A total of 658 patients attended the medical outpatient clinic during the 4 months period of enrolment, 306 patients were excluded from the study including 102 patients who had other medical conditions. Thus, 352 participants met the criteria to be included in this study, out of which 346 patients completed the 12 months follow up. The prevalence of CKD progression by a sustained decline in eGFR> 4 ml/min/1.73m2 per year was 28.0% (97/346) (Figure 1).
Baseline demographic and clinical characteristics of study patients
Of the 352 patients who were enrolled into the study, 98.3% (346/352) patients completed the study of whom 179 (51.7 %) were male and 248 (71.7 %) were married. Progression of CKD by a sustained decline in eGFR> 4 ml/min/1.73m2 per year occurred in 97 (28.0%) patients over 1 year of follow up. The median age was 56 (49 - 60) years for CKD progressors and 53 (46 - 59) years for those without CKD progression; the median eGFR at baseline, 43(41-49) mL/min/1.73 m2 for CKD progressors and 51(44-56) mL/min/1.73 m2 for those without CKD progression (p=0.001); the median urine protein creatinine ratio (uPCR) was 0.099(0.025-0.158) g/g for CKD progressors and 0.025(0.021-0.028) g/g for those without CKD progression (p=0.001); median haemoglobin of 11.7(9.7-12.6) g/dl for CKD progressors and 12.7(11.5-13.2) g/dl for those without CKD progression (p=0.001) (Table 1).
Table 1: Baseline demographic and clinical characteristics of study patients by their CKD progression status (n=346)
Variables
|
CKD progression
(n=97)
|
No CKD progression
(n=249)
|
P -value
|
|
Median (IQR) or Proportion
|
Median (IQR) or Proportion
|
|
Age (years)
|
56 (49-60)
|
53 (46-59)
|
0.020
|
Sex
Male
Female
|
44 (45.4%)
53 (54.6%)
|
135(54.2%)
114(45.8%)
|
0.139
|
Marital status
Married
Single
|
73(75.3%)
24(24.7%)
|
175(70.3%)
74(29.7%)
|
0.357
|
Level of education
Primary or less
Secondary and above
|
34(35.1%)
63(64.9%)
|
103(41.4%)
146(58.6%)
|
0.281
|
Residence
Rural
Urban
|
48(49.5%)
49(50.5%)
|
100(40.2%)
149(59.8%)
|
0.115
|
Occupation
Employed
Self-employed
|
25(25.8%)
72(74.2%)
|
66(26.5%)
183(73.5%)
|
0.890
|
NHIF status
Insured
Not insured
|
49(50.5%)
47(49.5%)
|
112(45.0%)
136(55.0%)
|
0.487
|
SBP (mmHg)
|
128(124-145)
|
128(122-142)
|
0.289
|
DBP (mmHg)
|
82(78-88)
|
80(78-86)
|
0.029
|
BMI (Kg/m2)
|
27.0(24.5-30.7)
|
24.9(23.5-27.5)
|
0.001
|
Waist circumference (cm)
|
94.0(87.5-103.5)
|
96.0(86.5-104.5)
|
0.518
|
HbA1c (%)
|
6.5(6.1-7.2)
|
5.7(5.1-6.3)
|
0.001
|
HB (g/dl)
|
11.7(9.7-12.6)
|
12.7(11.5-13.2)
|
0.001
|
Creatinine (umol/L)
|
134.0 (124.4-151.8)
|
127.0 (121.2-136.1)
|
0.001
|
eGFR (mil/min/1.73m2)
|
43(41-49)
|
51(44-56)
|
0.001
|
BUN (mmol/l)
|
8.4(7.4-10.6)
|
7.8(7.0-8.6)
|
0.001
|
UPCR (g/g)
|
0.099(0.025-0.158)
|
0.025 (0.021-0.028)
|
0.001
|
Total Cholesterol(mmol/l)
|
5.7(4.7-6.1)
|
4.9(4.2-5.8)
|
0.001
|
Triglycerides(mmol/l)
|
4.9(1.6-5.5)
|
1.6(1.5-5.0)
|
0.002
|
HDL-C(mmol/l)
|
0.9(0.8-1.4)
|
1.3(0.9-1.5)
|
0.001
|
LDL-C(mmol/l)
|
4.0(3.2-4.4)
|
3.3(3.1-4.1)
|
0.001
|
Clinical profile of the patients who had CKD progression
Of the 97 patients who had CKD progression, 73(75.3%) patients had diabetes mellitus and 70 (72.2%) of the patients had hypertension. More than half (58.8%) of the patients with CKD progressors presented with significant proteinuria as compared to 54(36.7%) of the patients without CKD progression. Anaemia was found in 57(58.8%) of the patients with CKD progression and in 86(34.5%) of the patients in those without CKD progression. Use of local herbs was found in 35(36.1%) of the patients with CKD progression and in 22(8.8%) of the patients in those without CKD progression (Table 2).
Table 2: Clinical profile of study patients by their CKD progression status (n=346)
Variables
|
CKD progression
(n=97)
|
No CKD progression
(n=249)
|
P - Value
|
|
Proportion (%)
|
Proportion (%)
|
|
Age (years
<50
≥50
|
25(25.8%)
72(74.2%)
|
93(21.7%)
156(78.3%)
|
0.043
|
Current alcohol use
No
Yes
|
44(45. 4%)
53(54.6%)
|
106(42.6%)
142(57.4%)
|
0.659
|
Current smoking
No
Yes
|
68(70.1%)
29(29.9%)
|
200(80.3%)
49(19.7%)
|
0.042
|
Overweight/Obesity
No
Yes
|
30(30.9%)
67(69.1%)
|
90(56.6%)
159(43.4%)
|
0.360
|
Hypertension
No
Yes
|
27(27.8%)
70(72.2%)
|
88(35.3%)
161(67.7%)
|
0.048
|
Diabetes Mellitus
No
Yes
|
24(24.7%)
73(75.3%)
|
161(64.7%)
88(35.3%)
|
0.001
|
Use local herbs
No
Yes
|
62(63.9%)
35(36.1%)
|
227(91.2%)
22(8.8%)
|
0.001
|
Anaemia
No
Yes
|
40(41.2%)
57(58.8%)
|
163(65.5%)
86(34.5%)
|
0.001
|
CKD stage
Stage 2
Stage 3
|
9(9.3%)
88(90.7%)
|
55(22.1%)
194(77.9%)
|
0.006
|
Lipid profile
Normal
Impaired
|
21(21.6%)
76 (78.4%)
|
124(49.8%)
125(50.2%)
|
0.001
|
Proteinuria
< 0.03
≥0.03
|
40(41.2%)
57(58.8%)
|
195(63.3%)
54(36.7%)
|
0.001
|
Factors associated with CKD progression
We divided the patients into two subgroups [(those with CKD progression) vs. (those without CKD progression)]. A total of 18 potential variables were identified after performing univariate logistic regression analyses. Backward elimination reduced this to 10 parameters; the variables associated with CKD progression on multivariate logistic regression analysis included; diabetes mellitus (OR =7.02, 95% CI 3.01-16.39, P=<0.001), use of local herbs (OR=27.98, 95% CI 11.08-70.70, P=<0.001), anaemia (OR=2.49, 95% CI 1.32-4.68, P=0.005), proteinuria (OR=7.51, 95% CI 3.49-16.19 P=<0.001). Age, male sex, rural residence, current history of smoking, hypertension, CKD stage 3, and dyslipidemia were statistically significantly associated with CKD progression on the univariate logistic regression analysis but the association was lost on multivariate logistic regression analysis (Table 3).
Table 3: Factors associated with CKD progression (n=97)
Variables
|
No of patients
|
Univariate
|
Multivariate
|
|
|
COR (95% CI)
|
P-value
|
AOR (95% CI)
|
P-value
|
Age
|
346
|
1(Reference)
1.03 (1.01-1.07)
|
0.028
|
1(Reference)
0.99(0.96-1.04)
|
0.905
|
Sex
Female
Male
|
53
44
|
1(Reference)
0.70(0.44-1.12)
|
0.139
|
1(Reference)
1.19(0.59-2.40)
|
0.631
|
Residence
Urban
Rural
|
49
48
|
1(Reference)
1.46(0.91-2. 34)
|
0.116
|
1(Reference)
1.54(0.82-2.90)
|
0.183
|
Current smoking
No
Yes
|
68
29
|
1(Reference)
1.74(1.02-2.97)
|
0.042
|
1(Reference)
2.00(0.94-4.24)
|
0.071
|
Hypertension s
No
Yes
|
27
70
|
1(Reference)
1.42(1.13-2.49)
|
0.048
|
1(Reference)
1.46(0.66-3.25)
|
0.353
|
Diabetes mellitus
No
Yes
|
24
73
|
1(Reference)
5.57(3.28-9.45)
|
0.001
|
1(Reference)
8.21(3.37-19.99)
|
0.001
|
Use of local herbs
No
Yes
|
62
35
|
1(Reference)
5.83(3.11-8.52)
|
0.001
|
1(Reference)
27.99(10.91-71.85)
|
0.001
|
CKD Stage
Stage 2
Stage 3
|
9
88
|
1(Reference)
2.77(1.31-5.86)
|
0.008
|
1(Reference)
0.86(0.29-2.50)
|
0.787
|
Anaemia
No
Yes
|
40
57
|
1(Reference)
2.70(1.67-4.37)
|
0.001
|
1(Reference)
2.85(1.48-5.48)
|
0.002
|
Proteinuria
<0.03
≥0.03
|
40
57
|
1(Reference)
5.15(3.11-8.52)
|
0.001
|
1(Reference)
8.22(3.76-17.99)
|
0.001
|
Lipid profile
Normal
Impaired
|
21
76
|
1(Reference)
3.59(2.09-6.18)
|
0.001
|
1(Reference)
2.01(0.91-3.83)
|
0.084
|
Outcomes of the patients who had CKD progression
Of the 97 patients who had CKD progression after 1 year of follow up, 51 (52.5%) of the patients were found to have LVH, 42 (43.3%) of the patients had new onset hypertension/worsening hypertension, 40 (41.2%) of the patients had new onset/worsening anemia, 26 (26.8%) of the patients had evidence of CAD on non-invasive testing, 25 (25.8%) of the patients had new onset heart failure/worsening heart and 24 (24.7%) of the patients developed electrolyte imbalance with hyperkalemia being the most common; presenting in 70.8% of the patients. A total of 10 (10.3%) developed end stage kidney disease (ESKD), 14 (11.9%) patients died during the study period; 11 (78.6%) of the patients who died had CKD progression (Table 4).
Table 4: Outcomes of the patients who had CKD progression
Variables
|
Frequency
|
Left ventricular hypertrophy (LVH)
No
Yes
|
46(47.5%)
51(52.5%)
|
New onset /worsening hypertension
No
Yes
|
55(56.7%)
42(43.3%)
|
New onset/worsening anemia
No
Yes
|
57(58.8%)
40(41.2%)
|
Coronary artery disease (CAD)
No
Yes
|
71(73.2%)
26(26.8%)
|
New onset/worsening heart failure
No
Yes
|
74(74.2%)
25(25.8%)
|
Electrolyte imbalance
No
Yes
|
73(75.3%)
24(24.7%)
|
End stage renal disease (ESRD)
No
Yes
|
87(89.7%)
10(10.3%)
|
Stroke
No
Yes
|
91(93.8%)
6(6.2%)
|
Mortality
Alive
Died
|
86(88.7%)
11(11.3%)
|