CHARACTERISTICS, MORTALITY AND RENAL OUTCOMES OF ATSI PATIENTS WITH DIABETES AND CKD WHO RECEIVE SPECIALIST NEPHROLOGY CARE

K-S TAN1,2,3, S MCDONALD4,5, WE HOY1,2
1NHMRC CKD.CRE and CKD.QLD, Brisbane, Australia, 2Faculty of Medicine, University of Queensland., Brisbane, Australia, 3Renal unit, Logan Hospital & Metro South Health Service, Brisbane, Australia, 4Central and Northern Adelaide Renal And Transplant Service, Adelaide, Australia, 5Adelaide Medical School, University of Adelaide, Adelaide, Australia

Background: Diabetes Mellitus (DM) is a common cause of end stage kidney failure (ESKF) and CKD in Australia. The CKD.QLD registry is a Queensland-based registry of patients with CKD who are followed up in the state’s public hospital renal units and have provided informed consent. Enrolment commenced in 2011.
Aims: Define baseline characteristics, mortality and renal outcomes of all Aboriginal and Torres Strait Islander (ATSI) patients with DM and CKD in the CKD.QLD registry.
Methods: ATSI patients with DM enrolled in the registry between 01/01/2011 and 31/12/2016 inclusive were included. Baseline characteristics, incidence of ESKF (defined as eGFR <10ml/min for >3 months or commencement of RRT) or death without ESKF were determined. Censor date was 31/12/2017.
Results: 270 patients (56% women) comprising 11.7% of all registry patients with DM identified as ATSI. Mean follow up was 2.96 years. Mean age at enrolment was 60.1y (SD 11.4). 53% were incident patients (enrolled within 6 months of first appointment).267 patients (99%) had DM2 (55% on insulin). Median eGFR at enrolment was 38ml/min (IQR 21-58) and 60% had enrolment eGFR <45ml/min. 66% had ACR>30mg/mmol (A3) at enrolment. At censor date, 79 patients had developed ESKF first (8 committed to supportive care) and 47 had died without ESKF, giving ESKF rate of 9 and death rate of 5.3 per 100 patient years f/u. 95% of ESKF patients had A3 at enrolment. All 69 patients who commenced RRT went onto dialysis (no pre-emptive transplants).
Conclusions: As befits a population attending specialist follow-up, patients had both significantly reduced eGFR and residual proteinuria at enrolment. The event rate was high.  Few patients with ESKD (10%) were managed conservatively.


Biography:
Nephrologist and Clinical Pharmacologist.

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