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Updated: Jul 23, 2025
Establishing a Competing Risk Regression Nomogram Model for Survival Data
Published on: October 23, 2020
Evaluation of laboratory values affecting mortality of end-stage renal disease patients: a competing risks approach
Rayka Malek1, Ahmadreza Baghestani2, Farin Rashid-Farokhi3
1School of Population Health sciences, King's College London, London, UK.
Insights
Male gender, high serum calcium, and high parathyroid hormone levels are linked to poorer survival for patients undergoing hemodialysis (HD). Addressing these factors may improve outcomes for chronic kidney disease (CKD) patients.
Area of Science:
- Nephrology
- Public Health
- Biostatistics
Background:
- Chronic Kidney Disease (CKD) is a growing global health concern.
- End-Stage Renal Disease (ESRD) patients on hemodialysis (HD) face significant survival challenges.
- Understanding factors influencing ESRD patient survival is crucial for improving care.
Purpose of the Study:
- To investigate demographic and laboratory predictors of survival in Iranian ESRD patients on HD.
- To evaluate the impact of specific parameters on mortality and kidney transplantation rates.
- To apply advanced statistical modeling for survival analysis in a real-world clinical setting.
Main Methods:
- A cohort of 109 patients receiving chronic HD in Iran (2014-2018) was analyzed.
- A two-parameter Weibull distribution and Bayesian approach modeled time to death and kidney transplantation (competing risks).
- Demographic data and serum levels of calcium and intact parathyroid hormone (iPTH) were assessed.
Main Results:
- Male gender, serum calcium >9.5 mg/dL, and iPTH >150 pg/mL were significantly associated with increased mortality hazard.
- The cumulative incidence of death surpassed transplantation after the first two years of HD.
- 4-year cumulative incidence was 63.7% for death and 36.3% for transplantation.
Conclusions:
- Male sex, hypercalcemia, and hypoparathyroidism are adverse prognostic factors in HD patients.
- Correction of these laboratory abnormalities may enhance survival rates in the ESRD population.
- This study highlights key modifiable factors for improving long-term outcomes in hemodialysis patients.
Background:
Chronic Kidney Disease (CKD) is a prevalent and life-threatening situation recognized as an emerging health issue. The present study aimed to evaluate the effect of demographic and laboratory parameters on the survival of patients with End-Stage Renal Disease (ESRD) in a hemodialysis (HD) center in Iran.
Materials And Methods:
This study was conducted on patients receiving chronic HD in Iran Helal Pharmaceutical and Clinical Complex between 2014 and 2018. The survival time was considered as the time interval between HD initiation and death. Receiving kidney transplantation was regarded as a competing risk, and an improper form of two-parameter Weibull distribution was utilized to simultaneously model the time to both death and renal transplantation. The Bayesian approach was conducted for parameters estimation.
Results:
Overall, 29 (26.6%) patients expired, and 19 (17.4%) received kidney transplants. The male gender was related to poor survival, having nearly 4.6 folds higher hazard of mortality (90% HPD region: 1.36-15.49). Moreover, Serum calcium levels [Formula: see text]9.5 mg/dL (adjusted Sub-hazard ratio (S-HR)=2.33, 90% HPD region: 1.05-5.32) and intact parathyroid hormone (iPTH) [Formula: see text]150 pg/mL (adjusted S-HR = 2.56, 90% HPD region: 1.09-6.15) were associated with an elevated hazard of mortality. The cumulative incidence function (CIF) for transplantation was greater than death in the first two years of the study. Subsequently, the CIF for death exceeded transplantation in the following two years. The 4-year cumulative incidence of death and kidney transplantation was 63.7% and 36.3%, respectively.
Conclusion:
Male gender, hypercalcemia, and hypoparathyroidism were associated with worse outcomes. Correcting mentioned laboratory parameters may improve patients' survival in the HD population.
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