A Retrospective Study Of The Management Of Patients With Kidney Failure Receiving Dialysis In Brunei Darussalam

Background: Kidney failure for many years remained as one of the highest causes of death among adults in Brunei Darussalam.To date,hemodialysis(HD)is found to be the most favored kidney replacement therapy(KRT)modality in the country.Although many studies have conflicting results on the survival advantage between hemodialysis(HD)and peritoneal dialysis(PD)where it has been reported that peritoneal dialysis(PD)has early survival advantages over hemodialysis(HD)particularly during the first and second year of treatment.This is also evident in the recent studies that have also supported that the excess mortality related to HD patients can be better explained according to their functional vascular access types.Therefore,this study aims to evaluate and compare the 1-year survival outcomes of patients with kidney failure in Brunei Darussalam who initiated maintenance dialysis and further exploring the different types of vascular-access.Moreover,the present study also aims to identify the significant risk factors that are associated with the poor survival outcomes.Methods/Design: A retrospective,Brunei Dialysis and Transplant Registry(BDTR)registry-based cohort study was conducted which enrolls all consecutive adult patients who received maintenance dialysis from January 1,2015 to December31,2019.The analyses were done on three(3)subgroups according to their initial dialysis modality and stratified to vascular-access types for HD;1)hemodialysis via arteriovenous fistula(HD-AVF),2)hemodialysis via catheter(HD-C)and 3)peritoneal dialysis(PD).Reported findings here are looking at baseline characteristics of enrolled incident kidney failure patients requiring maintenance dialysis and the comparison at 1-year of survival outcomes between these three subgroups.Both univariate and multivariate Cox regression analysis were used to compare the survival between these groups and evaluate the risk factors that were associated with the allcause mortality.Results: In total,there were 582 patients whom fulfilled the inclusion criteria where further categorized into 472(81.1%),56(9.62%),54(9.27%)for hemodialysis via catheter(HD-C),hemodialysis via arteriovenous fistula(HD-AVF)usage and peritoneal dialysis(PD)patients respectively.From the total cohort,a total of 60 patients died within the 12 months of follow-up with overall median length of follow up of 218 days.The overall 1-year cumulative survival was 89.7% with best annotated in peritoneal dialysis of 96.3%.In general,all-cause mortality rate was highest in hemodialysis via catheter(HD-C)usage with 54 deaths in total.The cause of death for catheter usage were catheter-related infection(n=33).This is followed by arteriovenous fistula(AVF)usage as vascular access type has the highest risk of death of all-cause mortality which was remained associated with further increased that results in higher mortality as evident in from both univariate and multivariate analysis.Overall,these may indicate as the important risk factors that are negatively impacting the survival however,our findings demonstrated that there is no significant difference when looking at age,gender,presence of certain comorbidies during dialysis initiation and access types.Conclusion: Provided findings here by utilizing the local data may give an updated or latest insight and guidance on where are we is at the moment in tackling kidney disease issues in the country either direct or indirectly.Based on our study findings,it clearly illustrates that peritoneal dialysis(PD)appear to have survival advantage after 1-year over hemodialysis(HD),even when further stratified to vascular access to either HD-C and HD-AVF.whereas AVF was associated with high risk of all-cause death.Identified limitations of the present study include the retrospective design of the study itself which utilized data from manually-maintained registry that is prone to inaccuracy and human errors then secondly,the existence of bias where selection bias particularly influenced by patient treatment preference and not solely from the finalized decision from a multidisciplinary health expert.Overall,these favor the view that vascular access does play a role in modifier for the chance of survival for dialysis patients and hence,the findings highlight the great influence of vascular access types although were found statistically insignificant.