Pattern of kidney disease among hypertensive patients attending cardiac clinics in Dar Es Salaam

Pattern of kidney disease among hypertensive patients attending cardiac clinics in Dar Es Salaam | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Method Article Pattern of kidney disease among hypertensive patients attending cardiac clinics in Dar Es Salaam Absalom Maiseri, Warles Charles, Yassini mgonda This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4738063/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract BACKGROUND Hypertension is a public health challenge and has become one of the leading causes of kidney disease over the years. Objective : The aim of this study was to determine the patterns of kidney disease among adults with hypertension in Dar es Salaam. Method : A descriptive cross-sectional study was employed. Social-demographic data were collected from the participants. Blood pressure, body weight and height were measured using a standardized method. Blood samples were collected to measure serum creatinine and the estimated eGFR using CKD EPI2021, while urine was collected for biochemical analysis, the dipstick method and determination of the albumin–creatinine ratio. Results : A total of 400 hypertensive patients were enrolled. In this study, 287 (72%) were females, and the mean and standard deviation of age were 59.9 and 15 years, respectively. A total of 249 (62%) had a primary education, 232 (58%) were unemployed, 240 (60%) had a history of hypertension for less than 10 years, 346 (86.5%) had no history of alcohol consumption, and 380 (95%) had no history of cigarette smoking. Furthermore, 240 (60%) and 211 (52.8%) had a blood pressure ≥140 mmHg for systolic and ≥90 mmHg for diastolic blood pressure, respectively. A BMI ≥25 kg/m 2 was found among 236 patients (59%). A reduced eGFR (<60 Ml/min/1. 73 M2 ) and microalbuminuria were observed in 119 (30%) and 179 (61.5%) patients, respectively. Conclusion: The clinical pattern of kidney disease was dominated by AKI (22.3%), nephrotic syndrome (12.8%) and end-stage renal disease (2.8%). Higher systolic blood pressure, advanced age, long-term hypertension and unemployment were significantly associated with a decrease in the eGFR. An increase in body mass index was significantly associated with an increase in albuminuria. Internal Medicine BACKGROUND Hypertension is a public health challenge globally, in Africa and even in Tanzania. Globally, an estimated 1.28 billion adults aged 30-79 years have hypertension, and most of these adults live in developing countries 1. In Africa, the WHO estimates that the highest incidence of hypertension is 27% in adults aged 25 years and older, compared to 18% in America 2 . In Tanzania, previous studies reported an increasing prevalence of hypertension in different rural and urban populations of Tanzania, from 2-10% in the 1960s to 13-79% in 2016, where alcohol, obesity and cigarette smoking were the main risk factors 6 . A study in Arusha and Morogoro Tanzania showed that 25.7% and 45% of adults, respectively, had hypertension, and the odds of having hypertension increased with male sex, old age > 60 years, and obesity 7,8 . A study at Muhimbili National Hospital reported a prevalence of hypertension of 68% and hypertension of 32% 10. Over the years, hypertension has become one of the leading causes of kidney disease worldwide. For instance, disability-adjusted life years and the rate of CKD due to hypertension increased from 1990 to 2019, with DALY numbers increasing by 125.2% and DALY rates increasing by 55.7%14. In Tanzania, a study performed in Dodoma reported a CKD incidence of 43.8% among hypertensive patients. 15 A study in northwestern Tanzania reported a prevalence of renal dysfunction of 53.9% among hypertensive patients, where older age, female sex, obesity, and high systolic blood pressure were predictors of renal dysfunction. Despite the fact that hypertension is an important cause of kidney disease, there are currently limited data explaining the patterns of kidney disease due to hypertension in Tanzania. In addition, treating people with hypertension-related kidney diseases imposes a heavy financial burden on healthcare budgets worldwide and even in Tanzania 8,25 , 26 , 27,28 . Therefore, this study emphasizes early kidney disease screening and comprehensive care at cardiac clinics, as it will have a beneficial impact on hypertension control and the management of kidney disease. METHODOLOGY Study Design A cross-sectional study was employed: 400 study subjects were recruited over a period of 6 months. Sampling Procedure Multistage cluster sampling was employed for selecting cardiac clinics. In Stage 1, all cardiac clinics found in Dar-Es-Salaam were listed; one group comprised public cardiac clinics, and the other group comprised private cardiac clinics. Public hospitals were selected by simple random sampling. Stage 2 involved the formation of three subgroups based on the level of health care provided by public hospitals, which included tertiary hospitals (Muhimbili National Hospital), regional referral hospitals and district hospitals. From these subgroups, the regional referral hospital was selected by simple random sampling. Study participants were selected from selected cardiac clinics using simple random sampling. Data Collection A Questionnaires were administered, and social demographic and anthropometric parameters were obtained. Serum creatinine levels were measured, and the GFR was estimated using the CKD EPI 2021 equation. Urinary creatinine levels were measured using dipstick analysis and a Mindray BS 240 chemical analyzer. Clinical Measurements Blood pressure was measured using an aneroid sphygmomanometer (China). Two consecutive readings were taken from each patient at 5 min intervals, and the average was taken as the mean BP. Hypertension was defined as a systolic blood pressure (SBP) ≥140 mmHg and diastolic blood pressure (DBP) ≥90 mmHg (WHO guidelines 2021). Weight (to the nearest 0.5 kg) and height (to the nearest 0.5 cm) were measured using a standardized weighing scale (RGZ-160 from Changzhou, China), and body mass index (BMI) was calculated using the formula weight (kg)/height (m2) (WHO Recommendation of Adult BMI). Laboratory measurements Blood test : Venous blood (3 ml) was taken from the cubital vein into a test tube and allowed to stand undisturbed for 10 min. Then, the tube was centrifuged at 2000 rpm for 15 min to remove clots. The resulting serum was transferred to a clean polypropylene tube. Serum creatinine was determined using a Mindray BS- 240 clinical chemistry analyzer (Guangdong, China). Glomerular filtration rate calculation: The CKD-EPI formula (2021 update) was used to calculate the eGFR: GFR = 141 * min (SC r/κ,1)α * max(SC r/κ, 1)-1.209 * 0.993Age * 1.018 [if female] * 1.159 [if black] According to the National Kidney Foundation guidelines (2013), kidney disease was defined as an eGFR 90 ml/min/1. 73 m2 . Renal function was staged as follows: stage 1 (normal) = GFR>90; stage 2 (mild to moderate renal impairment, GFR 60-89); and stage 3-5 (kidney disease, GFR< 60 ml/ml/1.73 m2). Urine test : Each patient was also given a sterile container to collect a urine sample, and a dipstick urinalysis was performed within ten minutes of sample collection using a urine dipstick Multistix. Urinary dipstick results were reported as negative to +1, classified as normal to mildly increased albuminuria; 2+, classified as severely increased albuminuria; and 3+ to 4+, classified as nephrotic syndrome. Any patient whose urine dipstick was negative for protein underwent further testing of urine for microalbuminuria using a Mindray BS-240 clinical chemistry analyzer (Guangdong, China). The UACR is a method of choice for detecting microalbuminuria, and a UACR 300 mg/g indicates that the patient has macroalbuminuria. The Kidney Disease Pattern: KDIGO guidelines were used to determine the proportion of patients with AKI. The criteria were based on a comparison with a known baseline SC r to determine AKI. This baseline SCr was obtained from previous patient medical records. For study participants for whom previous serum creatinine data were missing, an estimation of a reference baseline SC r was used. This information is provided by the KDIGO guidelines, where an estimated baseline is obtained through a back-calculation using the CKD-EPI equation and a glomerular filtration rate (GFR) of 75 mL/min/1.73 m 2 .This method was used for approximately 12% of the patients. End-stage renal failure and nephrotic syndrome were diagnosed based on KIDGO criteria with an estimated glomerular filtration rate. DATA ANALYSIS SPSS version 20 was used for data entry, cleaning, and analysis. T tests and chi-squared tests were used for categorical and continuous variables, respectively. A P value<0.05 was considered to indicate statistical significance. Ethical clearance Permission to conduct the study was obtained from the Institutional Research Ethics Committee of Hubert Kairuki Memorial University, and permission to conduct the study was obtained from the authorities of the selected hospitals. RESULTS Sociodemographic Status of the Study Participants In this study, 400 study participants were enrolled, for a response rate of 100%. Of these, 287 (72%) were female, and the mean and standard deviation of age were 59.9 and 15 years, respectively. Of the study participants, the majority had a primary education (249, 62%), and 232 (58%) had no employment. The majority of participants (240, 60%) had a history of hypertension for less than 10 years. Furthermore, 54 (13.5%) and 20 (5%) patients had a history of alcohol consumption and cigarette smoking , respectively . Clinical Characteristics Of the 400 study participants, 240 (60%) and 211 (52.8%) had uncontrolled systolic and diastolic blood pressure, respectively, while 204 (51%) had excess body weight (BMI≥25 kg/m 2 ). Furthermore, 119 (30%) study participants had reduced eGFR, while 179 (61.5%) had microalbuminuria. Distribution of eGFR and albuminuria in relation to age , sex , duration of hypertension and stages of hypertension Advanced age >65 years, long-standing hypertension and higher systolic blood pressure were significantly associated with a decrease in the eGFR. Seventy-five percent of the participants in the young age category in this study (18-39 years) had an eGFR of ≥60 and only 25% had an eGFR<60, while 57.5% of participants in the older age ≥65 years category had an eGFR of ≥60 and 42.5% had an eGFR < 60 eGFR with a p value of 0.0, indicating that the eGFR tends to decrease as age increases. Furthermore, long-standing hypertension was associated with a lower eGFR, as 36.6% of participants who had hypertension for more than 10 years had a lower eGFR, while 25.8% of participants who had hypertension for < 10 years had a lower eGFR, with a p value of 0.038. In addition, an increase in systolic blood pressure was significantly associated with a decrease in the eGFR (P value of 0.004). Albuminuria was significantly associated with aging (p value of 0.034). Table 3 shows the distribution of the estimated glomerular filtration rate (eGFR) in relation to age, sex, duration of HTN and stages of HTN among hypertensive patients attending cardiac clinics in Dar es Salaam (n=400). Distribution of albuminuria with eGFR among hypertensive patients attending cardiac clinics at Dar-es-Salaam (n=400 ). The serum creatinine ratio and eGFR were significantly (p=0.00) and linearly negatively correlated in the present study, indicating that the higher the ACR was, the lower the eGFR, as 21% of participants in the ACR 0-29.9 category had an eGFR 300 category with an eGFR <60 ml/min/1.73 m2. Correlations between eGFR, albuminuria and socioeconomic factors and BMI among hypertensive patients attending cardiac clinics at Dar-Es-Salaam (n=400) In this study. Low socioeconomic status was associated with a decrease in the eGFR, and nonemployment status was associated with a decrease in the eGFR, as 35% of the study participants in the nonemployment category had an eGFR< 60, while 22% of the study participants in the self-employment category had an eGFR< 60. This association was statistically significant, as the p value was 0.001. Furthermore, an increase in BMI was significantly associated with an increase in albuminuria (p value 0.0120). Table 5. The distributions of eGFR, albuminuria and socioeconomic factors and BMI among hypertensive patients admitted to cardiac clinics at Dar-es-Salaam Hospital (n=400) are shown. DISCUSSION Clinical patterns of renal disease among adult hypertensive patients were explored in this study and were dominated by AKI (89, 22.3%), nephrotic syndrome (12.8%) and end-stage renal failure (2.8%). This finding was in contrast with the findings of studies performed in Cameron and Ghana, where the clinical pattern of renal diseases was dominated by advanced CKD (61.8% and 70.8%, respectively) . This difference can be explained by the use of different study settings. In previous studies in Cameroon and Ghana, a retrospective study design was used , while in the present study, a descriptive cross-sectional study design was employed 30,31 . According to this study, seventy-five percent of the hypertensive patients had a decreased glomerular filtration rate (eGFR<90 ML/min/1. 73 M3 ), with at least 30% recording < 60 ML/min/1.73 M3 . This finding was similar to that of a study performed in Cameroon, in which 80% of the participants reported an eGFR<90 ML/min/1. 73 M3 and 36% reported an eGFR < 60 ML/min/1. 73 M2 36. However, in contrast to a study performed in Mwanza, which reported that 5% of patients had an eGFR<60 ml/min/1. 73 m2 (26) . Microalbuminuria was detected in 61.5% of the adult hypertensive patients in the current study, which was lower than that reported in Muhimbili National Hospital Tanzania (82.8%) (28) and higher than that reported in Mwanza and Cameroon (23.3% and 15%, respectively) (26,36). This difference might be due to differences in the study settings and methods used for the diagnosis of microalbuminuria and eGFR. In this study, higher systolic blood pressure was significantly associated with a decrease in the eGFR. Among adult hypertensive patients, patients with systolic blood pressure greater than 140 mmHg (stage I, II and III systolic HTN) were more likely to have a decrease in the eGFR of 46% than patients with other stages (P=0.004). This finding was in line with studies conducted in Northern Tanzania, Ghana, Cameroon and Norway ( 26,36,38,39 ). However, contrary to studies performed in Ethiopia, which showed that diastolic BP greater than 90 mmHg was more likely to lead to kidney disease 40 . In addition, increased systolic and diastolic blood pressure were associated with increased albuminuria. This might be due to uncontrolled HTN causing blood vessels around the kidney to narrow, weaken or harden, and as a result, these patients were not able to supply enough blood to the kidney; hence, this impairment led to glomerular HTN and increased proteinuria. Advanced age was significantly associated with decreased eGFR (P =0.000) and increased albuminuria (ACR) (P =0.034) among adult hypertensive patients in the current study. This finding was similar to those of studies performed in Mwanza, Ethiopia, Northern Cameroon, and Muhimbili National Hospital ( 26,2836 ). This might be due to normal physiology, whereby the decline in the eGFR with aging is accompanied by changes in renal structure and the percentage of glomeruli affected by glomerulosclerosis increases with advancing age even in the absence of any other conditions, such as diabetes and hypertension. Long-standing hypertension was significantly associated with a decrease in the eGFR among adult hypertensive patients (P=0.038), which showed that patients who experienced hypertension for more than 10 years had a greater percentage of decline in the eGFR (37%) than did those who experienced hypertension for less than 10 years (28%). This finding was in agreement with the findings of a study conducted in Ethiopia 37 . This might be because over time, high blood pressure may damage blood vessels throughout the kidney and reduce the blood supply to the kidney, leading to renal vascular nephropathy, which slowly leads to a decrease in the glomerular filtration rate. In this study, an increase in albuminuria was significantly associated with a decrease in the eGFR (P=0.000) among adult hypertensive patients and an increase in the risk of kidney disease. This finding was in line with studies performed by Levey AS et al . and Melsom T. 38,39 This might be because a minimal increase in the albumin-to-creatinine ratio (ACR) predicts cardiovascular disease and mortality. A low socioeconomic status was associated with a decrease in the eGFR and increased albuminuria among adult hypertensive patients, which showed that the percentage of patients with a lower occupation (unemployed) and education level and an eGFR <60 ml/min/1. 73 m2 (35%) were significantly greater than those with a higher occupation level (31%) and education level (p=0.001). This result was similar to those of studies performed in the Netherlands and Northern Tanzania/Kilimanjaro 40,41 . This might be because people with low education levels are unaware of behavioral factors that cause hypertension, and unemployment causes access to quality care/treatment difficulties. An increase in body mass index was significantly associated with an increase in albuminuria (ACR) (p value=0.012). This finding was in line with a study performed in Mwanza and China (26,55). This might be because obesity is associated with increased fat-free mass with vasodilatation of the afferent arteriole, resulting in increased renal plasma flow, eGFR and filtration fraction, and increased intraglomerular pressure drives glomerular filtration barrier injury 47,48 . CONCLUSION The clinical pattern of kidney disease was dominated by AKI, nephrotic syndrome and end-stage renal disease. Increased systolic blood pressure, advanced age, long-term hypertension, and unemployment were significantly associated with a decrease in the eGFR. Furthermore, an increase in body mass index was significantly associated with an increase in the albumin‒creatinine ratio among hypertensive patients. Declarations Ethical issues: The ethical clearance and permission to conduct this study were issued by Hubert Kairuki Memorial University (HKMU) and Medical Office are in charge of the Amana, Mwananyamala and Temeke hospitals, respectively. Consent was obtained from the study participants Consent for publication: Not applicable. Availability of data and materials: The datasets analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: Data collection and analysis were funded by TPDF. Authors’ contributions: All authors contributed equally to the study conception and research development. and study design. AM contributed to the data collection and entry. YM was instrumental in statistical analysis. All the authors have read and gave final approval for the submission of the manuscript. and publication. Acknowledgments: I would like to thank TPDF and HKMU & KH for their support during this study. I would like to thank all the participants who participated in this study. References WHO. World Health Organization Fact Sheet. 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BMC Nephrol 20:378 Kidney disease Improving Global Outcome(KDIGO)Clinical Practice Guideline for Acute Kidney Injury (2013) Kidney Int 3(Supplement):136–150 [Google Scholar Kidney disease Improving Global Outcomes (KDIGO) (2013) Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney inter 3(Suppl):1–150 Tamanji MT, Ngwakum DA, Mbouemboue OP (2017) A Profile of Renal Function in Northern Cameroonians with Essential Hypertension. Cardiorenal Med 7:324–333 Okyere P et al (2020) Spectrum and Clinical Characteristics of Renal Diseases in Ghanaian Adults: A 13-Year Retrospective Study. Int. J. Nephrol. 1–5 (2020) Bhalloo H (2013) Prevalence of microalbuminuria and associated factor among hypertensive patients at Muhimbili National Hospital Dar-es-salaam. Muhimbili University of Health and Allied Sciences Eriksen BO et al (2017) Blood pressure and age-related GFR decline in the general population. BMC Nephrol 18:77 Hunegnaw A, Mekonnen HS, Techane MA, Agegnehu CD (2021) Prevalence and Associated Factors of Chronic Kidney Disease among Adult Hypertensive Patients at Northwest Amhara Referral Hospitals, Northwest Ethiopia, 2020. Int. J. Hypertens. 1–8 (2021) Levey AS, Grams ME, Inker LA (2022) Uses of GFR and Albuminuria Level in Acute and Chronic Kidney Disease. N Engl J Med. 10.1056/nejmra2201153 Melsom T et al (2018) Mild Albuminuria Is a Risk Factor for Faster GFR Decline in the Nondiabetic Population. Kidney Int Rep. 10.1016/j.ekir.2018.01.015 Vart P et al (2019) Socioeconomic status and risk of kidney dysfunction: The Atherosclerosis Risk in Communities study. Nephrol Dial Transpl. 10.1093/ndt/gfy142 Stanifer JW et al (2015) The epidemiology of chronic kidney disease in Northern Tanzania: A population-based survey. PLoS ONE. 10.1371/journal.pone.0124506 Qin S, Wang A, Gu S et al (2021) Association between obesity and urinary albumin–creatinine ratio in the middle-aged and elderly population of Southern and Northern China: a cross-sectional study. BMJ Open 11(1):e040214. 10.1136/bmjopen-2020-040214 PMID: 33402405; PMCID: PMC7786798 Tables Tables 1 to 5 are available in the Supplementary Files section Additional Declarations The authors declare no competing interests. Supplementary Files Tables.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4738063","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Method Article","associatedPublications":[],"authors":[{"id":326705906,"identity":"ffc185c7-0aa2-4db4-9d04-1b0ef33c7332","order_by":0,"name":"Absalom Maiseri","email":"data:image/png;base64,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","orcid":"","institution":"HKMu","correspondingAuthor":true,"prefix":"","firstName":"Absalom","middleName":"","lastName":"Maiseri","suffix":""},{"id":326705942,"identity":"6d93c500-6215-4ec1-b331-333435a4a701","order_by":1,"name":"Warles Charles","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4UlEQVRIiWNgGAWjYHACxgMg0gDCsAEJNB4gpAemBcRIA2lpIEnLYYQILmBw/OyDAx/+MMibs4MZ5+3Wth8G2lJjE41Ty5l0g4Mz2xgMd/aAGbeTt51JBGo5lpbbgEOL2YE0hsO8DQwJBhDG7WSzA0AtjA2HcWs5/4zh8J8/QC0Qxrlks/MPCWi5ATScgQ2oBcI4YGd2g4At9jeeMRzsbZMw3ABhJCeY3QDakoDHL5L9aYwPfvyxkTc4D2bY2ZudT3/44EONDU4tUCABZyWCVSbgV47mUlIUj4JRMApGwcgAAOH1bKCTWbWIAAAAAElFTkSuQmCC","orcid":"","institution":"Hkmu","correspondingAuthor":true,"prefix":"","firstName":"Warles","middleName":"","lastName":"Charles","suffix":""},{"id":326705988,"identity":"e7a20ff0-e001-46ba-9285-4e4fe99d095c","order_by":2,"name":"Yassini mgonda","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYLCCBAYJMC3BUAEkmZkbSNFyBqSFkQgtMCDB2AaiCGgxOH788YeHOyyi5d17D974Oa82mr8dqOVHxTbcWs7kmEkknpHI3XjmXLJl77bjuTMOMzYw9py5jVvLgRw2hsQ2oJYZQL28247lNgC1MDO24dFy/vnjDzAtkn/nHMudT1DLjQQDCZCW+RI5ZtK8DTW5GwhpkbzxxgysZQPPGWNrmWMHcjcCtRzE5xe+8+mPP/5sq8ud395jePNNTV3uvPOHDz74UYFbi8IBeDiAqcNg8gA2pTAg34DKqMOneBSMglEwCkYoAACG1mIndbHrKAAAAABJRU5ErkJggg==","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Yassini","middleName":"","lastName":"mgonda","suffix":""}],"badges":[],"createdAt":"2024-07-14 10:46:00","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4738063/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4738063/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60394835,"identity":"24197506-38c4-4b98-b41a-a13c1f3dd2c0","added_by":"auto","created_at":"2024-07-16 09:40:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":391746,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4738063/v1/f963b2be-3988-42c0-81b2-a082c78510d5.pdf"},{"id":60394804,"identity":"aadf27e8-45ca-40f9-8095-587bc36d23cb","added_by":"auto","created_at":"2024-07-16 09:40:27","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":50739,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-4738063/v1/fe3420722e87c95b3740d3aa.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003ePattern of kidney disease among hypertensive patients attending cardiac clinics in Dar Es Salaam\u003c/p\u003e","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eHypertension is a public health challenge globally, in Africa and even in Tanzania. Globally, an estimated 1.28 billion adults aged 30-79 years have hypertension, and most of these adults live in developing countries\u003csup\u003e1.\u003c/sup\u003e In Africa,\u0026nbsp;the\u0026nbsp;WHO estimates\u0026nbsp;that\u0026nbsp;the highest\u0026nbsp;incidence\u0026nbsp;of hypertension\u0026nbsp;is\u0026nbsp;27%\u0026nbsp;in adults\u0026nbsp;aged\u0026nbsp;25 years\u0026nbsp;and older,\u0026nbsp;compared to 18%\u0026nbsp;in America\u0026nbsp;\u003csup\u003e2\u003c/sup\u003e.\u0026nbsp;In Tanzania,\u0026nbsp;previous studies reported\u0026nbsp;an\u0026nbsp;increasing\u0026nbsp;prevalence of hypertension\u0026nbsp;in different rural and urban populations of Tanzania,\u0026nbsp;from 2-10% in\u0026nbsp;the 1960s\u0026nbsp;to 13-79% in 2016,\u0026nbsp;where\u0026nbsp;alcohol, obesity and cigarette smoking were the main\u0026nbsp;risk factors \u003csup\u003e6\u003c/sup\u003e.\u0026nbsp;A study\u0026nbsp;in Arusha and Morogoro Tanzania\u0026nbsp;showed that\u0026nbsp;25.7% and 45% of\u0026nbsp;adults, respectively,\u0026nbsp;had\u0026nbsp;hypertension, and the\u0026nbsp;odds of\u0026nbsp;having hypertension\u0026nbsp;increased with\u0026nbsp;male\u0026nbsp;sex, old age\u0026nbsp;\u0026gt; 60 years, and obesity \u003csup\u003e7,8\u003c/sup\u003e. A study at Muhimbili National Hospital reported a prevalence of hypertension of 68% and hypertension of 32% \u003csup\u003e10.\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eOver the years,\u0026nbsp;hypertension has become one of the leading causes of kidney disease worldwide. For instance, disability-adjusted life years and the rate of CKD due to hypertension increased from 1990 to 2019, with DALY numbers increasing by 125.2% and DALY rates increasing by 55.7%14. In Tanzania, a study performed in Dodoma reported a CKD incidence of 43.8% among hypertensive patients.\u003csup\u003e15\u0026nbsp;\u003c/sup\u003eA study in northwestern Tanzania reported a prevalence of renal dysfunction of 53.9% among hypertensive patients, where older age, female sex, obesity, and high systolic blood pressure were predictors of renal dysfunction.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Despite the fact that\u0026nbsp;hypertension is an important cause of kidney disease, there\u0026nbsp;are currently\u0026nbsp;limited data explaining the patterns of kidney disease due to hypertension in Tanzania. In\u0026nbsp;addition,\u0026nbsp;treating people with hypertension-related kidney diseases imposes\u0026nbsp;a\u0026nbsp;heavy financial burden on healthcare budgets worldwide and even in Tanzania\u003csup\u003e8,25\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e26\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e27,28\u003c/sup\u003e\u003csup\u003e.\u0026nbsp;\u003c/sup\u003eTherefore, this study emphasizes early kidney disease screening and comprehensive care at cardiac clinics, as it will have a beneficial impact on hypertension control and the management of kidney disease.\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cp\u003eStudy Design\u003c/p\u003e\n\u003cp\u003eA\u0026nbsp;\u0026nbsp;cross-sectional study was employed:\u0026nbsp;400 study subjects were recruited over a period of\u0026nbsp;6 months.\u003c/p\u003e\n\u003cp\u003eSampling Procedure\u003c/p\u003e\n\u003cp\u003eMultistage\u0026nbsp;cluster sampling was employed\u0026nbsp;for\u0026nbsp;selecting cardiac clinics.\u0026nbsp;In\u0026nbsp;Stage 1, all cardiac clinics found in Dar-Es-Salaam\u0026nbsp;were listed;\u0026nbsp;one group comprised public cardiac clinics,\u0026nbsp;and the other group\u0026nbsp;comprised\u0026nbsp;private cardiac clinics. Public hospitals were selected by simple random sampling. Stage 2\u0026nbsp;involved the\u0026nbsp;formation of three\u0026nbsp;subgroups\u0026nbsp;based on\u0026nbsp;the\u0026nbsp;level of health care\u0026nbsp;provided by\u0026nbsp;public hospitals,\u0026nbsp;which included tertiary\u0026nbsp;hospitals\u0026nbsp;(Muhimbili National Hospital),\u0026nbsp;regional referral hospitals and\u0026nbsp;district hospitals. From these\u0026nbsp;subgroups, the regional referral hospital\u0026nbsp;was selected by simple random sampling. Study participants were selected from selected cardiac clinics\u0026nbsp;using simple random sampling.\u003c/p\u003e\n\u003cp\u003eData Collection\u003c/p\u003e\n\u003cp\u003eA Questionnaires were administered,\u0026nbsp;and\u0026nbsp;social demographic and anthropometric parameters were obtained. Serum creatinine\u0026nbsp;levels were\u0026nbsp;measured,\u0026nbsp;and\u0026nbsp;the\u0026nbsp;GFR\u0026nbsp;was\u0026nbsp;estimated using\u0026nbsp;the\u0026nbsp;CKD EPI 2021 equation.\u0026nbsp;Urinary creatinine levels were\u0026nbsp;measured using dipstick analysis and\u0026nbsp;a\u0026nbsp;Mindray BS 240 chemical\u0026nbsp;analyzer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Measurements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBlood pressure\u0026nbsp;was measured using\u0026nbsp;an\u0026nbsp;aneroid sphygmomanometer (China). Two consecutive readings were taken from each\u0026nbsp;patient\u0026nbsp;at 5 min\u0026nbsp;intervals,\u0026nbsp;and the average\u0026nbsp;was\u0026nbsp;taken as\u0026nbsp;the\u0026nbsp;mean BP. Hypertension was defined as\u0026nbsp;a\u0026nbsp;systolic blood pressure (SBP) \u0026ge;140 mmHg and diastolic blood pressure (DBP) \u0026ge;90 mmHg (WHO guidelines 2021). Weight (to the nearest 0.5 kg) and height (to the nearest 0.5 cm) were measured using a standardized weighing scale (RGZ-160 from Changzhou,\u0026nbsp;China),\u0026nbsp;and body mass index (BMI)\u0026nbsp;was\u0026nbsp;calculated using the formula\u0026nbsp;weight\u0026nbsp;(kg)/height (m2) (WHO Recommendation of\u0026nbsp;Adult\u0026nbsp;BMI).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Laboratory\u0026nbsp;\u003c/strong\u003emeasurements\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBlood\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003etest\u003c/strong\u003e: Venous blood (3 ml) was taken from\u0026nbsp;the\u0026nbsp;cubital vein into a test tube and allowed to stand undisturbed for 10 min. Then, the tube was centrifuged\u0026nbsp;at 2000 rpm for 15 min to remove clots. The resulting serum was transferred to a clean polypropylene tube. Serum creatinine was determined using\u0026nbsp;a\u0026nbsp;Mindray BS- 240 clinical chemistry\u0026nbsp;analyzer (Guangdong,\u0026nbsp;China). Glomerular filtration rate calculation:\u0026nbsp;The\u0026nbsp;CKD-EPI formula (2021 update) was used to calculate\u0026nbsp;the\u0026nbsp;eGFR:\u003c/p\u003e\n\u003cp\u003eGFR = 141 * min (SC r/\u0026kappa;,1)\u0026alpha; * max(SC r/\u0026kappa;, 1)-1.209 * 0.993Age * 1.018 [if female] * 1.159 [if black]\u003c/p\u003e\n\u003cp\u003eAccording to the\u0026nbsp;National Kidney Foundation\u0026nbsp;guidelines\u0026nbsp;(2013), kidney disease was\u0026nbsp;defined as an\u0026nbsp;eGFR \u0026lt;\u0026nbsp;60 ml/min/1.73\u0026nbsp;m2,\u0026nbsp;mild impairment of kidney function\u0026nbsp;was defined as an\u0026nbsp;eGFR \u0026ge;\u0026nbsp;60 ml/ml/1.73\u0026nbsp;m2,\u0026nbsp;and\u0026nbsp;no\u0026nbsp;kidney disease\u0026nbsp;was defined as an\u0026nbsp;eGFR\u0026gt;90 ml/min/1.\u003csup\u003e73 m2\u003c/sup\u003e. Renal function was staged as follows:\u0026nbsp;stage\u0026nbsp;1\u0026nbsp;(normal) = GFR\u0026gt;90;\u0026nbsp;stage\u0026nbsp;2 (mild to moderate renal impairment, GFR 60-89);\u0026nbsp;and\u0026nbsp;stage\u0026nbsp;3-5 (kidney disease, GFR\u0026lt;\u0026nbsp;60 ml/ml/1.73 m2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUrine test\u003c/strong\u003e: Each patient was also given a sterile container to collect a urine sample, and a dipstick urinalysis was performed within ten minutes of sample collection using a urine dipstick Multistix. Urinary dipstick results were reported as\u0026nbsp;negative\u0026nbsp;to +1,\u0026nbsp;classified as normal to mildly increased albuminuria;\u0026nbsp;2+,\u0026nbsp;classified as severely increased albuminuria;\u0026nbsp;and 3+ to 4+, classified\u0026nbsp;as nephrotic syndrome.\u0026nbsp;Any patient whose urine dipstick was negative for protein underwent further testing of urine for microalbuminuria using a Mindray BS-240 clinical chemistry\u0026nbsp;analyzer (Guangdong, China). The UACR\u0026nbsp;is\u0026nbsp;a method of choice\u0026nbsp;for detecting microalbuminuria, and a UACR \u0026lt;30 mg/g indicates normal ALB, a UACR ranging from 30-300 mg/g indicates that the patient has microalbuminuria, while an ACR \u0026gt;300 mg/g indicates that the patient has macroalbuminuria.\u003c/p\u003e\n\u003cp\u003eThe Kidney Disease\u0026nbsp;Pattern: KDIGO guidelines were used to determine the proportion of patients with AKI. The criteria were based on a comparison with a known baseline SC r to determine AKI. This baseline SCr was obtained from previous patient medical records. For study participants for whom previous serum creatinine data were missing, an estimation of a reference baseline SC r was used. This information is provided by the KDIGO guidelines, where an estimated baseline is obtained through a back-calculation using the CKD-EPI equation and a glomerular filtration rate (GFR) of 75 mL/min/1.73 m\u003csup\u003e2\u003c/sup\u003e.This method was used for approximately 12% of the patients. End-stage renal failure and nephrotic syndrome were diagnosed based on KIDGO criteria with an estimated glomerular filtration rate.\u003c/p\u003e\n\u003cp\u003eDATA ANALYSIS\u003c/p\u003e\n\u003cp\u003eSPSS version 20 was used for data entry, cleaning, and analysis. T tests and chi-squared tests were used for categorical and continuous variables, respectively. A P value\u0026lt;0.05 was considered to indicate statistical significance.\u003c/p\u003e\n\u003cp\u003eEthical clearance\u003c/p\u003e\n\u003cp\u003ePermission to conduct the study was obtained from the Institutional Research Ethics Committee of Hubert Kairuki Memorial University, and permission to conduct the study was obtained from the authorities of the selected hospitals. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u003c/p\u003e"},{"header":"RESULTS","content":"\u003ch2\u003eSociodemographic Status of the Study Participants\u003c/h2\u003e\n\u003cp\u003eIn this study, 400 study participants were enrolled, for\u0026nbsp;a response rate of 100%. Of these, 287\u0026nbsp;(72%)\u0026nbsp;were female, and\u0026nbsp;the mean and standard deviation of age\u0026nbsp;were\u0026nbsp;59.9 and 15\u0026nbsp;years,\u0026nbsp;respectively. Of the study participants,\u0026nbsp;the\u0026nbsp;majority had\u0026nbsp;a\u0026nbsp;primary education\u0026nbsp;(249,\u0026nbsp;62%),\u0026nbsp;and\u0026nbsp;232\u0026nbsp;(58%) had no employment.\u0026nbsp;The majority of participants (240,\u0026nbsp;60%) had\u0026nbsp;a\u0026nbsp;history of hypertension for less than\u0026nbsp;10 years. Furthermore, 54\u0026nbsp;(13.5%) and 20\u0026nbsp;(5%)\u0026nbsp;patients\u0026nbsp;had\u0026nbsp;a\u0026nbsp;history of alcohol consumption and cigarette smoking\u003cstrong\u003e, respectively \u0026nbsp;.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf\u0026nbsp;the\u0026nbsp;400 study participants, 240\u0026nbsp;(60%) and 211\u0026nbsp;(52.8%)\u0026nbsp;had uncontrolled systolic and diastolic blood pressure,\u0026nbsp;respectively,\u0026nbsp;while 204\u0026nbsp;(51%) had excess body weight\u0026nbsp;(BMI\u0026ge;25 kg/m\u003csup\u003e2\u003c/sup\u003e). Furthermore, 119 (30%) study participants had reduced eGFR, while 179 (61.5%) had microalbuminuria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDistribution of eGFR and\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ealbuminuria in relation to age\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003esex\u003c/strong\u003e\u003cstrong\u003e, duration of hypertension\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eand stages of hypertension\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdvanced age \u0026gt;65 years, long-standing hypertension and higher systolic blood pressure\u0026nbsp;were significantly\u0026nbsp;associated\u0026nbsp;with\u0026nbsp;a decrease in the eGFR. Seventy-five percent of the participants in the\u0026nbsp;young age category in this study (18-39 years) had an eGFR of \u0026ge;60\u0026nbsp;and only 25% had\u0026nbsp;an\u0026nbsp;eGFR\u0026lt;60, while 57.5% of\u0026nbsp;participants\u0026nbsp;in the\u0026nbsp;older age\u0026nbsp;\u0026ge;65 years\u0026nbsp;category had an eGFR of \u0026ge;60\u0026nbsp;and 42.5%\u0026nbsp;had an eGFR \u0026lt; 60 eGFR\u0026nbsp;with a p\u0026nbsp;value of 0.0,\u0026nbsp;indicating\u0026nbsp;that\u0026nbsp;the\u0026nbsp;eGFR tends to decrease as age increases. Furthermore, long-standing hypertension\u0026nbsp;was\u0026nbsp;associated with\u0026nbsp;a\u0026nbsp;lower eGFR,\u0026nbsp;as 36.6% of participants\u0026nbsp;who had\u0026nbsp;hypertension for more than\u0026nbsp;10 years\u0026nbsp;had\u0026nbsp;a\u0026nbsp;lower eGFR, while\u0026nbsp;25.8% of participants\u0026nbsp;who had hypertension for \u0026lt; 10 years had a lower eGFR, with a p\u0026nbsp;value of 0.038.\u0026nbsp;In addition,\u0026nbsp;an\u0026nbsp;increase in systolic blood pressure was\u0026nbsp;significantly\u0026nbsp;associated with\u0026nbsp;a decrease\u0026nbsp;in\u0026nbsp;the\u0026nbsp;eGFR\u0026nbsp;(P\u0026nbsp;value\u0026nbsp;of\u0026nbsp;0.004).\u0026nbsp;Albuminuria was\u0026nbsp;significantly\u0026nbsp;associated with aging\u0026nbsp;(p\u0026nbsp;value\u0026nbsp;of\u0026nbsp;0.034).\u003c/p\u003e\n\u003cp\u003eTable 3 shows the distribution of the estimated glomerular filtration rate (eGFR) in relation to age, sex, duration of HTN and stages of HTN among hypertensive patients attending cardiac clinics in Dar es Salaam (n=400).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDistribution of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ealbuminuria\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;with eGFR among hypertensive patients attending cardiac clinics\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eat\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Dar-es-Salaam\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(n=400\u003c/strong\u003e\u003cstrong\u003e).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe serum creatinine ratio and eGFR were significantly (p=0.00) and linearly negatively correlated in the present study, indicating that the higher the ACR was, the lower the eGFR, as 21% of participants in the ACR 0-29.9 category had an eGFR \u0026lt;60 ml/min/1.\u003csup\u003e73 m2\u003c/sup\u003e compared to 53% of participants in the ACR \u0026gt; 300 category with an eGFR \u0026lt;60 ml/min/1.73 m2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelations\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;between eGFR,\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ealbuminuria and socioeconomic\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;factors and BMI among hypertensive patients attending cardiac clinics\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eat\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Dar-Es-Salaam (n=400)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study. Low socioeconomic status was associated with a decrease in the eGFR, and nonemployment status was associated with a decrease in the eGFR, as 35% of the study participants in the nonemployment category had an eGFR\u0026lt; 60, while 22% of the study participants in the self-employment category had an eGFR\u0026lt; 60. This association was statistically significant, as the p value was 0.001. Furthermore, an increase in BMI was significantly associated with an increase in albuminuria (p value 0.0120).\u003c/p\u003e\n\u003cp\u003eTable 5. The distributions of eGFR, albuminuria and socioeconomic factors and BMI among hypertensive patients admitted to cardiac clinics at Dar-es-Salaam Hospital (n=400) are shown.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eClinical\u0026nbsp;patterns\u0026nbsp;of renal\u0026nbsp;disease among adult hypertensive patients were explored in this study and\u0026nbsp;were\u0026nbsp;dominated by AKI\u0026nbsp;(89,\u0026nbsp;22.3%), nephrotic syndrome\u0026nbsp;(12.8%)\u0026nbsp;and end-stage renal failure\u0026nbsp;(2.8%).\u0026nbsp;This finding was in contrast with the\u0026nbsp;findings of studies performed\u0026nbsp;in Cameron and Ghana, where\u0026nbsp;the clinical pattern of renal diseases\u0026nbsp;was\u0026nbsp;dominated by advanced CKD\u0026nbsp;(61.8% and 70.8%,\u0026nbsp;respectively)\u003csup\u003e.\u0026nbsp;\u003c/sup\u003eThis\u0026nbsp;difference can be explained\u0026nbsp;by\u0026nbsp;the use of different study settings. In\u0026nbsp;previous studies in Cameroon and Ghana,\u0026nbsp;a\u0026nbsp;retrospective study design was\u0026nbsp;used\u003csup\u003e,\u0026nbsp;\u003c/sup\u003ewhile in\u0026nbsp;the present study, a\u0026nbsp;descriptive cross-sectional\u0026nbsp;study design was employed\u003csup\u003e30,31\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eAccording to this study, seventy-five percent of the hypertensive patients\u0026nbsp;had a decreased glomerular filtration rate\u0026nbsp;(eGFR\u0026lt;90 ML/min/1.\u003csup\u003e73 M3\u003c/sup\u003e),\u0026nbsp;with at least 30% recording \u0026lt;\u003csup\u003e60 ML/min/1.73 M3\u003c/sup\u003e\u003csup\u003e.\u0026nbsp;\u003c/sup\u003eThis finding was similar to\u0026nbsp;that of a\u0026nbsp;study\u0026nbsp;performed\u0026nbsp;in Cameroon, in which\u0026nbsp;80% of the participants reported\u0026nbsp;an\u0026nbsp;eGFR\u0026lt;90 ML/min/1.\u003csup\u003e73 M3\u003c/sup\u003e and 36% reported\u0026nbsp;an\u0026nbsp;eGFR \u0026lt;\u0026nbsp;60 ML/min/1.\u003csup\u003e73 M2\u003c/sup\u003e \u003csup\u003e36.\u003c/sup\u003eHowever, in contrast to a\u0026nbsp;study\u0026nbsp;performed\u0026nbsp;in Mwanza,\u0026nbsp;which reported\u0026nbsp;that\u0026nbsp;5% of patients had\u0026nbsp;an\u0026nbsp;eGFR\u0026lt;60 ml/min/1.\u003csup\u003e73 m2\u003c/sup\u003e\u003csup\u003e(26)\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eMicroalbuminuria was detected in\u0026nbsp;61.5% of the adult hypertensive patients in\u0026nbsp;the\u0026nbsp;current study, which was\u0026nbsp;lower\u0026nbsp;than\u0026nbsp;that reported in Muhimbili National Hospital Tanzania\u0026nbsp;(82.8%)\u0026nbsp;\u003csup\u003e(28)\u003c/sup\u003e and higher than that reported in Mwanza and\u0026nbsp;Cameroon\u0026nbsp;(23.3% and\u0026nbsp;15%,\u0026nbsp;respectively)\u0026nbsp;\u003csup\u003e(26,36).\u003c/sup\u003e This\u0026nbsp;difference might be due to\u0026nbsp;differences in the\u0026nbsp;study\u0026nbsp;settings\u0026nbsp;and\u0026nbsp;methods used for the\u0026nbsp;diagnosis of\u0026nbsp;microalbuminuria\u0026nbsp;and eGFR.\u003c/p\u003e\n\u003cp\u003eIn\u0026nbsp;this study, higher systolic blood pressure was significantly associated with\u0026nbsp;a decrease\u0026nbsp;in\u0026nbsp;the\u0026nbsp;eGFR.\u0026nbsp;Among\u0026nbsp;adult hypertensive patients, patients with systolic blood pressure greater than\u0026nbsp;140 mmHg\u0026nbsp;(stage I, II and III systolic HTN)\u0026nbsp;were more likely to have a decrease in the eGFR of 46% than patients with other stages (P=0.004). This finding was in line with\u0026nbsp;studies\u0026nbsp;conducted in\u0026nbsp;Northern\u0026nbsp;Tanzania, Ghana, Cameroon\u0026nbsp;and Norway\u0026nbsp;(\u003csup\u003e26,36,38,39\u003c/sup\u003e).\u0026nbsp;However,\u0026nbsp;contrary to\u0026nbsp;studies performed\u0026nbsp;in Ethiopia,\u0026nbsp;which showed\u0026nbsp;that\u0026nbsp;diastolic BP greater than\u0026nbsp;90 mmHg was\u0026nbsp;more likely to\u0026nbsp;lead to\u0026nbsp;kidney disease\u003csup\u003e40\u003c/sup\u003e\u003csup\u003e.\u003c/sup\u003e In addition, increased\u0026nbsp;systolic and diastolic blood pressure\u0026nbsp;were\u0026nbsp;associated with\u0026nbsp;increased\u0026nbsp;albuminuria.\u0026nbsp;This might be due to uncontrolled HTN\u0026nbsp;causing\u0026nbsp;blood vessels around the kidney to narrow,\u0026nbsp;weaken or harden,\u0026nbsp;and as a result, these patients were\u0026nbsp;not able\u0026nbsp;to\u0026nbsp;supply enough blood to the kidney;\u0026nbsp;hence, this\u0026nbsp;impairment\u0026nbsp;led\u0026nbsp;to glomerular HTN and\u0026nbsp;increased\u0026nbsp;proteinuria.\u003c/p\u003e\n\u003cp\u003eAdvanced age was significantly associated with\u0026nbsp;decreased\u0026nbsp;eGFR\u0026nbsp;(P =0.000) and\u0026nbsp;increased\u0026nbsp;albuminuria\u0026nbsp;(ACR) (P\u0026nbsp;=0.034) among adult hypertensive patients in\u0026nbsp;the\u0026nbsp;current study. This finding\u0026nbsp;was\u0026nbsp;similar\u0026nbsp;to\u0026nbsp;those of studies performed\u0026nbsp;in Mwanza, Ethiopia, Northern Cameroon, and Muhimbili National Hospital\u0026nbsp;(\u003csup\u003e26,2836\u003c/sup\u003e).\u0026nbsp;This might be\u0026nbsp;due to normal physiology,\u0026nbsp;whereby the decline\u0026nbsp;in the\u0026nbsp;eGFR with\u0026nbsp;aging\u0026nbsp;is accompanied by changes in renal structure and the percentage of glomeruli affected by\u0026nbsp;glomerulosclerosis\u0026nbsp;increases\u0026nbsp;with advancing age even in the absence of any other conditions,\u0026nbsp;such as diabetes and hypertension.\u003c/p\u003e\n\u003cp\u003eLong-standing hypertension was significantly associated with\u0026nbsp;a decrease\u0026nbsp;in\u0026nbsp;the\u0026nbsp;eGFR among adult hypertensive patients\u0026nbsp;(P=0.038), which showed that\u0026nbsp;patients who experienced\u0026nbsp;hypertension\u0026nbsp;for\u0026nbsp;more than 10 years had\u0026nbsp;a greater\u0026nbsp;percentage of decline in\u0026nbsp;the\u0026nbsp;eGFR (37%)\u0026nbsp;than did\u0026nbsp;those\u0026nbsp;who experienced hypertension for\u0026nbsp;less than\u0026nbsp;10 years\u0026nbsp;(28%). This finding was in agreement with the\u0026nbsp;findings of a\u0026nbsp;study conducted in Ethiopia\u003csup\u003e37\u003c/sup\u003e.\u0026nbsp;This might be\u0026nbsp;because\u0026nbsp;over time, high blood pressure may damage blood vessels throughout the kidney and reduce the blood supply to the kidney, leading\u0026nbsp;to renal vascular nephropathy, which slowly leads to\u0026nbsp;a\u0026nbsp;decrease\u0026nbsp;in the\u0026nbsp;glomerular filtration rate.\u003c/p\u003e\n\u003cp\u003eIn this study,\u0026nbsp;an increase in albuminuria was significantly\u0026nbsp;associated\u0026nbsp;with\u0026nbsp;a decrease\u0026nbsp;in\u0026nbsp;the\u0026nbsp;eGFR (P=0.000) among adult hypertensive patients and\u0026nbsp;an\u0026nbsp;increase\u0026nbsp;in\u0026nbsp;the risk of kidney disease. This finding was in line with\u0026nbsp;studies performed\u0026nbsp;by Levey AS \u003cem\u003eet al\u003c/em\u003e.\u0026nbsp;and Melsom T.\u003csup\u003e38,39\u003c/sup\u003e This might be\u0026nbsp;because\u0026nbsp;a minimal increase in the albumin-to-creatinine ratio (ACR) predicts cardiovascular disease and mortality.\u003c/p\u003e\n\u003cp\u003eA\u0026nbsp;low socioeconomic\u0026nbsp;status\u0026nbsp;was\u0026nbsp;associated with\u0026nbsp;a decrease\u0026nbsp;in\u0026nbsp;the\u0026nbsp;eGFR and increased albuminuria among adult hypertensive patients,\u0026nbsp;which showed that\u0026nbsp;the\u0026nbsp;percentage of patients with\u0026nbsp;a\u0026nbsp;lower occupation (unemployed) and education\u0026nbsp;level\u0026nbsp;and\u0026nbsp;an\u0026nbsp;eGFR \u0026lt;60 ml/min/1.\u003csup\u003e73 m2\u0026nbsp;\u003c/sup\u003e(35%)\u0026nbsp;were significantly greater than\u0026nbsp;those with\u0026nbsp;a\u0026nbsp;higher occupation\u0026nbsp;level (31%)\u0026nbsp;and education level (p=0.001). This result was similar\u0026nbsp;to\u0026nbsp;those of studies performed in the Netherlands and Northern\u0026nbsp;Tanzania/Kilimanjaro\u003csup\u003e40,41\u003c/sup\u003e.\u0026nbsp;This might be\u0026nbsp;because\u0026nbsp;people with low education\u0026nbsp;levels are\u0026nbsp;unaware of\u0026nbsp;behavioral\u0026nbsp;factors that cause hypertension,\u0026nbsp;and\u0026nbsp;unemployment causes access to quality care/treatment difficulties.\u003c/p\u003e\n\u003cp\u003eAn increase\u0026nbsp;in body mass index was significantly\u0026nbsp;associated\u0026nbsp;with an increase in albuminuria (ACR)\u0026nbsp;(p\u0026nbsp;value=0.012). This finding was in line with\u0026nbsp;a\u0026nbsp;study\u0026nbsp;performed\u0026nbsp;in Mwanza and China \u003csup\u003e(26,55).\u003c/sup\u003e This might be\u0026nbsp;because\u0026nbsp;obesity is associated with increased fat-free mass with vasodilatation of the afferent arteriole, resulting in increased renal plasma flow, eGFR and filtration fraction,\u0026nbsp;and increased intraglomerular pressure drives glomerular filtration barrier injury\u003csup\u003e47,48\u003c/sup\u003e.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe clinical pattern of kidney disease was dominated by AKI, nephrotic syndrome and end-stage renal disease. Increased systolic blood pressure, advanced age, long-term hypertension, and unemployment were significantly associated with a decrease in the eGFR. Furthermore, an increase in body mass index was significantly associated with an increase in the albumin‒creatinine ratio among hypertensive patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthical issues: The ethical clearance and permission to conduct this study were issued by\u003c/p\u003e\n\u003cp\u003eHubert Kairuki Memorial University (HKMU) and Medical\u0026nbsp;Office are in charge of the\u0026nbsp;Amana, Mwananyamala\u0026nbsp;and Temeke hospitals,\u0026nbsp;respectively. Consent\u0026nbsp;was\u0026nbsp;obtained from\u0026nbsp;the\u0026nbsp;study participants\u003c/p\u003e\n\u003cp\u003eConsent for publication: Not applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: The\u0026nbsp;datasets\u0026nbsp;analyzed during the current study are available\u003c/p\u003e\n\u003cp\u003efrom the corresponding author\u0026nbsp;upon\u0026nbsp;reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding: Data collection and analysis were funded by TPDF.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions: All authors contributed equally\u0026nbsp;to the study\u0026nbsp;conception\u0026nbsp;and\u0026nbsp;research development.\u003c/p\u003e\n\u003cp\u003eand study design. AM contributed to the data collection and entry. YM was instrumental in statistical analysis. All the authors have read and gave final approval for the submission of the manuscript. and publication.\u003c/p\u003e\n\u003cp\u003eAcknowledgments: I would like to thank TPDF and HKMU \u0026amp; KH for their support during this study. I would like to thank all the participants who participated in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWHO. World Health Organization Fact Sheet. WHO (2021)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIsangula KG, Meda JR (2017) The Burden of Hypertension in the Rural and Urban populations of Tanzania: A review of Trends, Impacts and Response Helping Baby Breathe (HBB) in Tanzania View project Personal behaviors, NCD risk status and patient counseling practices in Tanzania View p. 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Kidney inter 3(Suppl):1\u0026ndash;150\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTamanji MT, Ngwakum DA, Mbouemboue OP (2017) A Profile of Renal Function in Northern Cameroonians with Essential Hypertension. Cardiorenal Med 7:324\u0026ndash;333\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOkyere P et al (2020) Spectrum and Clinical Characteristics of Renal Diseases in Ghanaian Adults: A 13-Year Retrospective Study. \u003cem\u003eInt. J. Nephrol.\u003c/em\u003e 1\u0026ndash;5 (2020)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhalloo H (2013) Prevalence of microalbuminuria and associated factor among hypertensive patients at Muhimbili National Hospital Dar-es-salaam. Muhimbili University of Health and Allied Sciences\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEriksen BO et al (2017) Blood pressure and age-related GFR decline in the general population. BMC Nephrol 18:77\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHunegnaw A, Mekonnen HS, Techane MA, Agegnehu CD (2021) Prevalence and Associated Factors of Chronic Kidney Disease among Adult Hypertensive Patients at Northwest Amhara Referral Hospitals, Northwest Ethiopia, 2020. \u003cem\u003eInt. J. Hypertens.\u003c/em\u003e 1\u0026ndash;8 (2021)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLevey AS, Grams ME, Inker LA (2022) Uses of GFR and Albuminuria Level in Acute and Chronic Kidney Disease. N Engl J Med. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1056/nejmra2201153\u003c/span\u003e\u003cspan address=\"10.1056/nejmra2201153\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMelsom T et al (2018) Mild Albuminuria Is a Risk Factor for Faster GFR Decline in the Nondiabetic Population. Kidney Int Rep. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ekir.2018.01.015\u003c/span\u003e\u003cspan address=\"10.1016/j.ekir.2018.01.015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVart P et al (2019) Socioeconomic status and risk of kidney dysfunction: The Atherosclerosis Risk in Communities study. Nephrol Dial Transpl. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/ndt/gfy142\u003c/span\u003e\u003cspan address=\"10.1093/ndt/gfy142\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStanifer JW et al (2015) The epidemiology of chronic kidney disease in Northern Tanzania: A population-based survey. PLoS ONE. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pone.0124506\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0124506\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQin S, Wang A, Gu S et al (2021) Association between obesity and urinary albumin\u0026ndash;creatinine ratio in the middle-aged and elderly population of Southern and Northern China: a cross-sectional study. BMJ Open 11(1):e040214. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjopen-2020-040214\u003c/span\u003e\u003cspan address=\"10.1136/bmjopen-2020-040214\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003ePMID: 33402405; PMCID: PMC7786798\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 5 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4738063/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4738063/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBACKGROUND\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHypertension is a public health challenge and has become one of the leading causes of kidney disease over the years. \u003cstrong\u003eObjective\u003c/strong\u003e: The aim of this study was to determine the patterns of kidney disease among adults with hypertension in Dar es Salaam.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e: A descriptive cross-sectional study was employed. Social-demographic data were collected from the participants. Blood pressure, body weight and height were measured using a standardized method. Blood samples were collected to measure serum creatinine and the estimated eGFR using CKD EPI2021, while urine was collected for biochemical analysis, the dipstick method and determination of the albumin–creatinine ratio.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: A total of 400 hypertensive patients were enrolled. In this study, 287 (72%) were females, and the mean and standard deviation of age were 59.9 and 15 years, respectively. A total of 249 (62%) had a primary education, 232 (58%) were unemployed, 240 (60%) had a history of hypertension for less than 10 years, 346 (86.5%) had no history of alcohol consumption, and 380 (95%) had no history of cigarette smoking. Furthermore, 240 (60%) and 211 (52.8%) had a blood pressure ≥140 mmHg for systolic and ≥90 mmHg for diastolic blood pressure, respectively. A BMI ≥25 kg/m\u003csup\u003e2 \u003c/sup\u003ewas found among 236 patients (59%). A reduced eGFR (\u0026lt;60 Ml/min/1.\u003csup\u003e73 M2\u003c/sup\u003e) and microalbuminuria were observed in 119 (30%) and 179 (61.5%) patients, respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The clinical pattern of kidney disease was dominated by AKI (22.3%), nephrotic syndrome (12.8%) and end-stage renal disease (2.8%). Higher systolic blood pressure, advanced age, long-term hypertension and unemployment were significantly associated with a decrease in the eGFR. An increase in body mass index was significantly associated with an increase in albuminuria.\u003c/p\u003e","manuscriptTitle":"Pattern of kidney disease among hypertensive patients attending cardiac clinics in Dar Es Salaam","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-16 09:40:23","doi":"10.21203/rs.3.rs-4738063/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1e90a43d-f581-45e2-9a5b-9c0c49092516","owner":[],"postedDate":"July 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":34568142,"name":"Internal Medicine"}],"tags":[],"updatedAt":"2024-07-16T09:40:23+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-16 09:40:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4738063","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"identity":"rs-4738063","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}