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The Study of Clinical Risk Factors of CKD Stage 4 and 5 in CKD Patient Satuek

Hospital, Buriram Province 2012


Atsada pongpruettipun
1
, Panlapa Khamanek
1
, Supawida chuachun
1
, Eakachai Yodkalw
2

1
Faculty of Medicine Suranaree University of Technology, NakhonRatchasima province,
Thailand
2
Satuek Hospital, Buriram province, Thailand
Background: Chronic kidney disease is common medical illness of the world. In 10 -20
years ago the prevalence of dialysis that was increase. The Chronic kidney disease has
affected morbidity and mortality of patient. The objectives of the study are to assess a risk
factors and clinical manifestation of CKD stage 4 and 5 in Satuek hospitals, Buriram
province in 2012.
Method: we reviewed medical record and collection data to determine of chronic kidney
disease. The definition of CKD is patient who treatment in Satuek hospital 2012 and they was
diagnosed chronic kidney disease or ICD-10 code is N17 N19 and CKD stage 4 and 5 was
CKD patient and had GFR < 30 ml/min/m between 1 January and 31 December 2012.
Unmatched case control study was performed to identify possible risk factors of CKD stage 4
and 5. Univariate and multivariate analyses were used to estimate crude odds ratio and
adjusted odds ratio with 95% confidence interval.
Result: CKD stage 4 and 5 was identifying 106 cases. Female to male ratio was 2.31:1.
Median age of cases was 70 years (IQR: 60-77 years) The highest attack rate was observed in
Sagear subdistrict (224.1 per 100,000 populations) followed by Satuek subdistrict (137.6 per
100,000 populations) and Kasang subdistrict (128.8 per 100,000 populations). The majority
of symptom were fatigue (36.8%) followed by flank pain (24.5%), loss of appetite (17.9%)
and edema (17.9%). In univariate analysis the significant factor were female (odd ratio=1.98,
95%CI=1.13-3.49), Diabetes Mellitus foot (odd ratio=9.74, 95%CI=1.21- 78.32), Diabetes
Mellitus nephropathy (odd ratio=1.81, 95%CI=1.03-3.15), Ischemic heart disease (odd
ratio=3.97, 95%CI=1.07-14.68) , History of kidney stone (odd ratio=6.63, 95%CI=1.44-
30.43) , Diabetes Mellitus duration (odd ratio=2.09, 95%CI=1.04-4.17) , Hematocrit < 30 %
(odd ratio=8.15, 95%CI=2.63-25.21) , Hemoglobin male <13g/dl (odd ratio=11.97,
95%CI=1.18-102.38) and stage of HT,stage1(odd ratio=4.00, 95%CI=1.024-12.80) ,stage2
(odd ratio=17.00, 95%CI=4.45-64.87). The significant of symptom were itchy skin (odd
ratio=15.97, 95%CI=2.06-123.87), edema (odd ratio=12.04, 95%CI=4.09-35.42), oliguria
(odd ratio=7.26, 95%CI=1.659-33.06), fatigue (odd ratio=2.71, 95%CI=1.51-4.84) and loss
of appetite (odd ratio=4.05, 95%CI=1.681-9.08). In multivariate analysis of risk factor had
significant 3 factors were hematocrit < 30 % (Adjusted odd ratio=9.61, 95%CI=2.03-45.37),
HT stage1 (Adjusted odd ratio=11.46, 95%CI=1.15-114.08) and HT stage 2 (Adjusted odd
ratio=82.90, 95%CI=2.96-513.52). The significant 3 symptom were itchy skin (Adjusted odd
ratio=10.38, 95%CI=1.23-87.06), edema (Adjusted odd ratio=8.63, 95%CI=2.82-26.45) and
loss of appetite (Adjusted odd ratio=2.54, 95%CI=1.01-6.41).
Conclusion: The warning symptom of CKD stage 4 and 5 in CKD patient was itchy skin,
edema and loss of appetite. The significant clinical risk factor was < 30 %, HT stage 1 and
HT stage 2.
Keyword: Chronic Kidney Disease, Satuek district, Burirum province, Thailand.