Chronic kidney disease in the Caribbean Island of Antigua: Causes, morbidity and mortality factors

Abstract

Background: Chronic kidney disease (CKD) and its associated high morbidity and mortality cause significant economic burden and decreased quality of life in affected patients in Antigua, the rest of the Caribbean and globally. The causes of CKD in Antigua, morbidity and mortality factors affecting the sampled patients were evaluated with a view to formulating interventions to minimize the occurrence and the impact of these factors. Objective: To determine the causes of CKD over a nine-year period and the causes of morbidity and mortality among patients with CKD at the two main hospitals in Antigua. Methods: A retrospective review was done of the clinical records of patients with CKD who were diagnosed during the period January 1, 2005 to December 13, 2013. Chronic kidney disease was defined as an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2. The cause of CKD, the patients' admission diagnoses, the causes of death and laboratory investigations were evaluated. Results: The causes of CKD were diabetes mellitus in 51%, hypertension in 26%, and glomerulonephritis in 5% and lupus nephritis in 4% of the patients, respectively. The causes of morbidity among the patients with CKD were: myocardial infarction 5.1%, unstable angina 12.7% and ischaemic stroke 12%. Contributing significantly to the patients' morbidity, were catheter-associated infections 8.15% (p < 0.001) and lower respiratory tract infections, 5.4%. The main factors contributing to the patients' mortality were: myocardial infarctions 16.1% and catheter-associated infections 16.1%. Conclusion: This study documented that the most common causes of CKD among the sampled patients in Antigua were: diabetes mellitus and hypertension. Ischaemic heart disease and infections were the major causes of morbidity and mortality among the patients. The early recognition and aggressive management of CKD and its risk factors and complications are important in the reduction of the clinical and economic burden of this disease.