Prevalence of pulmonary hypertension and its associated factors among chronic kidney disease patients in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: An institution-based retrospective study

Prevalence of pulmonary hypertension and its associated factors among chronic kidney disease patients in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: An institution-based retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence of pulmonary hypertension and its associated factors among chronic kidney disease patients in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: An institution-based retrospective study Yemisrach Begashaw Lakew, Hanan Yusuf Ahmed, Merga Daba Mulisa, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7383969/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 13 Jan, 2026 Read the published version in BMC Cardiovascular Disorders → Version 1 posted 12 You are reading this latest preprint version Abstract Background and aim: In chronic kidney disease (CKD), including dialysis patients, pulmonary hypertension (PH) is linked to significant morbidity and death; however, its prevalence in Ethiopia is unknown. Therefore, the aim of this study is to determine the prevalence of PH and its associated factors among patients with CKD at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Methods A four-year retrospective cross-sectional study was carried out among patients with CKD who were receiving follow up care at renal and diabetic clinics of Tikur Anbessa Specialized Hospital, Ethiopia, from Sept 2020 to Sept 2024. The patient's medical record chart and/or electronic medical records were the sources of the data. SPSS version 27.1 was used for data analysis. Descriptive analysis was used to summarize the data, and a logistic regression analysis was used to identify the variables associated with the pulmonary hypertension. For the multivariate analysis model, every variable that had a p-value less than 0.20 in the univariate analysis was chosen. A p-value of < 0.05 was considered to be statistically significant. Results A total of 243 CKD patients were included, with a mean age of 60.95 ± 12.53 years, and 61.7% were male. The prevalence of pulmonary hypertension (PH) was 16.04% (95% CI: 11.8–21.7%), with 6.2% classified as severe. Advanced CKD (stages 3–5) (AOR: 3.32, 95% CI: 1.95–11.58, p = 0.048), type 2 diabetes mellitus (AOR: 3.18, 95% CI: 1.28–7.89, p = 0.01), and hypertension (AOR: 3.11, 95% CI: 1.35–7.19, p = 0.008) were identified as independent risk factors for PH. Conclusion and recommendations: Pulmonary hypertension (PH) is a significant comorbidity among Ethiopian CKD patients, with modifiable risk factors contributing to its development. These findings emphasize both the importance of routine PH screening in high-risk CKD populations and context-specific management strategies in resource-limited setups. Pulmonary hypertension chronic kidney disease Prevalence Risk factors Ethiopia Figures Figure 1 1. Introduction Globally, the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD) is cardiovascular disease [ 1 ]. Individuals with CKD frequently develop heart failure (HF), coronary heart disease (CHD), and cardiac arrhythmias. Pulmonary hypertension (PH) is increasingly recognized as a highly prevalent and potentially significant complication in patients with CKD [ 2 ]. It is a pathological condition characterized by persistently elevated pulmonary arterial pressure (PAP), defined as a mean PAP ≥ 20 mmHg at rest [ 3 ]. According to the most recent ERS/ESC classification (2022), CKD-associated PH is categorized as Group V PH (PH with unclear and/or multifactorial mechanisms) [ 4 ]. Between 21 and 27 percent of patients with chronic kidney disease (CKD) and up to 47 percent of patients with end-stage kidney diseases (ESKD) have PH [ 5 ]. Uncertainty surrounds the mechanisms of PH in CKD patients, which may include anemia, recurrent pulmonary embolism, arteriovenous fistulas, left ventricular dysfunction, mineral and bone abnormalities, and an imbalance between vasoconstrictors and vasodilators [ 6 ]. According to the most recent meta-analysis (2024) of more than fifty studies, PH was significantly higher among CKD patients who were Black, had chronic obstructive pulmonary disease, had a history of cardiovascular disease;., were receiving prolonged dialysis, had diastolic and systolic dysfunction, or were in the later stages of CKD [ 7 ]. Right heart catheterization with floating catheters is currently the gold standard for diagnosing PH. Noninvasive echocardiography is frequently utilized to determine estimated pulmonary artery systolic pressure (ePASP) in order to diagnose PH because of the invasive nature of this diagnostic procedure [ 8 ]. Transthoracic echocardiography is therefore currently regarded as a great noninvasive screening tool for those with PH symptoms or risk factors. However, it may understate the PH, and therefore, cannot replace RHC [ 9 ]. To evaluate the prevalence [ 7 , 10 ], predictors, mortality [ 7 ], and prognosis [ 11 ] of PH among patients with chronic kidney disease (CKD), numerous studies have been carried out in recent years. However, only a small number were reported from African countries [ 12 , 13 ], none from Ethiopia, and the bulk were in industrialized countries. In Ethiopia, the emerging burden of non-communicable diseases has become a serious public health concern, which has had a great impact on the incidence and magnitude of chronic diseases [ 14 ]. A recent meta-analysis of twelve publications found that the combined prevalence of chronic kidney disease (CKD) among people with chronic conditions (HIV, diabetes mellitus, hypertension, and cardiovascular disease) in Ethiopia is 21.71%, with notable regional variation [ 15 ]. Chronic kidney disease (CKD) is also a major public health problem in Ethiopia, and it’s prevalence ranges from 9.3% to 25.9% in diabetes mellitus (DM) patients. To the best of our knowledge, no published paper shows the prevalence or risk factors of PH among CKD patients in Ethiopia. In this study, therefore, we examined the prevalence and predictors of PH of chronic kidney disease among patients who have follow-ups in Tikur Anbessa Specialized Hospital in Ethiopia 2. Methods From September 2020 to September 2024, an institution-based retrospective cross-sectional study was conducted in the diabetic and renal clinics at Tikur Anbessa Specialized Hospital, one of the tertiary referral hospitals in Addis Ababa, Ethiopia. With over 400,000 patients seen in an outpatient follow-up clinic each year, TASH is the biggest teaching and tertiary hospital in the nation. It is one of the biggest and most pioneering teaching centers under the administration of Addis Ababa University. The college runs multiple postgraduate and fellowship programs, not to mention it has been the earliest center for undergraduate medicine programs for more than 50 years. In the renal department of the hospital, approximately 4000 patients have been on follow-up, and it also provides dialysis and inpatient care. 2.1 Study population All adult patients with chronic kidney disease who have follow-ups at renal and diabetic clinics in TASH in Addis Ababa, Ethiopia, and who fulfilled the inclusion criteria. 2.2 Eligibility criteria Eligible patients were all CKD patients aged ≥ 18 years, based on the Kidney Disease Improving Global Outcome 2024 criteria, including CKD patients on hemodialysis with complete data needed for the study. 2.3 Sample size and sampling methods The sample size was calculated with the sample size determination using the single population formula at a 95% confidence interval (Za1/2 = 1.96), the margin of error (d) = 5%, and the proportion of PH among CKD patients is 23.5% in Egypt [ 16 ]. N \(\:=\frac{p\left(1-p\right)({Za/2)}^{2}}{({d)}^{2}}=\frac{0.235\left(1-0.235\right)({1.96)}^{2}\:\:}{({0.05)}^{2}}=\:\) 276 After adding a 10% nonresponse rate (incomplete data), the sample became 303. The study participants were selected through systematic random sampling technique. 2.4 Variables The dependent variable was the magnitude of the pulmonary hypertension, while the independent variables were socio-demographic characteristics (age, sex, location/address). Behavioral characteristics (smoking, alcohol use, k hat) , clinical characteristics (duration of CKD, cause of CKD, stage of CKD, management of CKD, investigation for CKD (Hgb, PTH, serum calcium level), comorbidities such as CHD, VHD, HIV, thyroid disorder, post-TB lung disease, OSA, PTE). 2.5 Data collection procedures and quality assurance A pre-made data abstraction tool and questionnaire were used to gather data. Trained general practitioners who had received training prior to the start of the data gathering process collected the information out of the patient's electronic and/or medical records. The lead investigator oversaw the procedure during that time. 2.6 Operational definition Pulmonary hypertension (PH ): PH is suggested echocardiographically when the TRV is ≥ 2.8 m/s, the ePASP exceeds 35 mmHg, and/or when RV size, wall thickness, and function are abnormal. It is classified as mild (35–50 mmHg), moderate (50–70 mmHg), and severe (> 70 mmHg) based on the systolic PA pressure [ 17 ]. Chronic kidney disease CKD is defined as abnormalities of kidney structure or function, present for > 3 months with health implications. Based on GFR estimated by CKD-EPI (without the race factor), classified as G1 (GFR ≥ 90), G2 (GFR 60–89), G3a (GFR 45–59), G3b (GFR 30–44), G4 (GFR 15–29), and G5 (GFR < 15) mL/min/1.73 m² [ 18 ]. 2.8 Data processing and analysis The data in Excel format (downloaded from Kobo Collect) was uploaded to SPSS version 27.1 for cleaning and analysis. We used proportions (percentages) to describe categorical data. For continuous variables, the normal distribution variables' mean (± standard deviation) was utilized, while the non-normal distribution variables' median (interquartile range) was employed. To compare categorical variables, the chi-square test or Fisher's exact test was employed. A logistic regression analysis was used to identify the variables associated with the PH. All variables with a p-value < 0.20 in the univariate analysis were selected for the multivariate analysis model. A p-value of < 0.05 and a 95% confidence interval were considered statistically significant. 3. Result 3.1 Sociodemographic and behavioral characteristics The total estimated sample was 303, with data collected from 243 participants, resulting in a response rate of 80.2%. The mean age of participants was 60.95 ± 12.53 years. Most participants were male (61.7%) and aged 46–65 years (52.7%). 21% of patients are from the diabetic clinic, whereas79% of individuals are from the renal clinic. The majority resided in the highlands (86.0%) and in Addis Ababa (77.4%). 13.6% have a history of smoking. Additionally, 30.7% of individuals have a body mass index > 25. (Table 1 ). Table 1 Demographic and Lifestyle Characteristics of CKD Patients in a Tertiary Hospital in Addis Ababa, Ethiopia Variables Count Percentage Sex Female 93 38.3 Male 150 61.7 Age groups (years) 65 84 34.6 Location Highlands (Dega) 209 86.0 Lowlands (Kolla) 20 8.2 Midland (Woina Dega) 14 5.8 Living Addis Ababa 188 77.4 Out of Addis Ababa 57 22.6 Smoking history Never smoke 210 86.4 Previous smoker 31 12.7 Current smoker 2 0.8 Alcoholic history Never drink 210 86.4 Occasionally 27 11.1 Regularly 6 2.5 Chat chewing Never Chew chat 230 94.6 Occasionally 7 2.9 Regularly 6 2.5 Body mass index (n = 189) 30 6 3.2 3.2 Cause of CKD, staging, and comorbidities The major findings of the study highlight that Stage 3b CKD (GFR 30–44) was the most prevalent, affecting 29.6% of patients, followed by Stage 3a (GFR 45–59) at 21.0%. Type II Diabetes Mellitus was the leading cause of CKD, contributing to 53.1% of cases, followed by hypertension at 30.5%. A large majority of patients (65.0%) had CKD for less than 5 years, with a mean duration of CKD of 3.9 ± 2.5 years, indicating recent diagnoses or slow progression. 7 patients were on hemodialysis. Comorbidities such as left heart disease (23.5%), valvular heart disease (10.2%), and HIV (8.6%) were common. In terms of treatment, enalapril/losartan (57.6%), statin (55.6%), and dapagliflozin (49.4%) were frequently prescribed medications.( Table 2 ) Table 2 Distribution of Study Participants by CKD Stage, Duration, Causes, Comorbidities, and Medication Use Variables Count Percentage Stage of CKD Stag 1(GFR > 90) 14 5.8 Stage 2(GFR 60–89) 41 16.9 Stage 3a (GFR 45–59) 51 21.0 Stage 3b (GFR 30–44) 72 29.6 Stage 4(GFR 15–29) 40 16.5 Stage 5(GFR < 15ml) 25 10.3 Duration of CKD Less than 5 years 158 65.0 5 to 10 years 79 32.5 Above 10 years 6 2.5 Cause of CKD Type II diabetes Mellitus 129 53.1 Hypertension 74 30.5 Obstructive uropathy 16 6.6 Glomerulonephritis 8 3.3 Cardiorenal syndrome 7 2.9 Others 6 2.5 Not documented 3 1.2 Comorbidities Chronic obstructive lung disease 10 4.1 Current/Previous pulmonary TB 19 7.8 Valvular heart disease 25 10.2 Left heart disease 57 23.5 Human immunodeficiency virus 21 8.6 Thyroid dysfunction 6 2.4 CKD medication (n = 152) Dapagliflozin 120 49.4 Enlapril /Losartan/ 140 57.6 Statin 135 55.6 Others 14 5.8 3.3 Laboratory findings The major findings show that the largest proportion of patients had creatinine levels between 1.6 and 2.5 mg/dL (37.0%), with 8.2% having levels above 4.5 mg/dL. In terms of hemoglobin levels, the majority of females (64.5%) and males (74.0%) had levels above normal, with males generally showing higher levels. Most patients had normal total calcium levels (8.5–10.5 mg/dL) (44.4%), while 13.2% had low levels (< 8.5 mg/dL). The majority had LDL levels below 100 mg/dL (49.8%), and the mean LDL was 77.54 mg/dL. A significant portion of patients had triglyceride levels below 150 mg/dL (42.4%), with 20.2% showing elevated levels (Table 3 ). The mean parathyroid hormone (PTH) (n = 26) was 397.34 ± 279.12 pg/mL, with a range from 99.5 to 935 pg/mL. HBV was present in 1.65% of patients, and HCV was detected in 0.41% of patients.(Table 3 ) Table 3 Laboratory findings of CKD patients in tertiary hospital in Addis Ababa Ethiopia Variables Count Percentage Creatinine level 4.5 20 8.2 Hemoglobin level Female 12g/dl 60 64.5 Male 13g/dl 111 74.0 Total calcium Less than 8.5 32 13.2 8.5–10.5 108 44.4 >10.5 15 6.2 Mean Low-density lipoprotein (n = 155) 77.54 + 32.52 100 mg/dl 34 14.0 Triglyceride level(n = 152) 135.19 + 74.2 150 mg/dL 49 20.2 3.4 Prevalence of PH among CKD The overall prevalence of pulmonary hypertension (PH) is 16.04% (39/243) (95% CI, 11.8–21.7%), with 6.2% of individuals exhibiting severe PH (> 70 mmHg), 5.3% with mild PH (35–50 mmHg), and 4.5% with moderate PH (50–70 mmHg) (Fig. 1 ). Additionally, right ventricular hypertrophy (RVH) was observed in 15.3% of individuals, and 64% had documented tricuspid regurgitation (TR). Among 215 individuals with documented left ventricular ejection fraction (LVEF), 57.2% had a normal LVEF (> 50%), 22.2% had a mildly reduced LVEF (40–49%), and 9.1% had a reduced LVEF (< 40%). 3.5. Comorbidities for PH among CKD patients The major findings of the study highlighted that left heart disease was the most prevalent comorbidity, found in 30.8% of PH patients, followed by valvular heart disease at 25.6%. Current/previous pulmonary TB accounted for 17.9%, HIV 7%, and HIV with TB coinfection accounted for 10.3% of total PH patients with CKD.( Table 4 ) Table 4 The proportion of PH among the comorbidities Variables Count Percentage HIV 3 7.7 Current/previous TB 7 17.9 HIV + TB 4 10.3 Valvular heart disease 10 25.6 Left side heart disease 12 30.8 COPD 2 5.1 Thyroid disease 1 2.6 3.6. Risk factors for PH among CKD patients In the crude analysis (COR), variables with a p-value less than 0.2 were considered for further analysis. Stage 3–5 CKD (p = 0.031), presence of type 2 diabetes mellitus (p = 0.043), presence of hypertension (p = 0.008), creatinine level (p = 0.09), and hemoglobin level (p = 0.08) met the inclusion criteria for multivariable analysis. In the multivariable analysis, patients with stage 3–5 CKD had a 3.32 times higher likelihood of developing pulmonary hypertension (PH) compared to those with stage 1–2 CKD (AOR: 3.32, 95% CI: 1.95–11.58, p = 0.048). The presence of type 2 diabetes mellitus was associated with a 3.18-fold increased risk of PH compared to those without diabetes (AOR: 3.18, 95% CI: 1.28–7.89, p = 0.01). Similarly, patients with hypertension had a 3.11-fold higher likelihood of developing PH compared to non-hypertensive individuals (AOR: 3.11, 95% CI: 1.35–7.19, p = 0.008) (Table 5 ). Table 5 Binary logistic Analysis of Factors Associated with Pulmonary Hypertension in CKD Patients in tertiary hospital in Addis Ababa, Ethiopia Variables COR (95%CI) P-Value AOR (95%CI) P- value Stage 3–5 CKD staging 3.83(1.13,12.98) 0.031 3.32(1.95,11.58) 0. 048 Creatinine level 1.18(0.98,1.39) 0.09 1.08(0.87,1.33) 0.49 Hemoglobin level 0.89(0.79,1.01) 0.08 0.92(0.81,1.05) 0.22 Presences of T2DM 2.45(1.03,5.86) 0.043 3.18(1.28,7.89) 0.01 Presences of HTN 2.93(1.32,6.53) 0.008 3.11(1.35,7.19) 0.008 COR: Crude Odds Ratio, AOR: Adjusted Odds Ratio 4. Discussion This study aimed to determine the prevalence of PH among CKD patients attending follow-up at a tertiary hospital in Ethiopia. The overall prevalence of PH was 16.04%, with 6.2% of individuals exhibiting severe PH (> 70 mmHg). In stages 3–5 CKD, the presence of T2DM and hypertension was identified as an independent risk factor for PH. The prevalence of PH in CKD patients varies significantly across studies. In our study, the overall PH prevalence was 16.04%, with 6.2% of cases classified as severe. This is notably lower than global meta-analyses, which reported rates of 30–42% in CKD populations, particularly among dialysis-dependent patients [ 7 , 19 , 20 ]. However, it aligns more closely with regional data from Iraq (15% in stage V CKD) [ 21 ] and Egypt (23.5%) [ 16 ]. These discrepancies may stem from differences in diagnostic criteria, such as the use of echocardiography in our study versus right heart catheterization in Egypt [ 16 ], which captures milder cases. Additionally, our cohort includes 7 dialysis patients compared to meta-analyses that predominantly pool data from these high-risk subgroups. For example, China and India reported PH prevalence as high as 47–50% in dialysis populations [ 22 , 2 ], underscoring the impact of renal replacement therapy on PH risk. Somalia’s exceptionally high prevalence (51%) [ 13 ] highlights how regional factors, such as older age and limited healthcare access, may exacerbate the PH burden. The 6.2% prevalence of severe PH (sPAP > 70 mmHg) in our study further highlights a high-risk subgroup. Severe PH is often irreversible and linked to poor outcomes, as seen in China, where 10–25% of CKD patients on hemodialysis develop severe PH due to vascular calcification and chronic volume overload [ 22 ]. Our lower severe PH prevalence may reflect earlier detection, less advanced cardiac remodeling, or differences in diagnostic rigor (e.g., echocardiography vs. catheterization). Advanced CKD (stages 3–5) emerged as a central risk factor in our study, aligning with global trends, including studies from China, where advanced (on dialysis) populations exhibit high PH prevalence (42–58%), which might be related to prolonged fluid shifts and vascular stress [ 22 ]. In our patients, the development of the PH might be due to mechanisms such as fluid overload from impaired sodium excretion, uremic toxin accumulation, and secondary hyperparathyroidism, which promote endothelial dysfunction and vascular calcification [ 7 , 22 ]. Type 2 diabetes mellitus was independently associated with PH in our study, which aligns with findings from India and the U.S., where T2DM amplifies PH risk [ 2 , 23 ]. Lastly, HTN, a well-documented PH risk factor, was another factor identified in our findings, consistent with India and U.S. [ 2 ] studies that tie HTN to left ventricular dysfunction and pulmonary venous congestion. However, dialysis-centric cohorts (e.g., China [ 22 ]) prioritize fluid overload and arteriovenous fistula hemodynamics, whereas our non-dialysis-heavy cohort underscores hypertension's metabolic contributions. 5. Conclusion and recommendation This study showed that the prevalence of PH in Ethiopian CKD patients was 16.04% and 6.2% of cases had severe PH, highlighting PH as a prominent comorbidity. Type 2 diabetes mellitus (T2DM), hypertension, and advanced chronic kidney disease (CKD) (stages 3–5) have been identified as important independent risk factors that correspond with global mechanistic pathways. An interdisciplinary strategy is necessary to address this problem. Clinically, high-risk CKD patients, especially those with advanced stages (3–5), type 2 diabetes mellitus (T2DM), and/or hypertension, should have PH screening by echocardiography incorporated into their regular care. In order to clarify long-term PH trajectories and enhance generalizability across various contexts, more research is required, particularly prospective multicenter trials with biomarker integration and extended regional cooperation. Abbreviations CKD: Chronic Kidney Disease DM: Diabetes mellitus ePASP: estimated pulmonary artery systolic pressure ESRD: End-Stage Renal Disease GFR: Glomerular filtration rate KRT: kidney replacement therapy PAH: Pulmonary Arterial Hypertension PH: Pulmonary Hypertension PTE: Pulmonary thromboembolism TRV: Tricuspid regurgitation velocity HIV: Human immunodeficiency virus Declarations Clinical trial number Not applicable. Ethics approval and consent to participate This study was approved by the Research Ethics Committee of Department of Internal Medicine, College of health sciences, Addis Ababa University ( Protocol number 156/24 ) . As a retrospective review of routinely collected data, informed consent was waived by the Research Ethics Committee. Patient identifiers were removed prior to analysis and data were stored on password-protected servers. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Consent for publication Consent is waived by the Research Ethics Committee of department of Internal medicine, college of health sciences, Addis Ababa University, Addis Ababa (Protocol number 156/24) Competing interests The authors declare no competing interests. Author’s details 1 Department of Internal medicine, College of health sciences, Addis Ababa University, Addis Ababa, Ethiopia. 2 Division of pulmonology, Department of Internal medicine, College of health sciences, Addis Ababa University, Addis Ababa, Ethiopia. 3 Department of Internal medicine,Yekatit 12 Hospital Medical college, Addis Ababa, Ethiopia 4 School of medicine, College of health science, Addis Ababa University, Addis Ababa, Ethiopia 5 Nephrology Unit, Department of Internal Medicine, School of Health Sciences Addis Ababa University Addis Ababa Ethiopia. Funding No funding was used for this study Author Contribution Y.B.L: Conceptualization, data collection, data analysis, reviewing and editingH.Y.A: Conceptualization,supervision,reviewing and editing, validationM.D.M: Reviewing and editing, final report writingB.A: Reviewing and editing, final report writingM.A: Data collection and report writingH.A: Data collection and report writingL.S.A: Supervision and validation Acknowledgement First and foremost, I would like to thank AAU and the CHS Department of Internal Medicine for facilitating this research experience. Data Availability The data used and/or analyzed during the current study is provided within the manuscript and further details can be requested from the first author/ corresponding author. References Clementi A, Virzì GM, Goh CY, Cruz DN, Granata A, Vescovo G, et al. Cardiorenal Syndrome Type 4: Rev Cardiorenal Med. 2013;3:63. Suresh H, Arun BS, Moger V, Vijayalaxmi PB, Murali Mohan KTK. 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Cite Share Download PDF Status: Published Journal Publication published 13 Jan, 2026 Read the published version in BMC Cardiovascular Disorders → Version 1 posted Editorial decision: Revision requested 18 Nov, 2025 Reviews received at journal 02 Nov, 2025 Reviewers agreed at journal 29 Oct, 2025 Reviewers agreed at journal 26 Oct, 2025 Reviewers agreed at journal 22 Oct, 2025 Reviews received at journal 18 Oct, 2025 Reviewers agreed at journal 28 Sep, 2025 Reviewers invited by journal 23 Sep, 2025 Editor assigned by journal 23 Sep, 2025 Editor invited by journal 15 Sep, 2025 Submission checks completed at journal 13 Sep, 2025 First submitted to journal 13 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Lakew","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIiWNgGAWjYJCCA4wNDAxs/M0HgGwJGeK18EkcSwBp4SHOGpAWOYYcAxCbsBaD492JB3/usEtsYzjz+dWNGgseBvbDRzfg1XLm7IbDvGeSE9uYe7dZ5xwDOownLe0GXi03cjccZmxjzm1jOLvNOIcNqEWCxwy/lvtvNxz82VYP1JLzzDjnHzFabvBuOMDbdhikhflxbhsRWiTPAB3G23a8vk3imBlzbp8EDxshv/AdP7v548+2amP5/ubHn3O+1cnxsx8+hleLwgEEm00CTOJTDgLyDQg28wdCqkfBKBgFo2BkAgDjF1Aq7gYK9AAAAABJRU5ErkJggg==","orcid":"","institution":"College of health science, Addis Ababa University","correspondingAuthor":true,"prefix":"","firstName":"Yemisrach","middleName":"Begashaw","lastName":"Lakew","suffix":""},{"id":524259439,"identity":"d6c14e3c-60e5-42ec-bc15-a62c945bffb5","order_by":1,"name":"Hanan Yusuf Ahmed","email":"","orcid":"","institution":"Division of pulmonology, Department of Internal medicine, College of health sciences, Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Hanan","middleName":"Yusuf","lastName":"Ahmed","suffix":""},{"id":524259440,"identity":"c3a0e56b-7c9c-46b3-8c5b-8bf1d0feec1c","order_by":2,"name":"Merga Daba Mulisa","email":"","orcid":"","institution":"Department of Internal medicine, College of health sciences, Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Merga","middleName":"Daba","lastName":"Mulisa","suffix":""},{"id":524259441,"identity":"83d70454-cbaa-4307-b2a1-717caa8760e0","order_by":3,"name":"Balew Arega","email":"","orcid":"","institution":"Department of Internal medicine,Yekatit 12 Hospital Medical college","correspondingAuthor":false,"prefix":"","firstName":"Balew","middleName":"","lastName":"Arega","suffix":""},{"id":524259442,"identity":"7036d847-fce2-4482-ae89-619a226726c0","order_by":4,"name":"Mikiyas Abebe","email":"","orcid":"","institution":"College of health science, Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Mikiyas","middleName":"","lastName":"Abebe","suffix":""},{"id":524259443,"identity":"93988dcf-d8ee-4ffc-a001-6a7297069ebe","order_by":5,"name":"Hiwot Anley","email":"","orcid":"","institution":"College of health science, Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Hiwot","middleName":"","lastName":"Anley","suffix":""},{"id":524259444,"identity":"d0f6de6e-56c3-4777-8103-d8a6b71b71a7","order_by":6,"name":"Lissane Seifu Asres","email":"","orcid":"","institution":"Nephrology Unit, Department of Internal Medicine, School of Health Sciences, Addis Ababa University","correspondingAuthor":false,"prefix":"","firstName":"Lissane","middleName":"Seifu","lastName":"Asres","suffix":""}],"badges":[],"createdAt":"2025-08-15 21:08:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7383969/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7383969/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12872-026-05516-2","type":"published","date":"2026-01-13T16:31:02+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":93006970,"identity":"70a54f6e-7ac1-4618-b2f2-8e163a2bc3c4","added_by":"auto","created_at":"2025-10-08 06:48:41","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":70316,"visible":true,"origin":"","legend":"","description":"","filename":"7.4PHstudy.docx","url":"https://assets-eu.researchsquare.com/files/rs-7383969/v1/ab00f0897e4e55d622e9a755.docx"},{"id":93006973,"identity":"26e1a00d-0a2f-48e6-9cc9-9badc2fa2286","added_by":"auto","created_at":"2025-10-08 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06:48:41","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":95114,"visible":true,"origin":"","legend":"","description":"","filename":"95adb6d535ad452083a344dba453e5c71structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7383969/v1/53501786bae36cbc1309c77e.xml"},{"id":93007843,"identity":"dda04f8d-b542-4e2d-bc2a-edfccd1495eb","added_by":"auto","created_at":"2025-10-08 06:56:41","extension":"html","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":104404,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7383969/v1/07836b48988c7a8a36daad1f.html"},{"id":93007842,"identity":"a6a3f6b2-2ca8-4248-9ee3-29bc9928f726","added_by":"auto","created_at":"2025-10-08 06:56:41","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":32481,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of PH among CKD patients in a tertiary hospital in Addis Ababa, Ethiopia\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7383969/v1/a26b49ee8e7f573fc1167bce.png"},{"id":100617921,"identity":"052ba304-1573-41ff-b67f-6f3c10e2819f","added_by":"auto","created_at":"2026-01-19 17:57:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1213042,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7383969/v1/bbf49728-cd97-47ad-a18e-ab124ad8176b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence of pulmonary hypertension and its associated factors among chronic kidney disease patients in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: An institution-based retrospective study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eGlobally, the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD) is cardiovascular disease [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Individuals with CKD frequently develop heart failure (HF), coronary heart disease (CHD), and cardiac arrhythmias. Pulmonary hypertension (PH) is increasingly recognized as a highly prevalent and potentially significant complication in patients with CKD [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. It is a pathological condition characterized by persistently elevated pulmonary arterial pressure (PAP), defined as a mean PAP\u0026thinsp;\u0026ge;\u0026thinsp;20 mmHg at rest [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. According to the most recent ERS/ESC classification (2022), CKD-associated PH is categorized as Group V PH (PH with unclear and/or multifactorial mechanisms) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBetween 21 and 27 percent of patients with chronic kidney disease (CKD) and up to 47 percent of patients with end-stage kidney diseases (ESKD) have PH [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Uncertainty surrounds the mechanisms of PH in CKD patients, which may include anemia, recurrent pulmonary embolism, arteriovenous fistulas, left ventricular dysfunction, mineral and bone abnormalities, and an imbalance between vasoconstrictors and vasodilators [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. According to the most recent meta-analysis (2024) of more than fifty studies, PH was significantly higher among CKD patients who were Black, had chronic obstructive pulmonary disease, had a history of cardiovascular disease;., were receiving prolonged dialysis, had diastolic and systolic dysfunction, or were in the later stages of CKD [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRight heart catheterization with floating catheters is currently the gold standard for diagnosing PH. Noninvasive echocardiography is frequently utilized to determine estimated pulmonary artery systolic pressure (ePASP) in order to diagnose PH because of the invasive nature of this diagnostic procedure [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Transthoracic echocardiography is therefore currently regarded as a great noninvasive screening tool for those with PH symptoms or risk factors. However, it may understate the PH, and therefore, cannot replace RHC [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTo evaluate the prevalence [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], predictors, mortality [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], and prognosis [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] of PH among patients with chronic kidney disease (CKD), numerous studies have been carried out in recent years. However, only a small number were reported from African countries [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], none from Ethiopia, and the bulk were in industrialized countries.\u003c/p\u003e\u003cp\u003eIn Ethiopia, the emerging burden of non-communicable diseases has become a serious public health concern, which has had a great impact on the incidence and magnitude of chronic diseases [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. A recent meta-analysis of twelve publications found that the combined prevalence of chronic kidney disease (CKD) among people with chronic conditions (HIV, diabetes mellitus, hypertension, and cardiovascular disease) in Ethiopia is 21.71%, with notable regional variation [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Chronic kidney disease (CKD) is also a major public health problem in Ethiopia, and it\u0026rsquo;s prevalence ranges from 9.3% to 25.9% in diabetes mellitus (DM) patients. To the best of our knowledge, no published paper shows the prevalence or risk factors of PH among CKD patients in Ethiopia. In this study, therefore, we examined the prevalence and predictors of PH of chronic kidney disease among patients who have follow-ups in Tikur Anbessa Specialized Hospital in Ethiopia\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eFrom September 2020 to September 2024, an institution-based retrospective cross-sectional study was conducted in the diabetic and renal clinics at Tikur Anbessa Specialized Hospital, one of the tertiary referral hospitals in Addis Ababa, Ethiopia. With over 400,000 patients seen in an outpatient follow-up clinic each year, TASH is the biggest teaching and tertiary hospital in the nation. It is one of the biggest and most pioneering teaching centers under the administration of Addis Ababa University. The college runs multiple postgraduate and fellowship programs, not to mention it has been the earliest center for undergraduate medicine programs for more than 50 years. In the renal department of the hospital, approximately 4000 patients have been on follow-up, and it also provides dialysis and inpatient care.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study population\u003c/h2\u003e\u003cp\u003eAll adult patients with chronic kidney disease who have follow-ups at renal and diabetic clinics in TASH in Addis Ababa, Ethiopia, and who fulfilled the inclusion criteria.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Eligibility criteria\u003c/h2\u003e\u003cp\u003eEligible patients were all CKD patients aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years, based on the Kidney Disease Improving Global Outcome 2024 criteria, including CKD patients on hemodialysis with complete data needed for the study.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Sample size and sampling methods\u003c/h2\u003e\u003cp\u003eThe sample size was calculated with the sample size determination using the single population formula at a 95% confidence interval (Za1/2\u0026thinsp;=\u0026thinsp;1.96), the margin of error (d)\u0026thinsp;=\u0026thinsp;5%, and the proportion of PH among CKD patients is 23.5% in Egypt [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eN \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:=\\frac{p\\left(1-p\\right)({Za/2)}^{2}}{({d)}^{2}}=\\frac{0.235\\left(1-0.235\\right)({1.96)}^{2}\\:\\:}{({0.05)}^{2}}=\\:\\)\u003c/span\u003e\u003c/span\u003e 276\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAfter adding a 10% nonresponse rate (incomplete data), the sample became 303.\u003c/p\u003e\u003cp\u003eThe study participants were selected through systematic random sampling technique.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Variables\u003c/h2\u003e\u003cp\u003eThe dependent variable was the magnitude of the pulmonary hypertension, while the independent variables were \u003cb\u003esocio-demographic characteristics\u003c/b\u003e (age, sex, location/address). \u003cb\u003eBehavioral characteristics\u003c/b\u003e (smoking, alcohol use, k\u003cb\u003ehat)\u003c/b\u003e, clinical characteristics (duration of CKD, cause of CKD, stage of CKD, management of CKD, investigation for CKD (Hgb, PTH, serum calcium level), comorbidities such as CHD, VHD, HIV, thyroid disorder, post-TB lung disease, OSA, PTE).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Data collection procedures and quality assurance\u003c/h2\u003e\u003cp\u003eA pre-made data abstraction tool and questionnaire were used to gather data. Trained general practitioners who had received training prior to the start of the data gathering process collected the information out of the patient's electronic and/or medical records. The lead investigator oversaw the procedure during that time.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.6 Operational definition\u003c/h2\u003e\u003cp\u003e\u003cb\u003ePulmonary hypertension (PH\u003c/b\u003e): PH is suggested echocardiographically when the TRV is \u0026ge;\u0026thinsp;2.8 m/s, the ePASP exceeds 35 mmHg, and/or when RV size, wall thickness, and function are abnormal. It is classified as mild (35\u0026ndash;50 mmHg), moderate (50\u0026ndash;70 mmHg), and severe (\u0026gt;\u0026thinsp;70 mmHg) based on the systolic PA pressure [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eChronic kidney disease\u003c/strong\u003e\u003cp\u003eCKD is defined as abnormalities of kidney structure or function, present for \u0026gt;\u0026thinsp;3 months with health implications. Based on GFR estimated by CKD-EPI (without the race factor), classified as G1 (GFR\u0026thinsp;\u0026ge;\u0026thinsp;90), G2 (GFR 60\u0026ndash;89), G3a (GFR 45\u0026ndash;59), G3b (GFR 30\u0026ndash;44), G4 (GFR 15\u0026ndash;29), and G5 (GFR\u0026thinsp;\u0026lt;\u0026thinsp;15) mL/min/1.73 m\u0026sup2; [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e2.8 Data processing and analysis\u003c/h2\u003e\u003cp\u003eThe data in Excel format (downloaded from Kobo Collect) was uploaded to SPSS version 27.1 for cleaning and analysis. We used proportions (percentages) to describe categorical data. For continuous variables, the normal distribution variables' mean (\u0026plusmn;\u0026thinsp;standard deviation) was utilized, while the non-normal distribution variables' median (interquartile range) was employed. To compare categorical variables, the chi-square test or Fisher's exact test was employed. A logistic regression analysis was used to identify the variables associated with the PH. All variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.20 in the univariate analysis were selected for the multivariate analysis model. A p-value of \u0026lt;\u0026thinsp;0.05 and a 95% confidence interval were considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Result","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Sociodemographic and behavioral characteristics\u003c/h2\u003e\u003cp\u003eThe total estimated sample was 303, with data collected from 243 participants, resulting in a response rate of 80.2%. The mean age of participants was 60.95\u0026thinsp;\u0026plusmn;\u0026thinsp;12.53 years. Most participants were male (61.7%) and aged 46\u0026ndash;65 years (52.7%). 21% of patients are from the diabetic clinic, whereas79% of individuals are from the renal clinic. The majority resided in the highlands (86.0%) and in Addis Ababa (77.4%). 13.6% have a history of smoking. Additionally, 30.7% of individuals have a body mass index\u0026thinsp;\u0026gt;\u0026thinsp;25. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic and Lifestyle Characteristics of CKD Patients in a Tertiary Hospital in Addis Ababa, Ethiopia\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCount\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e38.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e61.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eAge groups (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35\u0026ndash;45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46\u0026ndash;65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e52.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e34.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eLocation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHighlands (Dega)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e209\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e86.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLowlands (Kolla)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMidland (Woina Dega)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eLiving\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAddis Ababa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e188\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e77.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOut of Addis Ababa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e22.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eSmoking history\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNever smoke\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e86.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrevious smoker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCurrent smoker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eAlcoholic history\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNever drink\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e86.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOccasionally\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRegularly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eChat chewing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNever Chew chat\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e230\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e94.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOccasionally\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRegularly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eBody mass index\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;189)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;18.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18.5\u0026ndash;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e67.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25-29.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e27.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Cause of CKD, staging, and comorbidities\u003c/h2\u003e\u003cp\u003eThe major findings of the study highlight that Stage 3b CKD (GFR 30\u0026ndash;44) was the most prevalent, affecting 29.6% of patients, followed by Stage 3a (GFR 45\u0026ndash;59) at 21.0%. Type II Diabetes Mellitus was the leading cause of CKD, contributing to 53.1% of cases, followed by hypertension at 30.5%. A large majority of patients (65.0%) had CKD for less than 5 years, with a mean duration of CKD of 3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5 years, indicating recent diagnoses or slow progression. 7 patients were on hemodialysis. Comorbidities such as left heart disease (23.5%), valvular heart disease (10.2%), and HIV (8.6%) were common. In terms of treatment, enalapril/losartan (57.6%), statin (55.6%), and dapagliflozin (49.4%) were frequently prescribed medications.( Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e )\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of Study Participants by CKD Stage, Duration, Causes, Comorbidities, and Medication Use\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eCount\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eStage of CKD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStag 1(GFR\u0026thinsp;\u0026gt;\u0026thinsp;90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStage 2(GFR 60\u0026ndash;89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStage 3a (GFR 45\u0026ndash;59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStage 3b (GFR 30\u0026ndash;44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e29.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStage 4(GFR 15\u0026ndash;29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStage 5(GFR\u0026thinsp;\u0026lt;\u0026thinsp;15ml)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDuration of CKD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLess than 5 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e65.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 to 10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e32.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAbove 10 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCause of CKD\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eType II diabetes Mellitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e129\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e53.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e30.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eObstructive uropathy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGlomerulonephritis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCardiorenal syndrome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNot documented\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eComorbidities\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChronic obstructive lung disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCurrent/Previous pulmonary TB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eValvular heart disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLeft heart disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e23.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHuman immunodeficiency virus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThyroid dysfunction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCKD medication (n\u0026thinsp;=\u0026thinsp;152)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eDapagliflozin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e49.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eEnlapril /Losartan/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e57.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eStatin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e55.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Laboratory findings\u003c/h2\u003e\u003cp\u003eThe major findings show that the largest proportion of patients had creatinine levels between 1.6 and 2.5 mg/dL (37.0%), with 8.2% having levels above 4.5 mg/dL. In terms of hemoglobin levels, the majority of females (64.5%) and males (74.0%) had levels above normal, with males generally showing higher levels. Most patients had normal total calcium levels (8.5\u0026ndash;10.5 mg/dL) (44.4%), while 13.2% had low levels (\u0026lt;\u0026thinsp;8.5 mg/dL). The majority had LDL levels below 100 mg/dL (49.8%), and the mean LDL was 77.54 mg/dL. A significant portion of patients had triglyceride levels below 150 mg/dL (42.4%), with 20.2% showing elevated levels (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The mean parathyroid hormone (PTH) (n\u0026thinsp;=\u0026thinsp;26) was 397.34\u0026thinsp;\u0026plusmn;\u0026thinsp;279.12 pg/mL, with a range from 99.5 to 935 pg/mL. HBV was present in 1.65% of patients, and HCV was detected in 0.41% of patients.(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLaboratory findings of CKD patients in tertiary hospital in Addis Ababa Ethiopia\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCount\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eCreatinine level\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.2\u0026ndash;1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.6\u0026ndash;2.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e37.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.6\u0026ndash;4.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;4.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHemoglobin level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;8 g/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e6.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u0026ndash;9.9 g/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e9.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;11.9 g/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e19.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;12g/dl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e64.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;8 g/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e4.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u0026ndash;10.9 g/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e8.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;12.9 g/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e13.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;13g/dl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e74.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal calcium\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eLess than 8.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e13.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e8.5\u0026ndash;10.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e44.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u0026gt;10.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e6.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMean Low-density lipoprotein (n\u0026thinsp;=\u0026thinsp;155)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e77.54\u0026thinsp;+\u0026thinsp;32.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u0026lt;100 mg/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e121\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e49.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u0026gt;100 mg/dl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e14.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTriglyceride level(n\u0026thinsp;=\u0026thinsp;152)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e135.19\u0026thinsp;+\u0026thinsp;74.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;150 mg/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e103\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e42.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;150 mg/dL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e20.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Prevalence of PH among CKD\u003c/h2\u003e\u003cp\u003eThe overall prevalence of pulmonary hypertension (PH) is 16.04% (39/243) (95% CI, 11.8\u0026ndash;21.7%), with 6.2% of individuals exhibiting severe PH (\u0026gt;\u0026thinsp;70 mmHg), 5.3% with mild PH (35\u0026ndash;50 mmHg), and 4.5% with moderate PH (50\u0026ndash;70 mmHg) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Additionally, right ventricular hypertrophy (RVH) was observed in 15.3% of individuals, and 64% had documented tricuspid regurgitation (TR). Among 215 individuals with documented left ventricular ejection fraction (LVEF), 57.2% had a normal LVEF (\u0026gt;\u0026thinsp;50%), 22.2% had a mildly reduced LVEF (40\u0026ndash;49%), and 9.1% had a reduced LVEF (\u0026lt;\u0026thinsp;40%).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e3.5. Comorbidities for PH among CKD patients\u003c/h2\u003e\u003cp\u003eThe major findings of the study highlighted that left heart disease was the most prevalent comorbidity, found in 30.8% of PH patients, followed by valvular heart disease at 25.6%. Current/previous pulmonary TB accounted for 17.9%, HIV 7%, and HIV with TB coinfection accounted for 10.3% of total PH patients with CKD.( Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe proportion of PH among the comorbidities\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCount\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHIV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent/previous TB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHIV\u0026thinsp;+\u0026thinsp;TB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eValvular heart disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeft side heart disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCOPD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThyroid disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e3.6. Risk factors for PH among CKD patients\u003c/h2\u003e\u003cp\u003eIn the crude analysis (COR), variables with a p-value less than 0.2 were considered for further analysis. Stage 3\u0026ndash;5 CKD (p\u0026thinsp;=\u0026thinsp;0.031), presence of type 2 diabetes mellitus (p\u0026thinsp;=\u0026thinsp;0.043), presence of hypertension (p\u0026thinsp;=\u0026thinsp;0.008), creatinine level (p\u0026thinsp;=\u0026thinsp;0.09), and hemoglobin level (p\u0026thinsp;=\u0026thinsp;0.08) met the inclusion criteria for multivariable analysis.\u003c/p\u003e\u003cp\u003eIn the multivariable analysis, patients with stage 3\u0026ndash;5 CKD had a 3.32 times higher likelihood of developing pulmonary hypertension (PH) compared to those with stage 1\u0026ndash;2 CKD (AOR: 3.32, 95% CI: 1.95\u0026ndash;11.58, p\u0026thinsp;=\u0026thinsp;0.048). The presence of type 2 diabetes mellitus was associated with a 3.18-fold increased risk of PH compared to those without diabetes (AOR: 3.18, 95% CI: 1.28\u0026ndash;7.89, p\u0026thinsp;=\u0026thinsp;0.01). Similarly, patients with hypertension had a 3.11-fold higher likelihood of developing PH compared to non-hypertensive individuals (AOR: 3.11, 95% CI: 1.35\u0026ndash;7.19, p\u0026thinsp;=\u0026thinsp;0.008) (Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBinary logistic Analysis of Factors Associated with Pulmonary Hypertension in CKD Patients in tertiary hospital in Addis Ababa, Ethiopia\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCOR (95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP-Value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAOR (95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP- value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStage 3\u0026ndash;5 CKD staging\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.83(1.13,12.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.031\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.32(1.95,11.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0. 048\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCreatinine level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.18(0.98,1.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.08(0.87,1.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHemoglobin level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.89(0.79,1.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.92(0.81,1.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePresences of T2DM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.45(1.03,5.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.043\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.18(1.28,7.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePresences of HTN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.93(1.32,6.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.11(1.35,7.19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.008\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eCOR: Crude Odds Ratio, AOR: Adjusted Odds Ratio\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis study aimed to determine the prevalence of PH among CKD patients attending follow-up at a tertiary hospital in Ethiopia. The overall prevalence of PH was 16.04%, with 6.2% of individuals exhibiting severe PH (\u0026gt;\u0026thinsp;70 mmHg). In stages 3\u0026ndash;5 CKD, the presence of T2DM and hypertension was identified as an independent risk factor for PH.\u003c/p\u003e\u003cp\u003eThe prevalence of PH in CKD patients varies significantly across studies. In our study, the overall PH prevalence was 16.04%, with 6.2% of cases classified as severe. This is notably lower than global meta-analyses, which reported rates of 30\u0026ndash;42% in CKD populations, particularly among dialysis-dependent patients [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, it aligns more closely with regional data from Iraq (15% in stage V CKD) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and Egypt (23.5%) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. These discrepancies may stem from differences in diagnostic criteria, such as the use of echocardiography in our study versus right heart catheterization in Egypt [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], which captures milder cases. Additionally, our cohort includes 7 dialysis patients compared to meta-analyses that predominantly pool data from these high-risk subgroups. For example, China and India reported PH prevalence as high as 47\u0026ndash;50% in dialysis populations [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], underscoring the impact of renal replacement therapy on PH risk. Somalia\u0026rsquo;s exceptionally high prevalence (51%) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] highlights how regional factors, such as older age and limited healthcare access, may exacerbate the PH burden.\u003c/p\u003e\u003cp\u003eThe 6.2% prevalence of severe PH (sPAP\u0026thinsp;\u0026gt;\u0026thinsp;70 mmHg) in our study further highlights a high-risk subgroup. Severe PH is often irreversible and linked to poor outcomes, as seen in China, where 10\u0026ndash;25% of CKD patients on hemodialysis develop severe PH due to vascular calcification and chronic volume overload [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Our lower severe PH prevalence may reflect earlier detection, less advanced cardiac remodeling, or differences in diagnostic rigor (e.g., echocardiography vs. catheterization).\u003c/p\u003e\u003cp\u003eAdvanced CKD (stages 3\u0026ndash;5) emerged as a central risk factor in our study, aligning with global trends, including studies from China, where advanced (on dialysis) populations exhibit high PH prevalence (42\u0026ndash;58%), which might be related to prolonged fluid shifts and vascular stress [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In our patients, the development of the PH might be due to mechanisms such as fluid overload from impaired sodium excretion, uremic toxin accumulation, and secondary hyperparathyroidism, which promote endothelial dysfunction and vascular calcification [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Type 2 diabetes mellitus was independently associated with PH in our study, which aligns with findings from India and the U.S., where T2DM amplifies PH risk [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Lastly, HTN, a well-documented PH risk factor, was another factor identified in our findings, consistent with India and U.S. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] studies that tie HTN to left ventricular dysfunction and pulmonary venous congestion. However, dialysis-centric cohorts (e.g., China [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]) prioritize fluid overload and arteriovenous fistula hemodynamics, whereas our non-dialysis-heavy cohort underscores hypertension's metabolic contributions.\u003c/p\u003e"},{"header":"5. Conclusion and recommendation","content":"\u003cp\u003eThis study showed that the prevalence of PH in Ethiopian CKD patients was 16.04% and 6.2% of cases had severe PH, highlighting PH as a prominent comorbidity. Type 2 diabetes mellitus (T2DM), hypertension, and advanced chronic kidney disease (CKD) (stages 3\u0026ndash;5) have been identified as important independent risk factors that correspond with global mechanistic pathways.\u003c/p\u003e\u003cp\u003eAn interdisciplinary strategy is necessary to address this problem. Clinically, high-risk CKD patients, especially those with advanced stages (3\u0026ndash;5), type 2 diabetes mellitus (T2DM), and/or hypertension, should have PH screening by echocardiography incorporated into their regular care. In order to clarify long-term PH trajectories and enhance generalizability across various contexts, more research is required, particularly prospective multicenter trials with biomarker integration and extended regional cooperation.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCKD: Chronic Kidney Disease\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDM: Diabetes mellitus\u003c/p\u003e\n\u003cp\u003eePASP:\u0026nbsp;estimated pulmonary artery systolic pressure\u003c/p\u003e\n\u003cp\u003eESRD: End-Stage Renal Disease\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGFR: Glomerular filtration rate\u003c/p\u003e\n\u003cp\u003eKRT: kidney replacement therapy\u003c/p\u003e\n\u003cp\u003ePAH: Pulmonary Arterial Hypertension\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePH: Pulmonary Hypertension\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePTE: Pulmonary thromboembolism\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTRV: Tricuspid regurgitation velocity\u003c/p\u003e\n\u003cp\u003eHIV: Human immunodeficiency virus\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eClinical trial number\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003eThis study was approved by the Research Ethics Committee of Department of Internal Medicine, College of health sciences, Addis Ababa University \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e(\u003c/span\u003eProtocol number 156/24\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e)\u003c/span\u003e. As a retrospective review of routinely collected data, informed consent was waived by the Research Ethics Committee. Patient identifiers were removed prior to analysis and data were stored on password-protected servers. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003e Consent is waived by the Research Ethics Committee of department of Internal medicine, college of health sciences, Addis Ababa University, Addis Ababa (Protocol number 156/24)\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cp\u003eThe authors declare no competing interests.\u003cp\u003e\u003ch2\u003eAuthor\u0026rsquo;s details\u003c/h2\u003e\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eDepartment of Internal medicine, College of health sciences, Addis Ababa University, Addis Ababa, Ethiopia.\u003c/p\u003e\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eDivision of pulmonology, Department of Internal medicine, College of health sciences, Addis Ababa University, Addis Ababa, Ethiopia.\u003c/p\u003e\u003cp\u003e\u003csup\u003e3\u003c/sup\u003eDepartment of Internal medicine,Yekatit 12 Hospital Medical college, Addis Ababa, Ethiopia\u003c/p\u003e\u003cp\u003e\u003csup\u003e4\u003c/sup\u003eSchool of medicine, College of health science, Addis Ababa University, Addis Ababa, Ethiopia\u003c/p\u003e\u003cp\u003e\u003csup\u003e5\u003c/sup\u003eNephrology Unit, Department of Internal Medicine, School of Health Sciences Addis Ababa University Addis Ababa Ethiopia.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNo funding was used for this study\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eY.B.L: Conceptualization, data collection, data analysis, reviewing and editingH.Y.A: Conceptualization,supervision,reviewing and editing, validationM.D.M: Reviewing and editing, final report writingB.A: Reviewing and editing, final report writingM.A: Data collection and report writingH.A: Data collection and report writingL.S.A: Supervision and validation\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eFirst and foremost, I would like to thank AAU and the CHS Department of Internal Medicine for facilitating this research experience.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data used and/or analyzed during the current study is provided within the manuscript and further details can be requested from the first author/ corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eClementi A, Virz\u0026igrave; GM, Goh CY, Cruz DN, Granata A, Vescovo G, et al. 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ACCF/AHA 2009 expert consensus document on pulmonary hypertension: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: developed in collaboration with the American College of Chest Physicians, American Thoracic Society, Inc., and the Pulmonary Hypertension Association. Circulation. 2009;119:2250\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKidney Disease: Improving Global Outcomes CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl. 2012;3:S1\u0026ndash;150.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShang W, Li Y, Ren Y, Li W, Wei HL, Dong J. Prevalence of pulmonary hypertension in patients with chronic kidney disease without dialysis: a meta-analysis. Int Urol Nephrol. 2018;50:1497\u0026ndash;504.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBolignano D, Pisano A, Coppolino G, Tripepi GL, D\u0026rsquo;Arrigo G. Pulmonary Hypertension Predicts Adverse Outcomes in Renal Patients: A Systematic Review and Meta-Analysis. Therapeutic Apheresis Dialysis. 2019;23:369\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePrevalence and Risk of Pulmonary Hypertension in Chronic Kidney Disease. Int J Sci Res (IJSR). 2017;6:947\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhang Q, Wang L, Zeng H, Lv Y, Huang Y. Epidemiology and risk factors in CKD patients with pulmonary hypertension: A retrospective study. BMC Nephrol. 2018;19:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNavaneethan SD, Roy J, Tao K, Brecklin CS, Chen J, Deo R, et al. Prevalence, predictors, and outcomes of pulmonary hypertension in CKD. J Am Soc Nephrol. 2016;27:877\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pulmonary hypertension, chronic kidney disease, Prevalence, Risk factors, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-7383969/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7383969/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground and aim:\u003c/h2\u003e\u003cp\u003eIn chronic kidney disease (CKD), including dialysis patients, pulmonary hypertension (PH) is linked to significant morbidity and death; however, its prevalence in Ethiopia is unknown. Therefore, the aim of this study is to determine the prevalence of PH and its associated factors among patients with CKD at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003e A four-year retrospective cross-sectional study was carried out among patients with CKD who were receiving follow up care at renal and diabetic clinics of Tikur Anbessa Specialized Hospital, Ethiopia, from Sept 2020 to Sept 2024. The patient's medical record chart and/or electronic medical records were the sources of the data. SPSS version 27.1 was used for data analysis. Descriptive analysis was used to summarize the data, and a logistic regression analysis was used to identify the variables associated with the pulmonary hypertension. For the multivariate analysis model, every variable that had a p-value less than 0.20 in the univariate analysis was chosen. A p-value of \u0026lt;\u0026thinsp;0.05 was considered to be statistically significant.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 243 CKD patients were included, with a mean age of 60.95\u0026thinsp;\u0026plusmn;\u0026thinsp;12.53 years, and 61.7% were male. The prevalence of pulmonary hypertension (PH) was 16.04% (95% CI: 11.8\u0026ndash;21.7%), with 6.2% classified as severe. Advanced CKD (stages 3\u0026ndash;5) (AOR: 3.32, 95% CI: 1.95\u0026ndash;11.58, p\u0026thinsp;=\u0026thinsp;0.048), type 2 diabetes mellitus (AOR: 3.18, 95% CI: 1.28\u0026ndash;7.89, p\u0026thinsp;=\u0026thinsp;0.01), and hypertension (AOR: 3.11, 95% CI: 1.35\u0026ndash;7.19, p\u0026thinsp;=\u0026thinsp;0.008) were identified as independent risk factors for PH.\u003c/p\u003e\u003ch2\u003eConclusion and recommendations:\u003c/h2\u003e\u003cp\u003ePulmonary hypertension (PH) is a significant comorbidity among Ethiopian CKD patients, with modifiable risk factors contributing to its development. These findings emphasize both the importance of routine PH screening in high-risk CKD populations and context-specific management strategies in resource-limited setups.\u003c/p\u003e","manuscriptTitle":"Prevalence of pulmonary hypertension and its associated factors among chronic kidney disease patients in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: An institution-based retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 06:48:36","doi":"10.21203/rs.3.rs-7383969/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-18T10:15:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-02T14:48:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"238932865838229767039913891481695201862","date":"2025-10-29T15:16:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"249066648286044882915305630623554913291","date":"2025-10-26T14:14:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"153837866761741860883681962107230099903","date":"2025-10-22T14:12:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-18T10:13:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"139968845687672448394241456876019838039","date":"2025-09-28T12:39:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-23T12:14:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-23T12:12:57+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-15T06:10:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-13T11:14:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2025-09-13T11:11:10+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"52066965-da27-48e5-834a-d2788aab1a6b","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-19T17:27:15+00:00","versionOfRecord":{"articleIdentity":"rs-7383969","link":"https://doi.org/10.1186/s12872-026-05516-2","journal":{"identity":"bmc-cardiovascular-disorders","isVorOnly":false,"title":"BMC Cardiovascular Disorders"},"publishedOn":"2026-01-13 16:31:02","publishedOnDateReadable":"January 13th, 2026"},"versionCreatedAt":"2025-10-08 06:48:36","video":"","vorDoi":"10.1186/s12872-026-05516-2","vorDoiUrl":"https://doi.org/10.1186/s12872-026-05516-2","workflowStages":[]},"version":"v1","identity":"rs-7383969","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7383969","identity":"rs-7383969","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}