Treatment Outcome and Associated Factors among Hospitalized Chronic Kidney Disease Patients at Jimma University Medical Center, Southwest Ethiopia: Prospective Cohort Study

Abstract

Chronic kidney disease (CKD) is an increasing public health problems worldwide and greatly impact patients’ quality of life. Understanding the most prominent risk factors and treatment outcomes is essential to identify patients at high risk for adverse outcome like mortality. In Ethiopia, the treatment outcome of CKD as well as its predictors are not well studied. Objectives: To assess treatment outcomes and associated factors among hospitalized CKD patients attending Jimma University Medical College (JUMC) in Jimma from April 23 to September 25, 2018. Method and participants: A prospective cohort study was conducted among 130 CKD patients admitted to renal unit of JUMC. Patients with Acute Kidney Injury (AKI) on CKD diagnosis were categorized as exposure while CKD only group were considered as non-exposed ones. Relevant patient information was collected using data abstraction format. Data was entered into Epidata manager version 3.1 and analyzed using SPSS version 21. Data were summarized using univariate analysis. After selecting candidate variables in bivariate analysis at p-value <0.05 and p-value <0.20 for in-hospital and 30 day mortality, the final multivariable cox-proportional hazard model was fitted and variables with p-values were considered predictors of treatment outcome of CKD. The hazard ratio was used as a measure of strength of association. Result: Among 130 CKD patients followed, 92(70.8 %) were males with male: female ratio of 2.42:1. The rate of in hospital and within 30 day mortality were 16.9% and 30.0% respectively. Khat use (AHR: 3.37, 95% CI: 1.27-8.96), type of diagnosis at admission (AHR: 3.02, 95% CI: 1.21-7.54) and presence of proteinuria at admission (AHR: 0.11, 95%CI: 0.02-0.55) were significant predictors for in-hospital mortality. Whereas, sex of the patients (AHR: 2.66, 95% CI: 1.21-5.88), family history of hypertension (AHR: 0.29, 95% CI: 0.10-0.85), diagnosis at admission (AHR: 2.46, 95% CI: 1.26-4.78), and complication related to CKD (AHR: 5.38, 95% CI: 1.64- 17.72) were the significant independent predictors of 30 days mortality in the patients with CKD during the study period. The mean length of survival after hospital admission was 16.41±6.86 days for patients who died within 30 days. Conclusion and recommendation: CKD accompanied to higher rate of medical admissions, in hospital as well as 30 day mortality. Hypertension, anemia and heart failure were the common risk factors identified in CKD patients. As such a comprehensive public health awareness creating campaign on risk prevention, involvement of multidisciplinary sectors, better and affordable dialysis and Kidney transplantation center were some of the efforts expected from professional, government and stakeholders to improve the outcome of CKD patients.