ANALYSIS OF CHRONIC KIDNEY DISEASE IN KWAZULU–NATAL (SOUTH AFRICA) REVEALS 3 CLUSTERS: IS IT TIME TO REVIEW THE 5 STAGES OF CHRONIC KIDNEY DISEASES?

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ANALYSIS OF CHRONIC KIDNEY DISEASE IN KWAZULU–NATAL (SOUTH AFRICA) REVEALS 3 CLUSTERS: IS IT TIME TO REVIEW THE 5 STAGES OF CHRONIC KIDNEY DISEASES?

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Co-author 1

Alain Assounga assoungaa@ukzn.ac.za University of KwaZulu-Natal Department of Nephrology Durban South Africa * Inkosi Albert Luthuli Central Hospital Department of Nephrology Durban South Africa

Co-author 2

Peter Popoola petersees4real@gmail.com University of KwaZulu-Natal School of Mathematics, Statistics and Computer Durban South Africa -

Co-author 3

Verushka Reddy verushkared@gmail.com University of KwaZulu-Natal Department of Nephrology Durban South Africa - Inkosi Albert Luthuli Central Hospital Department of Nephrology Durban South Africa

Co-author 4

Jules-Raymond Tapamo Tapamoj@ukzn.ac.za University of KwaZulu-Natal 4. Discipline of Electrical, Electronics and Computer Engineering, School of Engineering Durban South Africa -

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Introduction

Chronic Kidney Disease (CKD) has a prevalence of 5 – 20% worldwide. Chronic Kidney Disease is typically classified into five stages based on eGFR levels. CKD stage 5 describes people whose eGFR is less than 15 ml/min, and who require kidney replacement therapy (KRT) for management. While many patients with CKD stage 5 exhibit uremic symptoms that may improve following KRT, some individuals with eGFR < 15ml/min remain asymptomatic and may be hesitant to begin KRT.

Methods

This study collected demographic, clinical, and laboratory data from electronic records of 280 CKD patients at Inkosi Albert Luthuli Central Hospital and analysed them using the Ahmad-Dey distance measure.

Results

Results: Unlike the widely recognized 5 stages, we found only 3 separate clusters based on age, sex, estimated glomerular filtration rate, urea, creatinine, haemoglobin, and uric acid—not on blood pressure or race. (Table 1). The mean and confidence interval of eGFR of the 3 clusters are: Cluster A = 75.76 [40.85 – 107.38], Cluster B = 12.34 [9.86 – 16.18] and Cluster C= 5.96 [4.72-6.84] (Table 1).

Table 1

Cluster	n	eGFR(ml/min) mean [CI]	HB(g/dL) mean [CI]	Uric Acid(µmol/L) mean [CI]
A	193	75.76 [40.85 – 107.38]	12.40 [11.30 – 13.50]	0.040 [0.30-0.50]
B	61	12.34 [9.86 – 16.18]	11.95 [10.90 – 13.00]	0.45 [0.40 – 0.050]
C	26	5.96 [4.72 – 6.84]	10.60 [10.03 – 10.76]	0.58 [0.40 – 0.60]
p-value		<0.05	<0.05	<0.05

Conclusion

The clinical significance of the 3 clusters needs further evaluation. Nonetheless, we suggest that patients in cluster A should be observed closely and receive treatment for any existing kidney disease. It is important to carefully monitor Cluster B patients for potential requirements of kidney replacement therapy, while also strengthening strategies for kidney protection. Patients in Cluster C ought to receive treatment with KRT. The content of this abstract was previously submitted to the American Society of Nephrology (ASN) congress in Houston in November 2025. ASN authorises resubmission of abstracts.

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