ATTAINMENT OF HEMOGLOBIN, CALCIUM AND PHOSPHATE TARGETS, MORTALITY AND TIME TO TRANSPLANT IN CHILDREN, ADOLESCENTS AND YOUNG ADULTS IN AUSTRALIA

AK LE PAGE1,2, D SIVANTHANAN1, K POLKINGHORNE2,3, L JOHNSTONE1,2 

1Monash Children’s Hospital, VIC; 2Monash University, VIC;  3Monash Medical Centre, VIC

Aim: To evaluate the association between evidence based targets of haemoglobin (Hb), phosphate and calcium in young (age <25yrs) dialysis patients with demographic and clinical variables, and explore the impact of these categories on time to transplant and survival on dialysis.

Background: Hb and phosphate are associated with mortality on dialysis in adult patients. Whether these relationships hold in young patients with less comorbidities is unclear. Off-target indices may also be associated with transplantation delay given postulated links to nonadherence.

Methods: All incident young Australian dialysis patients (N=789) within ANZDATA from 2003 to 2015 were assessed. First reported uncorrected calcium, haemoglobin (Hb) and phosphate at 3-15 months were categorised according to evidence based targets Multivariate Cox models with age stratification were developed to examine associations between categories with time to transplant and mortality.

Results:  Low calcium and phosphate were significantly more common in those with diabetic kidney disease (42.9%, 30.8% respectively) compared with glomerulonephritis (14.66%, 15%). High phosphate was associated with older age, and high calcium with younger age. Hb>120 was more common in regional/remote (25.2% versus 19% cities) or low socioeconomic postcodes (27.3% lowest SES, 13.9% highest SES).

Time to transplant did not associate with Hb, phosphate or calcium categories in the multivariate analysis.  Mortality was significantly associated with Hb>120 for those starting dialysis at 20-25 years (HR 4.1 95%CI 1.64-10.1). Low calcium was associated with mortality for the 15-20 year age group (HR 12.4 95%CI 1.7-91).

Conclusions: Age, remoteness, SES, race, and ESKD cause were associated with off-target calcium, phosphate and Hb. These indices did not associate with time to transplant, however high Hb was associated with increased mortality on dialysis.

About ANZSN

The ASM is hosted by Australian and New Zealand Society of Nephrology.

The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

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