Mortality Improvements among Dialysis Patients in a Dialysis Organization

Mortality amongst haemodialysis patients has traditionally been high, due to multitude of different factors, traditional and non-traditional. In Malaysia, the mortality rate for dialysis patients has averaged 14.2% yearly for the last 10 years (Malaysian Dialysis Transplant REgistry Annual Report,2014-2023), with a notable peak of 18% in 2021 due to the covid 19 pandemic. 

Davita Malaysia operates 71 clinics across Malaysia caring for 3800 patients, a large number of whom are from a lower socio-economic class. despite that, mortality rates within the network have been lower than national averages and are improving year on year. 

We sought to identify and codify the reasons for the reduction in mortality as well as identify the risk factors driving mortality in our patient population  

This was a retrospective study from January 2020 till July 2025. Mortality data was obtained from laboratory data aggregated across 44 DaVita Malaysia clinics. Data from 27 of the 71 clinics were not included as they had only recently been incorporated into the Davita network therefore did not have adequate data integrity to allow comparisons. 

We included all patients who had at least 1 dialysis session in a davita clinic. 

Mortality causes were obtained from official death certificates. If death reasons could not be ascertained, they were coded as Unknown

The graph below illustrates monthly mortality rates from January 2020 through August 2025. The overall yearly mortlity rates have dropped from a high of 1.49 to 0.8%. This translates to a yearly mortality of 6% to date, lower than national averages. 

The pictograph below illustrates the breakdown of death causes. The large majority of deaths were due to cardiac casues (33%) and infections (26%), Among the infectious causes of death, pnuemonia was listed as the casue for 33% of cases, illustrating the outside impact of pulmonary infections on mortality. 

Mortality was highest during the covid pandemic years, with monthly mortality rates reaching a peak of 2.6 in July of 2021 with annual mortality reaching 14.9%. Mortality also rises during certain times of the year, namely coinciding with festival months (Hari Raya and Chinese New Year). 

since then, mortality rates have improved year on year; with current numbers being the lowest since 2020. Monthly mortality currently is averaging 5%. Main causes of mortality remain cardio-cerebrovascular at 38% followed closely by infections at 27%.

Mortality improvements are possibly due to the following measures

1. Establishment of a performance indicator for medical outcomes, which includes factors that would be associated with mortality like haemoglobin (set at between 10-12) and kt/v (set at 1.3). 

2. Establishment of a clinical governance structure that would actively monitor medical outcomes and push outcomes to targets

3. Active monitoring of missed treatments / hospitalizations with regular quality meetings to dicuss gaps and actions plans

4. Active surveillance of infections 

5. Weekly mortality deep dive meetings 

6. 3 monthly ECG with active monitoring and active referrals to cardiology for assessment and possible intervention

7. Influenza vaccination program to reduce hospitalizations 

8. .Dedicated medical outcomes monitoring team 

The above illustrates a pathway towards reducing mortality in haemodialysis patients through structured governance measures. The improvements in mortality in comparison with national averages show that these measures can be applied in overseeing haemodialysis centres even with the challenges of operating in a developing country and with patients at a lower socioeconomic status.