Correlation of Comorbid Risk Factors on Mortality of Chronic Kidney Disease Patients Undergoing Hemodialysis
Abstract
Introduction: Chronic Kidney Disease (CKD) is a condition of decreased kidney function with GFR < 60 ml/minute per 1.73 m2 which occurs within 3 months. The global prevalence of CKD in 2017 reached 9.1% or 697.5 million cases in the world where women were 9.5% and men 7.3% cases and 1.2 million cases of death. In Indonesia, according to Riskesdas in 2013, the prevalence of CKD increases with age, with men at 0.3% while women at 0.2%. Comorbidity is known to increase the risk of death in CKD patients on hemodialysis. In this study, the comorbidities taken included hypertension, diabetes mellitus, heart failure, stroke, and urinary tract infections. This study aims to determine and analyze the relationship of comorbid risk factors to the mortality of chronic kidney disease patients undergoing hemodialysis.
Methods: This research is an analytic observational with a case control design. The subjects of this study were end-stage CKD patients with hemodialysis in RSUD dr. Moewardi in 2017-2021 with a total of 150 samples. Sampling using purposive sampling method based on inclusion and exclusion criteria. Data analysis used statistical software application SPSS 22 with chi-square test as bivariate analysis.
Results: Univariate analysis showed that age 51-60 years were the most experienced group with CKD, namely 64 people (42.67%). Women are more likely to experience CKD than men. The most comorbid that appeared in the case group (died) was UTI (Urine Tract Infection) with a total of 40 people (53.33%) followed by hypertension as many as 31 people (41.33%), diabetes mellitus as many as 24 people (32%), heart failure as many as 16 people (21.33%), and stroke as many as 16 people (21.33%). Bivariate analysis using the chi-square test showed that there was a significant relationship between comorbid hypertension (P = 0.038; OR = 2.077), diabetes mellitus (P = 0.037; OR = 2,244), heart failure (P = 0.041; OR = 2.634), stroke (P = 0.021; OR = 3.119), and urinary tract infections (P = 0.049; OR = 1.918) on the mortality of chronic kidney disease patients undergoing hemodialysis. Multivariate analysis using logistic regression showed that there was no factor that had the most influence on mortality in patients with chronic kidney disease on hemodialysis.
Conclusion: Risk factors for hypertension, diabetes mellitus, heart failure, stroke, and urinary tract infections have a significant relationship with the mortality rate of chronic kidney disease patients undergoing hemodialysis. Other factors that influence the mortality of CKD patients on hemodialysis are older age and female gender.
Keywords
Full Text:
PDFReferences
1. Webster AC, Nagler E V., Morton RL, Masson P. Chronic Kidney Disease [Internet]. Vol. 389, The Lancet. Lancet Publishing Group; 2017 [cited 2021 Feb 9]. p. 1238–52. Available from: https://pubmed.ncbi.nlm.nih.gov/27887750/
2. Carney EF. The impact of chronic kidney disease on global health [Internet]. Vol. 16, Nature Reviews Nephrology. Nature Research; 2020 [cited 2021 Feb 9]. p. 251–251. Available from: https://www.nature.com/articles/s41581-020-0268-7
3. Jones R. Chronic disease and comorbidity [Internet]. Vol. 60, British Journal of General Practice. Royal College of General Practitioners; 2010 [cited 2021 Feb 9]. p. 399. Available from: /pmc/articles/PMC2880735/
4. Lee W-C, Lee Y-T, Li L-C, Ng H-Y, Kuo W-H, Lin P-T, et al. The Number of Comorbidities Predicts Renal Outcomes in Patients with Stage 3–5 Chronic Kidney Disease. J Clin Med. 2018;7(12):493.
5. McQuillan R, Trpeski L, Fenton S, Lok CE. Modifiable risk factors for early mortality on hemodialysis. Int J Nephrol [Internet]. 2012 [cited 2021 Feb 9];2012. Available from: https://pubmed.ncbi.nlm.nih.gov/22888426/
6. Lida F. Hubungan antara Kondisi Komorbid dan Mortalitas Pada Pasien Gagal Ginjal Kronik yang Menjalani Hemodialisis di RSU Dokter Soedarso Pontianak. Progr Stud Pendidik Dr Fak Kedokt Univ Tanjungpura Pontianak. 2015;151:10–7.
7. Zou Y, Hong D, He Q, Wen Y, Li G. Epidemiology investigation and analysis of patients with hemodialysis in Sichuan province of China. Ren Fail [Internet]. 2019 Jan 1 [cited 2021 Feb 9];41(1):644–9. Available from: https://pubmed.ncbi.nlm.nih.gov/31296088/
8. Wido. LAPORAN KINERJA RSUD Dr. MOEWARDI. 2017;(April):14.
9. Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2019. Cdc [Internet]. 2019 [cited 2021 Aug 11];1:1–6. Available from: https://www.cdc.gov/kidneydisease/publications-resources/CKD-national-facts.html
10. Hallan SI, Matsushita K, Sang Y, Mahmoodi BK, Black C, Ishani A, et al. Age and association of kidney measures with mortality and end-stage renal disease. JAMA - J Am Med Assoc [Internet]. 2012 Dec 12 [cited 2021 Aug 13];308(22):2349–60. Available from: /pmc/articles/PMC3936348/
11. Ji A, Pan C, Wang H, Jin Z, Lee JH, Wu Q, et al. Prevalence and associated risk factors of chronic kidney disease in an elderly population from eastern China. Int J Environ Res Public Health [Internet]. 2019 Nov 2 [cited 2021 Aug 11];16(22). Available from: /pmc/articles/PMC6888049/
12. National Kidney Foundation. Kidney Failure Risk Factor: Gender (Sex) | National Kidney Foundation [Internet]. 2021 [cited 2021 Aug 11]. Available from: https://www.kidney.org/content/kidney-failure-risk-factor-gender-sex
13. Glassock R, Delanaye P, El Nahas M. An age-calibrated classification of chronic kidney disease [Internet]. Vol. 314, JAMA - Journal of the American Medical Association. JAMA; 2015 [cited 2021 Aug 11]. p. 559–60. Available from: https://pubmed.ncbi.nlm.nih.gov/26023760/
14. Carrero JJ, Hecking M, Chesnaye NC, Jager KJ. Sex and gender disparities in the epidemiology and outcomes of chronic kidney disease [Internet]. Vol. 14, Nature Reviews Nephrology. 2018 [cited 2021 Aug 11]. p. 151–64. Available from: www.nature.com/nrneph
15. Shankar M, Narasimhappa S, N.S. M. Urinary Tract Infection in Chronic Kidney Disease Population: A Clinical Observational Study. Cureus [Internet]. 2021 Jan 5 [cited 2021 Aug 11];13(1). Available from: /pmc/articles/PMC7861116/
16. Fraser SDS, Roderick PJ, May CR, McIntyre N, McIntyre C, Fluck RJ, et al. The burden of Comorbidity in people with chronic kidney disease stage 3: A cohort study. BMC Nephrol [Internet]. 2015 Dec 1 [cited 2021 Mar 31];16(1). Available from: /pmc/articles/PMC4666158/
17. Thompson S, James M, Wiebe N, Hemmelgarn B, Manns B, Klarenbach S, et al. Cause of death in patients with reduced kidney function. J Am Soc Nephrol [Internet]. 2015 Oct 1 [cited 2021 Aug 12];26(10):2504–11. Available from: https://jasn.asnjournals.org/content/26/10/2504
18. Lee W-C, Lee Y-T, Li L-C, Ng H-Y, Kuo W-H, Lin P-T, et al. The Number of Comorbidities Predicts Renal Outcomes in Patients with Stage 3–5 Chronic Kidney Disease. J Clin Med [Internet]. 2018 Nov 28 [cited 2021 Feb 9];7(12):493. Available from: /pmc/articles/PMC6306906/
19. Bansal N, McCulloch CE, Rahman M, Kusek JW, Anderson AH, Xie D, et al. Blood pressure and risk of all-cause mortality in advanced chronic kidney disease and hemodialysis the chronic renal insufficiency cohort study. Hypertension [Internet]. 2015 Jan 20 [cited 2021 Aug 13];65(1):93–100. Available from: https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.114.04334
20. Pugh D, Gallacher PJ, Dhaun N. Management of Hypertension in Chronic Kidney Disease. Drugs [Internet]. 2019 Mar 1 [cited 2021 Aug 13];79(4):365–79. Available from: /pmc/articles/PMC6422950/
21. Ku E, Lee BJ, Wei J, Weir MR. Hypertension in CKD: Core Curriculum 2019. Vol. 74, American Journal of Kidney Diseases. 2019. p. 120–31.
22. Huan Y, Cohen DL, Townsend RR. Pathophysiology of Hypertension in Chronic Kidney Disease. In: Chronic Renal Disease [Internet]. 2015 [cited 2021 Aug 29]. p. 163–9. Available from: http://dx.doi.org/10.1016/B978-0-12-411602-3.00014-7
23. Griffin KA, Polichnowski AJ, Bidani AK. Pathophysiology of Hypertension in Chronic Kidney Disease and Dialysis. In: Core Concepts in Hypertension in Kidney Disease. 2016. p. 35–61.
24. Wen CP, Chang CH, Tsai MK, Lee JH, Lu PJ, Tsai SP, et al. Diabetes with early kidney involvement may shorten life expectancy by 16 years. Kidney Int [Internet]. 2017 [cited 2021 Aug 29];92(2):388–96. Available from: http://dx.doi.org/10.1016/
25. Alicic RZ, Rooney MT, Tuttle KR. Diabetic kidney disease: Challenges, progress, and possibilities. Clin J Am Soc Nephrol [Internet]. 2017 Dec 7 [cited 2021 Apr 13];12(12):2032–45. Available from: https://doi.org/10.2215/CJN.11491116
26. Miller E, Shubrook JH. Sodium glucose co-transporter 2 inhibitors in the treatment of type 2 diabetes mellitus [Internet]. Vol. 7, Osteopathic Family Physician. Circulation; 2015 [cited 2021 Aug 30]. p. 10–30. Available from: https://pubmed.ncbi.nlm.nih.gov/27470878/
27. Tuttle KR. Back to the future: Glomerular hyperfiltration and the diabetic kidney [Internet]. Vol. 66, Diabetes. Diabetes; 2017 [cited 2021 Aug 30]. p. 14–6. Available from: https://pubmed.ncbi.nlm.nih.gov/27999101/
28. Lin YC, Chang YH, Yang SY, Wu KD, Chu TS. Update of pathophysiology and management of diabetic kidney disease. J Formos Med Assoc [Internet]. 2018;117(8):662–75. Available from: https://doi.org/10.1016/j.jfma.2018.02.007
29. Sanz AB, Sanchez-Niño MD, Ramos AM, Moreno JA, Santamaria B, Ruiz-Ortega M, et al. NF-κB in renal inflammation [Internet]. Vol. 21, Journal of the American Society of Nephrology. J Am Soc Nephrol; 2010 [cited 2021 Aug 30]. p. 1254–62. Available from: https://pubmed.ncbi.nlm.nih.gov/20651166/
30. Brosius FC, Tuttle KR, Kretzler M. JAK inhibition in the treatment of diabetic kidney disease [Internet]. Vol. 59, Diabetologia. Springer; 2016 [cited 2021 Aug 30]. p. 1624–7. Available from: https://link.springer.com/article/10.1007/s00125-016-4021-5
31. Toth-Manikowski S, Atta MG. Diabetic kidney disease: Pathophysiology and therapeutic targets [Internet]. Vol. 2015, Journal of Diabetes Research. Hindawi Limited; 2015 [cited 2021 Aug 30]. Available from: /pmc/articles/PMC4430644/
32. Wan EYF, Chin WY, Yu EYT, Wong ICK, Chan EWY, Li SX, et al. The impact of cardiovascular disease and chronic kidney disease on life expectancy and direct medical cost in a 10-year diabetes cohort study. Diabetes Care [Internet]. 2020 Aug 1 [cited 2021 Aug 30];43(8):1750–8. Available from: https://care.diabetesjournals.org/content/43/8/1750
33. Sud M, Tangri N, Pintilie M, Levey AS, Naimark DMJ. ESRD and death after heart failure in CKD. J Am Soc Nephrol [Internet]. 2015 Mar 1 [cited 2021 Aug 30];26(3):715–22. Available from: https://jasn.asnjournals.org/content/26/3/715
34. House AA. Management of Heart Failure in Advancing CKD: Core Curriculum 2018. Am J Kidney Dis [Internet]. 2018;72(2):284–95. Available from: https://doi.org/10.1053/j.ajkd.2017.12.006
35. Segall L, Nistor I, Covic A. Heart failure in patients with chronic kidney disease: A systematic integrative review. Vol. 2014, BioMed Research International. Hindawi Publishing Corporation; 2014.
36. Di Lullo L, Gorini A, Russo D, Santoboni A, Ronco C. Left Ventricular Hypertrophy in Chronic Kidney Disease Patients: From Pathophysiology to Treatment. CardioRenal Med [Internet]. 2015 Oct 20 [cited 2021 Sep 1];5(4):254–66. Available from: https://pubmed.ncbi.nlm.nih.gov/26648942/
37. Alhaj E, Alhaj N, Rahman I, Niazi TO, Berkowitz R, Klapholz M. Uremic cardiomyopathy: An underdiagnosed disease [Internet]. Vol. 19, Congestive Heart Failure. Congest Heart Fail; 2013 [cited 2021 Sep 1]. Available from: https://pubmed.ncbi.nlm.nih.gov/23615021/
38. Jankowski J, Floege J, Fliser D, Böhm M, Marx N. Cardiovascular Disease in Chronic Kidney Disease: Pathophysiological Insights and Therapeutic Options. Circulation [Internet]. 2021 Mar 16 [cited 2021 Sep 1];143:1157–72. Available from: https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.120.050686
39. Tomey MI, Winston JA. Cardiovascular pathophysiology in chronic kidney disease: Opportunities to transition from disease to health [Internet]. Vol. 80, Annals of Global Health. 2014 [cited 2021 Sep 1]. p. 69–76. Available from: https://reader.elsevier.com/reader/sd/pii/S2214999613000088?token=10D5FBC70BFDA9ABF7C6F3CE2DF6445B4A172D04626C6BE30A877F3ED6D727566F718E923B2726817EBC7DD79F1D6356&originRegion=eu-west-1&originCreation=20210831234534
40. Rangaswami J, Bhalla V, Blair JEA, Chang TI, Costa S, Lentine KL, et al. Cardiorenal Syndrome: Classification, Pathophysiology, Diagnosis, and Treatment Strategies: A Scientific Statement From the American Heart Association. Circulation [Internet]. 2019 Apr 16 [cited 2021 Sep 1];139(16):E840–78. Available from: https://www.ahajournals.org/doi/abs/10.1161/CIR.0000000000000664
41. Raizada V, Hillerson D, Amaram JS, Skipper B. Angiotensin II-Mediated left ventricular abnormalities in chronic kidney disease. In: Journal of Investigative Medicine [Internet]. BMJ Publishing Group Limited; 2012 [cited 2021 Sep 1]. p. 785–91. Available from: https://jim.bmj.com/content/60/5/785
42. Damman K, Testani JM. The kidney in heart failure: An update. Eur Heart J [Internet]. 2015 Jun 14 [cited 2021 Sep 1];36(23):1437–44. Available from: https://academic.oup.com/eurheartj/article/36/23/1437/2293294
43. De La Mata NL, Masson P, Al-Shahi Salman R, Kelly PJ, Webster AC. Death from Stroke in End-Stage Kidney Disease: A Population-Based Study Using Data Linkage. Stroke [Internet]. 2019 [cited 2021 Sep 1];50(2):487–90. Available from: https://www.ahajournals.org/doi/abs/10.1161/STROKEAHA.118.023644
44. Cherng YG, Lin CS, Shih CC, Hsu YH, Yeh CC, Hu CJ, et al. Stroke risk and outcomes in patients with chronic kidney disease or end-stage renal disease: Two nationwide studies. PLoS One [Internet]. 2018 Jan 1 [cited 2021 Sep 1];13(1):e0191155. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0191155
45. Ding WY, Gupta D, Lip GYH. Atrial fibrillation and the prothrombotic state: Revisiting Virchow’s triad in 2020 [Internet]. Vol. 106, Heart. Heart; 2020 [cited 2021 Sep 1]. p. 1463–8. Available from: https://pubmed.ncbi.nlm.nih.gov/32675218/
46. Ghoshal S, Freedman BI. Mechanisms of Stroke in Patients with Chronic Kidney Disease [Internet]. Vol. 50, American Journal of Nephrology. Karger Publishers; 2019 [cited 2021 Sep 1]. p. 229–39. Available from: https://www.karger.com/Article/FullText/502446
47. Chelluboina B, Vemuganti R. Chronic kidney disease in the pathogenesis of acute ischemic stroke. J Cereb Blood Flow Metab. 2019;39(10):1893–905.
48. Malek M. Brain consequences of acute kidney injury: Focusing on the hippocampus [Internet]. Vol. 37, Kidney Research and Clinical Practice. Kidney Res Clin Pract; 2018 [cited 2021 Sep 1]. p. 315–22. Available from: https://pubmed.ncbi.nlm.nih.gov/30619687/
49. Apostolov EO, Ok E, Burns S, Nawaz S, Savenka A, Shah S V., et al. Carbamylated-oxidized LDL: Proatherosclerotic effects on endothelial cells and macrophages. J Atheroscler Thromb [Internet]. 2013 [cited 2021 Sep 1];20(12):878–92. Available from: https://pubmed.ncbi.nlm.nih.gov/24067603/
50. Kuo IC, Lee JJ, Hwang DY, Lim LM, Lin HYH, Hwang SJ, et al. Pyuria, urinary tract infection and renal outcome in patients with chronic kidney disease stage 3–5. Sci Rep [Internet]. 2020 Nov 10 [cited 2021 Sep 2];10(1):1–9. Available from: https://www.nature.com/articles/s41598-020-76520-5
51. Wang HE, Gamboa C, Warnock DG, Muntner P. Chronic kidney disease and risk of death from infection. Am J Nephrol [Internet]. 2011 Oct [cited 2021 Sep 2];34(4):330–6. Available from: https://www.karger.com/Article/FullText/330673
52. Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: Epidemiology, mechanisms of infection and treatment options [Internet]. Vol. 13, Nature Reviews Microbiology. NIH Public Access; 2015 [cited 2021 Sep 3]. p. 269–84. Available from: /pmc/articles/PMC4457377/
53. Malhotra V, Beniwal P, Pursnani L. Infections in chronic kidney disease. Clin Queries Nephrol [Internet]. 2012 [cited 2021 Sep 3];1(4):253–8. Available from: http://dx.doi.org/10.1016/j.cqn.2012.09.005
54. Skupien J, Smiles AM, Valo E, Ahluwalia TS, Gyorgy B, Sandholm N, et al. Variations in risk of end-stage renal disease and risk of mortalityinaninternationalstudy of patients with type 1 diabetes and advanced nephropathy. Diabetes Care [Internet]. 2019 Jan 1 [cited 2021 Nov 3];42(1):93–101. Available from: https://care.diabetesjournals.org/content/42/1/93
55. Saeed F, Arrigain S, Schold JD, Nally J V, Navaneethan SD. What are the Risk Factors for One-Year Mortality in Older Patients with Chronic Kidney Disease? An Analysis of the Cleveland Clinic CKD Registry. Nephron [Internet]. 2019 [cited 2021 Nov 3];141(2):98–104. Available from: www.karger.com/nef
Refbacks
- There are currently no refbacks.
