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Little is known about the prevalence, causes, and management of advanced CKD in Kuwait. In addition, Kuwait has a large ethnically diverse expatriate community, representing 66% of the total population, but have a restricted access to free public health services compared to Kuwaitis, and their income and living standards are generally lower than that of Kuwaiti citizens.
Demographics, comorbidities, laboratory data, and medications of CKD stages 3-5 not on dialysis patients above the age of 12 with native kidneys attending nephrology clinics in seven ministry of health hospitals in Kuwait from 1/January/2022 to 31/December/2022 were collected.
Total number of reviewed cases was 2610 (mean eGFR: 30.8; mean age: 62.6; above 65 of age: 47.0%; males: 56.7%; Kuwaitis: 62.1%). This represents 0.06% of the total population of the country. Kuwaiti patients were older (63.94 vs 60.3), with slightly lower mean eGFR (30.4 vs 31.5), and less males (49.8% vs 67.9%) than non-Kuwaitis. The two groups had similarly high rates of DM, HTN, CAD, body mass index (BMI) > 30, and smoking. DKD as causes of CKD was higher in Kuwaitis (59.3% vs 52%), but CKD cases due to unknown cause were higher in non-Kuwaitis.
Kuwaiti patients had lower mean blood pressure (137.2/76.5 vs 139.1/78.9), lower mean HbA1c in diabetics (7.59 vs 7.82), and also a better lipid profile although mean BMI was higher (29.6 vs 28.9). Potassium levels were similar in both groups, even in patients on renin angiotensin aldosterone inhibitors (RAASi), however, potassium was higher in diabetics (4.61 vs 4.5 in non-diabetics). Parathyroid hormone was higher in Kuwaitis (17.6 vs 16) with higher phosphate but similar calcium values. Uric acid levels were normal with no difference between the two groups.
Only 50.5% of patients were on aspirin, and 39.6% on anti-hyperuricemia therapy, but more than 85% were on anti-dyslipidemia agents. Insulin was prescribed for 60.3% of diabetics, while metformin in less than 20%, with no difference between the two groups. SGLT2i used in only 22.6% of patients (76% were Kuwaitis). For HTN, centrally acting agents and dihydropyridine calcium channel blockers (CCB) were the most frequently used agents, followed by RAASi and beta-blockers (βB). All were used more frequently in Kuwaitis. Alpha blockers, non-dihydropyridine CCB, and vasodilators were used more frequently in non-Kuwaitis.
The low number of CKD3-5 ND under nephrology care is alarming and calls for better education, screening, and referral practices. Non-Kuwaitis have higher eGFR because they arrive in better health, but then they develop same comorbidities, with a restricted access to public health services and lower income leading to inferior management and diet, resulting in higher blood pressure, higher HbA1c, and worse lipid profile. The low usage of RAASi and SGLT2i is alarming and demands immediate action to improve it. Choices of antihypertensives calls for revision of protocols to improve utilization of RAASi, and thiazide diuretics.