Progression of chronic kidney disease among black patients attending a tertiary hospital in Johannesburg, South Africa

Chronic kidney disease (CKD) is a major public health issue worldwide and is an important contributor to the overall non-communicable disease burden. Chronic kidney disease is usually asymptomatic, and insidiously and silently progresses to advanced stages in resource limited settings. A prospective...

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Veröffentlicht in:PloS one Jg. 18; H. 2; S. e0276356
Hauptverfasser: Meremo, Alfred, Paget, Graham, Duarte, Raquel, Bintabara, Deogratius, Naicker, Saraladevi
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States Public Library of Science 13.02.2023
Public Library of Science (PLoS)
Schlagworte:
Aged
Ambulatory Care Facilities - statistics & numerical data
Analysis
Anemia
Autoimmune diseases
Biology and Life Sciences
Black People - statistics & numerical data
Blacks
Blood pressure
Body mass index
Cardiovascular diseases
Care and treatment
Chronic kidney failure
Clinics
Communicable diseases
Creatinine
Data collection
Developing countries
Development and progression
Diabetes
Diabetes mellitus
Diabetes Mellitus - epidemiology
Disease Progression
Distribution
Ethics
Ethnicity
Glomerular Filtration Rate
Glycated Hemoglobin
Health aspects
Hemoglobin
Hospitals
Humans
Hypertension
Hypertension - epidemiology
Hypocalcemia
Hypocalcemia - epidemiology
Hyponatremia
Kidney diseases
Kidneys
LDCs
Longitudinal Studies
Medical research
Medicine and Health Sciences
Medicine, Experimental
Middle Aged
Outpatient care facilities
Patients
Prevention
Prospective Studies
Proteinuria
Proteinuria - epidemiology
Public health
Regression analysis
Remission
Remission (Medicine)
Renal Insufficiency, Chronic - complications
Renal Insufficiency, Chronic - epidemiology
Renal Insufficiency, Chronic - ethnology
Risk Factors
Smoking
South Africa - epidemiology
Tertiary
Tertiary Care Centers - statistics & numerical data
South Africa
United Kingdom
Sub-Saharan Africa
Johannesburg South Africa
ISSN:1932-6203, 1932-6203
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Zusammenfassung:Chronic kidney disease (CKD) is a major public health issue worldwide and is an important contributor to the overall non-communicable disease burden. Chronic kidney disease is usually asymptomatic, and insidiously and silently progresses to advanced stages in resource limited settings. A prospective longitudinal study was carried out on black patients with CKD attending the kidney outpatient clinic at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in South Africa, between September 2019 to March 2022. Demographic and clinical data were extracted from the ongoing continuous clinic records, as well as measurements of vital signs and interviews at baseline and at follow up. Patients provided urine and blood samples for laboratory investigations as standard of care at study entry (0) and at 24 months, and were followed up prospectively for two (2) years. Data were descriptively and inferentially entered into REDcap and analysed using STATA version 17, and multivariable logistic regression analysis was used to identify predictors of CKD progression. A total of 312 patients were enrolled into the study, 297 (95.2%) patients completed the study, 10 (3.2%) patients were lost to follow and 5 (1.6%) patients died during the study period. The prevalence of CKD progression was 49.5%, while that of CKD remission was 33% and CKD regression was 17.5%. For patients with CKD progression the median age at baseline was 58 (46-67) years, the median eGFR was 37 (32-51) mL/min/1.73 m2, median urine protein creatinine ratio (uPCR) was 0.038 (0.016-0.82) g/mmol and the median haemoglobin (Hb) was 13.1 (11.7-14.4) g/dl; 95.2% had hypertension, 40.1% patients had diabetes mellitus and 39.5% had both hypertension and diabetes mellitus. Almost half (48.3%) of patients with CKD progression had severely increased proteinuria and 45.6% had anaemia. Variables associated with higher odds for CKD progression after multivariable logistic regression analysis were severely increased proteinuria (OR 32.3, 95% CI 2.8-368.6, P = 0.005), moderately increased proteinuria (OR 23.3, 95% CI 2.6-230.1, P = 0.007), hypocalcaemia (OR 3.8, 95% CI 1.0-14.8, P = 0.047), hyponatraemia (OR 4.5, 95% CI 0.8-23.6, P = 0.042), anaemia (OR 2.1, 95% CI 1.0-4.3, P = 0.048), diabetes mellitus (OR 1.8, 95% CI 0.9-3.6, P = 0.047), elevated HbA1c (OR 1.8, 95% CI 1.2-2.8, P = 0.007) and current smoking (OR 2.8, 95% CI 0.9-8.6, P = 0.049). Our study identified a higher prevalence of CKD progression in a prospective longitudinal study of black patients with CKD compared with literature reports. CKD Progression was associated with proteinuria, diabetes mellitus, elevated HbA1c, anaemia, hypocalcaemia, hyponatraemia and current smoking in a cohort of black patients with CKD who had controlled hypertension and diabetes mellitus at baseline.
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Competing Interests: The authors have declared that no competing interests exist.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0276356