Assessment of Clinical Outcome and Quality of Life of Chronic Kidney Disease Patients at Zewditu Memorial Hospital and Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia

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Addis Ababa University


Chronic kidney disease (CKD) is a worldwide public health problem. Although there is a holistic management for chronic kidney disease, people with CKD have significantly higher rates of morbidity, mortality, hospitalizations, and healthcare utilization. Evaluating the clinical outcome and quality of life, is used to identify CKD patients in need of clinical attention and to evaluate interventions for CKD patients and lead to better outcome. The present study was aimed to assess the clinical outcome and quality of life of CKD patients at Zewditu Memorial Hospital and Tikur Anbesa Specialized Hospital. A cross-sectional study design was used. Data was collected using the Kidney Disease and Quality of Life (KDQOL™-36) tool and patients’ medical records. Multivariate logistic regression analysis was used to determine factors associated with clinical outcome and quality of life (QOL). P≤0.05 was considered as statistically significant. To compare scores of QOL subscales by socio-demographic and diseaserelated factors, the Student’s independent t-test and one-way ANOVA were conducted to compare two groups and three or more groups in the analysis of QoL. Out of the total of 300 CKD patients half (50.3%) of the patients developed CKD related complications ,one tenth of the CKD patients progressed to ESRD and near to one fourth of the total CKD patients had hospitalization event due to CKD during their life time. Forty two percent of CKD patients had diabetes mellitus and hypertension were managed with non-ACEIs based regimens plus insulin whereas two fifth of the total CKD patients with hypertension were managed with ACEIs/ARB based regimens. CKD patients treated with enalapril reduced the progression of ESRD by 80% (AOR=0.2, 95% CI(0.001-0.45,P=0.01). The progression to ESRD in patients with 0-2 complications was reduced by 87% when compared to those who had ≥3 complications (AOR=0.13 ,95% CI(0.02-0.85,P=0.03). Use of amlodipine (AOR=3.56, 95% CI (1.02-12.65 ,p=0.048) and atenolol (AOR=5.82 ,95% CI(1.46-23.27,p=0.01) were associated with poor outcome. Mean domain score on the physical component summary (PCS), mental component summary(MCS), burden of kidney disease(BKD), symptoms and problems of kidney II disease(SPKD) and effect of kidney disease (EKD) subscales were 50.4, 59.5, 63.1, 80.4, and 74.6, respectively. In multivariate analysis, the odds of impaired PCS QOL in rural residents was reduced by 90% when compared to the urban residents (AOR=0.10, 95%CI (0.02-0.64, P=0.015)). On the other hand, presence of ≥3 comorbidities (AOR=4.21, 95%CI (1.5-11.80, P=0.006), and ≥3 complications (AOR=5.85, 95%CI (1.62-21.08, P=0.007) were associated with impaired MCS QOL respectively. Almost one tenth of the total CKD patients had progressed to ESRD. Three or more CKD related complications, use of amlodipine and atenolol were the significant predictors of poor clinical outcome of the CKD patients. The overall mean score of PCS and MCS was impaired and below the standard level. Lowest score of KDQOL™-36 scales was found in the PCS compared to the domaines of MCS QOL. Furthermore, the study revealed that, level of education, elevated serum creatinin, and smoking status were the significant predictors of PCS QOL whereas presence of ≥3 comorbidities, ≥3 CKD related complications and hemoglobin level were the significant predictors of impaired MCS QOL.



Chronic kidney disease, clinical outcome, quality of life, end stage renal disease