The Rate and Predictors of Progression among Chronic Kidney Disease Patients on Follow-Up, Addis Ababa, Ethiopia, 2020 – 2024
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Date
2025-01-23
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Addis Ababa University
Abstract
Background: Chronic kidney disease (CKD) is a progressive condition and a major global health issue that affects over 8 million people worldwide. However, information on the rate and predictors of CKD progression is limited. Therefore, this study aimed to assess the rate and predictors of CKD progression in chronic kidney disease patients who underwent follow-up in Addis Ababa, Ethiopia, from 2020 to 2024. Methods: A retrospective cohort study was conducted among patients with chronic kidney disease in Tikur Anbesa Specialized Hospital and Saint Paul Millennium Medical College from June 1, 2020, to August 31, 2024. A systematic random sampling technique was used to collect 402 study participants using Kobo toolbox software. The data was exported to STATA version 17 for analysis. A linear mixed-effects model of statistical analysis was used considering the random and fixed effects of the longitudinal data, and the mean estimated glomerular filtration rate and overall mean difference were adjusted using Bonferroni corrections. Multivariable linear mixed effects regression was performed for variables with a p-value of < 0.20 on the bivariate analysis to identify independent predictors of chronic kidney disease and variables with a p-value less than 0.05 in the multivariable analysis were considered to have statistical significance.
Results: Among the 402 patients, 64.93% were males. The mean age of the participants was 55.9 + 15.2 years, and 300 (74.63%) were in the age group of 40–74 years. The mean eGFR improved linearly by 2.7, 5.3, 7.63 and 6.44 from the baseline eGFR on years 1, 2, 3 and 4 respectively. The total chronic kidney disease events were 21.83% rapid progression with a total mean eGFR decline of -13.20 (SD = 8.97), 34.73% regression with mean eGFR 13.48 (SD = 7.65), 43.44% had a stable course with mean eGFR of 0.29 (SD =2.64) and 42.03% had achieved remission. Females, patients using ACEI or ARB, and metformin were predictors of a higher estimated glomerular filtration rate by 4.75 (CI: 1.43, 8.08), 5.17 (CI: 2.44, 7.89) and 4.58 (CI: 0.09, 9.07), respectively, compared to their counterparts. Baseline hemoglobin < 10.5g/dl, having diabetes mellitus, baseline proteinuria > +1 and primary education were predictors of declining estimated GFR by -11.02 (CI; -14.59, -7.45), -3.05 (CI; -5.75, -0.35), 3.47 (CI; -6.85, -0.09) and -5.28 (CI; -9.99, -0.57) respectively.
Conclusions: Treatment or management strategies seem to be effective, leading to a notable improvement in kidney function over time in this patient cohort in this setting. This suggests that patients are moving toward recovery or at least significant stabilization of their condition. Close monitoring and addressing of these predictors, improvement of data registration systems by hospitals, and further research on the topic incorporating hospitals with no nephrologist care is recommended.
Keywords: chronic kidney disease, estimated GFR, Progression, Predictors, linear mixed effect model, Ethiopia
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Keywords
chronic kidney disease estimated GFRProgression Predictors linear mixed effect model Ethiopia