TIME TO END STAGE OF RENAL DISEASE ASSOCIATED WITH SERUM CREATININE AMONG ADULT CHRONIC KIDNEY PATIENTS IN AYDER COMPREHENSIVE SPECIALIZED HOSPITAL: JOINT AND COPULA MODELING

Abstract

Background- Chronic kidney disease (CKD) is a global public health issue and around 13.4% of people had CKD. Out of these, 14.5 million people have end stage of renal disease (ESRD) and 7.083 million needed renal replacement therapy. Paired kidney shared the same gene and comes from the same person. In Ethiopia, the incidence of CKD is estimated to be 21.71%. The war between Ethiopia federal and Tigray government leads to 70–80% of health facility dysfunctional. Objective The main objective was to determine time to ESRD associated with longitudinal serum creatinine, joint time to right and left kidney failure among adult CKD patients, and determinant factors in Ayder Comprehensive Specialized Hospital from 2019 to 2024. Methods - A retrospective cohort study conducted among 408 adult CKD patients in Ayder Comprehensive Specialized Hospital from 2019 to 2024. CKD patients without ESRD at the start of follow-up included in the study and data collected from medical card. Pretest, supervision and training used to assess data completeness. Joint and Copula Cox-proportional hazard model (CoxPH) used. Archimedean Copula model fitted to predict joint time to fail both kidney and interpretation done using hazard ratio (HR) and 95% confidence interval (C.I). Result- In the joint Cox-PH model variables with HR and 95% C.I interpreted. A unit increased in hemoglobin level the hazard of ESRD decreased by 11 %, HR= 0.89(0.7865,0.9935). A unit increased in urea the hazard of ESRD increased by HR =1.01(1.0065,1.0135) times, as estimate glomerular filtration rate increased, hazard of ESRD decreased by 2%, HR= 0.98(0.9621,0.9978). As longitudinal serum creatinine increased, hazard of ESRD increased by HR= 4.31(3.5760,5.0641) and being hepatitis, hazard of ESRD increased by HR= 2.61(1.8936,3.3264) times. In the Copula model, 86% of time to ESRD due to dependency of right and left kidney. Conclusion and Recommendation - The variables hemoglobin level and glomerular filtration rate value had a negative association, whereas urea level, longitudinal serum creatinine value and hepatitis had a significant positive effect on time to ESRD at the 5% level of significance. These factors increase the incidence of ESRD among CKD. To decrease the progression, health professional should provide early screening of chronic disease and strictly follow for laboratorial abnormality, every patient should follow appropriately for medical service and life style modification to prevent for chronic disease.