The rise in risk factors like obesity, hypertension, and diabetes mellitus has partly led to the increase in the number of patients affected by chronic kidney disease, affecting an estimated 843 million people which is near about 10% of the general population worldwide in 2017 [1]. The Global Burden of Disease (GBD) studies reported that the findings from 1990 to 2019 have demonstrated that CKD has emerged as one of the major global causes of mortality, and the global all-age death rate attributed to CKD increased by 41.5% between 1990 and 2017. Besides, CKD is also the 12th leading cause of years of life lost (YLL) and predicted to become the 5th highest cause of YLL globally by 2040 [2, 3].
The number of people who suffer from kidney disease is rising globally and is predicted to keep rising. [4] Literature reports that the prevalence of stage 3 CKD is estimated to be between 11 to 13% [5]. Among the adult population living in Western, Middle, Eastern, Southern, and Northern Africa, the prevalence of CKD was estimated to be 19.8%, 16.0%, 14.4%, 10.4%, and 6.1%, respectively, and equivalent figures were higher at 32.3% among high-risk population (diabetes, and hypertension).[6] According to the World Bank health data (2019) for CKD stratified by global regions, the age-standardized prevalence and DALYs per 100,000 people were 11.5% and 790 respectively in Africa [6, 7]. A systematic review (2022) of 12 regional studies involving individuals with diabetes mellitus, hypertension, and HIV reported that the prevalence rate ranged from 12.2–38.9% in Ethiopia.[8] Further, it is important to recognize that the estimates of CKD were based on patchy surveillance data, and little is known about the scale, complications, and outcomes associated with CKD in the Sub-Saharan Africa region.
Like most developing countries in the world, Sub-Saharan African countries are witnessing an uptrend in individuals needing dialysis therapy [2, 9]. CKD patients are affected by symptoms related to their renal disease, comorbid, accelerated aging, and treatment options, which can compromise their quality of life [5]. Studies report that multi-factors like treatment-related issues, weakness, severity or stage of the disease, low level of energy, poly-medication, cognitive impairments, fatigue, physical frailty, and low activity level are often associated with functional limitations and disability among CKD patients [10–12]. Predicting the outcomes of CKD and its treatments [13] is a vital part of clinical care, decision-making, and more importantly resource allocation in developing countries. Disability among CKD patients are key factor in determining the treatment outcome and quality of life. Most often, kidney failures occurs during the late middle and old age, so problems like musculoskeletal manifestations, cognitive impairment, and incontinence can further increase the likelihood of experiencing a decline in physical functions[11, 14–16]. Further, even early stages of CKD can cast up 5 or more years into the aging process, hence CKD is often known as the model of accelerated aging [17]. Addressing functional status among this population warrants better insight into their disability index, pattern of functional decline, and determinants to be manipulated to improve their functional status [12, 16]. Measuring self-reported disability using a standardized tool will provide a measure of physical function among patients with CKD and also an insight into the variables that are associated with disability[13, 18]. It is therefore essential to investigate the functional status, and predictors associated, based on different psycho-social contexts to improve functional independence and decision-making in the management of CKD patients.
Almost all the epidemiological studies on CKD in the region [8, 19–21] have focused on exploring the relationship between the determinants of CKD, predictors of mortality in this population, and clinical characteristics. Seldom efforts were made to address the functional status, disability index, and the predictors of CKD in the country. The increasing trend of CKD prevalence in Africa and the sub-Saharan region is known. With the improving health care and renal care facilities in the process in Africa, research emphasizing the measure of function and clinical characteristics associated will immensely improve the understanding activity limitation domain among this population. Hence, this study aimed to determine the functional status and disability index among patients visiting the renal unit of the St Paul’s Hospital Millennium Medical College (SPHMMC), in addition to identifying the predictors of functional status and disability.