Chronic Kidney Disease (CKD) is a major global health concern, characterized by structural or functional abnormalities of the kidneys that progressively lead to irreversible loss of function. In its advanced stages, CKD culminates in end-stage renal disease (ESRD), a life-threatening condition requiring renal replacement therapy (RRT) such as dialysis or kidney transplantation (1,2). The global burden of CKD has been rising steadily, with both prevalence and mortality showing a significant upward trend in recent decades (3,4).

In the early phases, CKD is often silent, with symptoms becoming evident only when renal function declines substantially. By the time patients develop complications, immediate interventions like dialysis or transplantation are often necessary. The disease is influenced by a wide range of risk factors, including diabetes, hypertension, genetic predisposition, socioeconomic conditions, and lifestyle-related exposures. Among these, diabetes and hypertension remain the most significant contributors to CKD worldwide (5–10).

Early identification of CKD plays a pivotal role in delaying progression to kidney failure. Regular screening in high-risk populations—such as individuals with diabetes, hypertension, advanced age, or a family history of kidney disease—can reduce late detection and improve outcomes (6,7). Unfortunately, many patients are diagnosed at advanced stages, which leads to delayed initiation of RRT and poorer survival rates (11).

In India, the reported prevalence of CKD varies widely, ranging from less than 1% to nearly 17%, reflecting regional and methodological differences in detection (12–14). The high cost of dialysis and limited access to transplantation make CKD an enormous health and economic burden in the country (11,15). In resource-constrained settings, patients often face significant challenges in accessing timely and adequate care.

Understanding the clinical and biochemical profile of CKD patients on dialysis is therefore crucial. Such data not only provide insights into disease patterns and complications but also help guide patient management and public health strategies. With this background, the present study was undertaken to evaluate the clinical and biochemical characteristics of patients with CKD undergoing dialysis at a tertiary care hospital in South Gujarat.

Methodology

Study Design and Setting

This was a cross-sectional observational study conducted at a tertiary care hospital in South Gujarat. The study was carried out over 12 months, from March 2020 to March 2021, following ethical approval.

Study Population

The study included patients diagnosed with chronic kidney disease (CKD) undergoing maintenance dialysis at the tertiary care center. Diagnosis was made according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria.

Inclusion Criteria

• Patients aged ≥18 years
• Patients diagnosed with CKD on maintenance dialysis
• Patients willing to provide informed consent

Exclusion Criteria

• Patients aged <18 years
• Patients who had undergone renal transplantation
• Patients not willing to participate

Sample Size and Sampling Technique

All eligible patients who met the inclusion criteria and provided informed consent during the study period were included. The final study sample comprised 50 patients.

Data Collection

Baseline demographic and clinical details, including age, sex, medical history, risk factors, family history, and physical examination findings, were recorded. Anthropometric measurements such as standing height, weight, mid-upper arm circumference (MUAC), and waist-to-hip ratio were taken. Quality of life was assessed using a global quality of life scale. Radiological investigations included renal length measurement, chest X-ray, and ultrasonography.

Laboratory Investigations

Blood investigations included complete blood count (CBC), renal function test (RFT), liver function test (LFT), calcium, phosphate, uric acid, thyroid profile, coagulation profile, vitamin B12, vitamin D3, amylase, ferritin, parathyroid hormone (PTH), magnesium, glycated hemoglobin (HbA1c), and arterial blood gas (ABG). Serological tests for HIV, HBsAg, and HCV were performed. ECG was also recorded.

Specimen Collection:

• Blood: Venous blood samples were collected in appropriate vacutainers (EDTA, citrate, fluoride, and plain) and sent for analysis.
• Urine: Sterile urine samples were collected, centrifuged, and tested for routine and microscopic examination.

Statistical Analysis

Data were entered into Microsoft Excel spreadsheets. Descriptive statistics were applied, and results were expressed as frequencies and percentages for categorical variables, and mean ± standard deviation (SD) for continuous variables.

RESULTS

This cross-sectional study included 50 patients with chronic kidney disease (CKD) undergoing dialysis at a tertiary care hospital in South Gujarat. The results describe the demographic characteristics, clinical presentation, biochemical profile, and complications observed in this population.

Demographics and Clinical Characteristics

The mean age of the study cohort was 44 ± 12.29 years, with most patients (26; 52%) belonging to the 31–50 years age group. Males (34; 68%) outnumbered females (16; 32%). A prolonged disease history was common: 21 patients (42%) had CKD for 3–5 years, and 16 patients (32%) for more than 5 years.

Diabetic nephropathy was the leading cause of CKD, accounting for 20 cases (40%), followed by hypertensive nephropathy in 16 cases (32%). Etiology remained unknown in 5 cases (10%). Regarding habits, smoking was reported in 32 patients (64%), tobacco use in 14 (28%), and alcohol in 4 (8%).

Table 1. Clinical Characteristics of Patients (n = 50)

Symptomatic Profile at Presentation

Gastrointestinal symptoms were the most frequent, with 40 patients (80%) experiencing nausea, vomiting, or anorexia. Signs of volume overload, such as pedal edema and dyspnea, were present in 26 patients (52%). Neurological manifestations included paresthesia in 29 (58%) and headache in 10 (20%). Pruritis was reported by 22 patients (44%). Urinary complaints were noted in 33 patients (66%).

Biochemical and Clinical Parameters

The majority of patients (38; 76%) were in Stage 5 CKD (eGFR <15 mL/min/1.73 m²). Eleven patients (22%) were at Stage 4, and only one (2%) at Stage 3.

Table 2. Key Biochemical Findings

Hematological Profile

Anemia was a prominent finding, with 48 patients (96%) having hemoglobin <11 g/dL and 19 (38%) below 7 g/dL. The mean corpuscular volume (MCV) was 79.78 ± 8.21 fL, with 32 patients (64%) showing values <84 fL. The mean reticulocyte count was 1.73 ± 0.69%.

Table X. Hematological Profile of CKD Patients (n = 50)

Renal Function

The mean serum urea was 144.56 ± 61.25 mg/dL, with 30 patients (60%) in the 100–200 mg/dL range. The mean serum creatinine was 7.8 ± 3.53 mg/dL, and the mean creatinine clearance was 12.29 ± 7.21 mL/min/1.73m².

Table X. Renal Function Profile of CKD Patients (n = 50)

Mineral and Bone Disorder

Hypocalcemia was observed in 44 patients (88%) and hyperphosphatemia in 32 (64%). Secondary hyperparathyroidism was detected in 39 patients (78%), and vitamin D deficiency in 47 (94%).

Table X. Mineral and Bone Disorder Profile of CKD Patients (n = 50)

Quality of life:

In present study it shown that, the mean GQOL score of the study population was 50.5611.66.

DISCUSSION:

In the present study, males (68%) outnumbered females (32%). This male predominance is consistent with the findings from the CKD Registry of India (2013) (16), which reported 68.9% males and 31.3% females. Rohan G Patil et al. (2015) (17) and Satnyan S et al. (2017) (18) also documented a similar male predominance, though the ratio varied across cohorts. Christopher Babua (2018) (19) likewise observed a higher proportion of males. The greater vulnerability of men to CKD has been attributed to differences in lifestyle exposures, higher prevalence of smoking and alcohol use, and possible protective effects of estrogen in women.

In terms of etiology, diabetic nephropathy was the most common cause (40%), followed by hypertensive nephropathy (32%) and chronic glomerulonephritis (8%). This trend is in accordance with Sharma M et al. (2018) (20), who reported diabetes mellitus as the cause of CKD in 42.2% of cases. Similarly, Pathak A et al. (2016) (21) observed diabetes and hypertension as the leading etiologies of CKD in their cohort. Nirav et al. (2018) (22) and Xu et al. (2001) (23) also found that nearly half of CKD cases were attributable to diabetes. This shift in etiology reflects the increasing burden of diabetes and hypertension in India, paralleling global epidemiological trends.

Regarding clinical manifestations, gastrointestinal symptoms such as nausea, vomiting, and anorexia were most frequent, affecting 80% of patients. Pedal edema was observed in 52%, while neurological symptoms including paresthesia and dyspnea were noted in 26%. These findings are similar to those of Li et al. (2015) (24), who reported gastrointestinal symptoms in 81.5% and hypertension in 84% of CKD patients. Rohan G Patil et al. (2015) (17) also found pedal edema in 52% of their patients, in concordance with our study.

The prevalence of diabetes in the present study was 48%, aligning with Rohan G Patil et al. (2015) (17) who reported 52%. However, this was higher than the 24% reported by Satnyan S et al. (2017) (18) and 16.1% by Christopher Babua (2018) (19). In our cohort, 70.8% of diabetics had disease duration of less than 10 years, contrasting with the CKD Registry of India (2013) (16), where only 40.7% had diabetes for less than 10 years. Hypertension was observed in 66% of cases, comparable to 71% in the CKD Registry of India, though lower than 90% reported by Christopher Babua (2018) (19) and 72.6% by Althnian (2016) (25).

Lifestyle habits were an important observation in this study. Smoking was present in 64% of patients, tobacco chewing in 28%, and alcohol use in 48%. These results are in agreement with Nirav et al. (2018) (22), who found chronic tobacco use in 56% of cases. The CKD Registry of India (2013) (16) documented smoking in 32% and alcohol consumption in 6.4%. The much higher prevalence of substance use in our study highlights the importance of targeted interventions in lifestyle modification as a component of CKD care.

A striking observation was the advanced stage of disease at presentation, with 76% of patients in Stage 5 CKD (eGFR <15 ml/min/1.73 m²). This is similar to the CKD Registry of India (2013) (16), which reported 70.3% of patients presenting in Stage 5. Late presentation is a common challenge in India due to limited awareness, socioeconomic constraints, and delayed referral.

Anemia was observed in 96% of our cohort, with mean hemoglobin 7.5 ± 1.56 g/dl. This finding is consistent with McGonigle et al. (1984) (26), Wallin et al. (1993) (27), and Christopher Babua (2018) (19), who also reported anemia in the majority of CKD patients. Anemia in CKD is multifactorial, primarily due to decreased erythropoietin production, iron deficiency, and chronic inflammation, and significantly impacts morbidity, quality of life, and cardiovascular risk.

Biochemical disturbances were frequent. Hyperphosphatemia was present in 74% of patients, with mean serum phosphate 5.22 ± 1.45 mg/dl. This aligns with findings of Sarinak ML et al. (2010) (28) and Bansal et al. (2014) (29), who reported high prevalence of phosphate abnormalities among CKD patients. Serum magnesium was elevated in 60% of cases, with mean value 2.25 ± 0.58 mg/dl, contrasting with Ahmed H. Mitwalli et al. (1996) (30), who reported a much lower prevalence (22.9%).

Endocrine and metabolic abnormalities were also notable. Low T3 syndrome was detected in 42%, overt hypothyroidism in 2%, and subclinical hypothyroidism in 2%. These results are similar to Punehar J et al. (2013) (31) and Khatiwada et al. (2015) (32), who reported thyroid dysfunctions in a substantial proportion of CKD patients. Furthermore, vitamin deficiencies were highly prevalent: 50% had Vitamin B12 deficiency and 94% had Vitamin D deficiency. These findings corroborate reports by Dandge et al. (2016) (33) and Ghosh SK et al. (2015) (34).

Cardiovascular disease was documented in 58% of patients, with left ventricular hypertrophy being the most frequent manifestation (42%) followed by ischemic heart disease (16%). The CKD Registry of India (2013) (16) similarly noted a high burden of cardiovascular complications. Cardiovascular morbidity is recognized as the leading cause of mortality among CKD patients, reinforcing the need for early diagnosis and aggressive management of risk factors.

Serum amylase abnormalities were seen in 62% of patients, with values either below 30 U/L or above 110 U/L. Similar observations were reported by Royse VL et al. (1999) (35) and JB Keogh et al. (2001) (36), while Bindu et al. (2017) (37) found lower mean values of 84.2 ± 22.7 U/L.

Taken together, the findings of this study reveal a demographic profile, clinical spectrum, and biochemical abnormalities comparable with both national and international literature. The predominance of advanced disease at presentation, high prevalence of anemia, mineral bone disorder, thyroid and vitamin deficiencies, and cardiovascular complications highlight the multifactorial burden of CKD. Early detection, lifestyle modification, and comprehensive multidisciplinary management are essential to improve survival and quality of life in this vulnerable group.

Conclusion

The present cross-sectional study provides valuable insights into the demographic, clinical, and biochemical profile of chronic kidney disease (CKD) patients undergoing dialysis in South Gujarat. A clear male predominance was observed, with diabetic nephropathy and hypertensive nephropathy being the leading etiologies. Most patients presented at an advanced stage (Stage 5 CKD), reflecting late diagnosis and delayed access to healthcare services.

Anemia, gastrointestinal manifestations, and mineral bone disorders were highly prevalent, while significant proportions of patients demonstrated endocrine abnormalities such as thyroid dysfunction and deficiencies of Vitamin D and Vitamin B12. Lifestyle factors including smoking, tobacco chewing, and alcohol use were common, further aggravating disease progression. Cardiovascular involvement, particularly left ventricular hypertrophy and ischemic heart disease, was frequently encountered, highlighting the strong cardio-renal link in this population.

Overall, the findings emphasize the urgent need for early screening and detection of CKD in high-risk individuals, aggressive management of diabetes and hypertension, lifestyle modification, and regular monitoring of biochemical and endocrine parameters. Strengthening preventive strategies, ensuring timely referral, and implementing a multidisciplinary approach can reduce disease burden, delay progression to end-stage renal disease, and improve survival and quality of life in CKD patients.

Declaration on Competing Interests:
The authors declare no competing interests.

Funding:
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Ethical Clearance Status:
Approved by the [SMIMER Ethics Committee, Surat Gujarat]
Approval Number: [ /EC/3025]
 

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