M KHANAM1, J RADFORD1, R CASTELINO1, M JOSE1, A KITSOS1, J STANKOVICH1, L KINSMAN1, G PETERSON1
1University Of Tasmania, Sandy Bay, Australia
Aim: To describe the predictors of progression of chronic kidney disease (CKD) in Australian patients.
Background: There is a dearth of information regarding progression of CKD in Australia. National guidelines (Kidney Health Australia) are available to assist in the management of CKD patients, and are categorised into coloured action plans based on eGFR and albuminuria level.
Methods: Data from MedicineInsight (NPS MedicineWise) was used. MedicineInsight currently collects de-identified information from 557 participating general practices to create a longitudinal database of >3.5 million Australians. Patients within the yellow action plan (eGFR 45-59 mL/min/1.73m2 or eGFR>60 mL/min/1.73m2 plus microalbuminuria) were identified for the 2013 calendar year. The progression of their CKD was observed after approximately two years of follow-up. Multivariate analysis was performed to identify independent predictors for progression of CKD.
Results: 2,339 patients (36% of those with the required data for the time period) were initially identified in the yellow action zone. At follow-up, 54% had stayed within the yellow zone, 12% had improved to the green zone, and 30% and 4% had progressed to the orange and red stages of the CKD action plan, respectively. Having co-morbid conditions was significantly associated with progression, namely cardiovascular disease (OR 1.36; CI 1.13-1.64), diabetes (OR 1.40; CI 1.12-1.74) and hypertension (OR 1.53; CI 1.17-2.00). There was a tendency for men to progress more compared to women (OR 1.31; CI 1.10-1.57).
Conclusions: The majority of the patients stayed in yellow action plan zone or improved, over a two-year period. Special emphasis needs to be given to CKD patients with co-morbid conditions, which may be a challenge for general practitioners in the absence of robust guidelines for managing multi-morbid patients.
Masuma Khanam is a research fellow at the University of Tasmania. She qualified and worked as a medical doctor in Bangladesh, and subsequently completed a MPH (UNSW) and PhD (University of Newcastle). She is involved in research on chronic diseases and elderly health issues, with a focus on hypertension, chronic kidney disease and multimorbidity, and has generated 25 publications, a book chapter and a number of research grants. Her goal is to help generate new knowledge and an evidence base for best practice in public health approaches to chronic disease prevention and management, and building future capacity in these areas.