Clinical Profile and Outcome of In-Hospital Patients with Obstructive Nephropathy Admitted for Hemodialysis in Two Nigerian Urban Tertiary Care Centers

Abstract

A bstract Background: Obstructive nephropathy (ON) contributes significantly to the global cache of chronic kidney disease (CKD) patients reliant on hemodialytic therapy. The study was designed to elucidate the clinico-anthropologic correlates, outcomes, and survival determinants of in-hospital patients with ON admitted for hemodialysis in two Nigerian urban tertiary care centers. Materials and Methods: A two-centered retrospective evaluation of the clinical and dialysis documentations of eighty-one (81) patients with ON who had dialysis between September 1, 2021, and August 31, 2023, was undertaken. Descriptive and multivariate analyses on the clinico-anthropologic correlates and biochemical data obtained from these patients were undertaken using statistical product and service solutions version 25. Kaplan Meier survival plots were drawn with P value set at <0.05. Results: Of the 81 patients aged between 21 and 90 years with ON, who were offered 937 sessions of dialysis cumulatively, 56 (69.0%) were males. The mean age was 61.7 ± 15.5 years. Malignant causes ( n = 48, 59.3%) predominated, with prostatic cancer responsible for 40% of all cases of ON. Co-morbid conditions were identified in 43.2% ( n = 35). Twice-weekly hemodialysis sessions comprised the majority ( n = 44, 53.4%). The mortality rate was 11.6%. Acute renal deterioration heralded by sepsis on background CKD was predominant, occurring in 56 (71.6%) of these patients. Pre-dialytic sodium level ( P = 0.012) and duration on dialysis ( P = 0.027) were predictive of the outcomes. The survival of patients with ON was statistically influenced by intradialytic hypotension on Kaplan Meier analysis. Conclusion: Formulating preventive policies targeting diverse etiological bedrock of ON should be a global goal to reduce its rising burden as a cause of end-stage renal disease.