Mortality in hemodialysis patients in Ethiopia: a retrospective follow-up study in three centers

Beza Zewdu Desta, Abel Fekadu Dadi, Behailu Tariku Derseh, Beza Zewdu Desta, Abel Fekadu Dadi, Behailu Tariku Derseh

Abstract

Background: The prevalence of chronic kidney disease (CKD) is between 10 and 15% worldwide. Ethiopia is seeing a consistent increase in the number of dialysis patients. Patients on chronic hemodialysis have high mortality rates, but there is little information available in Ethiopia. Thus, this study looked into patient mortality and the factors that contributed to it at three dialysis centers in Addis Ababa for hemodialysis patients.

Method: A facility-based retrospective follow-up study was employed among End-Stage Renal Disease patients on hemodialysis from 2016 to 2020 at St. Paul Millennium Medical College (SPMMC), Zewditu Memorial Hospital (ZMH), and Menelik II Hospital. The proportional hazard assumption was checked by using the Log (-log (St)) plots and tests. Life-table analysis was fitted to estimate the one and five-year's survival probability of these patients and Cox Proportional regression analysis to model the predictors of mortality at p-value < 0.05.

Result: Over the course of 2772 person-months, 139 patients were tracked. Of these patients, 88 (63.3%) were male and the mean age (± SD) of the patients was 36.8 (± 11.9) years. During the follow-up period, 24 (17%) of the patients died, 67 (48.2%) were alive, 43 (30.9%) received a kidney transplant, and 5 (3.6%) were lost to follow-up. The mean survival time was 46.2 months (95% CI: 41.8, 50.5). According to estimates, there were 104 deaths per 1000 person-years at the end of the follow-up period. The likelihood that these patients would survive for one and 5 years was 91%% and 65%, respectively. Our analysis showed that patients with hypertension (Adjusted Hazard Rate (AHR) = 4.33; 95% CI: 1.02, 34.56), cardiovascular disease (AHR = 4.69; 95% CI: 1.32, 16.80), and infection during dialysis (AHR = 3.89; 95% CI: 1.96, 13.80) were more likely to die.

Conclusion: The hemodialysis patients' death rate in the chosen dialysis facilities was high. Preventing and treating comorbidities and complications during dialysis would probably reduce the mortality of CKD patients. Furthermore, the best way to avoid and manage chronic kidney disease is to take a complete and integrated approach to manage hypertension, diabetes, and obesity.

Keywords: Chronic kidney diseases; Hemodialysis patients; Incidence; Mortality.

Conflict of interest statement

The authors declare that they have no conflict of interest.

© 2023. The Author(s).

Figures

Fig. 1
Fig. 1
The sampling technique used to assess the survival and predictors of death among ESRD patients receiving hemodialysis in AA, Ethiopia, 2016 – 2020
Fig. 2
Fig. 2
Kaplan–Meier survival curves for hemodialysis patients with respect to the covariate infection status in Addis Ababa, Ethiopia from 2016–2020
Fig. 3
Fig. 3
Kaplan–Meier survival curves for hemodialysis patients with respect to the covariate status of hypertension in Addis Ababa, Ethiopia from 2016–2020
Fig. 4
Fig. 4
Kaplan–Meier survival curves for hemodialysis patients with respect to the covariate types of vascular access in Addis Ababa, Ethiopia from 2016–2020
Fig.5
Fig.5
Kaplan–Meier survival curves for hemodialysis patients with respect to the covariate cardiac complication in Addis Ababa, Ethiopia from 2016–2020
Fig. 6
Fig. 6
Kaplan–Meier survival curves for hemodialysis patients with respect to the covariate frequency of dialysis per week in Addis Ababa, Ethiopia from 2016–2020

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