Prevalence of Renal Insufficiency in Patients with Major Cancers and Associated Factors at Kenyatta National Hospital, Nairobi, Kenya

Abstract

Renal insufficiency, defined as a reduction in kidney function, represents a major global health challenge, affecting about 10% of the world’s population. In sub-Saharan Africa, the burden is estimated at 14%, while Kenya reports a prevalence of approximately 4% in the general population. Among cancer patients, earlier studies indicate that up to 27.1% experience renal insufficiency, often necessitating chemotherapy dose adjustments. This study aimed to determine the prevalence of renal insufficiency and identify associated demographic, clinical, and treatment-related factors among cancer patients receiving care at Kenyatta National Hospital. A cross-sectional study design was employed, involving 335 systematically selected oncology patients from KNH wards and clinics. Data were collected through structured interviewer-administered questionnaires and review of hospital records. After exclusion of five participants due to incomplete data, 330 patient records were analyzed. Data entry, cleaning, and analysis were conducted using R (version 4.1.2). Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI micromole/L calculator to diagnose and stage renal insufficiency. Descriptive statistics summarized patient characteristics, while associations between renal insufficiency and demographic, clinical, and treatment variables were assessed using bivariate and multivariable logistic regression. Statistical significance was set at p<0.05. Among the 330 participants, 56.1% were female. Most patients were aged 41–60 years (42.7%), followed closely by those above 60 years (41.5%). The overall prevalence of renal insufficiency was high at 38% (95% CI: 33–44%). Majority of patients had mild renal impairment (eGFR 61–89 mL/min/1.73 m²) accounting for 29.4% of cases whereas severe stages were less common, with stage 4 observed in (2)0.6% and stage 5 in (3)0.9% of patients. Multivariable logistic regression revealed two significant associations. Patients older than 60 years had a more than two-fold higher likelihood of renal insufficiency (AOR=2.33; 95% CI: 1.16–4.87; p=0.020). Conversely, the use of taxane-based chemotherapy was associated with a lower prevalence of renal insufficiency (AOR=0.47; 95% CI: 0.25–0.85; p=0.015). The study concludes that renal insufficiency is common among cancer patients at KNH, with advanced age posing a significant risk. Close monitoring of renal function, especially in elderly patients undergoing cancer treatment, is strongly recommended.