title: Chronic kidney disease in Nigeria: Late presentation is still the norm.
abstract: BACKGROUND
  Chronic kidney disease (CKD) has become a public health problem in Nigeria. Efforts are being geared toward early diagnosis and prevention of CKD. This study involved the evaluation of the referral pattern and mode of presentation of CKD patients at first contact in a tertiary health institution.
  
  
  METHODS
  Patients' records over an 18 month period were retrieved and the following information extracted: Sociodemographic data, referral hospital, mode of presentation, etiology of CKD, packed cell volume, blood pressure, and estimated glomerular filtration rate (GFR) at first presentation.
  
  
  RESULTS
  There were 202 CKD patients with a male: female ratio of 1.7:1 and a mean age of 48.15 ± 16.69 years. The median estimated GFR of the patients at presentation was 3.17 ml/min/1.73 m(2). The common etiologies of CKD were chronic glomerulonephritis, hypertension, diabetes mellitus, obstructive nephropathy in 69 (34.2%), 47 (23.3%), 38 (18.8%), and 21 (10.4%) respectively. Among these patients, 111 (55%) and 98 (48.6%) had moderate to severe hypertension and anemia, respectively, 173 (85.6%) presented in CKD Stage 5, 101 (50%) required urgent hemodialysis whereas 123 (60.9%) required in-hospital admission. Only (18) 9% of these CKD patients presented by self-referral while (103) 51% were referred from secondary and private health facilities.
  
  
  CONCLUSIONS
  Most Nigerian CKD patients still present very late to nephrologists implying that the present preventive strategies have not yielded desired results. Early diagnosis and referral of CKD patients could be better achieved through regular education of the public and retraining of health workers especially those in primary and secondary health institutions.
authors.affiliation: Kidney Care Centre, University of Medical Sciences, Ondo City, Ondo State, Nigeria.
authors.forename: Oluseyi A
authors.initials: OA
authors.lastname: Adejumo
authors.affiliation: Kidney Care Centre, University of Medical Sciences, Ondo City, Ondo State, Nigeria.
authors.forename: Ayodeji A
authors.initials: AA
authors.lastname: Akinbodewa
authors.affiliation: Department of Internal Medicine, University of Benin Teaching Hospital, Benin, Edo State, Nigeria.
authors.forename: Enajite I
authors.initials: EI
authors.lastname: Okaka
authors.affiliation: Kidney Care Centre, University of Medical Sciences, Ondo City, Ondo State, Nigeria.
authors.forename: Oladimeji E
authors.initials: OE
authors.lastname: Alli
authors.affiliation: Kidney Care Centre, University of Medical Sciences, Ondo City, Ondo State, Nigeria.
authors.forename: Ifedayo F
authors.initials: IF
authors.lastname: Ibukun
keywords: Chronic kidney disease; late; pattern; presentation; referral