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

Chronic kidney disease (CKD) is a worldwide public health problem. Although there is a holisticrnmanagement for chronic kidney disease, people with CKD have significantly higher rates ofrnmorbidity, mortality, hospitalizations, and healthcare utilization. Evaluating the clinical outcomernand quality of life, is used to identify CKD patients in need of clinical attention and to evaluaterninterventions for CKD patients and lead to better outcome. The present study was aimed tornassess the clinical outcome and quality of life of CKD patients at Zewditu Memorial Hospitalrnand Tikur Anbesa Specialized Hospital. A cross-sectional study design was used. Data wasrncollected using the Kidney Disease and Quality of Life (KDQOL™-36) tool and patients’rnmedical records. Multivariate logistic regression analysis was used to determine factorsrnassociated with clinical outcome and quality of life (QOL). P≤0.05 was considered asrnstatistically significant. To compare scores of QOL subscales by socio-demographic and diseaserelatedrnfactors, the Student’s independent t-test and one-way ANOVA were conducted torncompare two groups and three or more groups in the analysis of QoL. Out of the total of 300rnCKD patients half (50.3%) of the patients developed CKD related complications ,one tenth of thernCKD patients progressed to ESRD and near to one fourth of the total CKD patients hadrnhospitalization event due to CKD during their life time. Forty two percent of CKD patients hadrndiabetes mellitus and hypertension were managed with non-ACEIs based regimens plus insulinrnwhereas two fifth of the total CKD patients with hypertension were managed with ACEIs/ARBrnbased regimens. CKD patients treated with enalapril reduced the progression of ESRD by 80%rn(AOR=0.2, 95% CI(0.001-0.45,P=0.01). The progression to ESRD in patients with 0-2rncomplications was reduced by 87% when compared to those who had ≥3 complicationsrn(AOR=0.13 ,95% CI(0.02-0.85,P=0.03). Use of amlodipine (AOR=3.56, 95% CI (1.02-12.65rn,p=0.048) and atenolol (AOR=5.82 ,95% CI(1.46-23.27,p=0.01) were associated with poorrnoutcome. Mean domain score on the physical component summary (PCS), mental componentrnsummary(MCS), burden of kidney disease(BKD), symptoms and problems of kidneyrnIIrndisease(SPKD) and effect of kidney disease (EKD) subscales were 50.4, 59.5, 63.1, 80.4, andrn74.6, respectively. In multivariate analysis, the odds of impaired PCS QOL in rural residents wasrnreduced by 90% when compared to the urban residents (AOR=0.10, 95%CI (0.02-0.64,rnP=0.015)). On the other hand, presence of ≥3 comorbidities (AOR=4.21, 95%CI (1.5-11.80,rnP=0.006), and ≥3 complications (AOR=5.85, 95%CI (1.62-21.08, P=0.007) were associated withrnimpaired MCS QOL respectively. Almost one tenth of the total CKD patients had progressed tornESRD. Three or more CKD related complications, use of amlodipine and atenolol were thernsignificant predictors of poor clinical outcome of the CKD patients. The overall mean score ofrnPCS and MCS was impaired and below the standard level. Lowest score of KDQOL™-36 scalesrnwas found in the PCS compared to the domaines of MCS QOL. Furthermore, the study revealedrnthat, level of education, elevated serum creatinin, and smoking status were the significantrnpredictors of PCS QOL whereas presence of ≥3 comorbidities, ≥3 CKD related complicationsrnand hemoglobin level were the significant predictors of impaired MCS QOL.

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