key: cord-0267466-a1860a8h authors: zewdu, b. d.; Derseh, B. T.; Dadi, A. F. title: Mortality and predictors of Chronic Kidney Diseases (CKD) in selected dialysis centers in Addis Ababa, Ethiopia date: 2022-01-29 journal: nan DOI: 10.1101/2022.01.27.22269879 sha: 31e4d216af323b0d18e9178b45c7423842568627 doc_id: 267466 cord_uid: a1860a8h Background Chronic Kidney Disease (CKD) affects 10-15% of the population worldwide. The number of dialysis patients is steadily rising in Ethiopia. Chronic hemodialysis patients experience high rates of mortality; however, data is lacking in Ethiopia. We explored the mortality and its driving factors in selected dialysis center in Addis Ababa Method we retrospectively followed a group of End-Stage Renal Disease patients on hemodialysis from 2016 to2020 in St. Paul Millennium Medical College (SPMMC), Zewditu Memorial Hospital (ZMH), and Menellik II Hospital. We fitted Kaplan Meier analysis 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 We analyzed a data of (139) patients under follow up. The mean age ({+/-} SD) of the patients was 36.8 ({+/-}11.95) years. Twenty-four (17%) of the patients died at the end of follow-up. The median survival time was 46.2 months (95% CI: 41.8, 50.5). The one and five-year's survival probability of these patients was 64.8% and 18.7%, respectively. Our analysis showed that patients with hypertension (AHR = 4.33; 95% CI: 1.02, 34.56), cardiac complication (AHR = 4.69; 95% CI: 1.32, 16.8), and infection during dialysis (AHR = 3.89; 95% CI: 1.96, 13.8) were more likely to die. Conclusion The survival status of hemodialysis patients in three was low. Preventing and treating comorbidities and complication during dialysis would reduce mortality of CKD patients. 6 124 Data analysis 125 We entered the extracted data into Epi data and exported to SPSS for further analysis. 126 We used mean or median and standard deviation to present numeric data and 127 frequencies and percentages to present a categorical data. 128 We computed the person-time of follow-up from the date of starting hemodialysis to 129 death, loss to follow-up, or the end of the study. We calculated the Incidence rate of 130 death by dividing the number of deaths among CKD patients occurring by person-131 months of follow-up. We used actuarial life table to estimate survival after initiation of 132 hemodialysis; and the Kaplan-Meier test to estimate the probability of death and the 133 median time to death after initiation of hemodialysis. We did log-rank test to compare a 134 time to death between different covariates. We checked assumption of proportional 135 hazard model using the Log (-log (St)) plots and tests. We used the Cox proportional 136 hazard model to determine the probability of death after initiation of hemodialysis 137 adjusting for confounding factors. We excluded covariates that violate the assumption 138 of cox proportional hazard model from the analysis. All statistically significant variables 139 having a p-value ≤ 0.25 in the bivariate analysis were adjusted in the final model. We 140 estimated the crude and adjusted hazard ratio (HR) and its 95% confidence interval (CI) 141 were estimated to identify and report significant predictors of death at p-value < 0.05. Results 143 We found total of 139 chronic dialysis patients who started a dialysis between January 144 1, 2016, and December 30, 2020. 145 Socio demographic characteristic of the patients 146 is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted January 29, 2022. ; https://doi.org/10.1101/2022.01.27.22269879 doi: medRxiv preprint 9 213 Patients with cardiovascular complications had around four times increased risk of 214 mortality compared to those patients with no cardiac complications. In another way, the 215 mean survival months of patients with cardiac complication was 14 months lower. This 216 result is similar to a study reported from China; were cardiac complication was a 217 statistically significant predictor of mortality among ESRD patients(16). Similarly, we 218 found a cumulative hazard of mortality that was three times among patient with CVD 219 complications it has been reported that stroke was a prominent predictor of all-causes 220 of mortality in patients who had cardiovascular complications (16). The burden of 221 chronic kidney disease on mortality is significant and continues to increase, which 222 requires, optimal medical management. Studies reported the excess of cardiovascular 223 morbidity and mortality in patients with renal insufficiency particularly (17). 232 In the present study, another factor that was identified as a predictor of mortality 233 among patients on hemodialysis was the type of vascular access for hemodialysis 234 treatment. Those who were on arteriovenous Catheter had a risk of mortality about four 235 times compared to those patients with AFV access. This result is consistent with a study 236 reported in Iran a 3.6-fold higher risk of death (19). This study showed that a vascular 237 access using catheter accompanied with increased risk of death and this is highly likely 238 as the fact that. In fact, limiting the use of catheters minimized the infection 239 complications in patients. 240 Another two studies show that catheter use was associated with a mortality risk of 67% 241 and three times as compared with use of an AVF(17). We similarly found a risk of 242 mortality of about 47% higher among patients who used Catheter. 243 Dissimilar to our result a retrospective cohort study in Belgium found a vascular access 244 type was not independently correlated with patient survival, even after taking into 245 account change of vascular access over time (20) . And also the result of this study is . CC-BY 4.0 International license It is made available under a perpetuity. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint 253 Hypertension were another significant predictor of mortality in risk of having that was 254 four times. High blood pressure in our analysis was associated with a mortality risk of 255 four times and this is inconsistent with studies that found reverse association i.e., high 256 blood pressure associated with low risk and low blood pressure associated with high 257 risk of mortality in dialysis patients. Contradict to this study some of the existing studies 258 refer to this phenomenon as "reverse epidemiology", indicating a paradoxical 259 association between mortality and the effect of hypertension in dialysis patients. This 260 paradoxical phenomenon of lower BP or a decline in BP over time is associated with 261 increased mortality and higher BP is associated with lower mortality is described as 262 "reverse" epidemiology of hypertension (21). is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted January 29, 2022. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted January 29, 2022. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted January 29, 2022. ; https://doi.org/10.1101/2022.01.27.22269879 doi: medRxiv preprint 397 is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted January 29, 2022. ; https://doi.org/10.1101/2022.01.27.22269879 doi: medRxiv preprint 415 is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted January 29, 2022. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted January 29, 2022. ; https://doi.org/10.1101/2022.01.27.22269879 doi: medRxiv preprint months of follow-up, respectively. The median survival time was 46.2 months and the Hypertension, cardiovascular complication, infection, and types of vascular access were 186 turned-out to predict the mortality in adjusted model (show figure 1 and table 7) 76) times higher 190 risk of mortality. The risk of mortality among patients using Arterio-Venous Graft and 191 temporary venous catheter were 19 Dialysis remains the priority intervention for patients with advanced CKD as there are 197 limited organs for transplantation and excesses risks associated with the 198 transplantation for most of patients worldwide. Dialysis prolong and improve quality of 199 life of patients with kidney failure, and this needs a continues evaluation of the 200 procedure to improve treatment outcomes. We aimed to conduct this secondary data 201 analysis as an evaluation and to The median follow-up time of the patients was 46.2 months and its consistent with 204 patients in Adama hospital that estimated to be 43 months(13). Furthermore, the 205 survival rate of patients under follow up was 70% at 5-years and 86% at 1-years which 336 General Hospital Population Projections for Ethiopia Survival Analysis of Patients 341 with End Stage Renal Disease the Case of Adama Hospital, Ethiopia Mekiya Nephrology Dialysis Transplantation Predictors of mortality in long-term 345 haemodialysis patients with a low prevalence of comorbid conditions Institute of Clinical Medicine, Vilnius University 349 Faculty of Medicine V. E-POSTERS BLOOD PRESSURE DURING HEMODIALYSIS AS 350 PREDICTOR OF Mortality and Associated Risk 352 Factors in Dialysis Patients with Cardiovascular Disease. kidney internatonal Type of Vascular Access and 355 Survival among Incident Hemodialysis Patients : The Choices for Healthy 356 Outcomes in Caring for ESRD ( CHOICE ) Study Infection in Advanced Chronic Kidney Disease 358 and Subsequent Adverse Outcomes after Dialysis Initiation : A Nationwide Cohort 359 Study