Chronic Kidney Disease Among Hypertensive Patients: Need for Screening Programmes

Chronic Disease Among Hypertensive Patients: Need for Screening Programmes. Abstract Chronic kidney disease (CKD) has a high morbidity and mortality rates and costs a lot of money including health care, haemodialysis costs and management of complications of CKD. Patients with more progressive stages 3 and 4 CKD experience a high incidence of cardiovascular events and death compared with stages 1 and 2 of CKD. According to the Global Burden of Disease Study conducted in 2010, CKD became the 18th place on a list of the greatest causes of deaths in the world, with an annual mortality rate of 16.3 per 100,000 people. Due to the high prevalence of diabetes, hypertension and coronary artery disease, CKD became world widespread. In alignment with the presence of metabolic and cardiovascular diseases, the prevalence of hypertensive nephropathy prevalence is 7.75%. Unfortunately, the number of patients started to develop end stage renal disease because of hypertension is exceeding. Hypertension-induced renal damage includes the systemic blood pressure load, the degree of renal microvasculature affection, and local susceptibility factors to barotrauma, all of which are affected by the degrees of hypertension. Therefore, in developing countries, screening programmes are extremely needed to detect the early stages of CKD among hypertensive diabetics and non-diabetic patients attending primary healthcare centres.


Mini-Review
Chronic kidney disease (CKD) affects approximately 13% of the adult population. Unfortunately, CKD has a high morbidity and mortality rates and can cost the government a lot of money due to the haemodialysis and management of complications of CKD.
Patients with more progressive stages 3 and 4 CKD experience a high incidence of cardiovascular events and death compared to stages 1 and 2 of CKD [1]. Although, more than 90% of individuals who have CKD remain unrecognized, diabetes mellitus and hypertension are the major risk factors of CKD, respectively. Therefore, early screening and prevention of progression of CKD are one of the major challenges and goals for primary care physicians to avoid the high incidence of cardiovascular events [2].
CKD represents a decrease in glomerular filtration rate (GFR) in a progressive and irreversible manner [3]. Unfortunately, no specific treatment for most of the chronic nephropathies and they tend to progress spontaneously to end-stage renal disease (ESRD).
Whatever the underlying aetiology of the kidney disease, progressive renal function loss is a common and shared phenomenon in renal failure.
In the past, The National Kidney Foundation -Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) workgroup has defined CKD as the anatomical or functional aberrations of the kidney with or without decreased glomerular filtration rate (GFR) that, manifested by either aberration in the blood or urine composition,

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Electrolyte disturbance and other abnormalities due to tubular disorders.

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Structural abnormalities detected by ultrasound imaging or 6. History of kidney transplantation in such cases [5].
In the USA, it is estimated that 18% of the adult population, in the central region, Eastern region, Western region, and Southern region respectively [7].
In Egypt, when a cross-sectional study from communitybased screening programme was conducted on the relatives of CKD patients to detect the prevalence and risk factors for microalbuminuria (MA), it was found that the prevalence of MA, was more than 10% in the population screened and in the participants with diabetes, hypertension, obesity, or CVDs tends to be higher [8]. by worsening glomerular injury and proteinuria, which leads to further glomerular and tubulointerstitial injury, thus simulation of GFR fall [10].
Screening for CKD is supposed to be a priority for primary care and health care physicians to slow down the deterioration of kidney function and the progression towards the ESRD, they should be aware of any abnormalities in kidney functions for early treatment of CKD and its complications. It is better for general practitioners or family doctors (GPs/FDs) to carry out screening, as most of the population visits their GP/FD within a 3-year period and can be of essential integrated action systems to halt and avoid the deterioration of hypertensive or diabetic nephropathy that occur over numerous years [11][12][13][14][15][16].
Therefore, in developing countries, screening programmes are extremely needed to detect the early stages of CKD among hypertensive diabetics and non-diabetic patients attending primary healthcare centres.