Abstract:
Background: Chronic Kidney Disease is the most killer and ignored disease, and there are
several patients in our country Ethiopia. And the severity of this disease is measured by
glomerular filtration rate (GFR), and categorized into three called status namely improved
status (GFR of more than 60) and unimproved status (GFR of between 60 and 15), and kidney
failure (GFR of less than 15). Nevertheless, few studies were conducted before by considering
these categories of GFR. The main objective of this study is to analyze the joint modeling of the
longitudinal outcome of patient's status and survival time up to the End Stage Renal Disease.
Method: A retrospective cohort study was conducted with 343 CKD patients seen at outpatient
department in Felege Hiwot Comprehensive Specialized Referral Hospital and Gamby
Teaching Hospital, who had at least two, at most ten visits before the event outcome was
occurred, and also age more than two years old at the baseline of the study. Therefore, joint
model analysis was analyzed which consists of a mixed effect longitudinal binary sub-model for
the repeated status of Chronic Kidney Disease patients and cox proportional hazards sub-model
for time to the complication of ESRD using R software.
Result: Compared to full age spectrum GFR equation CKD-EPI had relatively similar results
as the hospitals identification of ESRD. Joint modeling analysis had smaller error of estimate,
smaller residual variability, and significant association parameter (-0.0059, p-value < 0.0001)
implies that good model for estimating parameters for each of the two models than using
separate models. Urea protein, nifedipine, and hematocrit were the significant predictors in
both survival and longitudinal model.
Conclusion: The Chronic Kidney Disease Epidemiological Collaboration was relatively good
measure for measuring GFR than Full Age Spectrum estimated GFR for the study area. The
increase in Urea protein and Hematocrit were the indication for less likely to have improved
statuses of patients and more likely for the complication of ESRD. The patients with improved
status of CKD patents were fewer hazards for the complication to ESRD. Diabetic mellitus type
one patients were less likely to have improved GFR. Health professionals and the concerned
bodies should give more attention for identifying the status renal patients.