END STAGE KIDNEY DISEASE IN TONGA INCIDENCE OF END STAGE KIDNEY DISEASE IN ADULT POPULATION AT VAIOLA HOSPITAL TONGA FROM JANUARY 2018 TO DECEMBER 2019

Mataka Sisi L I T H, Malani J, Latu S T
Keywords: End Stage Kidney Disease, Renal Replacement Therapy, Conservative management, Age adjusted incidence rates, Chronic Kidney Disease
Introduction: Kidney Disease is a global health burden. Tonga has no previous studies on kidney disease or even basic statistics on incidence of End Stage Kidney Disease (ESKD). Yet there is no treatment available in the country for ESKD. The aim of this study was to estimate the incidence and characteristics of ESKD in Tongan adults.
Method: A retrospective, single center, descriptive study was conducted on admitted adult cases to Variola hospital from January 2018 to December 2019. Suspected cases of ESKD were obtained from the Laboratory Biochemistry Register books. Confirmation of cases was after going through and auditing medical folders. Excluded from this study were those not admitted, age less than 20years, Acute Kidney Injury, missing medical folders and those previously diagnosed prior 2018. Data analysis was done using Microsoft Excel and IBM SPSS V25 software. Population data were obtained from the Tonga Statistical Department from last census in 2016. Ethical approval from CHREC and NHERC in Fiji and Tonga prior study was conducted.
Results: A total of 1872 suspected cases of ESKD were collected initially. After removing cases with eGFR≥15mL/min/1.73m2 as well as duplicates, remaining were 493 test results. The use of inclusion and exclusion criteria, 121 confirmed new cases of ESKD collected and used for this study. The average crude and age-adjusted incidence of ESKD were 810 per million population(pmp) and 1483pmp (95% CI 1153-1908) respectively. Age distribution ranges from 26 to 84 years old with a mean age of 60 years. The most common age groups was 70 -79 years (30%) and also noted a female predominance(64%). Diabetes (73%) was the most common risk factor contributing to ESKD.
Discussion: This was a retrospective study where some variables could not be controlled. The unavailability of diagnostic renal biopsies resulting in etiology of ESKD not well-defined. There was an underestimation of total cases of ESKD due to some new cases who were never admitted. Discovering the true incidence of ESKD will assist the Ministry Of Health and Tongan government in understanding the extent of disease and may subsequently make decisions on the appropriateness of RRT.