Prevalence, severity and associated factors of Electrolyte disturbance among pre-dialysis stage 3-5 Chronic kidney disease patients at medical chronic Follow up clinic at jumc, jimma, south, western Ethiopia

Abstract

Background: The kidneys play a pivotal role in the regulation of electrolyte, fluid and acid– base balance. With progressive loss of kidney function, derangements in electrolytes inevitably occur and contribute to poor patient outcomes. As chronic kidney disease (CKD) has become a worldwide epidemic, medical providers are increasingly confronted with such problems. Adequate diagnosis, treatment with proper investigation and monitoring of serum electrolytes will minimize complications and can potentially be lifesaving. Methodology: Institution based cross-sectional study was conducted from February 1 to March 29, 2023 GC. The eGFR was calculated using CKD-EPI equation. In total, 109 adult outpatients from medical follow up clinic with estimated glomerular filtration rate of less than 60ml/min/1.73m2 were included in this study. Data analysis were done using SPSS version 21, and the factors associated with outcome variable were assessed using multivariate logistic regression. P value < 0.05 were considered statistically significant. Result: A total of 109 patients of pre-dialysis CKD stage 3-5 were studied with proportion of stage G3a, G3b, G4 and G5 with 5.5%, 20.2%, 38.5 and 35.8 respectively. The respective prevalence of hyperkalemia, hyponatremia, hypocalcemia and hyperphosphatemia were elevated in patients with CKD stage G3b, G4 and G5, compared with those prevalences in patients with CKD stage G3a.The frequency of various electrolyte abnormalities was hyperkalemia 4.5%, 14.6%, 22%, hyponatremia 3.6%, 10%, 8.2%, hypocalcemia 12.5%, 18.7%, 33.3%, and hyperphosphatemia 6.4%, 25.8%, 29% with respective CKD stage G3b, G4 and G5. On multivariate logistic regression analysis showed that patients with eGFR stage 5 were 11.8 times more likely to have hyperkalemia when compared with eGFR stage 3a and 3b (AOR =11.834; 95% CI: (2.731–51.274)), patients having severe Anemia 17.7 times more likely to have hyperkalemia (AOR =17.722; 95% CI: 1.503–209.005)) and Patients eGFR stage 5 were 12 times more likely to had hypocalcemia (AOR = 12.143, 1.193–123.618)). Conclusion: Present study concludes that hyperkalemia, hyponatremia hypocalcemia and hyperphosphatemia is common in our pre-dialysis CKD patients and electrolytes abnormalities raises more with reduction of GFR. Frequent determination of serum electrolyte, early detection and early treatment of electrolyte abnormalities in CKD patients should be practiced including serum calcium, phosphate and vitamin D, in order to prevent and minimize complication and progression of the disease