Abstract
OBJECTIVE: To determine progression in adult patients with early-stage chronic kidney disease (CKD) attending tertiary hospitals in Dodoma, Tanzania. DESIGN: Prospective longitudinal study. SETTING: This study was conducted in two tertiary hospitals in Dodoma, Tanzania. PARTICIPANTS: The population in this study was adult patients aged ≥18 years with early-stage CKD who were attending nephrology and medical outpatient clinics at Benjamin Mkapa Hospital and Dodoma Regional Referral Hospital, which are tertiary hospitals in Dodoma, Tanzania, from November 2020 to March 2022. Inclusion criteria included: patients aged ≥18 years of age, attending the clinic for at least 3 months with baseline clinical data on their files, estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m(2) and who gave a written informed consent. A total of 352 patients were enrolled, of whom 182 were males and 170 were females. MAIN OUTCOME: The dependent variable in this study was CKD progression, which was assessed after 12 months of follow-up. RESULTS: A total of 352 participants with a median age of 54 (47-59) years were enrolled; the prevalence of progression of early-stage CKD was 28.0% (97/346). For patients with CKD progression, the baseline median eGFR was 43 (41-49) mL/min/1.73 m(2), urine protein creatinine ratio was 0.099 (0.025-0.158) mg/g, and haemoglobin was 11.7 (9.7-12.6) g/L. Of the patients with CKD progression, 75.3% (73/97) had diabetes mellitus, 72.2% (70/97) of the patients had hypertension, 58.8% (57/97) of the patients had significant proteinuria, and 58.8% (57/97) of the patients had anaemia. Variables associated with CKD progression after multivariate logistic regression analysis were; diabetes mellitus (OR=7.02, 95% CI 3.01 to 16.39, p=0.001), use of local herbs (OR=27.98, 95% CI 11.08 to 70.70, p=0.001), anaemia (OR=2.49, 95% CI 1.32 to 4.68, p=0.005), proteinuria (OR=7.51, 95% CI 3.49 to 16.19 p=0.001). Half, 52.5% (51/97) of the patients with CKD progression were found to have left ventricular hypertrophy (LVH), 26.8% (26/97) of the patients had evidence of coronary artery disease (CAD) on non-invasive testing, and 11.3% (11/97) of the patients died during the study period. CONCLUSION: A substantial portion of adult patients with early-stage CKD were found to have progression after 12 months of follow-up. Diabetes mellitus, proteinuria, anaemia and use of local herbal medicines were significant predictors for CKD progression. Of the patients with CKD progression, more than half of the patients were found to have LVH, almost one third of the patients had evidence of CAD on non-invasive testing, and few patients died.