N DE LA MATA1, P KELLY1, AC WEBSTER1,2
1Sydney School Of Public Health, The University Of Syd, Camperdown, Australia, 2Centre for Renal and Transplant Research, Westmead Hospital, Westmead, Australia
Aim: To estimate cardiovascular mortality rates and graft failure rates for people receiving dialysis and kidney transplant recipients in Australia and New Zealand, stratified by pre-existing cardiovascular disease (CVD).
Background: People with ESKD have a high burden of cardiovascular deaths.
Methods: We included incident ESKD patients in Australia,1980-2013 and New Zealand,1988-2012 from ANZDATA. We ascertained primary cause of death from data linkage with national death registries and patient related data from ANZDATA. Age-specific mortality rates were estimated by dividing the number of deaths by person-years (pys) of follow-up, stratified by age at ESKD treatment initiation, ESKD treatment (dialysis or transplant) and pre-existing CVD.
Results: Our analysis included 60,823 ESKD patients, with 8,223 cardiovascular deaths and 26,094 other deaths over 381,878pys. Of the 17,415 kidney transplant recipients, there were 4,145 graft failures over 136,930pys. The prevalence of CVD was 34.8% (95%CI:34.4-35.2%) in dialysis patients and 8.4% (95%CI:8.0-8.8%) in transplant recipients. Among dialysis patients, the cardiovascular mortality rate was almost double in those with CVD compared to without CVD in all ages, at 45.7 (95%CI:43.4-48.2)/1000pys versus 23.5 (95%CI:22.3-24.7)/1000pys in people aged 45-64yrs. Non-cardiovascular mortality rates were also higher among those with CVD compared to without CVD in all ages, at 116.9 (95%CI:113.1-120.8)/1000pys versus 82.8 (95%CI:80.7-85.0)/1000pys in people aged 45-64yrs. Mortality rates were similar in kidney transplant recipients with or without CVD, at 10.7 (95%CI:8.3-13.7)/1000pys and 8.0 (95%CI:7.3-8.8)/1000pys for cardiovascular deaths, and at 30.7 (95%CI:26.5-35.5)/1000pys and 23.4 (95%CI:22.1-24.8) for other deaths in recipients aged 45-64yrs. Graft failure rates did not differ by pre-existing CVD.
Conclusions: Dialysis patients with CVD experienced higher cardiovascular and non-cardiovascular mortality rates. While kidney transplant recipients with CVD had similar mortality and graft failure rates to those without CVD.
Nicole De La Mata is an early career researcher and biostatistician working with Sydney School of Public Health, The University of Sydney. She has previous experience in managing and utilizing large observational cohorts to evaluate patient outcomes and influence health policy. Her interests include cohort studies, data linkage and survival analysis. Her current research focuses on health outcomes in people with end-stage kidney disease (ESKD), living kidney donors and organ transplant recipients.