Elisabeth Sipayung, I Wayan Nariata, Yassir, Rumaisah Satyawati, Surya Oto Wijaya, Gesang Setia Budi, Anitha, Rivaldiansyah, Siti Maemun, Aninda Dinar Widiantari

Clinical and Laboratory Characterization of Hemodialysis Patients in Relation to Survival Outcomes at a Tertiary Referral Hospital in Indonesia

Introduction

Clinical and laboratory characterization of hemodialysis patients in relation to survival outcomes at a tertiary referral hospital in indonesia. Study characterizes hemodialysis patients in Indonesia, linking diabetes mellitus to mortality and severe uremia. Emphasizes optimized risk stratification & early intervention for chronic kidney disease.

Abstract

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: 1. This study examined undercharacterized hemodialysis patients at an Indonesian tertiary hospital, focusing on high comorbidity burdens and outcomes. 2. 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). 3. 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.

Review

This study aimed to characterize clinical and laboratory parameters in hemodialysis (HD) patients at a tertiary referral hospital in Indonesia, stratifying by survival outcomes. Addressing a recognized gap in understanding disease progression in a high-comorbidity population, particularly within an overburdened healthcare system, the research highlights critical issues for patient care. The finding of a 25.9% mortality rate, with diabetes mellitus significantly associated with adverse outcomes, underscores the severity of disease in this cohort. Furthermore, the high prevalence of hyperuricemia as an HD indication, alongside other significant complications like sepsis and glomerular disease, points to a complex and advanced patient profile. The study's focus on severe uremia and symptomatic progression reinforces the urgent need for optimized management strategies in this vulnerable population. The authors successfully identify several key clinical insights. The strong association between diabetes mellitus and mortality is a crucial finding that merits further investigation and could inform risk stratification. The observation that diabetic nephropathy contributed to elevated urea levels, alongside a high incidence of sepsis and glomerular disease, paints a clear picture of advanced multi-systemic complications. The study also broadens the understanding of comorbidities impacting these patients, explicitly mentioning infectious diseases such as COVID-19, drug-resistant tuberculosis, and hepatitis B/C in the highlights, which is highly relevant for a setting like Indonesia. These findings provide a valuable preliminary characterization of a patient group that has been historically under-studied, offering a foundation for future, more extensive research. Despite its important contributions, the study is hampered by several significant methodological limitations. Most notably, the stated study period of "March and July 2024" being in the future raises serious questions about the data's validity and the study's execution, which must be clarified immediately. Beyond this critical error, the retrospective design, small sample size (N=27), and purposive sampling inherently limit the generalizability of the findings and introduce potential biases. The limited scope of laboratory parameters presented (BUN, creatinine, eGFR) also restricts a comprehensive understanding of patient physiology. Future research should prioritize addressing the date discrepancy, employing larger, prospective cohorts with extended follow-up periods, and incorporating a more extensive range of clinical and biochemical markers to provide a robust evidence base for improving hemodialysis care in Indonesia.

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