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Evaluation of Laboratory Values Affecting Mortality of End-Stage Renal Disease Patients: A Competing Risks Approach Publisher Pubmed



Malek R1 ; Baghestani A2 ; Rashidfarokhi F3 ; Shafaghi S4 ; Minoo F5 ; Eghbali F6 ; Chandra N7 ; Shafaghi M8 ; Bonyadi K9 ; Hosseinibaharanchi FS6, 10
Authors
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Authors Affiliations
  1. 1. School of Population Health sciences, King’s College London, London, United Kingdom
  2. 2. Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  3. 3. Telemedicine Research Center, & Chronic Kidney Disease Research Center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  4. 4. Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  5. 5. Center of Excellence in Nephrology, Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran
  6. 6. Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
  7. 7. Department of Statistics, Ramanujan School of Mathematical Sciences, Pondicherry University, Puducherry, India
  8. 8. Strategic Planning and Executive Office Manager, International Federation of Inventors’ Associations, Geneva, Switzerland
  9. 9. Department of Biomedical (Biomechanics), Science and Research Branch, Islamic Azad University, Tehran, Iran
  10. 10. Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran

Source: BMC Nephrology Published:2023


Abstract

Background: Chronic Kidney Disease (CKD) is a prevalent and life-threatening situation recognized as an emerging health issue. The present study aimed to evaluate the effect of demographic and laboratory parameters on the survival of patients with End-Stage Renal Disease (ESRD) in a hemodialysis (HD) center in Iran. Materials and methods: This study was conducted on patients receiving chronic HD in Iran Helal Pharmaceutical and Clinical Complex between 2014 and 2018. The survival time was considered as the time interval between HD initiation and death. Receiving kidney transplantation was regarded as a competing risk, and an improper form of two-parameter Weibull distribution was utilized to simultaneously model the time to both death and renal transplantation. The Bayesian approach was conducted for parameters estimation. Results: Overall, 29 (26.6%) patients expired, and 19 (17.4%) received kidney transplants. The male gender was related to poor survival, having nearly 4.6 folds higher hazard of mortality (90% HPD region: 1.36–15.49). Moreover, Serum calcium levels ≥ 9.5 mg/dL (adjusted Sub-hazard ratio (S-HR)=2.33, 90% HPD region: 1.05–5.32) and intact parathyroid hormone (iPTH) ≤ 150 pg/mL (adjusted S-HR = 2.56, 90% HPD region: 1.09–6.15) were associated with an elevated hazard of mortality. The cumulative incidence function (CIF) for transplantation was greater than death in the first two years of the study. Subsequently, the CIF for death exceeded transplantation in the following two years. The 4-year cumulative incidence of death and kidney transplantation was 63.7% and 36.3%, respectively. Conclusion: Male gender, hypercalcemia, and hypoparathyroidism were associated with worse outcomes. Correcting mentioned laboratory parameters may improve patients’ survival in the HD population. © 2023, The Author(s).
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