Background The prevalence of chronic kidney disease (CKD) is increasing worldwide and in Africa. Health related quality of life (QOL) has become an essential outcome measure for patients with CKD and end stage renal disease (ESRD). There is growing interest worldwide in QOL of CKD patients but paucity of data in Ghana. This study sought to assess QOL in patients with moderate to advanced CKD (not on dialysis) and establish its determinants. Methods We conducted a cross sectional observational study at the renal outpatient clinic at Komfo Anokye Teaching Hospital (KATH). We collected demographic, clinical and laboratory data. A pretested self-administered Research and Development corporation (RAND®) 36-Item Health Survey questionnaire was administered and QOL scores in physical component summary (PCS) and mental component summary (MCS) were computed. Determinants of QOL were established by simple and multiple linear regression. P value of < 0.05 was considered statistically significant. Results The study included 202 patients with CKD not on dialysis. There were 118(58.5%) males. Mean age was 46.7 ± 16.2 years. The majority, 165(81.7%) of patients were on monthly salaries of less than GHS 500 (~USD 125). Chronic glomerulonephritis was the most common cause of CKD in 118 (58.5%) patients followed by diabetes mellitus in 40 (19.8%) patients and hypertension in 19 (9.4%) patients. The median serum creatinine was 634.2 μmol/L (IQR 333–1248) and the median eGFR was 7 ml/min/1.73m 2 (IQR 3–16). The most common stage was CKD stage 5 accounting for 143 (71.1%), followed by CKD stage 4 with 45 (22.4%) of cases and 13 (6.5%) of CKD stage 3. The overall mean QOL score was 40.3 ± 15.4. MCS score was significantly lower than PCS score (37.3 ± 10.8 versus 43.3 ± 21.6, P < 0.001). Multiple linear regression showed that low monthly income ( p = 0.002) and low haemoglobin levels ( p = 0.003) were predictive of overall mean QOL. Conclusion Patients with moderate to advanced CKD had low-income status, presented with advanced disease and had poor QOL. Anaemia and low-income status were significantly associated with poor QOL.

IntroductionRenal diseases commonly present to the Komfo Anokye Teaching Hospital (KATH). There has not been a comprehensive analysis of the number of renal cases managed. We set out to analyze comprehensively the renal cases seen at KATH to describe the trends a decade.MethodsA retrospective study was conducted from January 2006 to December 2016. We collected secondary data from the records on the wards, outpatient clinics and hemodialysis unit from the KATH annual reports. Trends in renal cases were then plotted. ResultsRenal outpatient clinics started in 2007. There were an average of 65,273 medical out patients seen yearly with renal conditions accounting for 5,397 (8.3%). Renal clinic patients increased by 271% from 710 in 2007 to 1927 in 2016.The average yearly medical admission was 6,880 patients of which renal admissions accounted for 276 (4.0%).  The average position of renal admissions was 6th (range 2nd-10th) of total medical admissions. The average annual mortality rate of renal admissions was 32.7%. The average mortality of general medical cases was 23.8% annually.Hemodialysis services commenced in 2006. Patients on haemodialysis have increased by 50 times from 8 in 2006 to 407 in 2016. Hemodialysis session also increased by 38.8 times from 59 in 2006 to 2350 in 2016. The average number of patients on hemodialysis per year was 211.5.ConclusionRenal disease is a common condition in KATH associated with significant morbidity and mortality. A concerted effort is needed to enhance the diagnosis and management of renal diseases in Ghana.

Patients in CM group self-administered Chinese herbal granules twice daily for 24 weeks, while patients in control received masked granules. All patients continued the routine therapy such as low-protein diet, control of blood pressure and so on. 24-hour urine total protein (UTP)， serum creatinine (Scr) and eGFR were analyzed at week 24. Results: Between April 2014 and Oct 2016, a total of 343 randomised patients were treated and 343 patients (171 in CM group versus 172 in control) were eligible for the full analysis set. Overall, at 24 weeks there was no statistical difference in UTP between the two groups (0.97AE1.14g/d versus 0.97AE1.25g/d). The levels of Scr in CM group decreased significantly compared with the control (130.78AE32.55mmol/L versus 149.12AE41.27mmol/L). eGFR in CM group remained stable while in control eGFR reduced statistically (55.74AE50.82 ml/min/1.73m 2 versus 44.46AE12.60ml/min/1.73m 2). There were 4.35% patients with stage 3a CKD in CM group progressed to stage 3b, and 57.97% reverse to stage 1 or stage 2, while that in control was 20.59% and 17.65%. There were 9.21% patients with stage 3b CKD in CM group progressed to stage 4, and 40.79% reverse to stage 1 or 2 or 3a, while that in control was 17.11% and 22.37%. Conclusions: Our data indicated that Chinese herbal compound combined with routine therapy maintains the kidney function in patients with stage 3 CKD for 24 weeks.