Management practice, adverse outcomes and associated factors among adult chronic kidney disease patients at Felegehiwot and Dessie referral hospitals, Ethiopia.

Abstract

Abstract Background: Chronic kidney disease (CKD) is a worldwide public health problem with an increasing incidence, prevalence, and adverse outcomes. Objectives: This study aimed to assess management practice, adverse outcomes and associated factors among adult chronic kidney disease patients at Felegehiot comprehensive specialized hospital, northwest Ethiopia, and Dessie referral hospital, northeast Ethiopia. Methods: A hospital-based crossectional study was conducted in all adult chronic kidney disease patients who fulfill the inclusion criteria at Felegehiot Comprehensive Specialized Hospital and Dessie Referral Hospital. Data were collected using the data abstraction checklist from May to August 2019. Collected data were coded, sorted, cleaned, entered into EpiInfo and exported to SPSS IBM version 20, statistical software for analysis. The abbreviated form of four-variable Modification of Diet in Renal Disease was used to estimate the glomerular filtration rate from serum creatinine for prediction of progression and CKD classification. Univariable and multivariable binary logistic regression analysis was computed to identify different associations with the outcome variables with end stage kidney disease. P-value < 0.05 was considered as statistically significant. Results: - From the two research sites, two hundred seventeen (217) patients were included in this study. Majority of CKD patients were treated by loop diuretics (furosemide 87.6%), CCBs (amlodipine 36.9%), ACEIs (enalapril 22.6%), BBs (atenolol 7.8%), ferrous gluconate (34.1%) and calcium gluconate (13.8%). Anemia 146 (67.3%), Uremic complications 103 (47.5%), fluid overload 79 (36.4%), Serum electrolyte abnormalities 68(31.3%) and Cardiovascular disease 45(20.7%) were major types of CKD complications. Hospitalization (98.2%), end stage kidney disease (68.2%) and mortality (10.6%) were found to be major adverse outcomes of CKD. The multivariable binary logistic regression analysis showed that sex, serum creatine, residence, enalapril, and nifedipine was independently associated with CKD with progression to end stage kidney disease. Conclusions: - Overall, majority of CKD patients were treated by loop diuretics (furosemide), CCBs (amlodipine), ACEIs (enalapril), BBs (atenolol), ferrous gluconate and calcium gluconate. Non- angiotensin converting enzyme inhibitor-based regimens were used in hypertensive only patients with CKD comorbidity. The majority of patients had at least one complication and progression to end stage kidney disease. Similarly, hospitalization, anemia, heart failure, uremic complications, end stage kidney disease, and mortality were the most common adverse outcomes of CKD complications. However, the majority of patients’ status was unknown. Finally, Serum creatine, residence, sex, enalapril, and nifedipine, were independent predictors of end stage kidney disease. Keywords: Chronic Kidney Disease, Management practice, Adverse clinical outcomes, Associated factors, Felegehiwot, Dessie, Ethiopia