Flaws in fighting kidney disease

Study says some doctors did not check patients for the dangerous condition

AL AIN // Researchers in the UAE have identified deficiencies in the diagnosis and treatment of a potentially fatal medical condition.

A study by scientists at the UAE University College of Medicine and Health Sciences in Al Ain found that some doctors were not checking patients who were at risk of chronic kidney disease (CKD) for signs of the condition, and were failing to use the most effective diagnostic methods.

CKD is particularly prevalent in the UAE, partly because of high levels of diabetes, hypertension (high blood pressure) and coronary artery disease.

It can lead to kidney failure, which is fatal if patients do not receive dialysis, and it is linked to higher death rates from heart attacks and other conditions.

According to reports, there are more than 2,000 UAE residents who have CKD and need kidney dialysis.

The number is rising annually by at least 10 per cent.

Published in the journal BMJ Open, the study was titled Provision of Care for Chronic Kidney Disease by Non-nephrologists in a Developing Nation: A National Survey.

It was written by Dr Saif Jaber Al Shamsi and Dr Ali Al Dhanhani, both assistant professors, and Dr Omran Bakoush and Dr Muhamud Sheek-Hussein, both associate professors.

The study’s findings are based on the responses of 159 doctors at Abu Dhabi Health Services Company, Dubai Health Authority and the Ministry of Health and Prevention. None of them is a kidney specialist (nephrologist).

Most of the doctors said they screened patients with hypertension and diabetes for CKD, which lacks clear symptoms in its early stages.

However, about a third of the doctors did not test patients with cardiovascular disease. For patients with heart disease, CKD could be left undiagnosed and untreated. About a third of elderly patients were also not tested for CKD.

When they did screen patients for CKD, many doctors did not use the most effective tests.

Only 77 per cent of them tested the patients’ glomerular filtration rate, which is the amount of blood that passes each minute through small filters in the kidney called the glomeruli.

Only 59 per cent of doctors measured the albumin to creatinine ratio of patients’ urine.

Albumin, a protein, is normally present in the blood, but is usually only found in the urine of people with kidney disease. It can be an early indicator of CKD. When CKD was identified, treatment did not always follow best practice.

Although nearly all the doctors viewed CKD as a risk factor for cardiovascular disease, only about two-thirds of them provided anti-lipid treatment or prescribe weight reduction to their patients, both of which can help patients vulnerable to heart disease. About one-fifth of doctors did not suggest that smokers give up their habit.

Dr Al Shamsi, the study’s senior author, said he was not surprised at the results.

Several factors could be causing the lack of recognition and lack of treatment of CKD, said Dr Al Shamsi. They include a lack of awareness of which patients are at risk and inadequate insurance coverage. Dr Al Shamsi said primary- care and family physicians were well-suited to identifying patients at risk and providing treatment to them in the early stages of the disease.

Dubai Health Authority declined to comment on the study, while the Health Authority Abu Dhabi and the Abu Dhabi Health Services Company did not respond to requests for comment.

The Ministry of Health and Prevention was not available for comment.

There are more than 2,000 UAE residents who have CKD