Clinical and Laboratory Characterization of Hemodialysis Patients in Relation to Survival Outcomes at a Tertiary Referral Hospital in Indonesia
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Introduction: Despite advancements in hemodialysis care, disease progression and outcomes in adults with various comorbidities, particularly in Indonesia’s overburdened tertiary hospitals, remain poorly characterized, limiting tailored care strategies. This study analyzed clinical characteristics and laboratory parameters among hemodialysis patients at Sulianti Saroso Infectious Disease Hospital, Jakarta, Indonesia, with stratification by survival outcomes.
Methods: We conducted a retrospective cohort study of adults (>18 years) undergoing hemodialysis at Sulianti Saroso Infectious Disease Hospital between March and July 2024. Using purposive sampling, we analyzed 27 cases with documented laboratory parameters (i.e., blood urea nitrogen (BUN), serum creatinine, and estimated glomerular filtration rate (eGFR)) and clinical outcomes. Associations between outcomes and laboratory/clinical variables were assessed using Fisher’s exact test and logistic regression (p<0.05).
Results: Mortality was reported in 25.9% of patients, including one who passed away due to complications related to coronavirus disease 2019 (COVID-19) shortly after being discharged. The leading indication for hemodialysis was hyperuricemia (85.2%), followed by chronic kidney disease. Nearly half of the patients (48.1%) had comorbid diabetes mellitus. Diabetic nephropathy was a key contributor to elevated urea levels. Prevalent complications reported among the patients included sepsis (70.4%) and glomerular disease (40.7%).
Conclusion: This study found an association between diabetes mellitus and mortality in chronic kidney disease patients who underwent hemodialysis. Severe uremia, marked by elevated BUN levels, and symptomatic complications such as shortness of breath were observed, indicative of advanced disease progression. Earlier detection and optimized management are necessary to mitigate preventable morbidity in high-risk populations.
Highlights:
- This study examined undercharacterized hemodialysis patients at an Indonesian tertiary hospital, focusing on high comorbidity burdens and outcomes.
- Severe kidney disease and high mortality were observed, driven by comorbidities such as diabetes mellitus, hypertension, coronavirus disease 2019 (COVID-19), and infectious diseases (drug-resistant tuberculosis and hepatitis B/C).
- The findings underscore the importance of optimized risk stratification and early intervention for end-stage renal failure in patients with both communicable and non-communicable disease comorbidities.
Arzhan S, Lew SQ, Ing TS, Tzamaloukas AH, Unruh ML (2021). Dysnatremias in chronic kidney disease: Pathophysiology, manifestations, and treatment. Frontiers in Medicine 8: 769287. doi: 10.3389/fmed.2021.769287.
Bikbov B, Purcell CA, Levey AS, Smith M, Abdoli A, et al. (2020). Global, regional, and national burden of chronic kidney disease, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet 395(10225): 709–733. doi: 10.1016/S0140-6736(20)30045-3.
Botheju WSM, Liyanage JA, Kannangara SDP (2021). The groundwater geochemistry and the human health risk assessment of drinking water in an area with a high prevalence of chronic kidney disease of unknown etiology (CKDu), Sri Lanka. Journal of Chemistry 2021: 1–18. doi: 10.1155/2021/1755140.
Cecconi M, Evans L, Levy M, Rhodes A (2018). Sepsis and septic shock. The Lancet 392(10141): 75–87. doi: 10.1016/S0140-6736(18)30696-2.
Chaudhari ST, Sadavarte AV, Chafekar D (2017). Clinical profile of end stage renal disease in patients undergoing hemodialysis. MVP Journal of Medical Sciences 4(1): 8–13. doi: 10.18311/mvpjms/2017/v4i1/8555.
Chopra CS, Handmacher M, Neubauer DC, Reid C (2023). Epidemiology. In: Translational Surgery. Elsevier. doi: 10.1016/B978-0-323-90300-4.00041-0.
De Broe ME, Gharbi MB, Zamd M, Elseviers M (2017). Why overestimate or underestimate chronic kidney disease when correct estimation is possible? Nephrology Dialysis Transplantation 32(suppl_2): ii136–ii141. doi: 10.1093/ndt/gfw267.
Dhungana D, Pun CB, Banstola B (2020). Clinical profile of end stage renal disease in patients on maintenance haemodialysis in a tertiary hospital. Journal of Gandaki Medical College-Nepal 13(2): 169–172. doi: 10.3126/jgmcn.v13i2.31336.
Fishbane S, Spinowitz B (2018). Update on anemia in ESRD and earlier stages of CKD: Core curriculum 2018. American Journal of Kidney Diseases 71(3): 423–435. doi: 10.1053/j.ajkd.2017.09.026.
Foote C, Kotwal S, Gallagher M, Cass A, Brown M, et al. (2016). Survival outcomes of supportive care versus dialysis therapies for elderly patients with end‐stage kidney disease: A systematic review and meta‐analysis. Nephrology 21(3): 241–253. doi: 10.1111/nep.12586.
Gomez-Rojas O, Nair GB (2025). Categorical variable analyses: Chi-square, Fisher exact, Mantel Haenszel test. In: Translational Pulmonology. Elsevier. doi: 10.1016/B978-0-323-90391-2.00059-2.
Guedes M, Guetter CR, Erbano LHO, Palone AG, Zee J, et al. (2020). Physical health-related quality of life at higher achieved hemoglobin levels among chronic kidney disease patients: A systematic review and meta-analysis. BMC Nephrology 21(1): 259. doi: 10.1186/s12882-020-01912-8.
He Q, Ying G, Fei X, Zha C, Chen Z, et al. (2020). Drug rash with eosinophilia and systemic symptoms and severe renal injury induced by proton pump inhibitor therapy. Medicine 99(42): e22509. doi: 10.1097/MD.0000000000022509.
Horne L, Ashfaq A, MacLachlan S, Sinsakul M, Qin L, et al. (2019). Epidemiology and health outcomes associated with hyperkalemia in a primary care setting in England. BMC Nephrology 20(1): 85. doi: 10.1186/s12882-019-1250-0.
Hustrini NM, Susalit E, Lydia A, Marbun MBH, Syafiq M, et al. (2023). The etiology of kidney failure in Indonesia: A multicenter study in tertiary-care centers in Jakarta. Annals of Global Health 89(1): 36. doi: 10.5334/aogh.4071.
Hustrini NM, Susalit E, Rotmans JI (2022). Prevalence and risk factors for chronic kidney disease in Indonesia: An analysis of the National Basic Health Survey 2018. Journal of Global Health 12: 04074. doi: 10.7189/jogh.12.04074.
IBM Corp. (2016). IBM SPSS Statistics for Windows, version 24.0. Armonk, NY: IBM Corp. Retrieved from https://www.ibm.com/support/pages/node/724325.
Jalalzadeh M (2021). Anemia in end stage renal disease. Nephro-Urology Monthly 13(1): e109246. doi: 10.5812/numonthly.109246.
Kaltsatou A, Sakkas GK, Poulianiti KP, Koutedakis Y, Tepetes K, et al. (2015). Uremic myopathy: Is oxidative stress implicated in muscle dysfunction in uremia? Frontiers in Physiology 6: 102. doi: 10.3389/fphys.2015.00102.
Kellum JA, Chawla LS, Keener C, Singbartl K, Palevsky PM, et al. (2016). The effects of alternative resuscitation strategies on acute kidney injury in patients with septic shock. American Journal of Respiratory and Critical Care Medicine 193(3): 281–287. doi: 10.1164/rccm.201505-0995OC.
Kim YL, Kim HW, Kwon YE, Ryu DR, Lee MJ, et al. (2016). Association between vitamin D deficiency and anemia in patients with end-stage renal disease: A cross-sectional study. Yonsei Medical Journal 57(5): 1159. doi: 10.3349/ymj.2016.57.5.1159.
Kovesdy CP (2022). Epidemiology of chronic kidney disease: An update 2022. Kidney International Supplements 12(1): 7–11. doi: 10.1016/j.kisu.2021.11.003.
Lim LM, Tsai NC, Lin MY, Hwang DY, Lin HYH, et al. (2016). Hyponatremia is associated with fluid imbalance and adverse renal outcome in chronic kidney disease patients treated with diuretics. Scientific Reports 6(1): 36817. doi: 10.1038/srep36817.
Luyckx VA, Tonelli M, Stanifer JW (2018). The global burden of kidney disease and the sustainable development goals. Bulletin of the World Health Organization 96(6): 414-422D. doi: 10.2471/BLT.17.206441.
Masakane I, Taniguchi M, Nakai S, Tsuchida K, Goto S, et al. (2018). Annual dialysis data report 2015, JSDT renal data registry. Renal Replacement Therapy 4(1): 19. doi: 10.1186/s41100-018-0149-8.
Microsoft Inc. (2025). Microsoft Excel for Windows, version 2504. Redmond, WA: Microsoft Inc. Retrieved from https://learn.microsoft.com/en-us/officeupdates/current-channel.
Ministry of Health of the Republic of Indonesia (2019). Laporan nasional Riskesdas 2018. Jakarta. Retrieved from https://repository.badankebijakan.kemkes.go.id/id/eprint/3514/.
Mishra P, Pandey C, Singh U, Gupta A, Sahu C, et al. (2019). Descriptive statistics and normality tests for statistical data. Annals of Cardiac Anaesthesia 22(1): 67. doi: 10.4103/aca.ACA_157_18.
Morales E, Cravedi P, Manrique J (2021). Management of chronic hyperkalemia in patients with chronic kidney disease: An old problem with news options. Frontiers in Medicine 8: 653634. doi: 10.3389/fmed.2021.653634.
Park H, Liu X, Henry L, Harman J, Ross EA (2018). Trends in anemia care in non-dialysis-dependent chronic kidney disease (CKD) patients in the United States (2006–2015). BMC Nephrology 19(1): 318. doi: 10.1186/s12882-018-1119-7.
Ploth DW, Mbwambo JK, Fonner VA, Horowitz B, Zager P, et al. (2018). Prevalence of CKD, diabetes, and hypertension in rural Tanzania. Kidney International Reports 3(4): 905–915. doi: 10.1016/j.ekir.2018.04.006.
Rajbhandari A, Bhusal U, Shrestha DB, Yadav J, Singh S, et al. (2022). End stage renal disease among patients undergoing haemodialysis at a tertiary care centre: A descriptive cross-sectional study. Journal of Nepal Medical Association 60(249): 448–452. doi: 10.31729/jnma.7258.
Salerno FR, Parraga G, McIntyre CW (2017). Why is your patient still short of breath? Understanding the complex pathophysiology of dyspnea in chronic kidney disease. Seminars in Dialysis 30(1): 50–57. doi: 10.1111/sdi.12548.
Serrano E, Whitaker-Menezes D, Lin Z, Roche M, Martinez-Cantarin MP (2022). Uremic myopathy and mitochondrial dysfunction in kidney disease. International Journal of Molecular Sciences 23(21): 13515. doi: 10.3390/ijms232113515.
Sumida K, Biruete A, Kistler BM, Khor BH, Ebrahim Z, et al. (2023). New insights into dietary approaches to potassium management in chronic kidney disease. Journal of Renal Nutrition 33(6): S6–S12. doi: 10.1053/j.jrn.2022.12.003.
Toft G, Heide-Jørgensen U, van Haalen H, James G, Hedman K, et al. (2020). Anemia and clinical outcomes in patients with non-dialysis dependent or dialysis dependent severe chronic kidney disease: A Danish population-based study. Journal of Nephrology 33(1): 147–156. doi: 10.1007/s40620-019-00652-9.
Winkelmayer WC, Mitani AA, Goldstein BA, Brookhart MA, Chertow GM (2014). Trends in anemia care in older patients approaching end-stage renal disease in the United States (1995-2010). JAMA Internal Medicine 174(5): 699. doi: 10.1001/jamainternmed.2014.87.
World Health Organization, Alliance for Health Policy and Systems Research (2017). Primary health care systems (primasys): Comprehensive case study from Indonesia. Retrieved from https://iris.who.int/handle/10665/341076.
Copyright (c) 2025 Elisabeth Sipayung, I Wayan Nariata, Yassir, Rumaisah Satyawati, Surya Oto Wijaya, Gesang Setia Budi, Anitha, Rivaldiansyah, Siti Maemun, Aninda Dinar Widiantari
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