Publication: Relative survival and excess hazard regression model for predictors of death among chronic kidney disease stage 5 patients in Kelantan
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Date
2024-12
Authors
Abdullah, Muhammad Nabil
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Abstract
Introduction: Chronic kidney disease (CKD) stage 5 is associated with significant morbidity and mortality, representing a substantial burden on patients, healthcare providers, and resources. This study aimed to estimate the relative survival rates and identify predictors of death among CKD stage 5 patients in Kelantan from 2015 to 2020.
Methods: This retrospective cohort study was conducted at Hospital Raja Perempuan Zainab II (HRPZII), a major tertiary referral centre in Kelantan, Malaysia. Data were collected from the hospital's electronic medical records, covering patients diagnosed with CKD stage 5 between 1st January 2015 and 31st December 2020, with an additional follow-up period extending from 1st January 2021 to 31st December 2022. The eligibility criteria for this study included adult patients aged 18 years and above who were Kelantan residents and diagnosed with CKD stage 5 between 1st January 2015 and 31st December 2020. After applying these criteria, a total of 515 patients were included in the final analysis. Relative survival was calculated using the Pohar-Perme method, and multivariable Poisson regression was performed to identify significant prognostic factors of excess hazard ratio (EHR) of death. Data on demographic, clinical, and laboratory parameters were collected and analysed. A complete life table for this study was derived by expanding the abridged life table provided by the Department of Statistics Malaysia (DOSM).
A total of 515 patients were included in the study, with a mean age of 58.05 years (SD: 12.66) and a female predominance (56.1%). Diabetes mellitus (DM) was the leading cause of CKD, affecting 76.3% of patients. High prevalence rates of anaemia (95.1%), low serum albumin (48.4%), and elevated phosphate levels (75.2%) were observed. Relative survival declined rapidly, with one-year survival at 76% (95% confidence interval CI: 72, 80), dropping to 45% (95% CI: 40, 50) at three years, and 29.6% (95% CI: 25, 36) at five years. Multivariable Poisson regression identified four significant predictors: diabetic kidney disease (DKD) increased excess mortality risk by 77% (EHR = 1.77, 95% CI: 1.27, 2.46, p < 0.001), while patients on conservative treatment had the highest excess hazard in the first six months (EHR = 13.56, 95% CI: 6.62, 27.76, p < 0.001), with a gradual decline over time. Low serum albumin doubled mortality risk (EHR = 1.99, 95% CI: 1.54, 2.59, p < 0.001), and elevated phosphate levels increased the risk of death by 66% (EHR = 1.66, 95% CI: 1.21, 2.27, p = 0.003).
Conclusion: Relative survival among CKD stage 5 patients in Kelantan is low, with a marked decline during the first two years post-diagnosis. Significant predictors of mortality include DKD, conservative treatment, low serum albumin, and high phosphate levels. The time-dependent effect of conservative treatment underscores the importance of early and aggressive management. Optimizing care for high-risk groups, particularly those undergoing conservative treatment, and addressing modifiable risk factors such as albumin and phosphate levels, is critical to improving survival outcomes in this population.
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Keywords
CKD stage 5 , relative survival