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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Date
2019-11
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Addis Ababa University
Abstract
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.
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Keywords
Chronic kidney disease, clinical outcome, quality of life, end stage renal disease