Knowledge, Attitude and Practices of Chronic Kidney Disease among hypertensive patients living in Kashipur region, Udham Singh Nagar

Abstract

Background: Non-communicable diseases (NCDs) have been highlighted as the major causes for death and disability. WHO has prioritized four metabolic risk factors which contribute to the development of different NCDs; elevated blood pressure, overweight/obesity, hyperglycemia and hyperlipidemia. Hypertension and its complications have become major public health problems globally contributing to numerous cardiovascular and renal consequences such as ischemic heart disease, chronic kidney disease etc. Hypertension and chronic renal disease are risk factors for each other. Globally, the burden of hypertension is increasing and this is contributing to the rise in incidence of chronic kidney disease. CKD has become a global health burden as it imposes high cost on health and financial condition of an individual. Appropriate pharmacologic control of hypertension and different life style interventions can reduce the burden of chronic kidney disease attributable to hypertension. No studies have assessed knowledge, attitude and practice related to CKD among hypertensive patients in India. Aim: The study explored the knowledge, attitude and practice (KAP) of hypertensive patients related to chronic kidney disease in Kashipur region of Udham Singh Nagar district of Uttarakhand. Methods: A cross sectional survey design using self-administered questionnaires was used for this study. The study population included adult hypertensive patients attending outpatient departments of the public and the two largest private hospitals in Kashipur region. Convenience sampling was used to recruit participants for the study. The study instrument consisted of five main domains: 1) Knowledge of CKD, 2) Attitude related to CKD, 3) Practices related to CKD, 4) Socio-demographic factors and 5) Presence of risk factors related to chronic kidney disease. Descriptive analysis was done to report the socio demographic characteristics, while linear regression analysis explored association of different independent variables with the practice score. Results: The mean age of the population was 50.85 years (SD 11.7). Males constituted the majority of the sample (61.8%). Around 85% of the study participants were married. The mean knowledge, attitude, practice and KAP percent scores were 50.6%, 65.5%, 47.64% and 51.70%, respectively. Socio economic status, educational status, employment status and type of hospital were significantly associated with the practice percent score in the adjusted analysis. Belonging to middle socio economic status as compared to low socio economic status was significantly associated with the practice score (β = -3.62, p value = 0.025 , CI: -6.788, -0.449). Having higher education as compared to primary education was negatively associated with the practice score (for secondary education, β = -4.67, p value = 0.003, CI: -7.728, - 1.619, for graduate and undergraduate education, β = -7.58, p value = 0.000, CI: -11.744, -3.148). Type of hospital for hypertension care maintained significant association with the outcome in the final adjusted model (β = 5.51, P value = 0.000, CI: 2.881, 8.131). Gender, place of residence and presence of comorbidities or other risk factors of CKD were not associated with the practice score. Conclusions: This was the first kind of study conducted in Uttarakhand which aimed to assess knowledge, attitude and practice related to chronic kidney disease. The results showed that the KAP related to CKD was inadequate among the hypertensive patients in Kashipur region. The findings of this study can be used for formulating new intervention programs to prevent CKD among hypertensive patients.