Survival Analysis and Its Predictors Among Hemodialysis Patients at Saint Paul Hospital Millennium Medical College and Myungsung Christian Medical Center in Addis Ababa, Ethiopia, 2021

Abstract

Background

Diabetes mellitus and hypertension are the most prominent conditions causing chronic kidney disease and eventually end-stage renal disease. Renal replacement therapy, particularly hemodialysis (HD), is the mainstay of treatment. The aim of this study is to assess the overall survival status of HD patients and potential survival predictors at Saint Paul hospital millennium medical college (SPHMMC) and Myungsung Christian Medical Center (MCM) in Addis Ababa, Ethiopia.

Methods

A retrospective cohort study was conducted on HD patients at SPHMMC and MCM general hospital from January 1, 2013 to December 30, 2020. Kaplan Meier, Log-rank, and Cox proportional regression models were used for the analysis. Estimated risks were reported as hazard ratios with 95% confidence intervals and P<0.05 was considered as having a significant association.

Results

A total of 128 patients were included in the study. Median survival time was 65 months. The predominant co-morbid condition was found to be diabetes mellitus with hypertension (42%). The total risk time for these patients was 143,617 person years. The overall incidence rate of death was 2.9 per 10,000 person years (95% CI=2.2–4). Patients who developed blood stream infection were 2.98-times more likely to die than those without infection. Those using an arteriovenous fistula were 66% less likely to die than those using a central venous catheter. Additionally, patients treated in a government-owned facility were 79% less likely to die.

Conclusion

The study identified that the median survival time of 65 months was comparable with developed nations. Significant predictors of death were found to be blood stream infection and type of vascular access. Government-owned treatment facilities showed better patient survival.

Keywords:

• survival status
• survival predictors
• hemodialysis predictors

Abbreviations

AVF, Arteriovenous Fistula; AVG, Arteriovenous Graft; BMI, Body Mass Index; CKD, Chronic Kidney Disease; CVD, Cardiovascular Disease; CVE, Cardiovascular Events; DSL, Dialysis Secession Length; ESRD, End-Stage Renal Disease; GFR, Glomerular Filtration; GOF, Goodness of Fit; HD, Hemodialysis; HR, Hazard Ratios; KM, Kaplan Meier; LVH, Left Ventricular Hypertrophy; MCM, Myungsung Christian Medical Center; NCD, Non-Communicable Disease; PH, Proportional Hazard; RRT, Renal Replacement Therapy; SPHMMC, Saint Paul Hospital Millennium Medical College; VC, Vascular Calcification; VIF, Variance Inflation Factor.

Ethics Approval and Informed Consent

The Ethical Review Board of Yekatit 12 Hospital Medical College evaluated the research proposal and determined that obtaining informed consent was not necessary, as the study only involved the collection and analysis of existing data, documents, and information that were recorded in a manner that would prevent the direct or indirect identification of research participants. This decision was in accordance with the National Research Ethics Review Guideline, Sixth Edition, Chapter 7, Section 7.2, and was consistent with the Declaration of Helsinki. As a result, the proposal was authorized for ethical approval under protocol number 48/21. Subsequently, permission letters were issued to Saint Paul Hospital Millennium Medical College and Myungsung Christian Medical Center to proceed with data collection.

Data Sharing Statement

The research’s findings were derived from the data collected and examined using the specified techniques and resources. On request, the original data that supports this conclusion will always be made available.

Acknowledgment

We are grateful to Yekatit 12 Hospital Medical College’s department of public health for accommodating all of our needs during this endeavor. We owe a similar obligation to all of the healthcare facilities involved in this initiative for their full cooperation to have this study done. Last but not least, we would like to acknowledge and thank the data collectors, supervisors, and data clerks of the respective healthcare facilities for their genuine support in assisting us in gathering the data for this study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

The research was funded by the authors.