ALLOCATION OF LOW-RISK KIDNEYS: CAN WE OPTIMISE UTILISATION?

P CLAYTON1,2,3, M SYPEK1,4, A GULYANI1,3, J KANELLIS5, S MCDONALD1,2,3
1Australia and New Zealand Dialysis And Transplant (ANZDATA) Registry, Adelaide, Australia, 2Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia, 3University of Adelaide, Adelaide, Australia, 4University of Melbourne, Melbourne, Australia, 5Renal Unit, Monash Medical Centre, Clayton, Australia

Aim: To simulate restricting the allocation of low-risk kidneys to recipients with favourable prognoses.
Background: The Australian deceased donor kidney allocation system does not attempt to match the prognosis of kidneys and recipients, leading in some instances to low-risk kidneys (with a high projected graft survival) being allocated to high-risk recipients (with a limited life expectancy).
Methods: We constructed an event-based simulation model by adapting the US Kidney-Pancreas Simulated Allocation Model software to the Australian context. We simulated the current allocation system over 2010-2014 (5,362 patients, 2,833 kidneys), and two alternative models: (1) low-risk kidneys (lowest 20% kidney donor risk index) restricted to non-high-risk recipients (lowest 80% estimated post-transplant survival score [EPTS]), (2) low-risk kidneys restricted to low-risk recipients (lowest 20% EPTS). In each alternative model national sharing for immunological advantage was preserved, and simulations used either the Australian EPTS (incorporating age, waiting time and prior transplantation) or the original US EPTS (additionally incorporating diabetes). Outcomes were the distribution of low-risk kidneys and overall projected life-years.
Results: The characteristics of low-risk kidney recipients were similar when comparing model 1 and the current allocation system, with the exception of less waiting time. In model 2, these kidneys were allocated to younger patients with less waiting time and fewer comorbidities. Overall projected life-years were 86,735 in the current system; 86,842 in model 1 and 87,411 in model 2 using the Australian EPTS; and 87,078 in model 1 and 87,732 in model 2 using the US EPTS.
Conclusions: Avoiding allocating low-risk kidneys to high-risk recipients made only a negligible difference; restricting their allocation to low-risk recipients made more difference to organ distribution but overall life-years gained remained modest.


Biography:
Dr Clayton is a nephrologist at the Royal Adelaide Hospital and serves on the executive of the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry.

 

MACHINE LEARNING PREDICTION FOR DE NOVO DONOR SPECIFIC ANTIBODIES (dnDSA), AMR AND GRAFT LOSS IN SIMULTANEOUS KIDNEY PANCREAS (SPK) TRANSPLANT RECIPIENTS

A SHARMA1,2, C COOREY1,2, A TAVERNITI1, B NANKIVELL3, J CHAPMAN3, J CRAIG1,2, P O’CONNELL3, H PLEASS3, W LIM4, J YANG5,6, G WONG1,2,3
1Centre for Kidney Research, Westmead, Australia, 2School of Public Health, University of Sydney, Sydney, Australia, 3Centre for Transplant and Renal Research, Westmead, Australia, 4Department of Renal Medicine, Perth, Australia, 5School of Mathematics and Statistics, University of Sydney, Sydney, Australia, 6Charles Perkins Centre, Sydney, Australia

Aim: To develop a prediction model for dnDSA and allograft loss based on the number and location of eplet mismatches in SPK transplant recipients.
Methods: 170 SPK transplant recipients (2005-2017) were assessed using data from ANZDATA registry and NOMS. Adjusted logistic regression were conducted to determine associations between class specific eplet HLA mismatches, dnDSA production, AMR and graft loss. Machine learning models (random forests) were used to predict dnDSA, AMR and allograft loss based on location of eplet mismatches.
Results: The cohort included 92 (54%) males with mean age 38.5 years (SD 6.9) and median follow up time 6.6 years (IQR: 3.9-11.0). The most common class I and II eplet mismatches were at 156RA (35%) and 70D (55%), respectively, with 33 (19%) and 52 (31%) recipients developing Class I and II dnDSA. An increased risk of dnDSA production was observed per 10 increase in Class I (adjusted odds ratio (aOR) 2.0, 95%CI 1.2-3.3, P=0.01), and Class II eplet mismatches (aOR 1.3, 95%CI 1.1-1.5, P=0.01). The presence of Class II dnDSA was associated with increased risk of AMR (aOR 3.9, 95%CI 1.6-9.5, P<0.01). The top eplet mismatches associated with class II dnDA production were located at 45EV and 46VY, corresponding to HLA DQB1*03:01 and DQB1*02:01. Random forest model with the location of the top 10 class specific eplet mismatches achieved a mean cross-validation accuracy of 63.9% and 61.2% for class I and II dnDSA production.
Conclusions: The number of eplet mismatches was associated with dnDSA production at class I and II, and the location of eplet mismatches at 45EV and 46VY on HLA DQB1*03:01 and DQB1*02:01 may predict Class II dnDSA after SPK transplant.


Biography:
Nephrologist and PhD candidate (University of Sydney)

COMPARATIVE COST EVALUATION OF DIALYSIS SERVICE MODELS IN REMOTE AND REGIONAL AUSTRALIA: DXMOC STUDY

G GORHAM1, K HOWARD2, Y ZHAO3, A AHMED1, P LAWTON1, C SAJIV3, S MAJONI3, P WOOD3, S  SIGNAL3, T CONLON3, S ROBINSON3, S BROWN4, A CASS1
1Menzies School Of Health Research, Casuarina, Australia, 2Sydney School of Public Health, University of Sydney, Sydney, Australia, 3NT Department of Health, Darwin, Australia, 4Western Desert Nganampa Walytja Palyantjaku Tjutaku , Alice Springs, Australia

Background: Maintenance dialysis is costly and resource intense. Inadequate health infrastructure and access to technically skilled staff can limit service provision in remote areas. Most dialysis cost studies are based on urban satellite dialysis service provision and few studies include broader costs often borne by patients. In the NT these costs are carried by the government.
Aims:
1. To identify the challenges in providing reliable costs estimates of different dialysis models of care (DxMoC) and
2. To calculate the service costs for DxMoC in regional and remote Australia for comparative analysis with the National Efficient Price (NEP) and previous cost studies.
Methods: Financial data for all renal services in the NT was sourced from funders for the period 2008-2014. Data was analysed by cost category and miscoded data was reallocated to appropriate cost centres. Missing and centralised costs were standardised using $2017 actual unit costs. For comparison across models of care and with the NEP, all costs were inflated to 2016-7 dollars using the AIHW Total Health Price Index (HPI). Adjustments, in accordance with NEP methodology, were made for remoteness and Indigenous status.
Results: DxMoC1 ($457-$529) and 2 ($437-$516), (urban and regional) were less than the NEP cost per treatment ($586-$638) while DxMoC3 and 4 ($710-$718) (remote and very remote nurse-supported) were higher than the NEP ($664). Self-care therapies were more costly than in other jurisdictions due to training length (differing language, culture and reduced health literacy) and costs not traditionally borne by governments (electricity, leasing and travel).
Conclusion: Remote dialysis services incur higher salary and fixed costs and NEP adjustments are insufficient to meet the actual costs of delivering services to remote-living Indigenous Australians.


Biography:
Gillian has 20 years experience as a senior renal manager in the Northern Territory and was involved in the design and establishment of many of the dialysis service models. She has worked with local, state and national bodies in the development of renal strategic documents. Gillian is currently the Renal Research Program Manager at Menzies School of Health Research and oversees a number of projects evaluating models of service delivery. She is currently a PhD candidate.

 

ASSOCIATION OF FRUIT AND VEGETABLE INTAKE WITH ALL-CAUSE MORTALITY IN HEMODIALYSIS PATIENTS (DIET-HD): A PROSPECTIVE COHORT STUDY

V SAGLIMBENE1,2, G WONG1, M RUOSPO2, S PALMER3, P NATALE2,6, V GARCIA-LARSEN4, K CAMPBELL5, A TEIXEIRA-PINTO1, J-J CARRERO7, P STENVINKEL7, L GARGANO2, A MURGO2, D JOHNSON8, M TONELLI9, R GELFMAN2, E CELIA2, T ECDER2, A  BERNAT2, D CASTILLO2, D TIMOFTE2, M TÖRÖK2, A BEDNAREK-SKUBLEWSKA2, J DUŁAWA2, P STROUMZA2, S HOISCHEN2, M HANSIS2, E FABRICIUS2, P FELACO10, C WOLLHEIM2, J HEGBRANT2, J CRAIG1,11, G STRIPPOLI1,2,6
1University Of Sydney, Sydney, Australia, 2Diaverum Medical-Scientific Office, Lund, Sweden, 3University of Otago Christchurch, Christchurch, New Zealand, 4Johns Hopkins Bloomberg School of Public Health, Baltimore, US, 5Princess Alexandra Hospital, Woolloongabba, Australia, 6University of Bari, Bari, Italy, 7Karolinska Institutet, Stockholm, Sweden, 8University of Queensland at the Princess Alexandra Hospital, Woolloongabba, Australia, 9University of Calgary, Calgary, Canada, 10Presidio Ospedalierio Penne, Pescara, Italty, 11Flinders University, Adelaide,  Australia

Aim: To evaluate the association of fruits and vegetables intake with mortality in adults on haemodialysis.
Background: Higher fruits and vegetables intake is associated with lower cardiovascular and all-cause mortality in the general population. It is unclear whether this association occurs in haemodialysis patients, in whom high fruits and vegetables intake is generally discouraged due to a potential risk of hyperkalaemia.
Methods: Fruits and vegetables intake was ascertained by the GA2LEN food frequency questionnaire within the DIET-HD study, a multinational cohort study of 9757 adults on haemodialysis. Adjusted Cox regression analyses clustered by country were conducted to evaluate the association between tertiles of fruits and vegetables intake with all-cause, cardiovascular, and non-cardiovascular mortality. Estimates were calculated as hazard ratio (HR) with 95% confidence interval (CI).
Results: During a median follow up of 2.7 years (18,586 person-years), there were 2082 deaths (954 cardiovascular). The median (interquartile range) number of servings of fruits and vegetables was 8 (4-14) per week; only 4% of the study population consumed at least 4 servings/ day as recommended in the general population. Compared with the lowest tertile of servings/ week (0 to 5.5, median 2), the adjusted HR (95% CI) for the middle (5.6 to 10, median 8) and highest (>10, median 17) tertiles were 0.90 (0.81-1.00) and 0.80 (0.71-0.91) for all-cause mortality; 0.88 (0.76-1.02) and 0.77 (0.66-0.91) for non-cardiovascular mortality; and 0.95 (0.81-1.11) and 0.84 (0.70-1.00) for cardiovascular mortality.
Conclusions: Fruits and vegetables intake in the haemodialysis population is substantially lower than recommended in the general population; an higher consumption (approximately 17 servings per week, 2 to 3 per day) is associated with lower risk of all-cause and non-cardiovascular mortality.


Biography:
Valeria Saglimbene has a Bachelor of Pharmaceutical Chemistry (Honours) from the University of Palermo (Italy) and a Master of Clinical Epidemiology at the University of Sydney. In 2008 she joined the Mario Negri Sud Consorzium (Italy) as Research Assistant at the Department of Pharmacology and Epidemiology, working on RCTs, cohort studies and systematic reviews in CKD. In 2016 she started a PhD at the University of Sydney focused on understanding novel determinants of health outcomes in CKD. As part of her PhD, she conducted a cohort study of 10,000 haemodialysis patients to investigate the association between nutrition and mortality

 

LONGITUDINAL CHANGES IN BODY MASS INDEX AND THE COMPETING OUTCOMES OF DEATH AND TRANSPLANT IN PATIENTS UNDERGOING HEMODIALYSIS: A LATENT CLASS JOINT MODELLING APPROACH

S BRILLEMAN2, M MORENO-BETANCUR1,4, K POLKINGHORNE1,2, S  MCDONALD3, M CROWTHER5, J THOMSON6, R WOLFE2
1Department of Nephrology, Monash Medical Centre, Melbourne, Australia, 2Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, 3ANZDATA Registry, SA Health and Medical Research Institute, Adelaide, Australia, 4Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Melbourne, Australia, 5Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK, 6Arthur Rylah Institute for Environmental Research, Department of Environment, Land, Water and Planning, Melbourne, Australia

Aim: To characterise hemodialysis patients by BMI trajectories over the course of treatment and their association with the rates of transplant and death without transplant.
Background: The relationship between body mass index (BMI) and patient survival in end-stage kidney disease in not well understood and has been the subject of much debate over recent years.
Methods: This study used a latent class joint modelling approach to identify latent groups that underpinned associations between patterns of change in BMI during hemodialysis and two competing events: transplant and death without transplant. We included all adult patients who initiated chronic hemodialysis treatment in Australia or New Zealand between 2005 and 2014.
Results: There were 16,414 patients included in the analyses; 2427 (14%) received a transplant, 6142 (35%) died prior to transplant, and 9122 (52%) were administratively censored. Our final model characterised patients based on five broad patterns of weight change (BMI trajectories): a “late BMI decline” (about two years after commencing hemodialysis); a “rapid BMI decline” (immediately after commencing hemodialysis); a “stable and normal or overweight BMI”; a “stable and morbidly obese BMI”; or an “increasing BMI”. Mortality rates were highest amongst classes with declining BMI, and the timing of weight loss coincided with the timing of increases in mortality. The two stable BMI classes had relatively similar mortality rates, regardless of starting BMI (normal/overweight, or morbidly obese).
Conclusions: Our results suggest that obesity is not necessarily protective in hemodialysis, but that the BMI trajectory is important, independent of BMI at dialysis initiation. Future research should be aimed at understanding the causes of weight changes during dialysis, to determine whether there could be strategies to improve patient survival.


Biography:
Nephrologist and Clinical Researcher Monash Medical Centre.

 

AUSTRALIAN ESKD HOT SPOTS

S MCDONALD1,2,3, S JESUDASON1,2,3
1Anzdata Registry, SAHMRI, Adelaide, Australia, 2Renal Unit, Royal Adelaide Hospital, Adelaide, Australia, 3University of Adelaide, Adelaide, Australia

Aim: Describe and plot geographical variation in ESKD incidence
Background: ESKD incidence in Australia has been well described in relation to clinical characteristics, but not geographic characteristics and spatial relationships.
Methods: Data from ABS and ANZDATA Registry data incident ESKD patients from 2012-16 were analysed to determine rates of new treated ESKD (dialysis and transplantation) in a geospatial framework. On the basis of residential postcodes, incidence rates overall and for various pre-defined sub-groups were determined for each statistical area level 3 (SA3 – typically 30-100,000 population). Detailed “heat maps” of ESKD incidence for Australia were created.
Results: Overall incidence was 116 per million per year (pmpy). The highest rates were noted in the Barkly region, NT (1058 [95% CI 732-1479] pmpy) ;  Alice Springs (973 [842-1118] pmpy)  and Katherine( 620 [479-791] pmpy). These “hot-spots” were associated with high proportions of Aboriginal and Torres Strait Islander population. Analyses restricted to non-indigenous populations revealed the areas of highest incidence were Biloela (Qld; 408 [95% CI 273-586] pmpy) followed by East Pilbara, Colac, Noosa and Goulbourn-Mulwaree. The highest absolute rates overall and for both indigenous and non-indigenous rates were in non-urban areas.
Conclusions: Linking of Registry information with geospatial data offers useful insights into disease patterns and service demands. Heat maps provide a powerful visual way of showing this data, and linking to other non-medical factors including community characteristics. In addition to SA3 areas, other potentially useful area for analysis include local government areas, “greater metropolitan” areas and hospital/health service catchment areas.


Biography:
Prof Stephen McDonald is Director of Dialysis at the Central Northern Adelaide Renal and Transplantation Service, Clinical Director of Renal Services for Country Health SA and Executive Officer of the Australia and New Zealand Dialysis and Transplant Registry. He also is a Clinical Professor in the Adelaide Medical School, and Principal Research Fellow in the SA Health and Medical Research institute (SAHMRI).

ASSOCIATION BETWEEN DURATION OF DELAYED GRAFT FUNCTION AND ALLOGRAFT OUTCOME AFTER KIDNEY TRANSPLANTATION

WH LIM1, D JOHNSON2, G WONG3

1Sir Charles Gairdner Hospital, Perth; 2Princess Alexandra Hospital, Queensland; 3Westmead Hospital, New South Wales 

Aim: To examine the association between duration of delayed graft function (DGF) and long-term graft outcome.

Background: Although a short duration of DGF may have no impact on graft outcome, the threshold of DGF associated with an adverse effect on out- come remains poorly defined.

Methods: In Australian and New Zealand, primary deceased donor kidney transplant recipients between 1994-2014 who had experienced DGF requiring dialysis were included. The associations between DGF duration and death censored graft loss (DCGL) and acute rejection at 6 months were examined using adjusted Cox regression analysis.

Results: Of 1718 kidney transplant recipients followed for a median of 5.4 years, 618 (36.0%) required between 3-7 days of dialysis post-transplant (referent), compared to 200 (11.6%), 459 (26.7%) and 441 (25.7%) who had required 1-2 days, 8-14 days and >14 days of dialysis, respectively. DGF duration of 8-14 and >14 days were associated with adjusted hazard ratios (HR) for acute rejection of 1.30 (95%CI 1.01, 1.67) and 1.93 (95%CI 1.52, 2.45), respectively. Compared to DGF duration of 3-7 days, DGF duration of >14 days was associated with adjusted HR for DCGL between 0-1 year of 3.00 (95%CI 1.59, 5.68), 2.14 (95%CI 1.35, 3.41) between 1-5 years, and 0.75 (95%CI 0.42, 1.31) between 5-10 years, independent of rejection. There was no association between DGF of 1-2 or 8-14 days and DCGL.

Conclusions: DGF of more than 14 days strongly increases the risk of DCGL independent of rejection. However, this association was time-dependent, with the excess risk of DCGL confined to within the first 5 years post-transplant. Future research evaluating interventions that aim to reduce DGF duration in susceptible kidney transplant recipients is urgently required.

THE IMPACT OF CHRONIC KIDNEY DISEASE (CKD) ON THE QUALITY OF LIFE OF CHILDREN AND ADOLESCENTS

A FRANCIS1,2,3, M DIDSBURY1,2, A VAN ZWIETEN1,2, K CHEN1,2, L JAMES1,2, S KIM1,2, K HOWARD, G WILLIAMS1,2, S MCTAGGART3, A WALKER4, F MACKIE5, T KARA6, N NASSAR2, A TEIXEIRA-PINTO1,2, A TONG1,2, DW JOHNSON7, JC CRAIG1,2, G WONG1,2,8

1Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales; 2Sydney School of Public Health, The University of Sydney, New South Wales; 3Child and Adolescent Renal Service, Children’s Health Queensland, Queensland; 4Department of Renal Medicine, The Royal Children’s Hospital, Melbourne, Victoria; 5Department of Nephrology, Sydney Children’s Hospital at Randwick, Sydney, New South Wales; 6Department of Nephrology, Starship Children’s Hospital, Auckland, New Zealand; 7Department of Nephrology, Princess Alexandra Hospital, Brisbane; 8Centre for Transplant and Renal Research, Westmead Hospital, Sydney, New South Wales

Aim: To compare overall and domain-specific health-related quality of life (HR-QOL) of children and adolescents with different stages of CKD and to determine factors associated with lower HR-QOL scores.

Background: Children with CKD suffer from reduced quality of life. The extent of impairment and risk factors for poorer HR-QOL are under-studied.

Methods: HR-QOL data were collected from children and adolescents (age 6-18 years) across five paediatric units in Australia and New Zealand. The Health Utilities Index 3 survey was used to measure overall and sub-domain HR-QOL (range from -0.36 [worse than dead] to 1 [perfect health]). HR-QOL scores were compared between CKD stages using the Mann-Whitney-U test. Multivariable linear regression assessed factors associated with decline in HR-QOL.

Results: There were 377 children with CKD (median age 12.6 years). The median unadjusted HR-QOL score for those with CKD stages 1-4 was 0.88 (interquartile range [IQR] 0.61-0.97), higher than those on dialysis (0.67, IQR 0.39-0.91, p<0.001), but not different from those with kidney transplants (0.83, IQR 0.59-0.97, p=0.4). Compared to patients with earlier stage CKD, dialysis patients experienced significant decrements in median pain (0.23, p<0.001), emotion (0.09, p<0.001) and cognition (0.11, p=0.04) scores. On multivariable analysis, factors associated with decrements in HR-QOL were being on dialysis (compared to CKD stages 1-4: reduction by 0.13, 95%CI 0.02-0.24, p=0.02) and lowest quartile family income (compared to highest income quartile: reduction by 0.10, 95%CI 0.01-0.20, p=0.04), when adjusted for age (p=0.3) and gender (p=0.2).

Conclusions: The overall and specific domains of HR-QOL such as pain, emotion and cognition are substantially worse in children on dialysis compared to earlier stage CKD and those with kidney transplants.

EFFECTS OF FISH OIL SUPPLEMENTATION AND ASPIRIN USE ON ARTERIOVENOUS FISTULA PATENCY, NEED FOR INTERVENTIONS AND DIALYSIS SUITABILITY IN PATIENTS REQUIRING HAEMODIALYSIS – POST HOC ANALYSIS OF THE FAVOURED STUDY

AK VIECELLI1, EM PASCOE1, CM HAWLEY1, KR POLKINGHORNE2,TA MORI3, DW JOHNSON1, AB IRISH3, FOR THE OMEGA-3 FATTY ACIDS(FISH OILS) AND ASPIRIN IN VASCULAR ACCESS OUTCOMES IN RENAL DISEASE (FAVOURED) STUDY COLLABORATIVE GROUP

1School of Medicine, University of Queensland, Brisbane, Queensland; 2School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria; 3School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia

Aim: To determine whether fish oil or aspirin reduce primary patency loss, the need for interventions and dialysis suitability failure of de-novo arteriovenous fistulae (AVF) as secondary and exploratory outcomes of the FAVOURED trial.

Background: Vascular access dysfunction contributes to the high morbidity and mortality of patients requiring haemodialysis. Treatments that improve the usability of AVF are lacking.

Methods: Adult patients with stage 4 or 5 chronic kidney disease currently receiving, or planned within 12 months to receive haemodialysis were randomly allocated to receive fish oil (4g/d) or matching placebo. A subset of 406 participants was randomized to receive aspirin (100mg/d) or matching placebo. Treatment started 1 day prior to surgery and continued for 12 weeks. The outcomes were primary patency loss within 12 months of access creation, need for interventions to assist maturation or maintain patency within 12 months, and late dialysis suitability failure (by 6 months post-surgery).

Results: The mean age of the 567 randomized participants was 55 years, 64% were male and 47% diabetic. Compared with placebo, fish oil had no significant effect on primary patency loss (81/266 [31%] vs 70/270 [26%], relative risk [RR] 0.85, 95% confidence interval [CI] 0.65-1.12), need for access interventions (52/266 [20%] vs 46/270 [17%], RR 0.87, 95% CI 0.611.25) or late dialysis suitability failure for participants on dialysis by 6 months (60/175 [34%] vs 65/181 [36%], RR 1.05, 95% CI 0.79-1.39). The risks of patency loss, interventions and dialysis suitability failure were similar between the aspirin and placebo arms.

Conclusions: Neither fish oil nor low-dose aspirin use reduced primary patency loss or the need for interventions within 12 months of surgery, or late dialysis suitability failure.

ADVERSE PREGNANCY OUTCOMES IN WOMEN WITH KIDNEY DISORDERS – A POPULATION STUDY OF >400,000 PREGNANCIES IN SOUTH AUSTRALIA (SA): 1990–2012

A FITZPATRICK1, B CATCHESIDE2, A NGUYEN2, K VENUGOPAL2, W SCHEIL2,3, SP MCDONALD3,4, S JESUDASON3,4,

1Royal Adelaide Hospital, Adelaide, South Australia; 2SA Pregnancy Outcomes Unit, SA Health, Adelaide, South Australia; 3School of Medicine, University of Adelaide, Adelaide, South Australia; 4Central and Northern Adelaide Renal and Transplantation Services (CNARTS), Adelaide, South Australia

Aim: To describe maternal and perinatal outcomes at a population level for South Australian women with renal disorders.

Background: Renal disease in pregnancy promotes adverse maternal and perinatal outcomes. Population-level data, notably in the Australian context, remain lacking.

Methods: SA Pregnancy Outcomes Unit data for singleton births (19902012) were analysed. Using maternal ICD-9 codes collected at delivery, renal conditions were broadly grouped as vesicoureteral reflux (VUR),  pyelonephritis, immunological, cystic/genetic, and urological conditions. Multivariable and multinomial logistic regression was utilized with covariates selected a priori, including age, ethnicity, socioeconomic status and diabetes.

Results: Of 407,580 women, 0.3% had a renal code ascribed. These women were more likely to be aged <25 years, Indigenous and of lower socioeconomic position. Any renal code in pregnancy was associated with adverse outcome, including hypertensive disorders (OR 2.15, 95%CI 1.82-2.56), induction of labour (RRR 2.10, 95%CI 1.06-1.19), caesarean section (OR 1.31, 95%CI 1.17-1.47), preterm birth <37 weeks (OR 2.76, 95%CI 2.40-3.18), low birth weight <2500g (OR 2.43 95%CI 2.07-2.84) and neonatal ICU admission (OR 2.64 95%CI 2.12-3.29). The greatest risk of adverse outcomes occurred in women with VUR and immunological renal conditions. VUR in particular conferred highest risk of hypertensive disorders (OR 8.57, 95%CI 4.29-17.12) and caesarean section (OR 4.18 95% CI 2.158.12) as well as preterm birth (OR 5.26, 95%CI 2.56-10.22). Immunological renal conditions were associated with increased odds of hypertensive disorders (5.03, 95%CI 2.64-9.60), preterm birth (OR 7.40, 95%CI 4.22-13.00) and low birth weight (OR 6.80 95%CI 3.79, 12.20).

Conclusions: The presence of any renal code was associated with adverse maternal and perinatal outcome, with the greatest risk experienced by women with VUR and immunological renal conditions.

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