Chronic kidney disease–mineral and bone disorder among maintenance hemodialysis patients in Addis Ababa, Ethiopia: prevalence, guideline adherence, complications, and quality of life

Abstract

Chronic kidney disease–mineral and bone disorder (CKD-MBD) contributes substantially to morbidity and reduced quality of life among patients receiving maintenance hemodialysis. Data regarding CKD-MBD burden and management in Ethiopia remain limited. This study assessed the prevalence of CKD-MBD biochemical abnormalities, adherence to KDIGO recommendations, CKD-MBD–related complications, and quality of life among maintenance hemodialysis patients in Addis Ababa, Ethiopia. We conducted an institution-based cross-sectional study among adult patients receiving maintenance hemodialysis at St Paul’s Hospital Millennium Medical College and affiliated private dialysis centers from 1 September 2025 to 28 February 2026. Sociodemographic, clinical, laboratory, treatment, and quality-of-life data were collected through structured interviews and medical record review. Multivariable logistic and linear regression analyses were performed to identify factors independently associated with CKD-MBD complications and lower quality of life. A total of 302 patients were included (response rate 89.1%). Elevated intact parathyroid hormone was observed in 47.4% of participants, hyperphosphatemia in 28.0%, hypocalcemia in 27.7%, and vitamin D deficiency in 19.6%. Adherence to KDIGO-recommended biochemical monitoring ranged from 53.6% to 62.9%. The most common CKD-MBD-related complications were bone pain and pruritus, both of which were independently associated with lower quality-of-life scores. Hyperphosphatemia, hypocalcemia, elevated iPTH, older age (≥60 years), and longer dialysis duration were independently associated with CKD-MBD complications. Older age, longer dialysis duration, hyperphosphatemia, hypocalcemia, and elevated iPTH were also independently associated with lower quality-of-life scores. CKD-MBD abnormalities and related complications are highly prevalent among maintenance hemodialysis patients in Ethiopia, with suboptimal adherence to KDIGO monitoring recommendations. Improved access to biochemical monitoring, guideline-concordant treatment, and multidisciplinary symptom management may help improve patient outcomes and quality of life.