Rizky Andhika 1, Afiatin1, Rudi Supriyadi1, Ria Bandiara1, Lilik Sukesi1, Adhika Putra Sudarmadi1, Kurnia Wahyudi 2, Yulia Sofiatin3 1Division of Nephrology and Hypertension, Department of Internal Medicine, Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia; 2Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia; 3Department of Epidemiology, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia

Background:

Chronic Kidney Disease (CKD) represents a significant global health challenge, with Indonesia experiencing the highest surge in End-Stage Kidney Disease (ESKD) prevalence over the past decade. Kidney registries are essential for reporting health outcomes, evaluating healthcare services, advocating for policy change, and informing health infrastructure development. Survival rates in ESKD patients undergoing hemodialysis (HD) are a critical outcome measure. However, there is a lack of survival analysis data for ESKD patients receiving HD in Indonesia.

Objective:

This study aims to assess the one-year survival rate of ESKD patients undergoing HD in Indonesia, while examining risk factors associated with survival, including age, gender, CKD etiology, and dialysis adequacy. Methods: This analytical observational study employed a retrospective cohort design, utilizing patient data from Indonesia Renal Registry between 2016 and 2019. Kaplan-Meier survival curves were generated, and Log rank test was applied to assess the significance of survival differences across subgroups based on age, gender, CKD etiology, and dialysis adequacy.

Results:

A total of 122,449 ESKD patients on HD were analyzed, with a mean age of 52 years; majority (55.5%) were male, and hypertensive kidney disease was the leading cause of CKD (43.7%). The overall one-year survival rate was 91.5% (95% CI: 91.3–91.6). Survival decreased significantly with advancing age (p < 0.01), and female patients exhibited lower survival rates compared to males (p < 0.01). Patients with diabetic nephropathy had the lowest survival rate among CKD etiologies (p < 0.01). Dialysis adequacy, assessed in 11,633 patients, revealed that 69.2% had a Kt/V below 1.8. Those with inadequate dialysis had significantly lower survival rates (p=0.00015). Conclusion: The one-year survival rate for ESKD patients undergoing HD in Indonesia is 91.5%. Increased age, female, diabetic nephropathy as the underlying CKD etiology, and inadequate dialysis adequacy are associated with reduced survival rates.

Keywords:

chronic kidney disease, hemodialysis, one-year survival, Indonesian renal registry

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Abstract

Background Hemodialysis (HD) is the modality of renal replacement therapy (RRT) with the highest mortality rate. The identification of prognostic factors will help achieve better outcomes among HD patients. In this study, we sought to conduct a survival analysis and determine the predictors of mortality among adult Indonesian HD patients using data obtained from Indonesian Renal Registry (IRR).

Methods

This is a retrospective cohort study which reviewed all adult hemodialysis patients in Indonesia based on the records of IRR during 2007–2022. Variables analyzed in this study include age, sex, etiology of CKD, cause of death, HD frequency, and initial vascular access. A 5-year follow-up was performed until the outcome of death or drop out was found.

Results

Among 99,552 eligible patients, the mean survival length was 1536.21 ± 2.50 days. The 5-year survival rate was 77%. Cox proportional hazard regression model revealed demographic and clinical characteristics that are significantly associated with mortality: male sex (HR: 1.038, 95% CI 1.002–1.075), age of 60 years or older (HR: 1.329, 95% CI 1.281– 1.379), diabetic nephropathy (HR: 1.347, 95% CI 1.249–1.452), twice-weekly hemodialysis frequency (HR: 1.080, 95% CI 1.011–1.155), initial vascular accesses with femoral vein puncture (HR: 2.710, 95% CI 2.568–2.860), and CVC (HR: 2.992, 95% CI 2.848–3.144).

Conclusions

The 5-year survival rate of Indonesian HD patients is 77. Male sex, age of HD onset at 60 years or older, diabetic nephropathy, twice-weekly HD frequency, and the initial vascular accesses with femoral vein puncture and CVC are associated with increased risk of mortality.

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BDURAHMAN, A*1, Bandiara, R1, Supriyadi, R2 1Hasan Sadikin Hospital, Internal Medicine, Bandung, Indonesia, 2Faculty of Medicine Universitas Padjadjaran, Internal Medicine, Bandung, Indonesia

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ABSTRAK

Aim

Discrepancy between the needs and access to kidney replacement therapy (KRT) is a worldwide problem. Shortages of hemodialysis (HD) nurses, machines, and attending physicians in Indonesia, the world’s fourth most populous country, result in inadequate HD. Data on provision is crucial for improvements; current reports publish national aggregates, but data on a more specific scale is needed. This study aimed to describe regency/city-level HD provision in West Java in 2022.

Methods

158 HD centres with complete information on new and active HD patients, attending physicians, nurses and machines for the period January-December 2022 were reviewed from the Indonesian Renal Registry (IRR) database. Incidences, prevalences and densities were calculated using population numbers from the West Java Central Bureau of Statistics. Comparisons were made with predicted values from a previous study.

Results

Of the 27 cities/regencies, 1 (Pangandaran Regency) had no HD centre. West Java HD incidence and prevalence were 232 pmp (131% from predicted) and 346 pmp (40%). Densities were as follows: adult nephrologists (0.3 pmp), HD-certified internists (2.1 pmp), all nurses (37 pmp, 30% from predicted), certified nurses (27 pmp), machines (58 pmp, 40% from predicted).

Conclusion

More efforts by administrative authorities and the Ministry of Health are needed to increase the number of training centres and their ease of access for specialists and nurses, as well as better distribution of these workforces.

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ABSTRAK

Aim

Chronic kidney disease (CKD) is a global health problem with an increasing prevalence. In Indonesia, data on the etiology of stage 5 CKD remain limited at the national level, despite the need for localized approaches to ensure effective prevention strategies. Variations in healthcare services and the management of chronic diseases across regions may influence the pattern of CKD etiology. More specific information at the regency or city level is essential for planning targeted interventions. This study aims to describe the etiological differences of stage 5 CKD among adult patients across level 2 healthcare regions in West Java in 2023, based on data from the Indonesian Renal Registry.

Methods

Data from the 2023 Indonesian Renal Registry (IRR) were reviewed for all new stage 5 CKD patients aged over 18 years in regencies and cities across West Java. A total of 11.611 patients from 26 regencies/cities were included in the analysis. The reviewed data comprised the location of dialysis units at the regency/city level, patient age, sex, and CKD etiology. Cases with incomplete data were excluded from the analysis. Comparisons of etiological distributions across regions were conducted using analytical statistical tests.

Results

A total of 11,611 eligible end-stage renal disease (ESRD) cases from 26 regencies/cities in West Java in 2023 were analyzed, excluding Pangandaran Regency due to the absence of hemodialysis facilities. Male patients constituted 51.89% (6,026 cases), slightly higher than females at 49.11% (5,585 cases). The predominant age group was 45–64 years, with the highest cases in the 55–64 age range (3,444 cases). Hypertensive kidney disease (E4) was the most common etiology, accounting for 48.27% of cases, followed by diabetic nephropathy (E2) at 27.19% and primary glomerulopathy (E1) at 10.89%. Regional variation was observed; for example, diabetic nephropathy predominated in Cirebon and Karawang, whereas primary glomerulopathy was highest in Subang. Other etiologies showed local dominance in certain regencies, such as other diseases (E9) in Ciamis, Cianjur, and Cirebon, and post-nephrectomy conditions (E8) in Sumedang. Six etiologies—hypertension, diabetes, primary glomerulopathy, other diseases, unknown etiology, and pyelonephritis—were consistently among the top three causes across regions. Chi-Square analysis indicated significant differences in etiological distribution (Pearson Chi-Square = 1054.128, df = 125, p < 0.001; Likelihood Ratio = 780.367, p < 0.001).

Conclusion

Hypertensive kidney disease remains the predominant cause of stage 5 chronic kidney disease (CKD) in West Java in 2023, with significant regional variations observed. Regarding regional variation, six etiologies consistently rank among the top three most common causes (MCE) across 26 regencies and cities. The Chi-Square test showed a statistically significant difference in the distribution of CKD etiologies among regions (p < 0.001), indicating that these differences are influenced by local demographic, social, and healthcare access factors. These findings emphasize the need for region-specific prevention and management strategies to effectively reduce the burden of end-stage renal disease, with particular attention to the differing risks in productive-age and elderly populations.

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