Factors associated with survival among patients with end-stage kidney disease undergoing hemodialysis in Tanzania: a cohort study

Abstract

Despite increased technological advances and trained health workers, morbidities and mortalities of patients on hemodialysis (HD) treatment remain unacceptably high, and factors affecting survival are largely unknown in Tanzania. This study aims to assess factors associated with survival among patients with end-stage kidney disease (ESKD) undergoing hemodialysis in Tanzania. This retrospective study involved 386 patients with ESKD aged 18 years and older who underwent HD at Muhimbili National Hospital (MNH) hemodialysis unit from January 2016 to December 2021. The Kaplan-Meier method was used to determine the survival rate of patients, and the Cox proportional hazard model was used to evaluate the factors associated with survival. Overall, 386 participants were enrolled in the study, with a mean age of 50.7 ± 15.87 years, and the median survival time was 2.5 years. The estimated survival rates for 1-, 2-, and 3-year were 66%, 53%, and 47%, respectively. In the multivariable model, patients with higher risks of mortality were those in the age group ≥ 56 years (Hazard ratio, HR = 2.19, 95% confidence interval, CI: 1.35, 3.53; P = 0.001), with primary education (HR = 2.02, 95%CI: 1.15, 3.54; P = 0.014) and secondary education (HR = 1.81, 95%CI: 1.03, 3.18, P = 0.039), unemployed (HR = 1.83, 95%CI: 1.10, 3.03, P = 0.019), catheter vascular access (HR = 1.44, 95%CI: 1.05, 0.97; P = 0.023); WBC count (HR = 1.38, 95%CI: 1.02, 1.86; P = 0.038) and platelets count (HR = 1.79, 95%CI: 1.29, 2.50; P = 0.001) not in a normal ranges. Patients with a lower risk of mortality were those whose ESKD was due to renal causes (HR = 0.42, 95% CI: 0.18, 0.97; P = 0.041) and those whose model of payment for treatment was Health insurance (HR = 0.58, 95% CI: 0.40, 0.83; P = 0.003). The results showed that the survival rates for 1-, 2-, and 3-year were 66%, 53%, and 47%, respectively. Younger age, college or university education, employment, health insurance, fistula vascular access, and normal range WBC count and platelet count were factors associated with higher survival rates. Not applicable.