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

Anahita Saeedi, Ahmadreza Baghestani, Seyed-Saeed Hashemi-Nazari, Farzanehsadat Minoo, Navid Mohseni, Zahra Esfahani
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]
Chronic Kidney Disease; Survival Analyses; Competing Risks; Renal Transplantation

Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2019. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2019.

Chapter 1: Definition and classification of CKD. Kidney Int Suppl (2011). 2013;3(1):19-62.

https://doi.org/10.1038/kisup.2012.64

PMid:25018975 PMCid:PMC4089693

Inker LA, Astor BC, Fox CH, Isakova T, Lash JP, Peralta CA, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis. 2014;63(5):713-35.

https://doi.org/10.1053/j.ajkd.2014.01.416

PMid:24647050

Nagata M, Ninomiya T, Doi Y, Yonemoto K, Kubo M, Hata J, et al. Trends in the prevalence of chronic kidney disease and its risk factors in a general Japanese population: the Hisayama Study. Nephrol Dial Transplant. 2010;25(8):2557-64.

https://doi.org/10.1093/ndt/gfq062

PMid:20176610

Naghibi M, Mojahedi MJ, Jarrahi L, Emadzadeh A, Ahmadi R, Emadzadeh M, et al. Prevalence of chronic kidney disease and its risk factors in Gonabad, Iran. Iran J Kidney Dis. 2015;9(6):449.

De Nicola L, Chiodini P, Zoccali C, Borrelli S, Cianciaruso B, Di Iorio B, et al. Prognosis of CKD patients receiving outpatient nephrology care in Italy. Clin J Am Soc Nephrol. 2011;6(10):2421-8.

https://doi.org/10.2215/CJN.01180211

PMid:21817127 PMCid:PMC3359552

Coresh J, Astor BC, Greene T, Eknoyan G, Levey AS. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis. 2003;41(1):1-12.

https://doi.org/10.1053/ajkd.2003.50007

PMid:12500213

Stanifer JW, Muiru A, Jafar TH, Patel UD. Chronic kidney disease in low- and middle-income countries. Nephrol Dial Transplant. 2016;31(6):868-74.

https://doi.org/10.1093/ndt/gfv466

PMid:27217391 PMCid:PMC4876969

Xie Y, Bowe B, Mokdad AH, Xian H, Yan Y, Li T, et al. Analysis of the Global Burden of Disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016. Kidney Int. 2018;94(3):567-81.

https://doi.org/10.1016/j.kint.2018.04.011

PMid:30078514

Bouya S, Balouchi A, Rafiemanesh H, Hesaraki M. Prevalence of Chronic Kidney Disease in Iranian General Population: A Meta-Analysis and Systematic Review. Ther Apher Dial. 2018;22(6):594-9.

https://doi.org/10.1111/1744-9987.12716

PMid:29974630

Tohidi M, Hasheminia M, Mohebi R, Khalili D, Hosseinpanah F, Yazdani B, et al. Incidence of Chronic Kidney Disease and Its Risk Factors, Results of Over 10 Year Follow Up in an Iranian Cohort. PLoS One. 2012;7(9):e45304.

https://doi.org/10.1371/journal.pone.0045304

PMid:23028919 PMCid:PMC3459968

Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385(9963):117-71.

https://doi.org/10.1016/S0140-6736(14)61682-2

Global Burden of Disease Study C. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743-800.

https://doi.org/10.1016/S0140-6736(15)60692-4

Vaidya SR AN. Chronic Renal Failure. StatPearls Publishing. 2020.

Neovius M, Jacobson SH, Eriksson JK, Elinder CG, Hylander B. Mortality in chronic kidney disease and renal replacement therapy: a population-based cohort study. BMJ Open. 2014;4(2):e004251.

https://doi.org/10.1136/bmjopen-2013-004251

PMid:24549162 PMCid:PMC3931988

Abecassis M, Bartlett ST, Collins AJ, Davis CL, Delmonico FL, Friedewald JJ, et al. Kidney transplantation as primary therapy for end-stage renal disease: a National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (NKF/KDOQITM) conference. Clin J Am Soc Nephrol. 2008;3(2):471-80.

https://doi.org/10.2215/CJN.05021107

PMid:18256371 PMCid:PMC2390948

Abdel-Qadir H, Fang J, Lee Douglas S, Tu Jack V, Amir E, Austin Peter C, et al. Importance of Considering Competing Risks in Time-to-Event Analyses. Circ Cardiovasc Qual Outcomes. 2018;11(7):e004580.

https://doi.org/10.1161/CIRCOUTCOMES.118.004580

PMid:29997149 PMCid:PMC7665273

Haile SR, Jeong JH, Chen X, Cheng Y. A 3-parameter Gompertz distribution for survival data with competing risks, with an application to breast cancer data. J Appl Stat. 2016;43(12):2239-53.

https://doi.org/10.1080/02664763.2015.1134450

Daugirdas JT, Blake P, Ing T. Handbook of Dialysis. 5th ed. New York, USA: Wolters Kluwer Health; 2015.

Jandaghi AB, Shakiba M, Nasseh H, Korouji Y, Esmaeili S, Maboudi AAK, et al. Application of bland-altman method in comparing transrectal and transabdominal ultrasonography for estimating prostate volume. Iran J Med Sci. 2015;40(1):34.

Dalrymple LS, Katz R, Kestenbaum B, Shlipak MG, Sarnak MJ, Stehman-Breen C, et al. Chronic kidney disease and the risk of end-stage renal disease versus death. J Gen Intern Med. 2011;26(4):379-85.

https://doi.org/10.1007/s11606-010-1511-x

PMid:20853156 PMCid:PMC3055978

Carrero JJ, Hecking M, Chesnaye NC, Jager KJ. Sex and gender disparities in the epidemiology and outcomes of chronic kidney disease. Nat Rev Nephrol. 2018;14(3):151-64.

https://doi.org/10.1038/nrneph.2017.181

PMid:29355169

Kim HJ, Kim Y, Kim S, Chin HJ, Lee H, Lee JP, et al. Age, sex, and the association of chronic kidney disease with all-cause mortality in Buddhist priests: An analysis of the standardized mortality ratio from the Korean Buddhist priests cohort. Medicine (Baltimore). 2018;97(45):e13099.

https://doi.org/10.1097/MD.0000000000013099

PMid:30407320 PMCid:PMC6250507

Ang YG, Heng BH, Saxena N, Liew STA, Chong P-N. Annual all-cause mortality rate for patients with diabetic kidney disease in Singapore. J Clin Transl Endocrinol. 2016;4:1-6.

https://doi.org/10.1016/j.jcte.2016.01.002

PMid:29159125 PMCid:PMC5680480

Chang P-Y, Chien L-N, Lin Y-F, Wu M-S, Chiu W-T, Chiou H-Y. Risk factors of gender for renal progression in patients with early chronic kidney disease. Medicine (Baltimore). 2016;95(30):e4203-e.

https://doi.org/10.1097/MD.0000000000004203

PMid:27472690 PMCid:PMC5265827

Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298(17):2038-47.

https://doi.org/10.1001/jama.298.17.2038

PMid:17986697

Johnson ES, Thorp ML, Yang X, Charansonney OL, Smith DH. Predicting renal replacement therapy and mortality in CKD. Am J Kidney Dis. 2007;50(4):559-65.

https://doi.org/10.1053/j.ajkd.2007.07.006

PMid:17900455

Eriksen BO, Ingebretsen OC. The progression of chronic kidney disease: a 10-year population-based study of the effects of gender and age. Kidney Int. 2006;69(2):375-82.

https://doi.org/10.1038/sj.ki.5000058

PMid:16408129

Segev DL, Kucirka LM, Oberai PC, Parekh RS, Boulware LE, Powe NR, et al. Age and comorbidities are effect modifiers of gender disparities in renal transplantation. J Am Soc Nephrol. 2009;20(3):621-8.

https://doi.org/10.1681/ASN.2008060591

PMid:19129311 PMCid:PMC2653677

Wang J, Wang F, Saran R, He Z, Zhao M-H, Li Y, et al. Mortality risk of chronic kidney disease: A comparison between the adult populations in urban China and the United States. PLoS One. 2018;13(3):e0193734-e.

https://doi.org/10.1371/journal.pone.0193734

PMid:29543826 PMCid:PMC5854279

Turin TC, Tonelli M, Manns BJ, Ravani P, Ahmed SB, Hemmelgarn BR. Chronic kidney disease and life expectancy. Nephrol Dial Transplant. 2012;27(8):3182-6.

https://doi.org/10.1093/ndt/gfs052

PMid:22442392

Meier-Kriesche H-U, Schold JD, Vanrenterghem Y, Halloran PF, Ekberg H. Uric acid levels have no significant effect on renal function in adult renal transplant recipients: evidence from the symphony study. Clin J Am Soc Nephrol. 2009;4(10):1655-60.

https://doi.org/10.2215/CJN.02700409

PMid:19713295 PMCid:PMC2758252

Chonchol M, Shlipak MG, Katz R, Sarnak MJ, Newman AB, Siscovick DS, et al. Relationship of uric acid with progression of kidney disease. Am J Kidney Dis. 2007;50(2):239-47.

https://doi.org/10.1053/j.ajkd.2007.05.013

PMid:17660025

Rincon-Choles H, Jolly SE, Arrigain S, Konig V, Schold JD, Nakhoul G, et al. Impact of Uric Acid Levels on Kidney Disease Progression. Am J Nephrol. 2017;46(4):315-22.

https://doi.org/10.1159/000481460

PMid:29032376

Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296-305.

https://doi.org/10.1056/NEJMoa041031

PMid:15385656

Hruska KA, Mathew S, Lund R, Qiu P, Pratt R. Hyperphosphatemia of chronic kidney disease. Kidney Int. 2008;74(2):148-57.

https://doi.org/10.1038/ki.2008.130

PMid:18449174 PMCid:PMC2735026

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