Kidney Disease Related Death in Working Age Group Over a Ten-Year Period at One Selected Public Hospital in Myanmar: A Retrospective Descriptive Study
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Abstract
Introduction: The prevalence of non-communicable disease is increasing world-wide; chronic kidney disease is one of them. The burden of kidney disease related mortality in working age group was not reported from Myanmar.
Methods: A hospital based retrospective descriptive study was conducted in one selected public hospital in Yangon, Myanmar. The design focused on analyzing data from brought-in-deaths (BID) and hospital admission deaths (HAD) among the working age group (18-62 years) over a 10-year period; January 1, 2015 to December 31, 2024. All cases underwent postmortem examination done by a forensic surgeon for BID cases and a pathologist for HAD cases. And the cause of death was verified.
Results: A total of 3,087 death cases were reviewed from hospital records; a quarter (744/3,087; 24.1%) was BID cases and two third (2,343/3,087; 75.9%) was HAD cases. Mean age was 44 years (SD ± 12). Gastrointestinal and hepatobiliary diseases were the most prevalent cause among all deaths, accounting for half of them (50.5%). The remaining cause of death in order of frequency were as follows: hypertension (37.1%), cardiac diseases (27.4%), hematological diseases (22%), tuberculosis (20%), renal diseases (16.2%), malignancy (15%), surgery related death (12.3%), chronic obstructive airway disease (COPD) (11%), HIV infection (10%), stroke (9%), autoimmune diseases (9%), accidents and injury (9%), diabetes mellitus (6%), and poisoning including suicide & homicide (3%). Nearly 85% of cases had more than one disease. Of all deaths, communicable diseases (CDs) attributed 30%; and 46% were due to non-communicable diseases (NCDs).
Among all deaths due to renal diseases, acute kidney injury (AKI) was noted in 10%; chronic kidney disease/end stage renal disease (CKD/ESRD) was seen in 90%. AKI was mainly associated with septicaemia and volume loss; septicemia led to septic shock multi-organ failure (acute respiratory distress syndrome (ARDS), and disseminated intravascular coagulation DIC). Those deaths with CKD/ESRD had co-morbid diseases like hypertension (90%), diabetes mellitus (10%), ischemic heart disease and heart failure (25%), cerebrovascular accidents (10%), COPD (10%), autoimmune diseases (10%) and chronic liver disease with portal hypertension (5%).
Regarding the proportion of BID and HAD cases in renal disease related deaths, only one percent them was BID and almost all (99%) were HAD indicating they received in-patient-care.
Conclusion: Number of death due to non-communicable diseases (NCDs) was higher than that of communicable diseases (NCDs) among working age group in 10 years retrospective study; kidney disease was sixth leading cause of death. Chronic kidney disease/ESRD attributed 90% of kidney disease related deaths and they had associated co-morbid diseases. Hypertension was the most common co-morbid disease. To reduce the kidney disease related morbidity and mortality in working age group, hospital in-patient-care was not adequate. We need to strengthen preventive measures, early detection and treatment of non-communicable diseases (hypertension, diabetes mellitus, CKD), health education and life style modification to delay/prevent the development of CKD. Management of CKD should be placed on the global/national public health agenda.
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