Prediction of Mortality Incidence in Patients with Chronic Kidney Disease Based on Influential Prognostic Factors with Competing Risks Approach

Abstract

Background: Chronic Kidney Disease (CKD) is a disease in which the kidney’s functionality declines gradually. The aim of this study was to identify significant laboratory prognostic factors on death due to CKD in a clinical complex. Materials and Methods: A retrospective study including 109 patients with the end-stage renal disease treated at Iran Helal pharmaceutical and the clinical complex was conducted between 2014-2018. The survival time was set as the time interval between starting dialysis until death due to CKD. Also, the transplantation was considered as competing risk, which was occurred for a few patients. A three-parameter Gompertz model was used that considers both the event of interest and the competing event simultaneously. Results: Death due to CKD occurred in 29 (26.6%) of the patients and 19(17.4%) with transplantation. Serum uric acid was a significant prognostic factor that decreased the hazard of mortality by 21%. Serum phosphorus and age by increasing the risk of death, were poor prognoses for the event of interest. Serum uric acid and phosphorus 6.9-9.9 (mg/dl) were associated with 72% and 4.05-fold increased hazard of transplant, respectively. The 4-year cumulative incidence of death and transplant was 48.4% and 29.2%, respectively. Conclusion: We have deduced that high serum phosphorus levels and increased levels of age were associated with worse outcomes. High serum uric acid level was related to better survival, which could be explained by having a better protein-rich diet alongside the high albumin level. [GMJ.2020;9:e1798]

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

“…This might be due to concurrent low levels of iPTH or unobserved C-reactive protein. Saeedi et al also reported no signi cant impact of high albumin levels on HD patients' survival in a study utilizing a complex competing risks model (14).…”

“…The results demonstrated that the male gender was associated with a higher risk of mortality. Similarly, Carrero et al concluded that, despite females having a greater prevalence of CKD, male HD patients had a higher mortality rate (14). Cardiovascular events are one of the most important causes of death in HD patients.…”

“…It is to utilize an appropriate statistical method to detect factors that could potentially predict the prognosis of the disease (14). In this study, the application of the competing risks analysis revealed that…”