STATISTICAL STUDY ON

CHRONIC KIDNEY DISEASE FOR

CLASS 4 AND CLASS 5

OBJECTIVES

• To study the prevalence of chronic kidney disease class 4 and class 5 in a referral hospital in India.

• To study whether it is worthwhile to treat patients with chronic kidney disease class 4 and 5

METHODOLOGY

The data for our project was collected from the Department of Nephrology in Christian Medical College, Vellore. The data was collected in the department of nephrology from 1998 to 2005 from the case records of patients coming for treatment.

INCLUSION CRITERIA

All patients having class 4 and class 5 chronic kidney diseases were included for this study.

EXCLUSION CRITERIA

Patients with class 1, 2 or 3 chronic kidney disease were excluded from our study.

Missing variables were not included for analysis.

PARAMETERS STUDIED WERE

Glomerular filtration rate Serum creatinine Serum albumin 24-hour urine protein Microscopic Hematuria Macroscopic Hematuria Dialysis done or not Drug treatment given or not Hypertension Diabetes Type of kidney disease

METHODS USED

CORRELATION COEFFICIENTMULTIVARIATE REGRESSIONUNIVARIATE ANALYSIS OF VARIANCECHI-SQUARE TESTMULTIVARIATE ANALYSIS

CORRELATION COEFFICIENT

• Consider two variables serum creatinine at time of biopsy and serum creatinine at last follow up, because based on the result of serum creatinine at last follow up we can infer that whether the patients responds to treatment or not.

• Serum creatinine at the time of biopsy and serum creatinine at last follow up have the correlation coefficient of 0.172 with p-value 17.2% which means that the two variables are not related. From this we can see that the patients are less responded to treatments.

MULTIPLE REGRESSION• To find there is any relationship between serum

createnine at time of biopsy, 24 hr urine protein at time of biopsy, Serum Albumin at the time of biopsy with dependent variable GFR at the time of biopsy. We choose GFR as dependent variable because based on this rate the patients are classified into two classes 4 and 5.

• The R square value is .717 i.e. 71% of total variation of GFR at the time of biopsy (dependent variable) influenced by independent variables, serum creatinine, 24 hour urine protein and serum albumin at the time of biopsy. Therefore GFR at the time of biopsy have more relationship with, serum creatinine, 24 hour urine protein and serum albumin at the time of biopsy.

UNIVARIATE ANALYSIS OF VARIANCE

• Here the age of the patients is classified into six groups less than 25 to greater than 65. Based on this we have to find there is any significant difference between the age and Serum Albumin at the time of biopsy.

• From the above table the significance value is 0.623. So there is no evidence to reject the hypothesis. Hence we conclude that there is no significant difference between the age and Serum Albumin at the time of biopsy. Age in not a factor for determining the disease.

CHI-SQUARE TEST

• Let us consider treatment group and hemodialysis of the patients. Treatment group is classified into 2 groups as treatment given to patients and not given to patients. Hemodialysis of the patients is classified into 2 group as had dialysis or not. Based on this variable we have to find there is any association between the treatment group and hemodialysis.

The p value is 0.950, so there is no evidence to reject the hypotheses. Hence we conclude that there is no association between treatment group and hemodialysis. Because Steroids are given to patients only if they are fit to treatment otherwise some basic treatment will be given for 3 months to 2 years, alternative to some steroid, dialysis is suggested to patients.

CHI-SQUARE TEST• Let us consider Hypertension and diabetes mellitus of

this patient. Hypertension and diabetes mellitus is classified into 2 groups as had and no for this patient. Based on this variable we have to find there is any association between the Hypertension and diabetes mellitus.

• The p value is 0.398, so there is no evidence to reject the hypotheses. Hence we conclude that there is no association between the Hypertension and diabetes mellitus. People with hypertension are suffering more here.

MULTIVARIATE ANALYSIS

• Here we consider the six age group of the patients from less 25 to greater than 65 and five variables serum creatinine, GFR, serum albumin, 24 hour urine protein at the time of biopsy and serum creatinine at last follow up. From the use of these variables we have to find there is any significant difference between the age wise of the patient and these five variables.

• We conclude that there is no significant difference between the age group regarding serum creatine, GFR, 24 hour urine protein, serum albumin at the time of biopsy and serum createnine at last follow up. All age group of patients respond equal to this test. The significance value is 0.788 which is greater the p value. We infer that no difference in age groups in all factors.

FIG 1: PERCENTAGE FOR AGE OF THE PATIENT

13%

26%

24%

21%

16%

<25

25-35

35-45

45-55

55-65

The above pie-chart shows the age of the patients. From this we can conclude that the patients in the age between 25-35 are suffering more from these diseases.

FIG 2: HEMODIALYSIS COMPARED WITH SEX OF THE PATIENT

hemodialysis

no dialysishad dialysis

Co

un

t

120

100

80

60

40

20

0

sex of the patient

male

female

53

7

99

27

The above diagram shows the patients with hemodialysis. From this diagram we infer that the patients who had not taken dialysis are more when compared to the patients those who took dialysis.

FIG 3: DIABETES MELLITUS OF THE PATIENT

16%

84%

had diabetes mellitus

no diabetes millitus

This chart shows the patients having diabetes and those not having diabetes. From this chart we can see that the patients those who do not have diabetes are more when compared to the others. Only 16.13 % of patients have diabetes mellitus.

FIG 4: HYPERTENSION OF THE PATIENT

15%

85%

had hypertension

no hypertension

The above chart indicates the patients having hypertension and not having hypertension. Here patients without hypertension are less.84.95% have hypertension.

FIG 5: SERUM CREATININE AT THE TIME OF BIOPSY AND SERUM CREATININE AT LAST FOLLOW UP COMPARED WITH

AGE GROUPS.

AGE OF THE PATIENTS

>6555-6545-5535-4525-35<25

Me

an

7.5

7.0

6.5

6.0

5.5

5.0

4.5

4.0

3.5

serum createnine at

time of biopsy

creatinine at last

follow up

This diagram shows that the serum creatinine at last follow up is slightly increased more than serum creatinine at the time of biopsy. And also it shows that the patients in the age < 25 are more affected. i.e. the patients are not responded to the treatments

FIG.6. FINAL DIAGNOSIS FOR THE CHRONIC KIDNEY DISEASE PATIENT

final diagnosis

final diagnosis

Fre

qu

en

cy

40

30

20

10

0

The above diagram shows the final diagnosis of the patients. From this we conclude that the patients suffering from the disease fsgs is high when compared to other diseases. Next to this disease is IgA followed by other diseases.

CONCLUSION

1. Comparing to female patients, more males are suffering from chronic kidney diseases.

2. Patients suffering from hypertension are more than diabetes mellitus. If a person has diabetes mellitus it’s not necessary that he will also get kidney disease.

3. In the age between 25-35 more people are suffering due to chronic kidney disease than other age groups. This may be because of some bad habits and also due to hereditary. And also they are suffering more from hypertension and diabetes mellitus.

4. Many Patients in this class 4 and 5 do not have undergone any treatment. This may be because of they are not fit for further treatment. Only thing they have to do is dialysis or renal transplantation. But patients are not ready to take dialysis mostly because of cost. Also most of the patients didn’t undergone dialysis.

• Chronic kidney disease is classified into 28 diseases. All patients fall into one of these diseases. Many patients affected by the disease FSGS is more next to this is IgA. FSGS is affected more in the age group 25-35. Mpgn is the less no of patients affected by this disease.

• We infer that there is no difference between the different age groups regarding serum createnine, GFR, 24 hour urine protein, serum albumin at the time of biopsy and serum createnine at last follow up. Age in not a factor for determining the disease. All age group of patients respond equal to this test.

CONCLUSION CONTN…

CONCLUSION CONTN…

5. We see that serum creatinine at last follow up is slightly higher than serum creatinine at the time of biopsy. So some patients are not responded to treatment.

6. Serum creatinine at last follow up doesn’t have much relationship with serum creatinine, 24 hour urine protein and serum albumin at the time of biopsy. It doesn’t depend on these testes. All tests are independent to each other.

7. But GFR have more relationship with this test. Because based on the GFR we can divide the class of patients. So all test must followed by GFR.

8. But all factors show some difference in sex wise. Male are suffering more from chronic kidney disease. It is therefore suggested that we should take care of our health from the childhood onwards. Once in every six months we have to go for complete checkup. That is prevention is better than cure.

PREVENTION• Chronic kidney disease cannot be prevented in most

situations. You may be able to protect your kidneys from damage, or slow the progression of the disease, by controlling your underlying conditions.

• Kidney disease has usually progressed fairly significantly by the time symptoms appear. If you are at high risk of developing chronic kidney disease, see your health care provider as recommended for screening tests. 

• If you have a chronic condition such as diabetes, high blood pressure, or high cholesterol, follow the treatment recommendations of your health care provider. See your health care provider regularly for monitoring. Aggressive treatment of these diseases is essential. Avoid exposure to alcohol, drugs, chemicals, and other toxic substances as much as possible.

REFERENCES

• S.P. Gupta, “Statistical Methods”, Sultan Chand & Sons, New Delhi.• B.C. Agarwal, “Statistical Methods-Concepts, Application & Computation”.• S.C. Gupta & V.K. Kapoor, “Fundamentals of Applied Statistics”.• T.W.Aderson, (1984) “An Introduction to Multivariate Statistical Analysis”

(second Edition) John Wiley & Sons, New York.• Gupta, S.C “Elementary Statistical Methods”, Sultan Chands and Sons.• Agarwal, B.L. “Programmed Statistics”, New Age International Publishers.• Kothari, C.R (1990) “Research Methodology “, Methods & techniques,

Wiley Eastern Limited.• Gupta, S.C & Kapoor, V (1976) “Fundamentals of Mathematical Statistics

“Sultan Chands and Sons. • Multivariate statistical methods by D.F.Morrisons(1986) published by Mc

Grawhill book company• Applied multivariate statistical analysis by RichardA. Johnson and Dean

W. Wichern

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