Dermatological disorders among patients with chronic kidney disease at Muhimbili national hospital, Dar es salaam. Tanzania: prevalence, pattern, associated factors and impact on quality of life

Abstract

ABSTRACT Background: Dermatological disorders in chronic kidney disease (CKD) are common and occur at any stage of the disease. They can occur denovo or as a consequence of CKD itself, underlying etiology, or treatment modality. However, locally, there is limited current information on their clinical presentation and their effect on quality of life of these patients. This study determined the prevalence, pattern and associated factors of dermatological disorders among patients with CKD and their effects on patients’ quality of life. Methodology: A hospital-based cross-sectional study was conducted from September 2023 to January 2024 at the MNH in Dar es Salaam. Patients were recruited from the Nephrology wards and clinic, as well as the Haemodialysis (HD) unit. All eligible and consenting adult patients (age≥18 years) with CKD attending the unit were consecutively enrolled until the sample size was attained. For each patient, data on socio-demographic, clinical and laboratory characteristics were collected through a structured questionnaire. A thorough dermatological examination was carried out to establish the diagnosis. Digital photographs of all skin lesions were taken for confirmation of the diagnosis by a Dermatologist. The impact on quality of life was assessed using the Dermatology Life Quality Index (DLQI). Results of descriptive statistics were reported as median (IQR) and proportions as appropriate. Comparison of categorical variables was done using the Chi square or Fisher’s exact test, where appropriate. Factors associated with the dermatological disorders were assessed using the Modified Poisson Regression Model at univariate and multivariate level analyses. A p-value <0.05 was considered statistically significant. Results: Two hundred and twenty-five CKD patients participated in the study, of whom 60.9% were male. The overall median age was 55 years (IQR 43,64). Among the participants; 64% were hypertensive, and 28.9% were diabetic. 86.7% had CKD stage 5, vii and 65.3% were on hemodialysis. Related complications were hypocalcemia in 68.4%, hyperphosphatemia in 72.4%, and anemia in 94.7%. The overall prevalence of dermatological disorders was 88.9%. The common dermatological manifestations were pallor (90.5%), xerosis (47.8%), pruritus (29.6%), onychomycosis (25.6%), Lindsay’s nail (19.2%), mucosal changes (14%) and hair changes (8.5%). Factors found to be strongly associated with the presence of dermatological disorders were advanced CKD, HIV, hypocalcemia and anemia, (all with p<0.05). The statistically significant independent predictors of dermatological disorders were HIV (aPR 1.17), hyperphosphatemia (aPR 1.21) and anemia (aPR 1.72), all with p value<0.05. Quality of life was impaired in 22% of the participants. Pruritus was the only significant predictor of impaired DLQI (p<0.001). Conclusion: Dermatological disorders are highly prevalent among patients with CKD in our setting and are strongly associated with HIV, hyperphosphatemia and anemia. The dermatoses, in particular; pruritus, are associated with a significant negative impact on quality of life among the already burdened CKD patients. Recommendation: Appropriate strategies in our national and institutional treatment guidelines need to be developed for the early diagnosis and intervention against dermatological disorders among patients with CKD. These should also incorporate an assessment of their impact on quality of life with established tools such as the Dermatological Life Quality Index.