Time to Death and Its Predictors Among Patients With Chronic Kidney Disease on Hemodialysis at Dialysis Unit in Addis Ababa, Ethiopia: a Retrospective Cohort Study

Abstract

Abstract Background Over 10% of the world's population suffers from chronic kidney disease, which is the primary cause of death in the twenty-first century and it progresses over time. Furthermore, it places a heavy financial strain on those receiving hemodialysis. The time to death and its predictors among hemodialysis patients in Ethiopia, have not been extensively studied. As a result, improving survival rates and improving the prognosis of hemodialysis patients requires an understanding of time to death and the predictors that influence it. 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 variables whose p-value < 0.25 and fulfilled proportional hazard assumption were 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 for time to death. 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 and work on those predictors.