Quality of life among patients with moderate to advanced chronic kidney disease in Ghana - a single centre study

Elliot K Tannor,Mogamat R Davids,Fred S Sarfo,Betty R Norman,Kwame K Adusei,George Bedu-Addo

doi:10.1186/s12882-019-1316-z

Abstract

BackgroundThe prevalence of chronic kidney disease (CKD) is increasing worldwide and in Africa. Health related quality of life (QOL) has become an essential outcome measure for patients with CKD and end stage renal disease (ESRD). There is growing interest worldwide in QOL of CKD patients but paucity of data in Ghana. This study sought to assess QOL in patients with moderate to advanced CKD (not on dialysis) and establish its determinants.MethodsWe conducted a cross sectional observational study at the renal outpatient clinic at Komfo Anokye Teaching Hospital (KATH). We collected demographic, clinical and laboratory data. A pretested self-administered Research and Development corporation (RAND®) 36-Item Health Survey questionnaire was administered and QOL scores in physical component summary (PCS) and mental component summary (MCS) were computed. Determinants of QOL were established by simple and multiple linear regression. P value of < 0.05 was considered statistically significant.ResultsThe study included 202 patients with CKD not on dialysis. There were 118(58.5%) males. Mean age was 46.7 ± 16.2 years. The majority, 165(81.7%) of patients were on monthly salaries of less than GHS 500 (~USD 125). Chronic glomerulonephritis was the most common cause of CKD in 118 (58.5%) patients followed by diabetes mellitus in 40 (19.8%) patients and hypertension in 19 (9.4%) patients. The median serum creatinine was 634.2 μmol/L (IQR 333–1248) and the median eGFR was 7 ml/min/1.73m2 (IQR 3–16). The most common stage was CKD stage 5 accounting for 143 (71.1%), followed by CKD stage 4 with 45 (22.4%) of cases and 13 (6.5%) of CKD stage 3. The overall mean QOL score was 40.3 ± 15.4. MCS score was significantly lower than PCS score (37.3 ± 10.8 versus 43.3 ± 21.6, P < 0.001). Multiple linear regression showed that low monthly income (p = 0.002) and low haemoglobin levels (p = 0.003) were predictive of overall mean QOL.ConclusionPatients with moderate to advanced CKD had low-income status, presented with advanced disease and had poor QOL. Anaemia and low-income status were significantly associated with poor QOL.

Highlights

The prevalence of chronic kidney disease (CKD) is increasing worldwide and in Africa
The most common cause of CKD was chronic glomerulonephritis accounting for 118 (58.4%) of patients followed by diabetes mellitus in 40 (19.8%) patients and hypertension in 19 (9.4%) patients
To our knowledge, this is the first ever study to assess the quality of life among patients with moderate to advanced CKD not on dialysis using the RAND® 36-Item Health Survey questionnaire in Ghana

Summary

Introduction

The prevalence of chronic kidney disease (CKD) is increasing worldwide and in Africa. Health related quality of life (QOL) has become an essential outcome measure for patients with CKD and end stage renal disease (ESRD). Chronic glomerulonephritis together with non-communicable diseases such as hypertension and QOL is defined by the World Health Organisation (WHO) as “an individual’s perception of their position in life in the context of the culture and value system where they live, and in relation to their goals, expectations, standards, and concerns” [8]. It is a comparison between patients’ expectations and reality. QOL reflects treatment quality in patients with CKD and end stage

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