Progression of chronic kidney disease among adults attending tertiary hospitals in Dodoma, Tanzania

Abstract Background Chronic kidney disease (CKD) in resource constrained settings can silently and rapidly progress to end stage kidney disease (ESKD). Thus, it is important to identify patients at risk of CKD progression for appropriate and timely interventions. Methods A prospective longitudinal study was conducted among adults with CKD attending nephrology and medical outpatient (MOPD) clinics of two tertiary hospitals in Dodoma, Tanzania between November 2020 to March 2022. Demographic and clinical data were extracted from patient files, as well as measurements of vital signs and face to face interviews conducted at baseline and at follow up. Patients provided urine and blood samples for laboratory investigations at study entry (0) and at 12 months. Descriptive and inferential statistics were performed using SPSS software version 26, and multivariable logistic regression analysis was used to identify factors associated with CKD progression. Results A total of 352 participants with median age of 54 (47–59) years were enrolled, the prevalence of CKD progression by a sustained decline in eGFR > 4 ml/min/1.73m2 per year was 28.0% (97/346). For CKD progressors; the baseline median eGFR was 43 (41–49) mL/min/1.73 m2, urine protein creatinine ratio (uPCR) was 0.099 (0.025–0.158) g/g and haemoglobin were 11.7 (9.7–12.6) g/dl. Of the patients with CKD progression, 73(75.3%) patients had diabetes mellitus, 70 (72.2%) of the patients had hypertension, 57 (58.8%) had significant proteinuria and 57 (58.8%) had anaemia. Variables associated with CKD progression after multivariate logistic regression analysis were; 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). Half (52.5%) of the patients with CKD progression were found to have left ventricular hypertrophy (LVH) and a total of 14 (11.9%) patients died during the study period. Conclusion The prevalence of CKD progression is high in our settings. Diabetes mellitus, proteinuria, anaemia and use of local herbal medicines were significant risk factors for CKD progression. More than half of the patients who had CKD progression were found to have LVH and few patients died.