ANNUAL SCREENING VERSUS NO SCREENING FOR ASYMPTOMATIC CORONARY ARTERY DISEASE IN WAIT-LISTED KIDNEY TRANSPLANT CANDIDATES: A MODELLED COST-EFFECTIVENESS ANALYSIS

T YING1,2,A TRAN2, AC WEBSTER2, H PILMORE3, P KELLY2, JS GILL4, S KLARENBACH5, S CHADBAN1,2, RL MORTON2
1Royal Prince Alfred Hospital, Camperdown, Australia, 2University of Sydney, Camperdown, Australia, 3Auckland City Hospital, Auckland, New Zealand, 4University of British Columbia, Vancouver, Canada, 5University of Alberta, Edmonton, Canada

Aim: To calculate the cost-effectiveness of repeated screening of kidney transplant candidates (KTC) for asymptomatic coronary artery disease (CAD) versus no screening (after wait-listing) from a health system perspective, and identify areas of current evidence uncertainty to be addressed in a forthcoming randomised trial.
Background: KTC often wait 2-6 years on the deceased-donor wait-list; cardiovascular fitness must be maintained prior to transplantation. Regular screening by non-invasive methods for CAD is routinely performed at many transplant centres; however the cost-effectiveness of this practice is unclear.
Methods: We developed a Markov model over a lifetime horizon to simulate a cohort of KTCs to undergo annual CAD screening compared with no further screening. We obtained quality-of-life utilities and probabilities of important clinical events including myocardial infarction, transplantation and death using published data. Resource use and costs were obtained from Australian Refined Diagnosis Related Groups, Medicare Benefits Schedule, the Australian Institute of Health and Welfare reports and the literature.
Results: In the base model, no further screening resulted in a cost-saving of $91,025 and additional 2.26 quality-adjusted life-years (QALYs) compared to annual screening. The lifetime costs of an average 40-year old undergoing annual screening was $1,467,078 compared with $1,376,052 for no screening. Annual screening yielded 11.16 QALYs vs 13.42 QALYs in the no-screening arm. Results were most sensitive to the costs of cardiovascular-death and the costs of transplantation in the first and subsequent years.
Conclusion: No further screening for asymptomatic CAD in KTCs is likely to be cost-saving. Detailed data on the real costs of cardiovascular events is required to reduce uncertainty in the results. The Canadian-Australasian Randomised trial of Screening Kidney transplant candidates seeks to answer this question.


BIOGRAPHY:
Tracey Ying is a nephrologist and a PhD candidate in kidney transplantation at the Kidney Node, Charles Perkins Centre at the University of Sydney

CKD.QLD: ASSOCIALTION OF MONOCLONAL GAMMOPATHIES AND CHRONIC KIDNEY DISEASE

S WILKINSON1, S VENUTHURUPALLI1,2,3, A CAMERON2,3,4, HG HEALY2,3,4, R FASSETT2,5,6, WE HOY2,3
1Darling Downs Hospital And Health Service, Toowoomba, Australia, 2NHMRC CKD.CRE and CKD.QLD, The University of Queensland, Brisbane, Australia, 3School of Clinical Medicine, Faculty of Medicine, The University of Queensland, Brisbane, Australia, 4Kidney Health Service (RBWH), Metro North Hospital and Health Service, Brisbane, Australia, 5School of Human Movement Studies, The University of Queensland, Brisbane, Australia, 6Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia

Aim: To explore the association between monoclonal gammopathies and chronic kidney disease (CKD)
Background: Chronic kidney disease (CKD) is a common complication of monoclonal gammopathies with multiple myeloma being the most widely recognized. In 2012, the International Kidney and Monoclonal Gammopathy (MG) Research Group introduced a new term, monoclonal gammopathy of renal significance (MGRS), which describes a group of renal disorders caused by a monoclonal immunoglobulin, or its components.
Methods: Records of CKD registry of patients attending renal clinics from the Darling Downs with documented monoclonal gammopathies were reviewed for demographic profile, renal biopsy rates, diagnostic ascertainment of CKD.
Results: A total of 27 (1.9%) cases were identified from 1400 recruited to the CKD Registry, with a median age of 68.9 years with male preponderance (59.2%).  A quarter of them (7/27) had confirmed multiple myeloma. Of the remaining 20 cases MGRS was diagnosed by renal histology in four (20%) with one each of AL amyloidosis, fibrillary nephropathy, monoclonal immune deposition disease (MIDD) and monoclonal related membranoproliferative glomerulonephritis (MPGN). Low-grade B-cell lymphoma was associated with two cases. The remaining 16 (59.2%) were documented as monoclonal gammopathy of undetermined significance (MGUS) with two had unrelated histology on renal biopsy (FSGS and membranous nephropathy). Kidney biopsy was performed in 7 (25%) cases only.  Remaining 14 cases were listed other aetiologias for renal disease without kidney biopsy.
Conclusion: Kidney biopsy was not done in half of CKD patients with paraproteinemia (MGUS) to ascertain the association of MG with kidney disease. Kidney biopsy may be considered in cases that would be otherwise labelled as MGUS, as potentially disease altering treatments for MGRS are being withheld.


Biography:
Sally Wilkinson is a basic physician trainee at Toowoomba Hospital. She is passionate about research involving chronic kidney disease especially the relation between cancer and CKD. She propose to pursue her advance traineeship in both Nephrology and Onchology

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.

THE SYMPTOM MONITORING WITH FEEDBACK TRIAL (SWIFT): A NOVEL REGISTRY-BASED CLUSTER RANDOMISED CONTROLLED TRIAL AMONG AUSTRALIAN AND NEW ZEALAND ADULTS WITH END-STAGE KIDNEY DISEASE MANAGED ON HAEMODIALYSIS

R MORTON1
1NHMRC Clinical Trials Centre, The Universty of Sydney, Camperdown, Australia, 2Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), Adelaide, Australia, 3School of Medicine, University of Tasmania, Hobart, Australia, 4Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia, 5New Royal Adelaide Hospital, Adelaide, Australia, 6University of Otago Christchurch, Christchurch , New Zealand, 7UK Renal Registry and University of Bristol, Bristol, UK, 8National French ESRD registry REIN, French Agence de la biomedicine, Paris ,  France, 9Metro South and Ipswich Nephrology and Transplant Services, Brisbane, Australia, 10Centre for Kidney Research, Westmead hospital, The University of Sydney, Westmead, Australia, 11Alberta Health Services Kidney Strategic Clinical Network, University of Calgary, Calgary, Canada, 12Western Sydney Renal Service, Westmead,  Australia, 13Australasian Kidney Trials Network, University of Queensland, Brisbane , Australia

Aim: To determine whether regular symptom monitoring with feedback to the renal team can improve health-related quality of life and overall survival among adults with end-stage kidney disease (ESKD) managed with facility-haemodialysis.
Background: Women and men on haemodialysis frequently experience symptoms of severe or overwhelming pain, fatigue, nausea, cramping, itching, trouble sleeping, and depression that contribute to poor quality of life. A focus on laboratory biomarkers of lower relevance to patients, may have resulted in missed opportunities to intervene and reduce symptoms and improve health-related quality of life. Recent trials in other clinical settings have shown that active symptom management can improve overall survival.
Methods: Using a novel ANZDATA registry-based cluster randomised trial design, with adults receiving haemodialysis, the proposed trial will test the hypothesis that: 1) three-monthly symptom monitoring using the IPOS-Renal tool with feedback to clinicians improves health-related quality of life (measured by the EQ-5D), dialysis duration and frequency, and cause-specific mortality compared with usual care; and 2) electronic capture of patient-reported outcomes within a clinical quality registry is cost-effective. A two-arm design of 160 clusters (~3072 individuals) has 90% power to detect a 7% clinically meaningful increase in health-related quality of life (primary endpoint); and 80% power to detect an 11% reduction in deaths from dialysis withdrawal (secondary endpoint).
Results & Conclusions:  The findings from SWIFT may result in improved quality of life, lower symptom burden (both severity and number of symptoms), and lower rates of dialysis withdrawal with the potential to change practice in haemodialysis care. Of significance, SWIFT provides a template for ongoing binational monitoring of patient-reported outcome measures and infrastructure for economic evaluation of subsequent interventions.


Biography:
Associate Professor Rachael Morton, MScMed(Clin Epi)(Hons), PhD, is Director of Health Economics at the NHMRC Clinical Trials Centre, University of Sydney. She is an academic health economist and clinical trialist with research interests in patient reported outcomes and economic evaluation of interventions in chronic kidney disease and cancer. A/Prof Morton leads the ANZDATA PROMs Working Group, and is an Executive Member of the ANZSN Dialysis Advisory Committee. She has over 100 publications and currently holds an NHMRC Translating Research Into Practice (TRIP) Fellowship to embed patient reported outcomes into clinical quality registries.

VALIDITY OF AKI DIAGNOSIS AMONG PATIENTS UNDERGOING PCI: DISCHARGE NOTES VERSUS BILLING CODES

W-Y KUO1, M-Y JIANG1
1Chi Mei Medical Center, Tainan, Taiwan

Aim: The objective of this study was to explore the physicians’ recognition rate of acute kidney injury (AKI) and validity of billing code-identified AKI among patients undergoing percutaneous coronary intervention (PCI).
Background: PCI is associated with higher risk to develop AKI. There had been several studies to examine the occurrence of AKI after PCI, either using creatinine-based method or AKI billing codes to identify patients with AKI. However, AKI was frequently under-recognized and was even more under-reported in administrative database.
Methods: We retrospectively reviewed the medical records of 1,175 patients undergoing PCIs at a tertiary care center. AKI and severe AKI were the reference standards, which were defined as an absolute increase of ≥ 0.3 mg/dL or ≥ 1.5-fold relative increase, and as ≥ 2-fold increase between baseline and post-procedural serum creatinine. We compared discharge diagnosis and billing code-identified AKI against the predefined reference standards of AKI to measure the validity of AKI diagnosis.
Results: The physicians’ recognition rate of AKI among patients who developed AKI and severe AKI after PCI were 30.98% (57/184) and 52.63% (40/76), respectively. The positive predictive value, negative predictive value, and specificity of discharge diagnosis of AKI were 68.76% & 48.19%, 88.37% & 96.70%, and 97.38% & 96.09% in patients with AKI & severe AKI after PCI. Billing code-identified AKI showed a high specificity (98.18% and 97.54%, respectively), intermediate positive predictive value (66.04% and 49.06%, respectively), but low sensitivity (19.02% and 34.21%, respectively) in patients with AKI and severe AKI after PCI.
Conclusions: AKI was under-recognized, even in more severe form of illness. Billing codes of claim data also appear to miss many patients with AKI after PCI.


Biography:
Dr. Ming-Yan Jiang is a nephrologist with 6-year working experience in nephrology division of Chi Mei Medical Center. He obtained the degree of Doctor of Medicine from Kaohsiung Medical University, Taiwan. He achieved the Master Degree in Public Health from College of Medicine, National Cheng Kung University, Tainan, Taiwan. The research interests include acute kidney injury, chronic kidney disease and end stage renal disease.

MEDICAL NUTRITION THERAPY SLOWS DOWN TIME TO DIALYSIS IN PATIENTS ATTENDING A PRE-DIALYSIS CLINIC: AN OBSERVATIONAL COHORT STUDY

S NOTARAS1,2,4, L GALEA1,3,  P LEE1, V BRITOS4, B YIP4, A MAKRIS1,2,3,4
1Dietetics Department, Liverpool Hospital, Liverpool, Australia, 2Western Sydney University, , Australia, 3University of New South Wales, , Australia, 4Renal Department, South Western Sydney Local Health District, , Australia

Aim: Investigate the impact of medical nutrition therapy (MNT) on time to dialysis for patients attending a pre-dialysis service.
Background: MNT is a key component of Chronic Kidney Disease (CKD) treatment. A multidisciplinary approach, including dietetics, has been reported as the most optimal model of care for dialysis preparation, focusing on symptom management and nutrition changes to delay dialysis. Delaying dialysis is a significant motivator for patients to change dietary behaviours. Evidence on the impact of MNT on delaying time to dialysis is limited.
Methods: A retrospective, multi-centre observational cohort study of patients attending pre-dialysis clinics within a metropolitan renal service. Demographic/medical data, MNT received and time to dialysis were collected from electronic medical records and letters. Patients who received MNT were compared to those who did not receive MNT over a 4-year period. Primary endpoint was time to dialysis. Patients excluded: under 18 years, those who received transplant prior to dialysis, commenced dialysis within three months of initial pre-dialysis visit or managed conservatively.
Results: A cohort of 259 patients was identified. Mean eGFR was 17ml/min (95%CI 16.2-17.7) at initial pre-dialysis clinic visit. Diabetic nephropathy was the cause of CKD in 53% of patients, 66% were English-speaking, 62% commenced dialysis. Only 42% of patients received MNT. There were significantly fewer patients needing to commence dialysis in those undergoing MNT compared to no-MNT HR 0.56 (95%CI 0.40-0.78;p=0.001 Cox proportion hazard). The MNT and no-MNT group commenced dialysis on average 960 days (95%CI 863-1058) and 710 days (95%CI 628-792) respectively after dialysis education.
Conclusions: Patients who received MNT had a slower progression to dialysis. Standardised referral pathways are needed to optimise patient access to pre-dialysis dietetic services.


Biography:
Stephanie Notaras is a Senior Renal Dietitian at Liverpool Hospital and an Accredited Practicing Dietitian. She has 9 years of work experience in both acute inpatient and outpatient settings. She has completed a Master of Social Health and Counselling with a research focus on the experiences of patients with chronic kidney disease and eating behaviour change. Stephanie is guest lecturer and OSCE examiner at the University of Wollongong and is also undertaking a PhD in renal nutrition.

OVERCOMING BARRIERS FOR INDIGENOUS AUSTRALIANS GAINING ACCESS TO THE KIDNEY TRANSPLANT LIST

A  ATKINSON1, S FORD1, H GOCK1, F IERINO1, D GOODMAN1
1St Vincent’s Hospital Melbourne, Fitzroy, Australia

Background: While Indigenous Australians represent 11.3% of the dialysis population, less than 10% receive kidney transplants.
Aim: To identify the barriers to Indigenous Australians gaining access to renal transplant waiting list and provide data to guide pre-transplant health services
Methods: Indigenous patients on dialysis (n=12) or previous dialysis (n=13) with kidney transplants (n=7) were studied. Information was derived from medical records and interviews.
Results: Twelve indigenous patients of 303 dialysis patients (3.9%) with a mean age of 59 years (range 39-80), 6 male & 6 females, 6 from Melbourne & 6 country Victoria, were studied. Mean dialysis time of 5.5 years (range 20 months-11.5 years). Co-morbidities include 10 of 12 with diabetes mellitus, ischaemic heart disease (4), ex-IVDU (4), depression (3), schizophrenia (1), BMI >35 (4), foot ulceration (1), bacterial endocarditis (1), and recent colon cancer (1). One patient, a smoker/drug user regularly misses dialysis, 1 had previously been on the active list, 1 patient declined transplant work up. Seven of 265 kidney transplant recipients over the past 10 years (2.6%) waited on average 4.5 years from dialysis commencement to transplantation. Over a period of 6 years, 13 Aboriginal dialysis patients died, cardiac related (3), cerebrovascular disease (1), unknown (2). 6 of 13 were <65 years with only 1 having tissue typing completed.
Conclusions: Medical co-morbidities are the main barrier to transplant listing. Indigenous patients, once listed, had a short waiting time due to accumulated “waiting time”. Our study supports the need for establishing a multi-disciplinary group comprising doctors, nurses, aboriginal liaison officers, social workers and local health providers to help overcome the barriers in a more culturally sensitive manner and potentially improve outcomes.


Biography:
An Indigenous registered nurse from country Victoria, Amy followed in her mothers footsteps of nursing.
Due to a family members health problems, dialysis sparked an interest for Amy who has since gained 4 years dialysis experience.
This research project has provided an opportunity to assist and make a difference in Indigenous health.

ESTABLISHING AN EFFECTIVE, MULTI-DISCIPLINARY, EVIDENCE-BASED COMMUNICATION SKILLS COURSE FOR NEPHROLOGY CLINICIANS IN NEW ZEALAND AND AUSTRALIA; EXPERIENCE AND OUTCOMES.

E STALLWORTHY1,  A O’CALLAGHAN1,2, J ADLER3,4, R THOMAS5, F DOSS1
1Auckland District Health Board, Auckland, New Zealand, 2The University of Auckland, Auckland, New Zealand, 3Capital and Coast District Health Board, Wellington, New Zealand, 4University of Otago, Wellington, New Zealand, 5Tasmanian Health Services South, Hobart, Australia

Aim: To establish a sustainable, evidence-based, multidisciplinary communication skills course for nephrology clinicians in Australasia.
Background: Healthcare professionals’ communication behaviours can be changed with intensive courses using didactic skills teaching and experiential learning. Improved communication has been linked to less intensive care at the end of life, improved patient satisfaction, and reduced clinician burnout.
Methods: The Auckland and Wellington nephrology departments collaborated with expert communication skills facilitators to develop a three-day workshop for staff. Communication challenges specific to nephrology were identified through a clinician survey. During the course, specific skills and evidence-based frameworks were delivered in brief plenary sessions. Simulated patients were used for skills practice during interactive small group sessions which incorporated self-appraisal, constructive feedback and reflection. Course efficacy was evaluated with pre- and post-course questionnaires for courses 1 to 3 and post-course questionnaires for course 4 and 5.
Results: Five courses involving sixty-five healthcare professionals have run in New Zealand and Australia since 2015. Twenty nephrologists, eight trainee nephrologists, thirty-three nurses, two dialysis physiologists and two social workers have participated. For courses 1 to 3 there was improvement in self assessed ability to discuss prognosis, conflict, end-of-life and to respond to emotion. Post course surveys from courses 4 and 5 are concordant.
Conclusions: To our knowledge this is the first multi-professional communication skills training for nephrology clinicians. There is demand from nephrology healthcare professionals in Australia and New Zealand for effective training in evidence-based communication strategies. Participant feedback indicates that this course successfully met this need.


Biography:
Dr Elizabeth Stallworthy is a renal physician with an interest in renal supportive care working in Auckland, New Zealand. Dr Stallworthy has a clinical diploma in palliative medicine from the Royal Australasian College of Physicians (RACP). She authored the advance care planning section of the 2013 ANZSN renal supportive care guidelines. Dr Stallworthy has been teaching communication skills to post-graduate health care professionals since 2013, initially with the New Zealand Advance Care Planning Cooperative and more recently as part of the project described in this abstract and for the RACP.

SHOULD WE BE MEASURING “WELLBEING” IN OLDER PEOPLE WITH END-STAGE KIDNEY DISEASE, RATHER THAN HEALTH-RELATED QUALITY OF LIFE? A PROSPECTIVE CROSS-SECTIONAL STUDY IN THE UK AND AUSTRALIA

K SHAH1, F MURTAGH2, K MCGEECHAN3,  S CRAIL4,  A BURNS5,  A TRAN1,  R MORTON1
1NHMRC Clinical Trials Centre, University Of Sydney, Camperdown, Australia, 2Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, , United Kingdom, 3School of Public Health, University of Sydney, Camperdown, Australia, 4Royal Adelaide Hospital, Adelaide, Australia, 5Royal Free Hospital, London NHS Foundation Trust, , United Kingdom

Aim: To measure and compare ‘wellbeing’ and health-related quality of life (HRQOL) among people over 75-years treated with either comprehensive conservative care or dialysis.
Background: A broader notion of wellbeing related to an individual’s capability to do the things that are important to them (based on Sen’s capability theory), rather than solely HRQOL, is proposed as a more meaningful measure to value healthcare. The capability index, ICECAP-O, measures five domains: attachment, role, enjoyment, security, and control.
Methods: A prospective cross-sectional study among people over 75-years with end-stage kidney disease treated with conservative care or dialysis was undertaken in three renal units in the UK and Australia (2014-2016). Wellbeing was scored on a 0-1 scale (0=no capability, 1=full capability) using UK population values and presented as mean values with standard deviation (SD). Student t-tests assessed difference in means between groups; and Pearson’s correlation coefficient assessed convergence validity between capability and HRQOL using the Short-Form 6D (SF-6D).
Results: Of 129 patients, mean age 82 years [IQR 78-85], 65% males, 46(36%) were managed with conservative care and 83(64%) managed with dialysis. The mean capability index for the whole cohort was 0.72 [SD 0.19]; significantly higher in those with private versus public health insurance (0.79 [SD 0.15]; 0.71 [SD 0.19]; p=0.03); and similar in those managed with conservative care compared with dialysis (0.76 [SD 0.20]; 0.71 [SD 0.18]; p=0.14). The dialysis group reported lower capability in four of five domains:  role, enjoyment, security and control. Convergence validity between the two instruments was moderate (Pearson’s coefficient 0.56, p<0.0001).
Conclusions: Wellbeing measured using a capability index provides additional insights into the impact of dialysis on older people, than HRQOL measurement alone.


Biography:
Karan Shah is a Health Economist at NHMRC Clinical Trials Centre, University of Sydney. Prior to his full-time role as a Health Economist, he pursued Masters of Science in Health Economics at Heidelberg University in Germany. He has research interest in methodological development in estimating quality of life, within trial health economic models, quantitative research methods: systematic reviews, meta-analysis, statistical analysis, assessment of test evaluation and monitoring.

CHARACTERISTICS, MORTALITY AND RENAL OUTCOMES OF PACIFIC ISLANDER & MAORI PATIENTS WITH DIABETES AND CKD WHO RECEIVE SPECIALIST NEPHROLOGY CARE

K-S TAN1,2,3,  S MCDONALD4,5, W 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: Define baseline characteristics, all-cause mortality and renal outcomes of all Pacific Islander/Maori (PI/M) patients with DM and CKD enrolled in the CKD.QLD registry.
Aims: Define baseline characteristics, all-cause mortality and renal outcomes of all Pacific Islander/Maori (PI/M) patients with DM and CKD enrolled in the CKD.QLD registry.
Methods: Diabetic PI/M patients enrolled in the registry between 01/01/2011 and 31/12/2016 were included. Baseline characteristics, incidence of ESKD (eGFR <10ml/min for >3 months or commencement of RRT) or death without ESKD were determined. Censor date was 31/12/2017.
Results: 100 patients (47% women) comprising 4% of all registry patients with DM identified as PI/M .  Mean follow up was 2.87 years. Mean age at enrolment was 60.6y (SD 11.5), significantly younger than non-ATSI, non-PI/M counterparts with DM (mean age 67, p<0.001). 61% of patients were incident (enrolled within 6 months of 1st appointment). 99% had DM2 (56% receiving insulin).  Median eGFR at enrolment was 38ml/min (IQR 25-53). 60% had enrolment eGFR <45ml/min. 57% had ACR >30mg/mmol at enrolment.  At censor date, 30 patients had developed ESKF (5 on supportive care, 25 commenced dialysis) whilst 14 had died without ESKF. ESKF rate was 27.5 and death rate 16.4 per 100 patient years follow-up. 100% of ESKF patients had ACR >30mg/mmol at enrolment although enrolment ACR category was not associated with development of ESKF in a multivariate regression model.
Conclusions: As befits a group receiving specialist renal care, patients had both significantly reduced eGFR and significant albuminuria at enrolment. The event rate was high.


Biography:
Nephrologist and Clinical Pharmacologist.

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