Anaesthetic profile and perioperative mobi-mortality according to renal function in patients undergoing urgent and elective surgery at Monkole Hospital, Kinshasa: a cross-sectional study

1 Introduction

Chronic kidney disease (CKD) represents a major global public health challenge, with a steadily increasing prevalence and a high rate of cardiovascular mortality (1, 2). Patients with end-stage renal disease (ESRD) face an elevated perioperative risk due to frequent comorbidities such as hypertension, diabetes, anemia, and cardiovascular disorders, as well as metabolic and hematologic alterations associated with dialysis (3, 4).

Surgery in this population is particularly complex, and postoperative morbidity and mortality are closely linked to the nature of the surgical procedure, the preoperative clinical status, and the quality of anaesthetic management (3, 5). The pathophysiological disturbances characteristic of ESRD—including metabolic acidosis, electrolyte imbalances, coagulopathy, and anemia—directly affect the pharmacokinetics and pharmacodynamics of anaesthetic agents, increasing the risk of hemodynamic and respiratory complications (5–7). Among these disturbances, hyperkalemia represents a critical perioperative risk, as it may induce life-threatening cardiac arrhythmias and contribute to intraoperative and postoperative instability (7).

Several studies have shown that urgent surgery in patients with CKD is associated with a significantly higher rate of complications compared to elective procedures, due to the lack of preoperative optimization and the frequent presence of physiological decompensation (4, 6). Infectious, cardiovascular, and metabolic complications are the main drivers of perioperative morbidity and mortality, highlighting the importance of rigorous preoperative assessment, hemodynamic and metabolic optimization, and intensive perioperative monitoring (6, 7).

Furthermore, identifying the most appropriate anaesthetic profile—considering the risk–benefit balance of anaesthetic agents, the choice of anaesthetic technique, and fluid management—remains a critical step to improve surgical outcomes and reduce mortality (5, 8). A systematic and individualized approach allows clinicians to anticipate complications, shorten intensive care stays, and optimize postoperative recovery (8).

In this context, the present study aims to describe the anaesthetic profile, as well as perioperative morbidity and mortality, of patients with CKD undergoing urgent or elective surgery at Monkole Hospital in Kinshasa, providing local data to guide perioperative management and inform tailored anaesthetic protocols.

2 Methods

2.1 Study design and setting

This study is a retrospective cross-sectional analysis conducted at Monkole Hospital, a secondary referral center in Kinshasa, Democratic Republic of Congo. The study aimed to investigate perioperative anaesthetic practices and outcomes in adult patients with chronic kidney disease (CKD) undergoing urgent or elective surgery between February 2018 and December 2024. All data were collected from hospital records during this period, and follow-up was limited to the hospital stay.

2.2 Participants

Eligible participants were adult patients (≥18 years) who underwent surgical procedures at Monkole Hospital and had complete perioperative records, including demographic, clinical, laboratory, surgical, anaesthetic, and perioperative information. Patients with incomplete records or under 18 years were excluded. CKD status was defined according to the CKD-EPI 2021 equation, and patients were categorized into standard CKD stages: G1 (≥90 mL/min/1.73 m²), G2 (60–89), G3 (30–59), G4 (15–29), and G5 (<15). All adult patients meeting inclusion criteria were considered, ensuring representativeness. As a cross-sectional design, there was no prospective follow-up beyond hospital discharge. No matching was applied, but subgroup analyses were performed by GFR (Glomerular filtration rate) category to evaluate the influence of renal function on outcomes.

2.3 Variables

The primary outcome was perioperative morbidity and mortality, defined as any anaesthetic or surgical complication or in-hospital death. Secondary outcomes included intraoperative incidents, blood transfusion, postoperative opioid use, duration of surgery, and duration of Anaesthesia. Exposures and predictors included CKD stage, age, sex, comorbidities (hypertension, diabetes, cardiovascular disease), surgical procedure type and urgency, surgeon qualification, type of Anaesthesia, and anaesthetic agents used for induction and maintenance.

Potential confounders included demographic characteristics and surgical complexity, while effect modifiers explored included CKD stage interaction with anaesthetic and clinical parameters.

2.4 Data sources and measurement

Data were extracted retrospectively from hospital medical records using standardized electronic forms. Measurements included:

• Demographics: age, sex, BMI
• Clinical: comorbidities, smoking, vital signs
• Laboratory: haemoglobin, hematocrit, sodium, potassium, glucose, urea, creatinine
• Surgical: specialty, procedure type (minor vs. major: minor surgery refers to less invasive procedures with short duration and low physiological stress, e.g., biopsy or hernia repair; major surgery refers to more invasive procedures with longer duration, greater blood loss, and higher physiological stress, e.g., colectomy or cardiac surgery), duration, surgeon qualification, urgency
• Anaesthesia: type (general, spinal, peripheric locoregional, sedation), induction and maintenance agents, opioids, muscles relaxants, duration
• Perioperative outcomes: complications, transfusions, Anaesthesia use, mortality
• All variables were measured using hospital standard procedures, ensuring consistency across patients.

2.5 Bias

Efforts to minimize bias included: Inclusion of all eligible patients with complete data; Standardized data extraction forms to reduce misclassification; Cross-verification of surgical and anaesthetic data with operative reports; Analysis adjusted for potential confounders (age, sex, type of surgery, Anaesthesia type).

2.6 Study size

The sample included 418 surgical procedures, representing all eligible patients during the study period with complete data. The number was determined a priori to maximize representativeness and ensure adequate power for subgroup analyses by CKD stage. Continuous variables (age, BMI, lab parameters, duration of surgery/Anaesthesia) were summarized as mean ± SD (standard deviation). CKD stages were analysed as categorical variables (G1–G5) to allow clinically meaningful comparisons.

2.7 Statistical methods

Univariate analyses compared demographic, clinical, laboratory, surgical, and anaesthetic characteristics across CKD stages. Associations between CKD stage and perioperative outcomes were assessed using multivariate logistic regression, adjusting for age, sex, type of surgery, and Anaesthesia type. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were reported. In addition to analyses across the five CKD stages, a secondary analysis was conducted using a dichotomous classification of renal function (GFR < 60 vs. ≥60 mL/min/1.73 m²). This threshold was selected in accordance with KDIGO guidelines, which define CKD stage ≥3 as clinically significant renal impairment. The dichotomization was prespecified to enhance clinical interpretability and improve statistical robustness, particularly given the limited number of patients in advanced CKD stages (G4–G5). Interactions between CKD stage and key parameters (e.g., creatinine, urea, surgical duration, Anaesthesia type) were visualized with a heatmap. Missing data were minimal and addressed via listwise deletion. Sensitivity analyses included subgroup analyses by CKD stage and procedure type. Statistical significance was defined as p < 0.05. Analyses were performed using standard statistical software, ensuring reproducibility and transparency.

3 Results

3.1 Distribution of the study population by GFR

The study population was stratified according to glomerular filtration rate (GFR), revealing a heterogeneous distribution across kidney function categories. Most patients fell within the G3 range (30–59 mL/min/1.73 m²), accounting for 201 individuals, or 48.1% of the cohort. This was followed by the G2 category (60–89 mL/min/1.73 m²) with 103 patients (24.6%), and the G1 category (≥90 mL/min/1.73 m²) with 64 patients (15.3%). Patients with severely reduced kidney function were less represented, with 34 individuals (8.1%) in the G5 category (<15 mL/min/1.73 m²) and 16 individuals (3.8%) in the G4 category (15–29 mL/min/1.73 m²) Figure 1.

3.2 Clinical characteristics of study population

The clinical profile of the study population was analyzed across GFR categories (G1–G5), considering age, sex distribution, body weight, and comorbidities to describe the general health characteristics. Mean age increased gradually from 50.0 ± 16.0 years in G1 to 59.9 ± 11.7 years in G4, then slightly decreased to 52.2 ± 14.7 years in G5. Mean body weight was relatively stable across the categories, ranging from 64.0 ± 16.7 kg in G5 to 69.0 ± 14.5 kg in G2. The proportion of males varied between 25.0% in G4 and 47.3% in G3, with females comprising the remaining percentages. Hypertension was present in 43.8% of patients in G4 and peaked at 58.8% in G5, while diabetes prevalence ranged from 41.2% in G5 to 56.2% in G4. Cardiovascular disease was rare, reported in only one patient in G3. Smoking rates were low across all categories, ranging from 0% in G4 to 7.8% in G1 (Table 1). Overall, these data indicate a population with moderate comorbid burden, increasing age in advanced CKD stages, and a balanced distribution of sex and weight across GFR categories.

Table 1. Clinical characteristics by GFR category.

Table 1 presents the main clinical characteristics of the study population stratified by GFR category (G1–G5). Continuous variables are shown as means with standard deviations, and categorical variables as counts with percentages.

3.3 Biological characteristics of study population

Biological markers were evaluated to assess kidney function and related biochemical parameters across GFR categories (G1–G5). Hemoglobin and hematocrit levels declined progressively with worsening renal function, reflecting CKD-associated anemia. Hemoglobin decreased from 13.6 ± 1.0 g/dL in G1 to 12.5 ± 1.6 g/dL in G5, while hematocrit dropped from 41.5 ± 3.2% to 38.5 ± 3.9% over the same range. Sodium and potassium levels remained relatively stable across all categories, indicating effective perioperative electrolyte management. Mean sodium ranged from 139.1 ± 2.4 mmol/L in G1 to 136.0 ± 3.8 mmol/L in G5, and potassium from 4.4 ± 0.5 mmol/L to 4.2 ± 0.5 mmol/L. Blood glucose showed minor fluctuations without a clear trend. Urea levels increased markedly with declining GFR, from 37.11 ± 40.27 mmol/L in G1 to 85.65 ± 82.67 mmol/L in G5, consistent with progressive impairment of renal clearance. Overall, these findings highlight the expected laboratory changes associated with CKD progression, with anemia and uremia worsening in advanced stages, while electrolytes remain well-managed perioperatively (Table 2). No patient in this cohort underwent preoperative renal replacement therapy, reflecting limited access to dialysis in this setting.

Table 2. Biological characteristics by GFR category.

Table 2 summarizes the biological characteristics of participants according to GFR categories. Values are expressed as means with standard deviations. This table highlights how renal function deterioration correlates with key laboratory parameters.

3.4 Surgical characteristics of study population

A total of 418 surgical procedures were analyzed according to the five GFR categories. Surgical indications were predominantly general and visceral surgery, especially in patients with severely impaired GFR (G4: 87.5%, G5: 70.6%). Gyneco-obstetric surgeries were most common in G3 patients (26.4%). Minor surgeries accounted for 38%–54% of procedures depending on GFR stage, and most operations were performed by specialist surgeons (>88% across all categories). The mean duration of surgery ranged from 63.4 ± 45.0 min in G4 to 87.1 ± 83.6 min in G2 (Table 3).

Table 3. Surgical characteristics by GFR category.

Data are presented as count (n) and percentage (%) for categorical variables and mean ± standard deviation for continuous variables. GFR, glomerular filtration rate (mL/min/1.73 m²), classified according to CKD stages: G1 ≥ 90, G2 60–89, G3 30–59, G4 15–29, G5 < 15.

3.5 Anaesthetic characteristics of study population

Anaesthetic characteristics show that general Anaesthesia with orotracheal intubation was more frequent in G1 (54.7%) and G5 (50%) patients, whereas spinal Anaesthesia predominated in G2 (49.5%) and G3 (51.2%). Propofol was the main induction agent in G1–G3, while ketamine use increased in G4 and G5. Premedication was rare in all categories (>85%). For maintenance, isoflurane and sevoflurane were the main hypnotics, and fentanyl and sufentanil were the most frequently used opioids. Most patients did not receive additional muscle relaxants during maintenance (>73%). Mean Anaesthesia duration ranged from 77.9 ± 52.6 min in G5 to 99.3 ± 93.8 min in G2 (Table 4).

Table 4. Anaesthetic characteristics by GFR category.

Data are presented as count (n) and percentage (%) for categorical variables and mean ± standard deviation for continuous variables. GFR categories: G1 ≥ 90, G2 60–89, G3 30–59, G4 15–29, G5 < 15 mL/min/1.73 m².

3.6 Perioperative complications and mortality

Among the 418 patients included, perioperative outcomes varied across GFR categories. Overall, most patients did not experience perioperative incidents, ranging from 94% in G4 to 71% in G5. The absence of incidents was observed in 73% of G1, 83% of G2, 76% of G3, 94% of G4, and 71% of G5 patients. Anaesthetic-related incidents were relatively comparable across groups, accounting for 23% in G1, 16% in G2, 24% in G3, 6% in G4, and 21% in G5. Surgical incidents were uncommon overall, representing 3% in G1, 2% in G2, none in G3 and G4, and 9% in G5. Regarding the type of incidents, hypotension was the most frequent specific event, particularly in G5 (21%) and G1 (17%), followed by G3 (15%). Hemorrhage remained infrequent, occurring in 3% of G1 and G3, and 2% of G2, with no cases reported in G4 or G5. Miscellaneous (“other”) events were rare overall (≤3% across groups). Postoperative morphine use was generally low, ranging from 6% in G2 to 11% in G1 and G3, with no use reported in G4% and 6% in G5. Blood transfusion was more frequent in G1 (36%) and G3 (29%), while rates were 15% in G2, 25% in G4, and 26% in G5. Perioperative mortality increased with worsening renal function, reaching 19% in G4% and 12% in G5, compared with 8% in G1, 4% in G2, and 10% in G3. Overall perioperative complications were observed in 23% of G1, 9% of G2, 18% of G3, 31% of G4, and 18% of G5 patients (Table 5).

Table 5. Perioperative complications according to GFR categories.

Incidents: 0 = absent, 1 = anaesthetic, 2 = surgical; type of incident: 0 = none, 1 = hypotension, 2 = hypertension, 3 = bradycardia, 4 = hemorrhage, 5 = infection, 6 = anaesthetic failure, 7 = other; postoperative morphine: 0 = no, 1 = yes; transfusion: 0 = no, 1 = yes; death: 0 = no, 1 = yes; perioperative complication: 0 = No, 1 = Yes.

3.7 Perioperative outcomes

3.7.1 Multivariate analysis: predictors of perioperative outcomes

In the multivariate analysis examining predictors of perioperative morbidity and mortality, sex, surgical procedure, type of Anaesthesia, and age showed significant associations. Male patients had nearly twice the odds of perioperative complications compared to females (OR 1.98, 95% CI 1.02–3.87, p = 0.045). The type of surgical procedure was strongly associated with outcomes: patients undergoing procedure type 1 had a markedly lower risk of complications (OR 0.22, 95% CI 0.10–0.49, p < 0.001). Similarly, Anaesthesia type influenced risk, with type 2 and type 3 Anaesthesia associated with reduced odds of adverse outcomes (OR 0.32, 95% CI 0.17–0.60, p < 0.001; OR 0.21, 95% CI 0.05–0.97, p = 0.045, respectively). Increasing age slightly decreased the odds of complications (OR 0.978 per year, 95% CI 0.957–0.999, p = 0.036). GFR categories did not reach statistical significance as independent predictors. Compared with patients in GFR category G1, the odds ratios for G2, G3, G4, and G5 were 0.44, 1.12, 2.76, and 0.80, respectively, with all 95% confidence intervals crossing 1.0 (p-values 0.092–0.705). This suggests that, after adjusting for demographic and procedural factors, GFR alone was not independently associated with perioperative morbidity or mortality (Table 6).

Table 6. Multivariate logistic regression analysis for perioperative outcomes.

Odds ratios (OR) with 95% confidence intervals (CI) and p-values for predictors of perioperative complications, adjusted for all variables in the model. Reference categories: GFR G1, female sex, type 1 surgery. OR > 1 indicates increased risk; OR < 1 indicates decreased risk.

3.8 Interaction between renal function and clinical and biological parameters

The analysis categorized patients' GFR values into standard CKD stages (G1–G5) and examined how clinical, biological, anaesthetic, and surgical parameters vary across these categories. Mean Creatinine levels rise sharply from 0.59 mg/dL in G1 to 6.03 mg/dL in G5, reflecting progressive renal impairment. Urea displays a U-shaped pattern, decreasing from 37.11 mg/dL in G1 to 21.22 mg/dL in G3a, then sharply increasing to 85.65 mg/dL in G5. Age tends to increase with CKD progression, peaking at 59.88 years in G4, with a slight decrease to 52.18 years in G5. Mean surgical duration is longest in G2 (87.07 min) and shortest in G4 (63.44 min). High blood pressure shows minor fluctuations, with highest prevalence in G3a (0.65) and lowest in G5 (0.41). Perioperative complication rates are elevated in G3b (0.29) and G4 (0.31), and lowest in G2 (0.09). Type of Anaesthesia varies slightly across categories (1.53–1.88), while patient weight does not follow a clear trend, peaking at 64.19 kg in G4 and dropping to 43.93 kg in G3b. Overall, creatinine and urea are the strongest markers of CKD severity, while complication risk peaks in intermediate to advanced CKD stages (Figure 2).

3.9 Perioperative outcomes according GFR < 60 vs. GFR ≥ 60 mL/min/1.73 m²

The analysis of perioperative outcomes according to glomerular filtration rate (GFR) reveals notable differences between patients with a GFR below 60 mL/min/1.73 m² and those with a GFR of 60 mL/min/1.73 m² or higher. Mortality was higher in patients with GFR < 60, with a rate of 11.16%, compared with 5.39% in patients with GFR ≥ 60. The incidence rates were similar between the two groups, at 24.70% for patients with GFR < 60 and 23.35% for those with GFR ≥ 60. In contrast, perioperative complications occurred more frequently in patients with impaired renal function, with a rate of 18.73% in the GFR < 60 group vs. 14.37% in the GFR ≥ 60 group. Overall, reduced GFR was associated with higher rates of mortality and perioperative complications, while the occurrence of perioperative incidents showed minimal variation between GFR categories (Figure 3).

3.10. Multivariate logistic regression analysis of factors associated with GFR < 60 mL/min/1.73 m²

When patients are divided into two groups based on GFR (GFR < 60 mL/min/1.73 m² vs. GFR ≥ 60 mL/min/1.73 m²), those with GFR < 60 have significantly higher odds of death compared to patients with GFR ≥ 60 (OR 2.61, 95% CI 1.01–6.71, p = 0.047), after adjusting for age, sex, weight, creatinine, urea, hemoglobin, sodium, potassium, and hypertension. These patients also show a trend toward increased perioperative complications (OR 1.95, 95% CI 0.99–3.84, p = 0.054), although this association does not reach statistical significance. No significant association was observed with perioperative incidents (OR 1.09, 95% CI 0.63–1.87, p = 0.767). Overall, reduced GFR appears to be an independent predictor of mortality and may contribute to a higher risk of perioperative complications (Table 7).

Table 7. Multivariate logistic regression of GFR < 60 and clinical outcomes.

Multivariate logistic regression results; OR, odds ratio; CI, confidence interval; GFR, glomerular filtration rate. OR > 1 indicates higher odds for GFR < 60.

4 Discussion

Our study provides a comprehensive assessment of the anaesthetic profile and perioperative outcomes in patients with chronic kidney disease (CKD) undergoing urgent and elective surgery at Monkole Hospital. The findings underscore the complex interplay between renal function, patient characteristics, and perioperative risk, consistent with global data on CKD and surgical outcomes (1–3).

4.1 CKD and perioperative risk

Patients with reduced glomerular filtration rate (GFR < 60 mL/min/1.73 m²) exhibited significantly higher mortality compared to those with GFR ≥ 60, with an adjusted odds ratio of 2.61 (95% CI 1.01–6.71, p = 0.047). This aligns with prior evidence suggesting that impaired renal function independently increases susceptibility to perioperative adverse outcomes, likely due to accumulated comorbidities, altered hemodynamic, and metabolic derangements (3, 5, 9). Notably, the trend toward increased perioperative complications in the GFR < 60 group, although not statistically significant, reflects the heightened vulnerability of this population to both anaesthetic and surgical stress (6, 7).

The absence of a statistically significant association between GFR and perioperative incidents suggests that while renal impairment elevates systemic risk, careful anaesthetic management may mitigate the occurrence of intraoperative events. This observation is supported by literature highlighting that individualized anaesthetic protocols and vigilant intraoperative monitoring can reduce acute perioperative complications in CKD patients (5, 8).

4.2 Anaesthetic profile and surgical considerations

Induction agents varied according to renal function, reflecting both pharmacokinetic constraints and hemodynamic considerations in CKD patients. Ketamine use increased notably in advanced CKD stages (G4–G5), likely due to its hemodynamic stability, minimal renal clearance, and ability to maintain cardiac output under perioperative stress (5, 7). This makes ketamine a preferred choice in patients with severe renal impairment, where hypotension or drug accumulation from renally excreted agents could exacerbate perioperative morbidity.

In patients with moderate CKD (G2–G3), induction agents such as propofol and etomidate were more frequently used. Although effective, careful dose adjustment is essential to avoid hypotension, prolonged sedation, or accumulation of active metabolites, which may increase the risk of perioperative complications (5, 6).

The variation in induction strategies illustrates a deliberate tailoring of anaesthetic management to renal function, aiming to optimize hemodynamic stability, minimize renal stress, and reduce perioperative morbidity (3, 5, 6, 8). Importantly, these findings suggest that individualized induction protocols may contribute to the observed differences in perioperative outcomes between patients with GFR ≥ 60 and those with GFR < 60 mL/min/1.73 m², reinforcing the central role of renal function assessment in perioperative risk stratification.

4.3 Biological and clinical correlates

Laboratory data revealed progressive derangements in creatinine and urea across CKD stages, reflecting the natural history of renal decline. Haemoglobin and hematocrit decreased with worsening GFR, consistent with CKD-associated anemia, which may contribute to reduced oxygen delivery and increased perioperative mortality (1–3). Electrolytes remained relatively stable, likely due to preoperative optimization and hospital-based monitoring. In addition to anemia and uremia, electrolyte disturbances—particularly hyperkalemia—plays a central role in perioperative morbidity among patients with advanced CKD. Hyperkalemia can precipitate severe cardiac arrhythmias and hemodynamic instability, especially in the context of anaesthetic drug administration and surgical stress. Although potassium levels appeared relatively stable in our cohort, likely reflecting perioperative optimization, this risk remains a major concern in clinical practice and warrants systematic monitoring and management (7).

Interestingly, hemorrhagic events were not more frequent in advanced CKD stages, possibly reflecting effective perioperative management despite known platelet dysfunction in uremia.

Importantly, intermediate to advanced CKD stages (G3b–G4) displayed higher rates of perioperative complications, suggesting a nonlinear relationship between renal impairment and perioperative risk. This pattern agrees with prior cohort analyses, which demonstrate that moderate CKD carries substantial risk despite often preserved hemodynamic (10, 11).

4.4 Implications for perioperative management

Our study highlights that GFR < 60 is a critical threshold for increased mortality risk, reinforcing the need for meticulous preoperative evaluation, hemodynamic optimization, and perioperative monitoring (4, 6). Adjustments in anaesthetic technique, agent selection, and fluid management should be individualized according to renal function and comorbidities (5, 8). These findings are consistent with recommendations emphasizing a systematic, patient-centred approach in CKD populations to reduce perioperative morbidity and mortality (5, 6, 8, 12).

Moreover, the results underscore the importance of early identification and stratification of patients at risk. Multivariate analyses indicate that sex, surgical type, Anaesthesia type, and age independently influence perioperative outcomes, suggesting that CKD interacts with multiple clinical factors rather than serving as a sole determinant of risk (10, 11, 13). This multifactorial model aligns with current perioperative risk prediction frameworks advocating for integrated assessment of renal function, comorbidities, and procedural complexity (14–16). In this context, notably, none of the patients received preoperative renal replacement therapy. This likely reflects limited access to dialysis in our setting and may have contributed to the increased perioperative risk observed in advanced CKD. The absence of preoperative dialysis may also contribute to uncontrolled metabolic disturbances, particularly hyperkalemia.

4.5 Strengths and limitations

This study benefits from a robust sample size and comprehensive perioperative data, allowing stratification across GFR categories and detailed multivariate analysis. The use of standardized data extraction and adjustment for confounders enhances the validity of the findings. However, limitations include the retrospective cross-sectional design, restriction to a single center, and follow-up limited to hospital stay, which precludes assessment of long-term outcomes. Additionally, although multivariate models adjusted for key variables, residual confounding cannot be entirely excluded.

5 Conclusion

In this cohort from Monkole Hospital, CKD patients with GFR < 60 mL/min/1.73 m² exhibited a significantly higher risk of perioperative mortality and a trend toward increased perioperative complications. These findings reinforce the importance of integrating renal function assessment into perioperative risk stratification, tailoring anaesthetic management, and optimizing comorbidities to improve surgical outcomes. Future prospective studies are warranted to evaluate long-term morbidity, refine anaesthetic protocols, and validate predictive models in diverse CKD populations.

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Footnotes

Edited by: Lucas Ferreira Gomes Pereira, Universidade de Sao Paulo Anestesiologia, Brazil

Reviewed by: Ashish Malik, Indraprastha Apollo Hospitals, India

Christian Bohringer, UC Davis Medical Center, United States

Abbreviations BMI, body mass index; CKD, chronic kidney disease; CKD-EPI, chronic kidney disease epidemiology collaboration; CI, confidence interval; ESRD, end-stage renal disease; GFR, glomerular filtration rate; HBP, high blood pressure; OR, odds ratio; SD, standard deviation; KDIGO, kidney disease: improving global outcomes.