Time To Death And Its Predictors Among Patients With Chronic Kidney Disease On Hemodialysis At Dialysis Unit In Addis Ababa, Ethiopia, 2023

Abstract

Background: Chronic kidney disease is a progressive disease that affects more than 10% of the world's population and the leading cause of death in the twenty-first century. In addition, it has a significant financial burden on peoples undergoing hemodialysis. However, there are few research, particularly in the study area, on time to death and its predicators among hemodialysis patients in Ethiopia, therefore knowing of time to death and identifying predicators that affect the survival time is crucial in order to improve survival time and enhance prognosis of hemodialysis patient. Objective: To assess time to death and its predictors among patients with chronic kidney disease on hemodialysis at dialysis unit in Addis Ababa, Ethiopia, 2023. Methods: Institution-based retrospective cohort study was carried out among 370 chronic kidney disease patients on hemodialysis from January 1st, 2017 to December 30th, 2022. Data were extracted from April 1st -May 20th, 2023, and each variable was coded and entered into Epi Data version 3.1 and then exported into STATA version 15 software for analysis. Kaplan-Meier and the log-rank test was done. Bivariable Cox-proportional regression was done, and a variable whose p-value < 0.25 and fulfilled proportional hazard assumption by using graphical and Shenfield residual was entered into multivariable Cox-proportional regression. Finally, a variable whose p-value < 0.05 and Adjusted hazard ratio with its CI was declared statistically significant predictors. Result: In this study the overall median survival time was 47 month (95% CI: 36.7, 56), with incidence rate of death 16.8/1000 person-month of observation (95% CI: 13.8- 20.3). Age 64 and above (Adjusted Hazard Ration: 2.8; 95% CI: 1.67–4.98), Catheter vascular access (Adjusted Hazard Ration 3.47; 95% CI: 2.03–5.93), Cardiovascular disease (Adjusted Hazard Ration 1.88; 95% CI: 1.15–3.07), blood group B (Adjusted Hazard Ration 2.07; 95% CI: 1.17– 3.69) were significant predictors of time to death among hemodialysis patients. Conclusion and recommendation: The incidence rate of death was 16.8/1000 person-months of observation, and the median survival time was 47 months with an Interquartile range of 40. Cardiovascular disease, older adults, central venous catheters, and blood type B were significant predictors of time to death for hemodialysis patients. Therefore, in order to improve the survival of hemodialysis patients, health professionals should pay attention to and work on those predictors.