Abstract
BackgroundPatients with end-stage kidney disease (ESKD) are required to undergo consecutive time-based blood and biochemical tests to determine the progression of the disease according to changes in their blood and biochemical data. This study employed a random intercept model to investigate whether time-based blood and biochemical data present any notable clinical meaning that can be used to track disease progression.MethodsThis study conducted a retrospective analysis on the dialytic data of 148 patients with ESKD, who received hemodialysis between January 2005 and December 2015. The patients were all at least 20 years old, and the data used included patient demographic information and results for at least 60 blood and biochemical tests. A random intercept model was used to analyze the relationships among blood and biochemical test results, explanatory variables of patient comorbidities, and time.ResultsThe age range of patients was between 33 and 98 years, with an average of 66.1 years and those over 65 years old comprising 51.3% (n = 76) of the total. Furthermore, hypertension was found to be the most common comorbidity among patients (87.2%, n = 129), followed by anemia (48.6%, n = 72), diabetes (47.3%, n = 70), dyslipidemia (19.6%, n = 29), and peptic ulcer (19.6%, n = 29). Coronary atherosclerotic heart disease is a comorbidity that can serve as a strong and independent marker for prognosis in patients with ESKD. Serum creatinine level can serve as an alternative indicator because patients with ESKD and comorbid diabetes may exhibit increased creatinine levels.ConclusionsThe results of a parameter estimation for longitudinal data analysis suggested that comorbidity and time were critical variables influencing blood and biochemical test results. Furthermore, WBC and HBC, HCT, albumin, protein, and creatinine levels were recognized as variables of critical significance. The results obtained in this study indicate that multimorbidity increases the treatment burden on patients, leading to polypharmacy. For this reason, comprehensive care and treatment of ESKD cannot rely solely on data from one single time point; instead, longitudinal analysis and other data that can affect patient prognosis must also be considered.
Highlights
Patients with end-stage kidney disease (ESKD) are required to undergo consecutive time-based blood and biochemical tests to determine the progression of the disease according to changes in their blood and biochemical data
All of the included patients had been diagnosed with ESKD by nephrologists on the basis of the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, wherein disease severity was determined based on the cause, glomerular filtration rate (GFR), and albuminuria categories (CGA) [19]
For patients with ESKD, the demographic data and test results of at least 60 blood and biochemical tests were used
Summary
Patients with end-stage kidney disease (ESKD) are required to undergo consecutive time-based blood and biochemical tests to determine the progression of the disease according to changes in their blood and biochemical data. Patient blood and biochemical data are repeatedly obtained after the patient has undergone hemodialysis to monitor for signs of kidney failure or associated comorbidities These data include platelet count, white blood cell count (WBC), and alanine transaminase (ALT), aspartate transaminase (AST), albumin, alkaline, protein, total bilirubin, hemoglobin count (HBC), hematocrit (HCT), mean corpuscular volume (MCV), creatinine, K, Na, uric acid, Ca, and P levels [4,5,6]. These blood and biochemical test items are all related to kidney functions, and each has its own limitations and can be affected by patient demographic or physiological characteristics. This indicates that in most medical or research settings, deteriorating conditions must not be diagnosed according to a single symptom or sign; rather, multiple items must be investigated to ensure an accurate diagnosis [9, 10]
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