O ADEGBIJA1,2,6, WE HOY1,2,6, Z WANG1,2, A CAMERON1,2,3, HGHEALY1,3, KS TAN1,4, SK VENUTHURUPALLI1,2,5
1School of Medicine, The University Of Queensland, Brisbane, Australia, 2NHMRC CKD.CRE and CKD.QLD, Brisbane, Queensland, Brisbane, Australia, 3Kidney Health Service (RBWH); Metro North Hospital and Health Service, Brisbane, Queensland, Brisbane, Australia, 4Renal Services (Logan), Metro South Hospital and Health Service, Brisbane, Queensland, Logan, Australia, 5Renal Services (Toowoomba Hospital), Darling Downs Hospital and Health Service, Queensland, Toowoomba, Australia, 6Australia and New Zealand Dialysis and Transplantation Registry (ANZDATA), Adelaide, Australia
Aim: To highlight some differences between CKD and RRT patients.
Background: It is often assumed that pre-terminal CKD patients and those on RRT have similar characteristics.
Methods: Characteristics of preterminal CKD patients in three public renal practices who joined CKD.QLD registry between May 2011 and April 2016 (n=3,451) were compared with those of persons who started RRT (incident RRT) in Queensland (n=2,376) from January 2011 to December 2015, as recorded in ANZDATA.
Results: Mean(SD) ages of the CKD and RRT groups were 65 (15.8) and 60 (15.9) years, p<0.0001, with proportions of age>=70 years 45% and 31%, p<0.0001. Proportions of males were 52% and 62% respectively, p<0.0001. Assigned causes of renal diseases among CKD and RRT patients for diabetic nephropathy were 24% vs 35%, p<0.0001, for glomerulonephritis 13% vs 17%, p<0.0001 and for renalvascular disease/hypertension 31% vs 15%, p<0.0001. Proportions with coronary heart disease in the CKD and RRT groups were 26% vs 38%, p<0.0001; with peripheral vascular disease, 12% vs 23%, p<0.0001; and with chronic lung disease 22% vs 14%, p<0.0001. Rates of death were 4.8 (CI 4.3-5.3) vs 9.7 (CI 8.8-10.6) per 100 person-years among CKD and RRT patients and mean(SD) ages at death were 75 (10.5) and 69(14) years respectively p<0.0001.
Conclusions: Patients who evolve to, or are selected for RRT have a somewhat different weighting of characteristics than the broader CKD population in public renal speciality practice. They are generally younger, more often male, more often have diabetic nephropathy and glomerulonephritis and less often have hypertensive/renalvascular disease. They have a greater burden of cardiovascular disease, and less representation of chronic lung disease. Despite their younger ages, they have higher death rates.
Professor Wendy Hoy is Director of the Centre for Chronic Disease at the University of Queensland. She is a graduate of Sydney University, with first class honours in Immunology (BScMed) and in Medicine and Surgery (MB BS), and is board certified in Medicine and Nephrology in the USA and Australia. She leads the CKD.QLD Collaborative and the NHMRC CKD Centre for Research Excellence. CKD.QLD is a core member of the iNET-CKD, an international research collaborative of CKD cohorts.