Incidence and Risk Factors of Cardio-Cerebrovascular Event, Hospitalization, and Mortality in Patients Undergoing Regular Hemodialysis

Abstract

Background: CKD patients undergoing regular HD experience high rate of hospitalization and mortality compared with general population. The main contributing factors were cardiovascular event and infection. In Indonesia, there has been no comprehensive and representative data available. This study aims to discover the incidence and risk factors of cardio-cerebrovascular events, hospitalization and mortality, as well as the survival rate among patients undergoing regular HD at Sanglah general hospital Denpasar.   Methods: The study was an analytic retrospective cohort study conducted in Sanglah general hospital Denpasar from July 1st to December 31st 2017. Inclusion criteria were patients with CKD stage-5, ≥ 18 years old, and have undergone regular HD for at least 3 months. Patients with malignancy and requiring elective hospitalization were excluded. The Kaplan-Meier method was used to calculate the cumulative survival rate, and the log-rank test was used for extracting the risk factors that influenced the survival rate. Multivariate Cox regression analysis was used to test contributing risk factors towards composite outcomes (cardio-cerebrovascular events, hospitalization and mortality) and mortality outcome. The risk factors contributors were declared with a value of relative risk and odds ratio adjusted with the confidence interval (CI) 95%, the level of significance (α) was specified in the value of p<0.05.   Results: The composite outcome incidence of 222 subject within 6 months (184 days) was 18.09% and mortality outcome was 8.11%, with cardiovascular event was a major cause (56%) of mortality outcome. Risk factors significantly contributed on composite outcome related to etiology (p=0.03) as follows: 1) Diabetic nephropathy (OR=1.33; CI 95% 0.16-11.06); 2) Hypertensive nephrosclerosis (OR=0.98; CI 95% 0.11 - 8.47); 3) Chronic pyelonephritis (OR=0.36; CI 95% 0.05 – 2.74); 4) Chronic Glomerulonephritis (OR=0.23; CI 95% 0.02 – 2.66) and AV fistula (+) (OR=0.37; CI 95% 0.17 – 0.77; p=0.01). Whereas risk factors significantly contributed on mortality outcome related to AV fistula (+) (OR=0.46; CI 95% 0.23 - 0.92; p=0.028) and age < 52 years old (OR=0.51; CI 95% 0.26 to 0.99; p=0.047). The cumulative survival rate (composite outcome) was 165.83±3.57 days with the cumulative survival rate (mortality outcome) was 177.34±2.00 days.   Conclusion: This study concluded that the incidence of mortality outcome was 8.11% within 6 months (184 days), with cardiovascular event was a major cause (56%), risk factors significantly contributed on mortality outcomes were AV fistula and age, whereas the cumulative survival rate (mortality outcome) was 177.34±2.00 days.