THE END OF THE CKD JOURNEY- RRT OR DEATH WITHOUT RRT: THE CKD.QLD EXPERIENCE

WE HOY1,2, J ZHANG1,2, Z WANG1,2, A CAMERON1,2, HG HEALY1,3, S VENUTHURUPALLI1,3, K-S TAN3, S GOVINDARAJULU3, A ROLFE3, M MANTHA3, T TITUS3, R CHERIAN3,  P WU3,  C  BANNEY3, C  MUTATIRI3, K MADHAN3, D RANGANATHAN3, G KAN3, T HAN3, S HOSSAIN3, A KARK3, S COLEMAN3, B TAYLOR3, A MALLETT3
1NHMRC CKD.CRE and CKD.QLD , Brisbane , Australia, 2Faculty of Medicine, University Of Queensland , Brisbane, Australia, 3Queensland Health , Brisbane, Australia

Aim: To examine the fate of patients with CKD in selected public renal specialty clinics in Queensland and compare those who started RRT with those who died without RRT.
Background. An AIHW study suggests that, in Australia, the number of persons who start RRT is equalled or exceeded by those who die of end stage kidney failure (ESKF) without receiving RRT.
Methods: 6,371 patients in CKD.QLD (54% males, mostly CKD stages 3b, 4 and 5, were followed from consent date until the start of RRT, death, or a censor date of June 30, 2016. Outcomes and causes of death were ascertained from Queensland Health records, through a data linkage collaboration. Follow up ranged from 0 to 5.4 years, median (IQR) of 2.8 (3) years, or a total of 15,714 person years.
Results: By the censor date, 605 (9.5%) patients had started RRT, at a median (IQR) age of 63 (20) and 837 (13.1%) had died without RRT, at median (IQR) age 78 (14). Rates of both were higher in males than females, with RRT incidences of 3.8 vs 2.7, p=0.001, and death rates of 5.8 vs 4.8, p=0.001. Among deaths without RRT, 377 (45.5%) mentioned terminal ESKF or chronic renal failure, 193 (23.3%) mentioned CKD, an additional 57 (6.9%) mentioned AKI, with no gender difference in terms of the causes.
Discussion. More of these CKD patients died without RRT than started RRT. Average ESKF-free survival was 15 years longer for patients who did not start RRT (78 vs 63 years). About half the deaths without RRT were ESKF deaths, while another 30% mentioned a renal diagnosis. Ascertainment of CKD in death certificates was very good.


Biography:
Dr Wendy Hoy was awarded an Officer of the Order of Australia [2010] for service to medical research in the field of chronic disease, particularly renal disease, through her promotion of health service delivery reform and advocacy for Indigenous health in Australia and the USA. Also recognised internationally for her multidisciplinary research and leadership in CKDu in Sri Lanka, PAHO and WHO projects, she was elected as a Fellow of the Australian Academy of Science [2015]. Based at The University of Queensland, she leads the Centre for Chronic Disease, the NHMRC CKD Centre for Research Excellence, and the CKD.QLD Collaborative.

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