Chronic kidney disease patients’ Management Outcome and associated factors at selected tertiary hospitals in Ethiopia: Multicenter prospective observational study

Abstract

Background; Globally, chronic kidney disease becomes a major threat with an exponential increase over the years and caused remarkable mortality and morbidity. In Ethiopia, despite the prevalence of chronic kidney disease is increasing, the studies addressed the mortality of non dialysis dependent chronic kidney disease patients are scarce. Considering the importance to identify some modifiable risk factors for early mortality can improve these patients’ survival. Objective: The study aimed to determine chronic kidney disease patients’ management outcome and associated factors at selected tertiary hospitals in Ethiopia. Methods: Prospective observational study was conducted among admitted non-dialysis-dependent chronic kidney disease patients from June 2022 to March 2023 at selected tertiary hospitals in Ethiopia. A total of 170 study participants were enrolled consecutively. Data were collected using interviewer-administered questionnaires, data abstraction, and phone-call follow-up formats. Epidata 4.6.0. was used for data entry and Statistical Packages for Social Science 25 was used for statistical analysis. Bivariate and multivariate Cox regression analysis was conducted to identify predictors of chronic kidney disease mortality. A p-value ≤ 0.05 was statistically significant. Result: Over 649.266 person-months, 170 patients were followed. Of these patients, 120(70.6%) were male and the mean (± SD) age of the patients was 45.19 ± 13.86 years. Overall, 71 (41.8%) were died with an estimated 109 deaths per 1000 person-months. The mean survival time was 116.9 days (95% CI: 105.3- 128.5). Hypertension (90%) and edema (99.4%) were the most frequently prevalent comorbidity and complications, respectively. Severe anemia at admission [AHR = 3.3, 95% CI, (1.39-7.8)], systolic blood pressure at discharge > 159 mmHg [AHR= 4.65, 95%CI (2.07-10.42)], modified Charleston comorbidity index score ≥ 5 [AHR= 5.00, 95%CI (2.60-9.64)], and uremic encephalopathy [AHR= 2.58, 95%CI (1.45-4.5)] were predictors of chronic kidney disease patients’ mortality. Conclusions and recommendations: Over the course of the study, the total fatality rate among patients with chronic kidney disease was an alarming. Hypertension and edema were the common comorbidity and complications. Severe anemia at admission, refractory systolic blood pressure at discharge, Charleston comorbidity index score ≥ 5, and presence of uremic encephalopathy were identified predictors of mortality. Therefore, targeting these factors would probably reduce the mortality of chronic kidney disease patients.