Abstract: PUB375
Clinical Implications of Cluster Analysis of CKD in KwaZulu-Natal (South Africa): Is It Time to Review the Five Stages of CKD?
Session Information
Category: CKD (Non-Dialysis)
- 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Author
- Assounga, Alain Guy Honoré, University of KwaZulu-Natal College of Health Sciences, Durban, KZN, South Africa
Background
Chronic Kidney Disease (CKD) has a prevalence of 5 – 20% worldwide. Chronic Kidney Disease is routinely divided into 5 stages, using eGFR. CKD stage 5 corresponds to patients with eGFR <15ml/min, they are treated by kidney replacement therapy (KRT). Most of the patients at CKD stage 5 experience uremic symptoms which improve with KRT. However, few patients with eGFR < 15ml/min may not have any symptoms and are often reluctant to agree to start KRT.
Methods
In this study demographic clinical and laboratory data from electronic records of 280 CKD patients attending Inkosi Albert Luthuli Central Hospital were collected and clustered using Ahmad-Dey distance as similarity measure.
Results
Contrary to the 5 stages commonly known, only 3 distinct clusters were identified by age, sex, estimated Glomerular filtration rate, urea, creatinine and hemoglobin, uric acid and not by blood pressure or race. (Table 1). The mean and confidence interval of eGFR of the 3 clusters are: Cluster A = 75, 75 [40÷84 – 107, 38], Cluster B = 12, 34 [9.86 – 16.18] and C 5.96 [4.72-6.84] (Table 1).
Conclusion
The clinical significance of the 3 clusters needs further evaluation. We proposed that cluster A patients be monitored and to receive treatment underlying kidney disease. For cluster B, patients to be closely monitored for the need for KRT while intensify kidney protection management. For cluster C, patient to be treated by KRT.
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 | <0.05 |
Funding
- Government Support – Non-U.S.