Heterogeneity of Health Needs Among Patients With Chronic Kidney Disease and Its Association With Mortality Risk: A Study Based on a Public Health Database

Cox proportional hazards regression models were applied to evaluate the associations of different health need classes with the risks of all-cause mortality and kidney related mortality.Results Three distinct health need phenotypes were identified: the low health burden type, including 947 patients (51.05%); the behavior and sleep risk type, including 236 patients (12.72%); and the functional limitation and multimorbidity type, including 672 patients (36.23%).

During a median follow up of 6.15 years, the proportions of all-cause mortality were 27.76%, 29.36%, and 41.33%, respectively, with a statistically significant difference among the three groups (P<0.01). Using the low health burden type as the reference, after multivariable adjustment, the risks of all-cause mortality were increased by 64% in the behavior and sleep risk type (HR=1.64, 95%CI: 1.14 to 2.38) and by 98% in the functional limitation and multimorbidity type (HR=1.98, 95%CI: 1.65 to 2.39).

Patients with the functional limitation and multimorbidity type had a significantly higher risk of kidney related mortality than those with the low health burden type or the behavior and sleep risk type (HR=5.27, 95%CI: 1.61 to 17.29).Conclusions Distinct latent classes of health needs exist among patients with CKD. Patients with the behavior and sleep risk type and the functional limitation and multimorbidity type have higher risks of all-cause mortality, while those with the functional limitation and multimorbidity type also have a markedly increased risk of kidney related mortality.

Classification based on multidimensional health needs may help identify high risk patients with CKD and provide a basis for precision health management.