473-9.

United States Renal Data System. USRDS 2007annual data report. Bethesda: the national institutes of health, national institute of diabetes and digestive and kidney diseases;2007.

Zhang QL, Rothenbacher D. Prevalence of chronic kidney disease in population-based studies: systematic review. BMC Public Health 2008;8: 117-30.