PREDICTORS OF PROGRESSION OF CHRONIC KIDNEY (CKD) IN AUSTRALIAN GENERAL PRACTICE PATIENTS

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.


Biography:
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.

DIETARY PLANT AND ANIMAL PROTEIN INTAKE AND THE DECLINE IN ESTIMATED GLOMERULAR FILTRATION RATE AMONG ELDERLY WOMEN: A 10-YEAR LONGITUDINAL COHORT STUDY

A BERNIER-JEAN1, J LEWIS1,2,3, J CRAIG1, J HODGSON2,3, W LIM3,4, R PRINCE2,4, A TEIXEIRA-PINTO1, G WONG1
1Centre for Kidney Research, Children’s Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia, 2School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia, 3Medical School, University of Western Australia, Perth, Australia, 4Sir Charles Gairdner Hospital, Perth, Australia

Aim: To assess the association between the two origins of dietary protein, plant and animal, and the decline in kidney function over time in older women.
Background: Current guidelines advise against high protein intake in people with chronic kidney disease (CKD) for fear of accelerated progression in CKD. However, proteins from plant and animal origin may affect kidney function differently and have opposite effects on acid-base balance.
Methods: In a cohort of 1374 older Caucasian women (mean age 75±2.7 years-old), 999(73%) had estimated glomerular filtration rate (eGFR) measured at 5 years, and 661(48%) at 10 years, using CKD-EPI creatinine-cystatin equation. We assessed the association between plant and animal protein intake at baseline, 5 and 10 years and change in eGFR using linear mixed modelling.
Results: Mean decline of eGFR over time was 0.64 95%CI [0.56-0.72] ml/min/1.73m² per year. Higher intakes of plant protein were significantly associated with a slower decline in eGFR after adjusting for covariates such as animal protein and energy intake (P=0.008). For each 10g of plant protein, the yearly rate of eGFR decline was slower by 0.14 95%CI [0.04, 0.24] ml/min/1.73m². Animal protein intake was not associated with eGFR decline (0.03 95%CI [-0.01, 0.07] ml/min/1.73m²/year per 10g, P=0.18). Throughout 10 years, consuming the mean intake of plant protein (29g/day) was associated with a decline in eGFR of 2.5 95%CI [1.4, 3.7] ml/min/1.73m² while consuming one standard deviation above the mean (37g/day) was associated with a decline of 1.4 95%CI [-0.1, 3.1] ml/min/1.73m².
Conclusions: Older women consuming a higher plant protein intake may be protected against declining kidney function. Recommendations to reduce protein intake may need to be modified to incorporate protein origin.


Biography:
Amelie is a PhD student at the Centre for Kidney Research affiliated with the University of Sydney. She completed her nephrology training in 2016 in Montreal, Canada. She is interested in lifestyle in chronic kidney disease (CKD). Her work examines the dietary patterns associated with CKD progression as well as the benefits of exercise training in people with CKD. Her thesis is currently supported by an NHMRC Post-Graduate scholarship.

THE MAKE-UP OF CARDIOVASCULAR DISEASE AS KIDNEY FUNCTION DECLINES: RESULTS FROM A POPULATION-BASED COHORT STUDY (EXTEND45)

L SUKKAR1,2, B SMYTH1,2, A KANG1,  M JUN1,  C FOOTE3,   K ROGERS1,  A SCARIA1, B NEUEN1, M GALLAGHER1, A CASS4,  D SULLIVAN5, C POLLOCK6, G Wong7, J Knight1, D Peiris1,  M Jardine1
1The George Institute For Global Health, , Australia, 2Sydney School of Public Health, The University of Sydney, , Australia, 3Concord Repatriation General Hospital, , Australia, 4Menzies School of Health Research, , Australia, 5NHMRC Clinical Trials Centre, The University of Sydney, , Australia, 6Kolling Institute for Medical Research, , Australia, 7Centre for Kidney Research, The University of Sydney , , Australia

Aim: To examine the relative contributions of myocardial and endoluminal disease to cardiovascular morbidity as kidney function declines.
Background: The pathophysiological process behind cardiovascular morbidity differs between people with Chronic Kidney Disease and the general population.
Methods: Based on data from the EXTEND45 study (the 45 and Up Study linked to hospital and community pathology datasets by the Centre for Health Record and Linkage[CHeReL]), we identified a population-based cohort (2006-2014) of 41,099 people aged ≥45 years who had a measure of kidney function(estimated glomerular filtration rate[eGFR]). Cardiac hospitalisations were identified using ICD-10 codes and classified into endoluminal (all coronary artery disease including complications), myocardial (all cardiac failure and arrhythmias) or other (all valvular disease and infective cardiac processes). We compared the proportion of endoluminal, myocardial and other causes of hospitalisation by KDIGO stage using the Chi-squared test and the trend in proportions between endoluminal and myocardial causes using the Cochran-Armitage trend test.
Results: Of 41,099 participants 3,177 experienced ≥1 hospitalised cardiac event(1901, 837, 439 endoluminal, myocardial and other respectively) over a median follow-up of 1.9 years. Endoluminal causes as a total proportion of cardiac hospitalisation decreased as kidney function declined(64.5%, 61.8%, 57.2%, 53.1%, 50% for Stages 1, 2, 3a, 3b, and 4-5, respectively) while myocardial(26.7%, 25.5%, 27.0%, 28.1%, 29.6% respectively) causes increased(P-value 0.0005) and this trend was significant(P= 0.02). Other causes were also found to increase(8.8%, 12.7%, 15.9%, 18.8%, 20.5% respectively, P-value 0.0005).
Conclusions: The trend towards a decrease in the proportion of endoluminal and an increase in myocardial causes of hospitalisation with kidney function decline was significant. Understanding risk factors that lead to this divergence in cardiovascular morbidity may help reduce the burden.


Biography:
Dr Louisa Sukkar is a PhD scholar at the George Institute for Global health and a clinical nephrologist. Her research interests is in understanding the progression of chronic kidney disease, its associated co-morbidities and its impact on patients. Her research explores the determinants of progression with a particular focus on processes of care of chronic disease and its relationship to health outcomes and health resource utilization.

INFECTION-RELATED HOSPITALISATIONS ACROSS DIFFERENT LEVELS OF KIDNEY FUNCTION: DATA FROM THE EXTEND45 STUDY

B NEUEN1, M JARDINE1, L SUKKAR1,2, A KANG1, C FOOTE3, K ROGERS1, A SCARIA1,  A CASS4, M GALLAGHER1, M JUN
1The George Institute For Global Health, UNSW Sydney, Newtown, Australia, 2University of Sydney, Camperdown, Australia, 3Concord Repatriation General Hospital, Concord, Australia, 4Menzies School of Health Research, Darwin, Australia

Aim: To determine the risk of infection-related hospitalisation and mean hospital length of stay across different levels of kidney function in a community-based cohort study.
Background: The risk of infection associated with differing levels of kidney function is unclear.
Methods: Based on data from the EXTEND45 Study (the 45 and Up Study linked to hospital and community pathology datasets by the Centre for Health Record Linkage [CHeReL]), we identified a population-based cohort (2006-2014) of 41,099 people aged ≥45 years who had a measure of kidney function (estimated glomerular filtration rate [eGFR]). The risk of infection-related hospitalisation and mean hospital length of stay were assessed by eGFR categories (≥90, 60-89, 45-59, 30-44 and <30ml/min/1.73m2) using multivariable Cox regression.
Results: Of 41,099 participants, 18.6% had an eGFR <60 ml/min/1.73m2. Overall, 2,598 (6.3%) participants experienced ≥1 infection-related hospitalisation over a mean follow-up of 5.8 years. After adjusting for age and sex, risk of infection increased with declining eGFR in a graded and linear fashion (HR 0.91 [95% CI: 0.79-1.04], 1.16 [0.99-1.37], 1.48 [1.22-1.78], and 1.83 [1.44-2.31] for eGFR ≥90, 60-89, 45-59, 30-44, and <30 ml/min/1.73 respectively). Pneumonia, urinary tract infections, and cellulitis were the most common infections across all eGFR categories. Mean hospital length of stay similarly increased with declining eGFR categories (4.9, 6.5, 7.5, 7.8 and 7.9 days, respectively).
Conclusion: The risk of serious infection increases as kidney function declines, independent of age and sex, suggesting that susceptibility is likely related to other factors (e.g. alterations in immune function) and begins in mild-moderate renal impairment.


Biography:

Dr Brendon Neuen is a PhD candidate at The George Institute for Global Health and Medical Registrar at Royal Prince Alfred Hospital. His primary interest is diabetes and CKD; he is leading several analyses of the CANVAS Clinical Trial Program to determine the potential cardiovascular and renoprotective effects of SGLT2 inhibitors. In 2018, he was awarded an Oxford Australia Clarendon Scholarship to undertake an MSc in Global Health at the University of Oxford. He has a keen interest in the role of social media in nephrology and is a member of the ISN Social Media Education Team. He can be found on Twitter as @brendonneuen

KUPI – DRINKING WATER AND RENAL DISEASE IN REMOTE AREAS OF AUSTRALIA

C JEFFRIES-STOKES1,  A STOKES1
1Rural Clinical School Of WA, Kalgoorlie, Australia

The Western Desert Kidney Health project (WDKHP) was an innovative research project that grew from the despair of the Aboriginal people of the Goldfields of Western Australia and their desire to understand more about diabetes and renal disease.
Aims: To determine the prevalence of type 2 diabetes (T2DM), kidney disease and the risk factors for these diseases in Aboriginal and Non-Aboriginal adults and children in a remote area of Western Australia and to compare those prevalence rates with national rates
Methods: The WDKHP was a community based participatory research project featuring annual cross sectional surveys over 3 years. It was conducted in 5 towns and 5 remote Aboriginal communities over lands of people of Western Desert Language groups. Participation was offered to all people regardless of age or ethnicity.
Results: Almost 80% of the Aboriginal population (n=818) and 12% (n=297) of non-Aboriginal population completed at least one health assessment.The WDKHP found higher than predicted rates of T2DM, hypertension, haematuria, aciduria and elevated ACR in Aboriginal and non-Aboriginal participants. Risk factors were found in children as young as 2 years. There was no difference between Aboriginal and non-Aboriginal children.
Conclusion: The rates of T2DM, hypertension and markers for kidney disease for Aboriginal and non-Aboriginal participants were higher than expected suggesting ethnicity might be less important that environmental and lifestyle factors. Drinking water in many remote areas does not comply with national and international safety standards and needs to be considered as a contributing factors in renal disease.


Biography:
Dr Christine Jeffries-Stokes is a Paediatrician who has been working in clinical practice and research in the Goldfields of Western Australia for more than 20 years. She has a PhD and a Masters in Public Health.

Annette Stokes is a senior woman of the Wongutha Tribe of the Eastern Goldfields. She has been integral to several major health and research projects in the Goldfields region and her contribution to medicine was recognised in 2018 was awarded an Order of Australia (AM). Annette and Christine are sisters in law.

12 MONTH PROSPECTIVE STUDY OF SNAKEBITE CASES AT THE MANDALAY GENERAL HOSPITAL IN MYANMAR REVEALS ENORMOUS BURDEN OF ACUTE KIDNEY INJURY

C PEH1,3, J WHITE,2,3, S ALFRED,1, D BATES,2, A MAHMOOD,3, D WARRELL,4, T THWIN5, M THEIN, 6,  S SAN, 6, K SWE, 7, M KYAW, 7,L MYINT, 7, A AUNG, 7, M HAN, 7, C KHINE, S CHAW 71
Royal Adelaide Hospital, , Australia, 2Women’s and Children’s Hospital, Adelaide, Australia, 3University of Adelaide, , Australia, 4Oxford University, , UK, 5Yangon Specialty Hospital, Yangon, Myanmar, 6Myanmar Snakebite Project Office, Mandalay, Myanmar, 7Mandalay General Hospital, Mandalay, Myanmar

As part of the Myanmar Snakebite Project, a clinical case record database was established at the Mandalay General Hospital to capture clinical data of snakebite patients. The study period was 12 months in 2016. 965 patients were enrolled, of whom 948 were included for analysis. The male: female ratio was 1.58:1. The great majority of cases were due to bites from Russell’s vipers (Daboia siamensis). Cobras and green pit vipers make up the rest. 9.8% of cases were fatal, all following Russell’s viper bites, which caused all cases of acute kidney injury. Most cases involved bites to the lower limbs of adults involved in farm work. Most patients sought care from the healthcare system, not traditional healers as their first point of contact. The pressure pad method of first-aid for snakebite was seldom used, while most patients used some form of tourniquet (92.0%). For all cases, clinical features included local swelling (76.5%); local pain (62.6%); acute kidney injury (59.8%), of whom 40% required dialysis; coagulopathy (57.9%); regional lymphadenopathy (39.8%); nausea/vomiting (40.4%); thrombocytopenia (53.6%); abdominal pain (28.8%); shock (11.8%); secondary infection (8.6%) and pan-hypopituitarism (2.1%).


Biography:
Dr Chen Au Peh is a renal physician at the Royal Adelaide Hospital. His clinical research interest include ANCA-associated vasculitis, lupus nephritis and membranous nephropathy. He is project leader of an Australian DFAT-funded project that aims to improve the health outcomes of snakebite patients in Myanmar.

MEDICATION BURDEN, ADHERENCE AND HEALTH-RELATED QUALITY OF LIFE IN ADVANCED CHRONIC KIDNEY DISEASE

W TESFAYE1, RL CASTELINO2, BC WIMMER1, C McKERCHER3, MD JOSE1,3,4, AL NEIL3, ST ZAIDI1

1School of Medicine, University of Tasmania, Hobart, Tasmania; 2The University of Sydney, Sydney, New South Wales; 3Menzies Institute for Medical Research, Hobart, Tasmania; 4Royal Hobart Hospital, Hobart, Tasmania

Aim: To examine the relationship between medication burden, adherence and health-related quality of life (HRQoL).

Background: Poor medication adherence in patients with advanced chronic kidney disease (CKD) is associated with disease progression and mortality. However, little is known about the associations between medication burden, adherence and HRQoL.

Methods: Medication burden, actual and perceived, was measured using the Medication Regimen Complexity Index (MRCI) and the perceived Burden of Oral Therapy (BOT). Medication adherence was assessed using the Tool for Adherence Behaviour Screening (TABS). HRQoL was measured using the Kidney Disease and Quality of Life Short-Form, containing disease-specific and generic physical (PCS) and mental (MCS) component summaries, and EuroQol 5 Dimensions 3 Levels (EQ-5D-3L). Associations were examined using Spearman’s rho.

Results: Fifty adults (16 women, 32%) aged ≥18 years (mean 72.0±11.1 years) with CKD (eGFR <30 ml/min/1.73 m2) and not receiving dialysis were recruited via treating physicians. Overall, 418 medications, predominantly cardiovascular agents (38%), were prescribed. Mean number of medications was 8.4±3.8 with a MRCI score of 21.3±10.6 and 48% (n=24) of participants were adherent (TABS). Actual and perceived medication burden were associated with EQ-5D-3L (r=-0.34, p<0.01; r=-0.32, p<0.01). While BOT was correlated with age (r=-0.43, p<0.05), number of medications (r=-0.33, p<0.05) and MRCI (r=-0.34, p<0.05) were associated with PCS. Similarly, higher adherence scores were associated with lower scores of PCS (r=-0.40, p<0.01).

Conclusions: Participants who self-reported higher medication adherence tended to report lower perceived physical health (PCS). Those who had a higher medication burden also self-reported lower HRQoL (EQ-5D-3L). Exploring the determinants of adherence and their interplay with different aspects of HRQoL may help to understand the drivers of adherence in people with CKD.

APPROPRIATENESS OF NEPHROLOGY REFERRALS IN REGIONAL AUSTRALIA: IMPLICATIONS FOR A SPECIALIST SERVICE

J WRIGHT1, R THWAITES2, K GLENISTER1, D TERRY1

1Department of Rural Health, University of Melbourne, Shepparton, VIC; 2Rural Clinical School, University of Melbourne, Shepparton, VIC

Aim: A retrospective study, examining referrals to a regional nephrology service from 2013-2015, to establish whether referrals to a regional nephrology service met with Australian referral guidelines

Background: Regional nephrology outpatient services have limited resources. It is important that such resources are utilised efficiently to see appropriate patients in a timely manner.

Methods: All referrals to the nephrology service for chronic kidney disease were included in the study. Of a total 659 referrals, 582 were included in the study. The remainder were excluded if they did not attend the appointment, if they had a known renal disorder, or if they were referred for consideration of renal transplant donation. Data available from the referral letter, and renal function tests at the initial clinic visit were examined to determine whether data included in the referral letters met referral guidelines, and whether, when taking into account renal functional tests from the initial clinic visit, referral guidelines were met.

Results: Of 582 referrals included in the study, 253 (43.5%) met referral guidelines. After consideration of renal functional tests performed at the initial consultation, 335 (57.6%) met referral guidelines. With regard to data provided in referral letters, estimated glomerular filtration rate was included in 435 (74.7%), more than one eGFR result in 298 (51.2%), renal imaging in 201 (34.5%), blood pressure in 100 (17.2%), urinalysis for albuminuria/proteinuria in 223 (38.3%), urinary red cells in 70 (11.9%) of cases.

Conclusions: The majority of nephrology referrals to a regional Australian service did not meet referral guidelines. This has significant implications for a regional nephrology service due to workforce pressures. It is imperative that knowledge and implementation of nephrology referral guidelines are increased.

PREVALENCE AND SEROCONVERSION OF HEPATITIS C VIRUS AMONG HAEMODIALYSIS PATIENTS IN PEMALANG, INDONESIA

AZIZ MN1,PARTININGRUM DL1,ARWANTO A1,CHASANI S1, LESTARININGSIH L1

1Division of Nephrology and Hypertension, Internal Medicine Department, Medical Faculty of Diponegoro University/Dr. Kariadi Hospital Semarang

Aim: This study to evaluate the prevalence and seroconvesion of hepatitis C virus (HCV) among hemodialysis patient in Pemalang, Indonesia

Backgraound: Hepatitis C virus (HCV) remains a problem within hemodialysis units.  Many studies have shown that incidence of HCV transmission continue to occur in haemodialysis centers and prevalence and seroconversion greatly vary among haemodialysis facilities. More recent studies in some haemodialysis facilities have shown decline in seroconversion,where as the transmission of the disease continues to persist within several dialysis units.

Method: The study was prospective observational study done in 36 patients on maintenance haemodyalisis serological test for antibodies using Elisa was done. This serological test was repested to see any seroconversion after 3 months.

Result: The mean age of haemodialysis patients was year 47 years.  Among the patients 44.6% were female and 55.4% were male the main duration of haemodialysis was 24 month. The prevalence of HCV was 44.4% (16 of 36). The seroconverssion of HCV after 3 month was  30.5% (11 of 36).

Conclusions: The prevalence of HCV was higher than the national prevalence of HCV in haemodialysis patients by 1% taken from Indonesian Renal Registry (IRR) 2013 Seroconversion of HCV after 3 months was 30,5%(11 of 36).  Early detection of HCV is important in patients with CKD undergoing hemodialysis because of the high prevalence of infection and the requirement.

CKD.QLD: RELATIONSHIP BETWEEN SMOKING AND CHRONIC KIDNEY DISEASE (CKD) IN THE DARLING DOWNS REGION, QUEENSLAND.

SK VENUTHURUPALLI 1,2,3 , WE HOY 2,3 , HG HEALY 2,3,4 , Z WANG 2 , A CAMERON 2 , RG FASSETT 5,6

1Renal Services, (TBH) Darling Downs Hospital And Health Service, Toowoomba Queensland; 2NHMRC CKD CRE and CKD.QLD, The University of Queensland, Brisbane Queensland; 3Faculty of Medicine, The University of Queensland, Brisbane Queensland; 4Kidney Health Service (RBWH), Metro North Hospital and Health Service, Brisbane Queensland; 5School of Human Movement Studies, The University of Queensland, Brisbane Queensland; 6Faculty of Health Sciences and Medicine, Bond University, Gold Coast Queensland.

Aim: To explore the associations of smoking with other cardiovascular risk factors in chronic kidney disease (CKD)

Background: CKD is associated with excessive cardiovascular risk. Another strong risk factor is smoking and it is preventable. We analysed the associations between smoking and other cardiovascular risk factors in a CKD cohort from the Darling Downs region in Queensland.

Methods: Participants ≥18 years were recruited from renal clinics in Toowoomba Hospital into the CKD.QLD Registry between June 2011 and December 2016. Smoking was reported as current, former or never. Cardiovascular risk profile was defined by gender, body mass index (BMI), diabetes and hypertension. The association cardiovascular risk factors and smoking status was analysed by Stata Version 14 and values were reported as percentages and P value <0.05 was considered significant.

Results: 1051 participants were recruited, with a median age of 67 years (male 55.3%). The majority (57.1%) of the cohort was either former (45.9%) or current (11.2%) smokers. Compared to non-smokers, smokers were predominantly male (62.7%) and diabetic (47%) with significantly higher rates of coronary artery disease (29.7% Vs 18.8%) (P<0.00), chronic lung disease (22.6% Vs 3.78%) (P<0.00), peripheral vascular disease (10.6% Vs 6.8%) (P<0.03) and premature mortality (13.9% Vs 8.8%) (P<0.01). Smoking status was not significantly associated with BMI, hypertension and Cerebro-vascular disease.

Conclusion: Smoking is a significant additional risk factor for cardiovascular disease in this CKD cohort from the Darling Downs region, as well as for chronic lung disease and premature death. Education and smoking cessation programs to reduce smoking rates to minimise cardiovascular risk in this group may be of benefit. Measures targeting the CKD subpopulation who are current smokers are a priority.

About ANZSN

The ASM is hosted by Australian and New Zealand Society of Nephrology.

The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

Conference Managers

Please contact the team at Conference Design with any questions regarding the Annual Scientific Meeting

© 2015 - 2016 Conference Design Pty Ltd