Prevalence of microalbuminuria and associated factors among hypertensive patients at Muhimbili national hospital Dar es salaam

Abstract

Introduction: Persistent microalbuminuria is the earliest indicator of chronic kidney disease (CKD) in patients with diabetes and hypertension. Patients with microalbuminuria have high risk for target organ damage resulting in stroke, retinopathy and adverse CV events.

Objective: To determine the prevalence of Microalbuminuria among hypertensive patients at Muhimbili Hospital – Dar es Salaam. Methodology: This was a cross-sectional descriptive epidemiological study which comprised of a sample size of 341 hypertensives (mean age of 53.1 years with SD ± 1.58) from August 2012 to January 2013. Data was collected using a structured questionnaire. Variables that were entered in the equation were duration of diabetes mellitus (DM), type of DM, history of smoking, history of alcohol drinking and duration of drinking and BMI. In all participants urine albuminuria was measured in spot urine sample using initially urine dipstick, and if normoalbuminuria on dipstick, urine samples were further tested for microalbuminuria using microalbumin 2-1 combo strips to assess the albumin creatinine ratio. Other laboratory blood tests included lipid profile and random blood glucose measurements

Results: The prevalence of microalbuminuria in hypertensives attending the Cardiac clinic at Muhimbili National Hospital was found to be 24% within the study group. The prevalence of microalbuminuria in males and females were found to be 27.4% and 21.6% respectively. The prevalence of microalbuminuria was noted to be higher among males but was not statistically different (p=0.421). Age group of greater than 61 years comprised of 24.5% of the microalbuminurics among the different age groups with the mean age of 53.1years with SD±1.586, but statistically, no significant difference was seen. p=0.518 .Cigarette smoking, alcohol consumption, BMI or lipid levels were statistically not associated with the occurrence of microalbuminuria among hypertensive patients.

Conclusion: This study showed that the prevalence of microalbuminuria was 24% among hypertensive patients seen at the cardiac clinic at the MNH. When any form of albuminuria was considered the prevalence was almost 100%. Almost all patients seen in this study had a form of proteinuria, either macro or micro which showed that majority of patients has already progressed to some form of albuminuria. This suggests that microalbuminuria screening should be aggressively used as a screening tool to pick up early evidences of microalbuminuria in hypertensive patients. There were no statistically significantly factors associated with the occurrence of microalbuminuria among the hypertensive patients Recommendations: Microalbuminuria is regarded as the earliest marker of capillary endothelial damage and therefore an important predictor of capillary injury in hypertensive patients; hence vigorous screening of this relatively inexpensive tool is essential which is underperformed at our centre. It is hence important that in every hypertensive patient, this inexpensive test for urine albumin be measures routinely at every outpatient clinic at Muhimbili Hosp so as to detected early those at an in increased risk of vascular and cardiac morbidity and mortality and appropriate measures for its prevention or delay taken early.