KENYA MEDICAL TRAINING COLLEGE

RESEARCH PROJECT ON,

A STUDY TO DETERMINE PREVALENCE AND RISK FACTORS

ASSOCIATED WITH CHRONIC KIDNEY DISEASE AMONG PATIENTS
ATTENDING RENAL CARE UNIT IN NYAMIRA COUNTY REFERRAL
HOSPITAL.

MANDERE O. JOSEPHAT

D/NURS/20016/2148

SUBMITTED TO DEPARTMENT OF NURSING IN PARTIAL

FULFILLMENT FOR THE AWARD OF A DIPLOMA IN COMMUNITY
HEALTH NURSING

2023
 DECLARATION
This research project is my own original work and has not been submitted for the award of
Diploma in any other institution.

SIGNATURE:………………………………………,,,,… DATE:
………………………………….

MANDERA O. JOSEPHAT

D/NURS/20016/2148

This project is submitted with my approval as the college supervisor

SIGNATURE:……………………………………………..… DATE:
…………………………………..

MR. GILBERT ONYONO

i
 ACKNOWLEDGEMENT
I am grateful to the Almighty God for sound health, guidance, care and protection for the far I
have reached in my research project. Special gratitude to my supervisor Mr. Gilbert Onyono
my family and friends for their prayers and support.

ii
 DEDICATION
I dedicate this work to all those with greatest interest of me in their heart, starting with my
parents, relatives, real friends, my supervisor and lecturers.

May God bless you abundantly.

iii
Contents
DECLARATION..............................................................................................................................i

ACKNOWLEDGEMENT...............................................................................................................ii

DEDICATION...............................................................................................................................iii

Contents..................................................................................................................................iv

CHAPTER ONE..............................................................................................................................1

1.1 BACKGROUND INFORMATION.................................................................................1

1.2 PROBLEM STATEMENT....................................................................................................2

1.3 JUSTIFICATION..................................................................................................................2

1.4 BROAD OBJECTIVE...........................................................................................................3

1.4.1 SPECIFIC OBJECTIVES...................................................................................................3

CHAPTER TWO.............................................................................................................................4

LITERATURE REVIEW............................................................................................................4

2.1 INTRODUCTION.................................................................................................................4

2.2 PREVALENCE OF CHRONIC KIDNEY DISEASE..........................................................4

2.3 RISK FACTORS ASSOCIATED WITH CHRONIC KIDNEY DISEASE.........................6

2.4 KNOWLEDGE AND PRACTICE ON PREVENTION OF CHRONIC KIDNEY

DISEASE.....................................................................................................................................7

CHAPTER THREE.........................................................................................................................9

RESEARCH METHODOLOGY................................................................................................9

3.1 INTRODUCTION.................................................................................................................9

3.2 STUDY AREA......................................................................................................................9

3.3 STUDY POPULATION........................................................................................................9

3.4 STUDY DESIGN..................................................................................................................9

3.5 SAMPLING TECHNIQUES.................................................................................................9

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 3.6 SAMPLE DETERMINATION.............................................................................................9

3.7 INCLUSION AND EXCLUSION CRITERIA...................................................................10

3.8 STUDY VARIABLES.........................................................................................................11

3.9 DATA COLLECTION METHODS AND TOOLS............................................................11

3.10 PLOT STUDY...................................................................................................................11

3.11 DATA ANALYSIS AND PRESENTATION...................................................................11

3.12 ETHICAL CONSIDERATIONS.......................................................................................11

CHAPTER FOUR.........................................................................................................................12

PRESENTATION OF RESEARCH FINDINGS......................................................................12

4.1 INTRODUCTION...............................................................................................................12

4.2 SOCIAL DEMOGRAPHOIC INFORMATION.................................................................12

4.3 PREVALENCE OF CHRONIC KIDNEY DISEASE........................................................16

4.4 RISK FACTORS ASSOCIATED WITH CHRONIC KIDNEY DISEASE.......................19

4.5 KNOWLEDGE AND PRACTICE ON PREVENTION OF CHRONIC KIDNEY

DISEASE...................................................................................................................................22

CHAPTER FIVE...........................................................................................................................26

DISCUSSION OF RESEARCH FINDINGS............................................................................26

CHAPTER SIX..............................................................................................................................29

CONCLUSION AND RECOMMENDATIONS......................................................................29

6.1 CONCLUSION....................................................................................................................29

6.2 RECOMMENDATIONS.....................................................................................................29

REFERENCES..............................................................................................................................30

APPENDIX I: QUESTIONNAIRE...............................................................................................34

INSTRUCTIONS......................................................................................................................34

APPENDIX II: BUDGET..............................................................................................................38

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APPENDIX III: WORK PLAN.....................................................................................................39

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 CHAPTER ONE

1.1 BACKGROUND INFORMATION

Chronic kidney disease is a functional disease characterized by progressive and irreversible
decline in glomerular rate. According to (Coresh et al; 2017) they stated that prevalence
incidences of CKD is on the increase globally and currently estimated at 10% of the world
population death annually. The overall estimation in sub-Sahara Africa is 13.9% with
insignificant difference between the rural that is 16.5%and urban is 12.4% communities (stanifer
et al 2018).

According to the daily nation newspaper, dated 17th march 2019, it is estimated that CKD causes
approximately 2-4 million deaths per year globally and is rated on the sixth fastest grooming
cause of death. According to the world Health Report 2012 and global burden of disease (GBD)
project, diseases of the kidney and urinary tract contribute to the global burden of diseases, with
approximately 85,000 deaths every year and 15,010,167 disability adjusted life years. They are
the 12th cause of deaths and the 17th cause of disability, respectively (Riebe, Ehrman, Lignori and
Magal, 2018). However, the rapid surge in diabetes and hypertension, both of which are
predicted to drive epidemics in CKD, will dramatically escalated this burden. CKD is expected
to be a profound 21th century medical challenge.

In sub-sahara Africa, CKD more community affects individuals aged between 20 and 50 years,
(Arogundade et al, 2018) and the age of onset of end- stage renal disease (ESRD) is 20 years
earlier in population of African descent compared with others ethnic groups in western countries
which underscores the need for early detection especially in the resource-depleted Africa. The
incidence of ESRD (CKD stage 5) is 783 per million population in African Americans compared
to 295 per million population in non-Hispanic whites (USRDS 2017 annual data report). The
cumulative life time risk of ESRD is 7.5% in African American and 2.1% in cancasians (Kiberd
B et al, 2020). Low to middle -income countries are undergoing epidemiologic transmission
typified by a reactive increase in the burden of non-communicable chronic diseases (such on
diabetes mecuntus, obesity, hypertension, cardiovasnear diseases and CKD)(Crren Roder R et al,

1
2021) on the prevalence of infection diseases diminishes with improved sanitation and
immunization programs.

In Kenya, there is increased prevalence of CKD, which is partly explained by high rick factors
such as lifestyles and demographic in both urban and rural communities. The level of awareness
of CKD and the lifestyle related disease is low and hence the late presentation of patients with
complication. Less than 10% of end-stage renal disease patients have access to any kind of renal
replacement therapy. There is limited data on CKD to aid in planning interventional measures
among the rural and urban communities. The largest proportion of the Kenya population (76%)
lives in rural areas (KNBS). Strategies used at managing the disease in Kenya cordially depends
on a reliable assessment of the burden of the problem and establishment of affordable early
detection program.

Previous studies show that the prevalence of CKD among genuine population of this condition in
disease trigger other chronic conditions such as diabetes. In 2019 world kidney day exercise
promoted an opportunity to identify chronic kidney disease risk factors for early detection and
intervention.

1.2 PROBLEM STATEMENT

While working in Nyamira County Referral Hospital the renal unit department the researcher
noted that the prevalence of chronic kidney disease is on the rise globally. And currently
estimated Nyamira population is 10% die annually.

Thus, this disease is becoming a burden hence its important to determine risk factors contributing
to progression of the disease and planning of preventive measures based on the prevalence of the
disease.

The increasing cases of chronic kidney disease in Nyamira county Hospital promoted the
researcher to start a study to find out specific causes and ultimate solutions reached and will be
given to management for it to take necessary action, to either stop the infection or reduce the
ration of the patients being infected. (source; Victor Nyabuto, 2022).

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1.3 JUSTIFICATION
Understanding factors that predisposes people to chronic kidney disease in health facilities is
particularly important in order to monitor existing gaps and improve the quality of health
services to groups of people to reduce disabilities related to chronic kidney diseases.

There is a rising number of reported cases of chronic kidney disease at Nyamira County referral
hospital. 10 out of hundreds patients attending out-patient is diagnosed having chronic kidney
disease and 10 patients with chronic kidney disease is undergoing rural dialysis per week. This
seek the researcher to determine prevalence and risk factors associated with chronic kidney
disease.

The study findings will be used by the residence of the study area to create awareness on cause
and risk factors and set control measures, since it will give specific measures on areas of
influential at the household level.

The study will also help the researcher to increase knowledge for research. The other reason for
carrying out this research is for partial fulfillment of the requirement of a diploma award in
Kenya registered community health nursing. (source Nyamira County Referral Hospital Medical
Records,2020-2022).

1.4 BROAD OBJECTIVE

To determine prevalence and risk factors associated with chronic kidney disease among patients
attending renal care unit in Nyamira county Referral Hospital.

1.4.1 SPECIFIC OBJECTIVES

1. To determine prevalence of chronic kidney diseases among patients attending renal care
unit in Nyamira County Referral Hospital.
2. To identify risk factors associated with chronic kidney disease among patients attending
renal care unit in Nyamira County referral hospital.
3. To assess knowledge and practice on prevention of chronic kidney disease among
patients attending renal care unit in Nyamira county referral hospital.

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 CHAPTER TWO
LITERATURE REVIEW
This chapter entails the relevant literature to the study. The organization is based on the specific
objectives which compare and give a relevance view of the study.

2.1 INTRODUCTION
Kidney damage can be assessed by albumin creatinine rate (ACR), albuminuna is one of the
identifiers of kidney function in a timed urine collection. (Udhayarasu et al, 2018), have stated
that one of the reasons for the (excretion of profeinuna) is due to intake of cooked meat or
increased intake of protein or any kidney infection. Basically, the ACR in young adults is less
10mg/g. The urine ACR categmes are an found. ACR 10-29 mg/g indicates high or normal risk,
300mg/g high risk and greater 300mg/g very high risk and when ACR is less 200mg/g symptoms
of hephrotic syndrome (low serum albumin oedema, high serum cholesterol) appear. The
glomerular filtration rate (GFR) is helpful to estimate the performance of the kidney function.

Chronic kidney disease (CKD) is divided into five stages. The stages are based on e GFR test
result and how well the kidney work to filter waste and extra fluid out of the blood. As the stages
go up, kidney disease gets worse and kidneys work less well. At each stage, its important to take
steps to slow down the damage of the kidneys. In early stages (stages 1-3), the kidneys are still
able to filter waste out of blood. In the later stages (stages 4-5), kidneys must work harder to
filter and may stop working altogether.

The goal at each stage of CKD is to take steps to slow down the damage to kidneys and keep
kidney working as long as possible. To find out the stage of CKD, doctors will test such as e
GFR tests (blood tests), which is a measure of how well kidney are working and urine (pee) tests.

2.2 PREVALENCE OF CHRONIC KIDNEY DISEASE

Chronic kidney disease is an emerging global public health problem (“chronic kidney disease
(CKD),” 2019). The disease is a component of a new epidemic of chronic condition that replaced
malnutrition and infections as leading causes of mortality during the 26 th century (Coresh et al,
2018). Age standardized death rates due to CKD have increased during the last 20 years,
whereby chronic kidney disease has shifted from the 36th cause of death to the 19th cause in 2018

4
(Levey & Caresh, 2019). This increase necessitating renal replacement therapy and high rate of
cardiovascular mortality and morbidity attributing to chronic kidney disease (Batis et al, 2018).

CKD is a spectrum ranging from mild stage disease to severe disease (end stage renal disease)
thus renal replacement therapy which is costly and is associated with high chances of mortality
and morbidity (EL NAHAS 2020).

The chronic on communicable conducive escalates the prevalence of CKD includes diabetes,
hypertension whose prevalence is increasing in line with global trends due to epidemiological
trends(MALINDAISA 2018).

Estimates show that 4 million Kenyans have chronic kidney disease with a significant proportion
of this population progressing to kidney failure. Out of these, about 10,000 people have end stage
renal disease and requires dialysis yet only 10% of those who need dialysis are able to access the
seminar.

In an article from the daily nation 14th October, 2018, Edwin Sigu, reports how people living
with diabetes and hypertension are suffering from chronic kidney disease which is preventable.
The caretakers and family members have too little earnings and they prorating rent and day care
over feeding the affected people (Sigu, 2018). From this article it is evident that poverty is
contributing greatly to occurrence of chronic kidney disease in some people.

In Kenya there is increased prevalence of CKD which is partly explained by the risk factors
examples lifestyle and demographical factors, the increase in life related diseases example
hypertension and metabolic syndrome(SIGAMANI 2019).

The focus of this study was to find out some demographic factors which relate to occurrence of
chronic kidney disease among patients aged 30-70 years attending Nyamira County Referral
Hospital renal unit since it was not clearly known and identified. The research will help coming
up with possible programs that can be indicted in the day care centers of the renal unit to prevent
occurrence of chronic kidney disease among unaffected group.

The global burden of CKD is estimated to be 11 to 13%. The prevalence of renal disease in
Africa is not known, though estimates point to a substantiated burden especially in the middle
aged. Prevalence of CKD in specific health conditions has previously been estimated in Kenya,

5
including in HIV, rheumatoid arthrotis, heart failure and type 2 diabetes. However, little is
known on overall prevalence of CKD in the Kenyan population, such data would be invaluable
in informing public health investment in treatment facilities and prevention.

The gold standard for determining CKD burden is population surveys, however, these are
difficult due to time and financial constraints. Prevalence of CKD in medical in patients at
referral health facilities has been used in several studies in different countries and settings to
estimate the overall disease burden and its complications. These include Uganda, Botswana and
the United states.

My study aims to estimate the prevalence and identify factors associated with CKD among
medical inpatients in Nyamira County Referral Hospital renal unit.

2.3 RISK FACTORS ASSOCIATED WITH CHRONIC KIDNEY DISEASE

According to WHO, 2019 it shows that cultures, lifestyle and dietary are more risk factors
associated with chronic kidney disease. Cultural practices such as use of traditional medicine for
ailments damaged kidney. They added that culture might promote practices that put males at a
higher risk of developing CKD. Male are the most involved in spraying cattle and crops,
culturally accepted to seek herbal medicines for many animals in the African communities
(Brimblecombe, Ferguson, Liberato&O’Dea, 2018). The study was found that 57.0% of patients
with CKD had use of traditional medicines prior to outset of the disease. Some others ill after use
of traditional medicines (Kanbay, Chen, Solac&Sanders,2019). Culturally practices with both
traditional and non-traditional risk factor influences progression and prevalence of CKD in Sub-
sahara Africa is provided in a study on a hospital in Zambia population (Kovesdy, 2020). Use of
herbal medicines had adverse effects drug reactions that could promote renal injury and increase
case of CKD. Subsequent literature review on use of Africa Herbal Medicine (AHM) labeled as
“popular medicinal plants” and how they are linked with observed adverse drug reaction in
African communities confirmed inadequate on indication, dosage and contamination of these
preparation(white,2018).

Chronic kidney disease has become a serious public health issue. These are currently over 1-4
million patients receiving renal replacement therapy worldwide (WHO,2019). One way to reduce
the economic burden of chronic kidney disease would be early intervention. In order to achieve

6
this, we should be able to identify individuals with increased risk of renal disease (coresh et
al :2018). An individual’s genetic make up puts him/her at risk of kidney disease. Factors such as
race, gender, age and family history. For instance, being of African-American descent, older age,
low birth weight and family history of kidney disease are considered to be strong risk factors for
CKD. Moreover, smoking, obesity hypertension and diabetes mellitus (DM) can also lead to
kidney disease. Uncontrolled DM and hypertension can easily and quickly progress ESRD
(Davidson et al, 2017). Exposure to heavy metals, excessive alcohol consumption, smoking and
use of analgesic mediations also contribute to risks. Experiencing acute kidney injury, a history
of cardiovascular disease, hypempidemia, metabolic syndrome, hepatitis C virus and HIV
infection are function risk factors (SIGAMANI 2019).

CKD is a health problem which could lead to ESRD and increased cardiovascular morbidity and
mortality. According to the registries of different countries including the United states, CKD
affects 10-16% of adults around the world. Within the Turki9sh population the prevalence of
CKD is 14.7%. (Romney, 2018). Lifestyle such as are of excess alcohol, physical exercise and
smoking cigarette has been found to be related with CKD (Mallamaci & Tripepic, 2020).
Smoking cigarette as emerged as an important modifiable risk factor of CKD based on multiple
studies that have documented a distinct assassination with almost five-fold increase odd of
developing CKD. Use of excess alcohol causes nephrotoxicity which progresses to kidney
failure. Lack of physical exercises regularly predispose to condition like hypertension which
cause damage to kidney (Macmahon et al, 2018). Dietary factors like low protein diet are
difficult to adhere to and carry a risk of inducing malnutrition. This malnutrition lead to a smaller
number of nephrons which reduces GFR leading to kidney failure (Davidsons 20th edictim).

2.4 KNOWLEDGE AND PRACTICE ON PREVENTION OF CHRONIC KIDNEY

DISEASE
According to 2018 united states renal data system Annual Data Report, the leading cause of
CKD are diabetes (incidents case of ESRD of 153 million of population in 2017) hypertension
account for 99 million of population and glomerulonephritis which account for 23.7 million of
population. However, in developing countries like Kenya, diabetes and hypertension appear to be
the leading cause of ESRD with a prevalence of about 30% and 21% respectively (sanders,2020).

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The levels of awareness of the disease is low and hence late presentation of patients with
complications and absence of higmighting the seiners of this unfolding global epidemic (Jonsen
et al. 2021). Government, communities, patients and health providers do not implement
preventive measures which are known to slow or stop progression of early stages of chronic
kidney disease (weir&fink, 2019).

Diabetes is a major cause of CKD. Over 5% of people with newly diagnosed with type II
diabetes already have CKD and estimated 40%of both type I diabetes and type II diabetes will
develop chronic kidney disease during their lifetime (Wright & Cavanaugh, 2020). Too much
glucose in blood damages nephrons which leads to reduced GFR and albuminuna. The
progression of chronic kidney disease lead to ESRD. This will require renal dialysis or kidney
transplant for survival which may not be affordable in developing countries. In patients with
ESRD increases prevalence of ischemic heart disease and congestive heart failure (Kundu,
2018).

Currently unwanted hypertension is the leading cause of CKD. It causes artery damage, the
kidney is packed with arteries which are supposed with dense blood vessels and high volumes of
blood flow through them overtime, and unimproved hypertension can cause narrowness of the
arteries which reduces supplied of blood to kidney. This result loses the ability of kidney to filter
blood and regulate the fluid hormones, acids and salt in the body (Dale, 2019).

Obesity is one of the strongest yet modifiable risk factors for ESRD in the twenty-century.
Glomerular hypertrophy and hyper filtration may accelerate kidney injury by increase capillary
wall tense of the glomeruli and decrease podocyte density (Hashash, Proksell, Kuan & Behari,
2020). In a study which was carried out at Fiji show that over weight of BMI > 25kg/m ꓥ 2 at
age of 20 was associated with a significant three-fold excess risk for CKD in compares with BMI
< 25kg/m ꓥ 2. Obesity may contribute to the pathogenesis of kidney damage through
inflammation, oxidative stress, endothecial dystamation, prothrombotic stage, hypervolemia and
adipocyte de-arrangements. Besides high BMI, carrying excess weight around abdomen is linked
to an increase risk of CKD, found that in multivariate analysis, higher waist to hip retime was
associated with lower effective renal plasma flow and higher filtration fractal even adjustment
for sex, age, mean arterial pressure and BMI (@ 2018 International Society of Nephrology).

8
Family members of CKD patients have high prevalence of kidney chronic disease. It shows that
23% of incident dialysis patient had close relative with ESRD, this is due to hereditary disorder
and urologic cause (WHO, 2019)

CHAPTER THREE
RESEARCH METHODOLOGY
3.1 INTRODUCTION
This chapter describes the various methology used in the study it includes the study. It includes
the study area, study design, study population, study sample, study variables, sample size and
data collection methods and tools and ethical considerations.

3.2 STUDY AREA

The study was done in Nyamira County referral hospital. Its located in Nyamira town, township
ward, Nyamira location, Nyamira County. It has a renal unit with four dialysis machines and
renal out patient clinic weekly. The hospital serves Nyamira and Kisii County residents mostly
on catchment area. Nyamira county has a population of 421,186 and an area of 930KM squared.
The main economic activity is agriculture. Most residents are peasant farmers depending on their
farms to support their households. Majority residents are Kisiis.

3.3 STUDY POPULATION

The target population includes patients with chronic kidney disease in Nyamira County. The
study population includes patients with chronic kidney disease in Nyamira county referral
hospital which includes those that are attending the renal clinic, outpatient department and those
that are undergoing dialysis in Nyamira County hospital renal unit.

3.4 STUDY DESIGN

The study employed descriptive cross-sectional design due to small number of respondents who
are on dialysis and follow up for CKD .

3.5 SAMPLING TECHNIQUES

The study adopted the convenient sampling technique to reach the respondents. This is a specific
type of non-probability sampling method that reviews on data collection from population
members who are conveniently available to participate in the study.

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3.6 SAMPLE DETERMINATION
The sample size was calculated by the formula used by Fisher’s et al (1998) therefore Andrew
Fishers of population of more than 1000 was used.

Z 2 PQ
N=
d2

Where;

Z- is the standard normal deviate (z-value=-1-96)

P- proportion in the target population (0.50)

Q= 1-P

d- degree of accuracy required (set at 6.5)

N=¿ ¿

N= 384 (this was the desired sample size)

Since the target population was less than 10,000 the required sample size was smaller.

To calculate the sample size, the formula to be used

n
nf =
n Where;
1+
N

nf= desired sample size (where population is < 10,000)

n= desired sample

N= estimated population (24)

384
nf =
384
1+
24

22.588=

23 respondents

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3.7 INCLUSION AND EXCLUSION CRITERIA
i. Inclusion
 Those patients attending dialysis
 Those attending renal outpatient clinic.
 Those in the wards during the time of data collection.
ii. Exclusion
 The patients who have undergone renal replacement therapy.
 Newly diagnosed patients not on follow up.

3.8 STUDY VARIABLES

The dependent variable is chronic kidney disease. The independent variables include knowledge
and practice on prevention of chronic kidney disease, risk associated with chronic kidney disease
and prevalence of chronic kidney disease.

3.9 DATA COLLECTION METHODS AND TOOLS

The study adopted questionnaires on a tool for collecting data questionnaires was on closed
ended and open-ended structure.

3.10 PLOT STUDY

The researcher conducted a pre-test to determine how effective the tool is in collecting the data.

3.11 DATA ANALYSIS AND PRESENTATION

The researcher used statistical package for the social sciences (SPSS) version 21 to analyze the
data and it used tables, graphs and pie charts for data presentation.

3.12 ETHICAL CONSIDERATIONS

To ensure that the study complies with the ethical issues pertaining research undertaking
permission to conduct the researcher sought from the respective authorities. A full disclosure of
all the activities concerning the study was explained to the authorities and this involves the study
intention which is only for learning purposes. A high level of confidentiality and privacy was
observed and the findings of the study were only submitted to the Nyamira KMTC and Nyamira
County referral hospital. A letter of introduction was also be obtained from the college to serve
an evidence of the purpose of the study. In respect for the informants and in order to protect them

11
from abuse resulting from the data they gave for the research, data was presented in such a way
that it does not identify individuals who gave it except by the researcher who might need to seek
clarification during analysis of data. Participation in the study by the respondents was free and
voluntary in that they could withdraw at any time from the study.

CHAPTER FOUR
PRESENTATION OF RESEARCH FINDINGS
4.1 INTRODUCTION
The study sought to determine prevalence and risk factors associated with chronic kidney disease
among patients attending renal care unit in Nyamira county Referral Hospital. A total of 23
respondents were randomly picked for the study, 23 questionnaires were generated and
distributed, all the questionnaires were filled and returned therefore the research response rate
was 100%.

4.2 SOCIAL DEMOGRAPHOIC INFORMATION

The study sought for the socio demographic information of the respondents, 34.8% were aged 45
years and above, 30.4% were aged between 35 and 44 years, 21.7% were aged 25-34 years while
13% were aged 18 – 24 years. On the gender of the respondents, 52.2% were male, 47.8% were
female. On the residence of the respondents, 60.9% were rural dwellers while 39.1% were urban
dwellers. On the occupation of the respondents, 43.5% were self-employed, 39.1% were
unemployed while 17.4% were employed. On the marital status of the respondents, 65.2% were
married, 21.7% were single, 8.7% were divorced and 4.3% were widowed. On the educational
level of the respondents, 34.8% had attained college/university, 30.4% had attained secondary
level of education, 21.7% were illiterate while 13.0% had attained primary level of education.

Table 4.2.1: Respondent’s age

Respondent’s age Frequency Percentage

18-24 3 13.0
25-34 5 21.7
35-44 7 30.4
45 and above 8 34.8

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 Total 23 100%

Figure 4.2.1: Respondent’s age

Age of respondents
8

0
18-24 25-34 35-44 45 and above

Age of respondents

Table 4.2.2: Respondent’s gender

Respondent’s gender Frequency Percentage

Male 12 52.2%
Female 11 47.8%
Total 23 100%

Figure 4.2.2: Respondent’s gender

13
 Respondent’s gender

Male Female

Table 4.2.3: Respondent’s residence

Respondent’s residence Frequency Percentage

Rural 14 60.9%
Urban 9 39.1%
Total 23 100%

Figure 4.2.3: Respondent’s residence

Respondent’s residence

Rural Urban

Table 4.2.4: Respondent’s marital status

14
 Respondent’s marital Frequency Percentage
status
Single 5 21.7%
Married 15 65.2%
Widowed 1 4.3%
Divorced 2 8.7%
Total 23 100%

Figure 4.2.4: Respondent’s marital status

Respondent’s marital status

70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Single Married Widowed Divorced

Respondent’s marital status

Table 4.2.5: Respondent’s level of education

Respondent’s level of Frequency Percentage

education
Primary 3 13.0%
Secondary 7 30.4%
College/ university 8 34.8%
Illiterate 5 21.7%
Total 23 100%

Figure 4.2.5: Respondent’s level of education

15
 Respondent’s level of education
40.00%
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
Primary Secondary College/ Illiterate
university

Respondent’s level of education

4.3 PREVALENCE OF CHRONIC KIDNEY DISEASE

The study sought for the prevalence of chronic kidney disease, 34.8% cited having a great deal of
knowledge about their condition, 21.7% cited they had extensive knowledge about their
condition, 17.4% cited they had very little knowledge about their condition, 13.0% cited either
they had limited knowledge about their condition or they had a great deal of knowledge of
knowledge about their condition. The study further sought when the respondents were first told
they had kidney failure, 30.4% cited the very visit they had on the day of data collection, 26.1%
cited one or more years ago. 21.7% cited either weeks ago or months ago respectively. The study
further sought when the respondents first saw a nephrologist, 34.8% cited the very day of data
collection, 26.1% cited months ago, 21.7% cited weeks ago while 17.4% cited one or more years
ago. The study further sought whether the respondents were aware what caused the disease.
65.2% cited yes while 34.8% declined.

Table 4.3.1: knowledge on level of your chronic kidney disease

Response Frequency Percentage

I have extensive knowledge 5 21.7%
about my condition
I have a great deal of 3 13.0%
knowledge about my
condition
I have some knowledge my 8 34.8%
condition

16
 I have limited knowledge 3 13.0%
about my condition
I have very little or no 4 17.4%
knowledge about my
condition
Total 23 100%

Figure 4.3.1: knowledge on level of your chronic kidney disease

knowledge on level of your chronic kidney disease

30.00%
15.00%
0.00%

knowledge on level of your chronic kidney disease

Table 4.3.2: Response on the first time when you were told of your kidney problem

Response Frequency Percentage

At today’s visit to the doctor 7 30.4%
Weeks ago 5 21.7%
Month ago 5 21.7%
One or more years ago 6 26.1%
Total 23 100%

Figure 4.3.2: Response on the first time when you were told of your kidney problem

17
 Response on the first time when you
were told of your kidney problem
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
At today’s visit Weeks ago Month ago One or more
to the doctor years ago

Response on the first time when you were told of your kidney problem

Table 4.3.3: Response on the first time you saw a nephrologist

Response Frequency Percentage

At today’s visit to the doctor 8 34.8%
Weeks ago 5 21.7%
Month ago 6 26.1%
One or more years ago 4 17.4%
Total 23 100%
Figure 4.3.3: Response on the first time you saw a nephrologist

Response on the first time you saw a

nephrologist
40.00%
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
At today’s visit Weeks ago Month ago One or more
to the doctor years ago

Response on the first time you saw a nephrologist

Table 4.3.4: Response on the cause of kidney disease

18
 Response Frequency Percentage
Yes 15 65.2%
No 8 34.8%
Total 23 100%

Figure 4.3.4: Response on the cause of kidney disease

Response on the cause of kidney disease

Yes No

4.4 RISK FACTORS ASSOCIATED WITH CHRONIC KIDNEY DISEASE

The study sought for the risk factors associated with chronic kidney disease. The study sought
whether the respondents smoked cigarette, 52.2% cited yes while 47.8% cited no. the study
further sought whether the respondent’s drunk alcohol, 52.2% acknowledged while 47.8%
declined. The study further sought whether the respondents ate food rich in protein, 60.9% cited
yes while 39.1% cited no. The researcher further sought whether there was any family member
suffering from Kidney failure, 30.4% cited yes while 69.6% cited no. on whether the respondents
were suffering from any chronic disease, 73.9% cited no while 26.1% cited yes.

Table 4.4.1: Response on cigarettes smoking

Response Frequency Percentage

Yes 12 52.2%
No 11 47.8%

19
 Total 23 100%

Figure 4.4.1: Response on cigarettes smoking

Response on cigarettes smoking

Yes No

Table 4.4.2: Response on alcohol drinking

Response Frequency Percentage

Yes 11 47.8%
No 12 52.2%
Total 23 100%

Figure 4.4.2: Response on alcohol drinking

20
 Response on alcohol drinking

Yes No

Table 4.4.3: Response on eating of ford rick in protein

Response Frequency Percentage

Yes 14 60.9%
No 9 39.1%
Total 23 100%

Figure 4.4.3: Response on eating of ford rick in protein

Response on eating of ford rick in protein

Yes No

Table 4.4.4: Response on any family member suffering from chronic kidney disease

21
 Response Frequency Percentage
Yes 7 30.4%
No 16 69.6%
Total 23 100%

Figure 4.4.4: Response on any family member suffering from chronic kidney disease

Response on any family member suffering

from chronic kidney disease

Yes No

4.5 KNOWLEDGE AND PRACTICE ON PREVENTION OF CHRONIC KIDNEY

DISEASE
The study sought for knowledge and practice on prevention of chronic kidney disease, the study
sought the eligible person who can suffer from diabetes mellitus, 43.5% cited yes while 30.4%
cited no while 26.1% cited they did not know. The study further sought whether overweight
wasincrease the prevalence of chronic disease, 47.8% cited they did not know, 34.8% cited yes
while 17.4% cited yes. The study further sought whether family history of chronic disease
predispose one to chronic kidney disease, 47.8% cited they did not know, 30.4% cited yes while
21.7% cited no. The study further sought whether the respondents avoided 10% of daily calories
from added sugars.

Table 4.5.1: Response on high chances of developing chronic kidney disease

Response Frequency Percentage

No 7 30.4%

22
 Yes 10 43.5%
I don’t know 6 26.1%
Total 23 100%

Figure 4.5.1: Response on high chances of developing chronic kidney disease

Response on high chances of develop-

ing chronic kidney disease

No Yes I don’t know

Table 4.5.2: Response on overweight increases prevalence of chronic kidney disease

Response Frequency Percentage

No 4 17.4%
Yes 8 34.8%
I don’t know 11 47.8%
Total 23 100%

Figure 4.5.2: Response on overweight increases prevalence of chronic kidney disease

23
 Response on overweight increases preva-
lence of chronic kidney disease

No Yes I don’t know

Table 4.5.3: Response on family history about kidney disease

Response Frequency Percentage

Yes 7 30.4%
No 5 21.7%
I don’t know 11 47.8%
Total 23 100%

Figure 4.5.3: Response on family history about kidney disease

Response on family history about kidney

disease

Yes No I don’t know

Table 4.5.4: Response on avoiding 10% of daily calories from added sugar

24
 Response Frequency Percentage
No 16 96.6%
Yes 7 30.4%
Total 23 100%

Figure 4.5.4: Response on avoiding 10% of daily calories from added sugar

Response on avoiding 10% of daily

calories from added sugar

No Yes

25
 CHAPTER FIVE
DISCUSSION OF RESEARCH FINDINGS
This health facility-based study revealed a high burden of Chronic Kidney Disease in the
inpatient population, with a prevalence of approximately 4 out of 10 inpatients. Anaemia and low
serum sodium were the most common abnormalities among the Chronic Kidney Disease
patients. On staging, approximately half of the Chronic Kidney Disease cases in our study had
mild disease (stage G1 and G2) while a quarter had advanced disease. Male sex, previous history
of haematuria, proteinuria, anaemia, hypertension and use of herbal medications as factors
associated with Chronic Kidney Disease in this inpatient population.

Other studies done in Kenya on prevalence of Chronic Kidney Disease in specific conditions
have found prevalence ranging from 17.6% among HIV patients on HAART to 54.5% among
ambulatory type 2 diabetic patients. Diabetes is a major risk factor for Chronic Kidney
DISEASE, therefore could explain the prevalence higher than our study. The Chronic Kidney
Disease cases originated from 27 out of 47 Kenyan Counties, all along the Northern corridor.
This is likely due to the fact that majority of the Kenyan population live along this particular
corridor; the ease of accessibility also may have made it easier for people from these regions to
seek specialized care at the tertiary health facility. Majority of the Chronic Kidney Disease cases
were male; while Chronic Kidney Disease generally is more prevalent in women, severe forms
are higher in men. One suggested mechanism is role of testosterone and protective function of
oestrogen in women .

Majority of the Chronic Kidney Disease cases were middle-aged, and were significantly older
than their non-Chronic Kidney Disease counterparts. Older age is also a recognized risk factor
for Chronic Kidney Disease. One explanation is that renal function generally decreases with age;
hence older individuals are more prone to Chronic Kidney Disease after renal injury. In our
study, most of the cases were rural residents. A systematic review and meta-analysis of studies
on Chronic Kidney Disease in Sub-Saharan Africa did not find any difference in prevalence
between rural and urban populations. The Kenya STEPS survey 2015 did not find significant
differences between rural and urban prevalence of diabetes and hypertension and since majority
of the population are rural residents, this could explain higher disease burden in this

26
demographic. Another possible explanation could be affordability; richer, urban dwellers are
likely to prefer private hospitals rather than the public tertiary facility.

Our study found male sex, having been diagnosed with haematuria, proteinuria, anaemia or
hypertension at some time in the past (preceding CKD diagnosis) and use of herbal medications
as factors associated with CKD in this inpatient population. In comparison, a study in India
reported association of CKD with anaemia . Another study in Asia found association with male
sex. Association with urinary proteins has also been reported. Use of herbal medications has
been previously associated with acute kidney injury (AKI) which is a recognized precursor of
CKD . Other suggested mechanisms of herbal medications role in CKD include direct
nephrotoxicity augmented by underlying predisposing conditions such as dehydration;
contamination, or adulteration of remedies; inappropriate use or preparation or interactions with
other medications. Haematuria has been identified as frequent manifestation of glomerular
disease, a forerunner of CKD and may have a role in diagnosing early renal damage.

We found that older age was associated with impaired eGFR and albuminuria, this finding is
consistent with prior studies . The increased prevalence of kidney disease in the older patients is
probably largely as a result of increasing comorbid renal risk factors such as diabetes and
hypertension as well as due to structural and functional changes in the aging kidneys . In the
present study, 35% of inpatients were more than 60 years of age, and the prevalence of diabetes
and hypertension were 31.8% and 29.5%, and 21.7% and 22.5% in patients aged less than 60
years (data not shown). Our results also showed that male gender was associated with increased
risk of having albuminuria. Similar results were reported in the Kenyan and Chinese studies.
This is, however inconsistent with the results reported in the Southwest Ethiopian study, where
male gender was associated with a higher risk of eGFR impairment, but not albuminuria.
Therefore, the role of male gender in predicting kidney disease risk warrants further research.
Our study has also shown that a family history of kidney disease was associated with impaired
eGFR and albuminuria. Most studies show that patients with a family history of kidney disease
have an increased risk of impaired eGFR and albuminuria and assessment of kidney disease in
subgroups of people with positive family history has been advocated by recent guidelines.
However, there are no data that compare differences with a family history of kidney disease in
the hospitalized population.

27
Our results demonstrate diabetes and hypertension as major risk factors for impaired eGFR and
albuminuria. Several studies have shown diabetes and hypertension as independent risk factors
for kidney disease, as evidenced by impaired eGFR and/or albuminuria. This may reflect that
patients with previously known diabetes and hypertension are likely to have higher rates of
complications, including renal involvements during hospitalization. Therefore, inpatient
screening of these patients for impaired eGFR and albuminuria can be helpful in the early
recognition and treatment of kidney disease. In our study, HIV patients are at greater risk of
having impaired eGFR and albuminuria. This was consistent with findings from previous study,
which revealed that HIV positivity was independently associated with being diagnosed with
kidney disease during hospitalization. In the Zambian study by Banda et al, a higher prevalence
of renal impairment was found in hospitalized HIV infected patients compared to uninfected
patients with a twofold increased risk of developing kidney disease. HIV infection itself,
comorbidities and exposure to potentially nephrotoxic antiretroviral agents may play a role in
eGFR impairment and albuminuria in HIV/AIDS patients

28
 CHAPTER SIX
CONCLUSION AND RECOMMENDATIONS.
6.1 CONCLUSION
The prevalence of CKD was found to be 6.0% with higher prevalence among male, participants
with no formal education, urban residents, smokers and participants with overweight and obese.
CKD was independently associated with older age, hypertension, DM, increased waist hip ratio,
raised TC and educational level of the respondents. Our findings highlight the need for early
preventive measures to manage predisposing conditions such as diabetes and hypertension which
could ultimately lead to CKD and to reduce the prevalence and mortality arising from the
associated comorbidities in Nyamira County and referral Hospital.

There was high burden of CKD in medical inpatients at this Kenyan tertiary facility. Obesity
and Diabetes mellitus were common among patients with CKD . Male sex, previous
documented history of Kidney failure in the family, smoking and drinking alcohol, hematuria or
proteinuria and herbal medications use were identified as associated factors.

6.2 RECOMMENDATIONS
From the findings of the study, the following recommendations were drawn;

i) Early diagnostic work-up for CKD with urinalysis should be advised for primary
care settings as possible early markers of CKD . Protein or blood in urine on
urinalysis, especially in males, should serve as referral criteria for more extensive
workup.
ii) Public education on dangers of herbal medications should be carried out at the
national level, emphasizing their association with CKD diagnosis. Our study
findings could serve as pilot data for planning of population-based surveys, both in a
rural and urban setting, to better characterize the burden of CKD in Kenya.

29
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10.1038/kisup.2012.76
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Identification and Management of Chronic Kidney Disease in Adults in
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2020. http://guidance.nice.org.uk/CG73/Guidance/pdf/English. Accessed 26 January
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10.7196/SAMJ.9412.
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27. USRDS 2017 , Chronic kidney disease and cardiovascular risk: epidemiology,
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6736(13)60595-4. 
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33
 APPENDIX I: QUESTIONNAIRE
INSTRUCTIONS
1. Put a tick where appropriate.
2. Whatever shall be collected from you is private and confidential.
3. Never write your name on the questionnaire.
4. Be accurate and sincere.
5. Ask for clarification whenever you done understand.

SECTION A: SOCIAL DEMOGRAPHIC INFORMATION

1. Age?
a) 18-24
b) 25-34
c) 35-44
d) 45 and above
2. Gender?
a) Male
b) Female
3. Residence?
a) Urban
b) Rural
4. Occupation?
a) Employed
b) Self employed
c) Unemployed
5. Marital status?
a) Married
b) Single
c) Divorced
d) Widowed
6. Education level?

34
 a) Primary
b) Secondary
c) College/ University
d) Illiterate

SECTION B: PREVALENCE OF CHRONIC KIDNEY DISEASE

1. In general, how would you rate your level of knowledge about your chronic kidney
disease?
a) I have extensive knowledge about my condition
b) I have a great deal of knowledge about my condition
c) I have some knowledge about my condition
d) I have limited knowledge about my condition
e) I have very little or no knowledge about my condition
2. When were you first told you had a problem with your kidney?
a) At today’s visit to the doctor or
b) Weeks ago (enter a value between 1 and 4) or
c) Months ago (enter a value between 1 and 12) or
d) One or more years ago (enter a value greater than 1)
3. When is the first time you saw a nephrologist (kidney doctor)
a) At today’s visit to the doctor or
b) Weeks ago (enter a value between 1 and 4) or
c) Months ago (enter a value between 1 and 12) or
d) One or more years ago (enter a value greater than 1)
4. How many times did your nephrologist in the past years?
a) Times (if this is your first visit enter 0)

…………………………………………………………………………………….

5. Do you know what is causing your kidney disease?

a) Yes
b) No

SECTION C: RISK FACTORS ASSOCIATED WITH CHRONIC KIDNEY DISEASE

35
 1. Have you ever smoked cigarettes?
a) Yes
b) No
i. If Yes, how many packets per day do you smoke?
………………………………………………………………………………….
ii. For how long have you been smoking?
………………………………………………………………………………….
2. Have you ever drunk alcohol?
a) No
b) Yes
i. If Yes, for how long you have been drinking?
…………………………………………………………………………………………
3. Do you eat ford rick in protein?
a) Yes
b) No
4. Is any family member suffering from chronic kidney disease?
a) Yes
b) No
5. Are you suffering from any chronic disease?
a) Yes
b) No
i. If Yes, which one?
………………………………………………………………………………………………
………………………………………………………………………………………………

SECTION D: KNOWLEDGE AND PRACTICE ON PREVENTION OF CHRONIC

KIDNEY DISEASE

1. Can anybody suffering from diabetes milieus have high chance of developing chronic
kidney disease?
a) No
b) Yes

36
 c) I don’t know
2. Overweight will increase prevalence of chronic kidney disease?
a) No
b) Yes
c) I don’t know
3. Does family history of chronic kidney disease predispose one to chronic kidney disease?
a) Yes
b) No
c) I don’t know
4. Do you avoid 10% of daily calories from added sugars?
a) No
b) Yes
5. What are the diseases which you are more likely to develop kidney disease when you
have? (List them)
………………………………………………………………………………………………
…………………………………………………………………………………………….

37
 APPENDIX II: BUDGET
ITEM NAME QUANTITY UNIT COST TOTAL
1. Research permit 4 1000
2. Printing materials 1 rem 400 400
3. Pens and pencils 10 10 100
4. Rubber 5 5 25
5. Notebook 1 1 50
6. File 1 1 50
7. Printing services 12 10 120
8. Binding 2 booklets 100 200
9. Miscellaneous 400
TOTAL 2,300

38
 APPENDIX III: WORK PLAN
ACTIVITY SEP OCT NOV DEC JAN FEB MAR
2022 2023
Searching of
proposed
topic
Formulation
of objectives
of study
Problem
statement
Justification
Background
information
Literature
review
Research
methodolog
y
Proposal
writing,
printing,
binding and
submission
of research
proposal

39