Causes of end stage renal failure among haemodialysis patients in Khartoum State/Sudan.

BACKGROUND: End stage renal failure (ESRF) has become a major health problem in Sub Saharan Africa (SSA). There were limited data about causes of ESRF in the Sudan.

METHODS: This is a cross sectional hospital based descriptive study. The subjects of the study are ESRF adults' patients on regular haemodialysis treatment in 15 haemdoialysis centres in Khartoum State-Sudan. Clinical and epidemiological data were obtained from 1583 patients. The medical files of each patient were reviewed to identify the cause of ESRF. Concerning the causes of ESRF, diabetes was diagnosed based on the past medical history and result of the glucose tolerance test, hypertension was diagnosed based on past history of hypertension based on blood pressure of more than 140/90 mmHg, glomerulonephritis was diagnosed based on results of previous kidney biopsies and on clinical grounds, polycystic kidney disease and obstructive uropathy were diagnosed based on abdominal ultrasound and other imaging modalities, sickle cell anaemia was diagnosed based on the result of haemoglobin electrophoresis, systemic lupus erythematosus was diagnosed based on the clinical criteria in addition to lab results of auto antibodies, and analgesic nephropathy was diagnosed based on past medical history of chronic analgesic drugs usage with no other identifiable risk factors. We included all ESRF patients on regular haemodialysis treatment. We excluded ESRF patients less than 18 years old.

RESULTS: The results showed that the mean age of ESRF Patients was 49 ± 15.8 (years) and 63.4% were male and 76.3% were unemployed. The mean duration of haemodialysis is 4.38 ± 4.24 (years). The most common cause of ESRF in our patients was hypertension (34.6%) followed by chronic glomerulonephritis (17.6%), diabetes mellitus (12.8%), obstructive uropathy (9.6 %), autosomal dominant poly cystic kidney disease (ADPKD) (4.7%), chronic pyelonephritis (4.6%), analgesic nephropathy (3.5%). However in (10.7%) no cause was found. In patient aged less than 40 years old the leading cause of ESRF was glomerulonephritis (29.3%) followed by hypertension (25%). In patient aged between 40 to 60 years old the leading cause of ESRF was hypertension (38.5%) followed by diabetes mellitus (14%). In patient aged older than 60 years the leading cause of ESRF was hypertension (38.4%) followed by diabetes mellitus (23.3%).

CONCLUSIONS: ESRF in Sudan affects the economically productive age group; unemployment rate among ESRF patients is high. The study showed that hypertension is a leading cause of ESRF in Sudan followed by chronic glomerulonephritis. Hypertension and diabetes mellitus are the leading causes of ESRF among patients over 40 years old.