Demographic and Clinical Profile of Black Patients with Chronic Kidney Disease Attending Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in Johannesburg, South Africa

Background The prevalence of chronic kidney disease (CKD) is increasing worldwide; black patients have an increased risk of developing CKD and end stage kidney disease (ESKD) at significantly higher rates than other races. Methods A cross sectional study was carried out on black patients with CKD attending the kidney outpatient clinic at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in South Africa, between September 2019 to March 2020. Demographic and clinical data were extracted from the ongoing kidney outpatient clinic records and interviews, and were filled in a questionnaire. Patients provided blood and urine for laboratory investigations as standard of care, data were descriptively and inferentially analysed using STATA version 17. Multivariable logistic regression analysis was used to identify demographic and clinical data associated with advanced CKD. Results A total of 312 black patients with CKD were enrolled during the study period; 58% patients had advanced CKD, of whom 31.5 % had grossly increased proteinuria, 96.7 % had hypertension, 38.7 % had diabetes mellitus and 38.1 % had both hypertension and diabetes mellitus. For patients with advanced CKD, the median age was 61 (IQR 51-69) years, eGFR 33 (30 -39) mL/min/1.73 m2, serum bicarbonate 22 (IQR 20 – 24), hemoglobin 12.9 (IQR 11.5 – 14.0) g/dl, serum transferrin 2.44 (IQR 2.23 – 2.73) g/L, serum uric acid 0.43 (IQR 0.37 – 0.53) and serum potassium 4.4 (IQR 3.9 – 4.8) mmol/L. The prevalence of metabolic acidosis was 62.4 %, anemia 46.4 %, gout 30.9 %, low transferrin levels 16.6 % and hyperkalemia 8.8 % among those with advanced CKD, while the prevalence of metabolic acidosis and anemia was 46.6 % and 25.9 % respectively in those with early CKD. Variables with higher odds for advanced CKD after multivariable logistic regression analysis were hypertension (OR 3.3, 95 % CI 1.2 - 9.2, P = 0.020), diabetes mellitus (OR 1.8, 95 % CI 1.1 - 3.3, P = 0.024), severe proteinuria (OR 3.5, 95 % CI 1.9 - 6.5, P = 0.001), angina (OR 2.5, 95 % CI 1.2 - 5.1, P = 0.008), anaemia (OR 2.9, 95% CI 1.7 - 4.9, P= 0.001), hyperuricemia (OR 2.4, 95 % CI 1.4 - 4.1, P = 0.001), and metabolic acidosis (OR 2.0, 95% CI 1.2 - 3.1, P= 0.005). Other associations with advanced CKD were widow/widower (OR 3.2, 95 % CI 1.4 - 7.4, P = 0.006), low transferrin (OR 2.4, 95% CI 1.1 - 5.1, P= 0.028), hyperkalemia (OR 5.4, 95% CI 1.2 - 24.1, P= 0.029), allopurinol (OR 2.4, 95 % CI 1.4 - 4.3, P = 0.005) and doxazosin (OR 1.9, 95% CI 1.2 - 3.1, P = 0.006). Conclusion Hypertension and diabetes mellitus were strongly associated with advanced CKD, suggesting a need for primary and secondary population-based prevention measures. Metabolic acidosis, anaemia with low transferrin levels, hyperuricemia and hyperkalemia were highly prevalent in our patients, including those with early CKD, and they were strongly associated with advanced CKD, calling for the proactive role of clinicians and dietitians in supporting the needs of CKD patients in meeting their daily dietary requirements towards preventing and slowing the progression of CKD. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The authors received no specific funding for this work ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval was obtained from the Human Research Ethics Committee of the University of Witwatersrand, Johannesburg (ethics clearance certificate No. M190553). Informed consent was obtained from each of the participants before embarking on data collection. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Not Applicable All relevant data are within the manuscript and its Supporting Information files. * CKD : chronic kidney diseases CMJAH : Charlotte Maxeke Johannesburg Academic Hospital CKD-EPI : chronic kidney disease epidemiology collaboration ESKD : end stage kidney disease T2DM : Type 2 Diabetes Mellitus eGFR : estimated glomerular filtration rate IDMS : isotope dilution mass spectroscopy uPCR : urine protein creatinine ratio CCBs : calcium channel blockers ACEIs : angiotensin converting enzyme inhibitors ARBs : Aldosterone receptors blockers KDIGO : kidney disease improving global outcomes NCDs : non-communicable diseases SSA : sub Saharan Africa