T SCOTT1,2, I EITHER1,3, D JOHNSON1,2,4, C HAWLEY1,2,4, Y CHO1,2,4
1Princess Alexandra Hospital, Brisbane, Australia, 2School of Medicine, University of Queensland, Brisbane, Australia, 3Centre Hospitalier de l’Université de Montréal, Montreal, Canada, 4Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
Background: Cardiovascular disease is a leading cause of mortality in kidney failure (KF). Patients with KF from atheroembolic disease are at higher risk of cardiovascular disease than other aetiologies due to their predisposing vascular disease. This study aimed to determine survival on dialysis for patients with KF from atheroembolic disease.
Methods: All adult patients with KF between January 1, 1990 and December 31, 2017 according to the ANZDATA registry were included. Patients were grouped into: KF from atheroembolic disease and all other causes of KF. Survival outcomes were assessed by the Kaplan-Meier and Cox regression analysis adjusted for patient characteristics.
Results: Among 65, 266 patients with KF receiving dialysis during the study period, there were 334 patients with KF from atheroembolic disease. Patients with KF from atheroembolic disease were older, more likely to be male, Caucasian and to have comorbidities of coronary artery disease, peripheral vascular disease, cerebrovascular disease and chronic lung disease. A temporal trend suggestive of practice change was noted with decreasing annual incidence of KF from atheroembolic disease observed since 2008. Those with KF from atheroembolic disease demonstrated worse survival on dialysis compared to patients with other aetiologies (HR 1.80 95% CI 1.61-2.03). The respective one and five-year survival were 77% and 23% for KF from atheroembolic disease and 88% and 47% for other causes of KF. However, after adjustment for patient characteristics, KF from atheroembolic disease was not associated with increased mortality (adjusted HR 0.93 95% CI 0.82-1.05).
Conclusions: Survival outcomes on dialysis are worse for individuals with KF from atheroembolic disease in comparison to those with other causes of KF, probably due to the patients’ demographics and higher co-morbid status.
Tahira Scott is a nephrology advance trainee from the Princess Alexandra hospital. With interests in Aboriginal and Torres Strait islanders health and home therapies.