Introduction:
End-Stage Kidney Disease (ESKD) is a critical health issue requiring long-term dialysis treatment, particularly in resource-limited settings where transplant services are not routinely available and affordable. Understanding the demographic and clinical characteristics of patients undergoing dialysis is essential for optimizing treatment strategies and improving patient outcomes. This study aims to describe the baseline demographic and clinical characteristics of ESKD dialysis patients at a private tertiary facility in Nairobi, Kenya.
Methods:
This study utilized secondary data for the period from July 2023 to July 2024 from a comprehensive database of dialysis patients at a private tertiary facility in Nairobi. The dataset included demographic information, clinical characteristics, comorbidities, dialysis treatment details, and longitudinal laboratory parameters. The analysis was descriptive, focusing on summarizing key characteristics of the patient population. Statistical measures such as medians, interquartile ranges (IQR), and means with standard deviations (SD) were used to analyze and present the data.
Results:
A total of 78 participants were included in the study, of whom 49 (62.8%) were males. The median age of the participants was 62.0 years (IQR: 53.3-71.8). The majority (n=34; 43.6%) had been on dialysis for a period between 1-3 years, while 31 (39.7%) had been on dialysis for more than 3 years. Most of the participants (71.8%) were receiving dialysis through a tunneled catheter and were undergoing dialysis sessions twice a week (83.3%). 28.2% of the patients had an arteriovenous fistula. 3 (3.8%) patients developed confirmed central line associated blood stream infection which were treated successfully. The median weight gain between sessions was 1.7 kilograms (IQR: 1.2-2.2). Additionally, 68 participants (87.2%) had received the hepatitis B vaccine, highlighting a significant coverage rate for this preventive measure.
Comorbidities were prevalent among the participants, with hypertension (HTN) being the most common, affecting 76 patients (94.9%), followed by diabetes mellitus (DM) in 45 patients (57.7%). Other notable comorbidities included hepatitis B and C, systemic lupus erythematosus (SLE), multiple myeloma, HIV and congestive cardiac failure. Regarding antihypertensive treatment, 38 patients (50%) were on fewer than three antihypertensive drugs. For diabetes management, 24 patients (53.3%) were on oral antidiabetic medications, seven on insulin, and six on a combination of oral and insulin medications. Among those on oral antidiabetic drugs, 15 patients (62.5%) were on monotherapy, eight (33.3%) on dual therapy, and only one patient was on a triple-drug regimen.
Longitudinal analysis of laboratory parameters revealed significant variability among the participants. The overall average for hemoglobin (HB) was 11.0 g/dL (SD: 1.72), creatinine was 767.0 µmol/L (SD: 373.0), calcium (Ca) was 2.2 mmol/L (SD: 0.248), albumin was 39.7 g/L (SD: 4.37), phosphate (PO4) was 1.48 mmol/L (SD: 0.596), and potassium (K) was 5.17 mmol/L (SD: 0.899). These laboratory findings underscore the complexity and variability in managing ESKD patients on dialysis.
Conclusions:
The findings from this study provide a comprehensive overview of the demographic and clinical characteristics of ESKD patients undergoing dialysis at a private tertiary facility in Nairobi. The data highlights the significant burden of comorbidities, particularly hypertension and diabetes, and the variability in laboratory parameters, which pose challenges to the management of these patients. The average hemoglobin and potassium levels were within the normal range showing efficient dialysis and good use of erythopoeitin stimulating agents and iron therapies. These insights are crucial for tailoring patient-centered care strategies and improving clinical outcomes in the dialysis population. Further research is needed to explore the long-term outcomes and the effectiveness of current treatment protocols in this setting.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.