K TAN1,2,3, S MCDONALD4,5,6, J ZHANG1,2, Z WANG1,2, 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, 4Faculty of medicine, Adelaide University, Adelaide, Australia, 5ANZDATA, Adelaide, Australia, 6Renal unit, CNAHS, Adelaide, Australia
Background: The combination of diabetes mellitus (DM) and chronic kidney disease (CKD) leads to significant cardiovascular morbidity. However, it is unclear if this remains true of patients who receive specialist kidney care but are not on kidney replacement therapy (KRT).
Aims: Define the morbidity of patients with DM enrolled in the CKD.QLD registry by examining hospital admission data.
Methods: Patients were those with DM enrolled in the registry, with none on KRT at enrolment. The observation period was 23/3/2011 – 30/6/2016 inclusive. Follow-up was censored at death, kidney failure and relocation interstate/overseas. Primary discharge diagnoses from Queensland Hospital Admission patient data collection were analysed using both Major Diagnostic Category (MDC) description and individual ICD-10(version 2016) disease codes.
Results: 2,355 patients underwent a total of 10,869 patient-years follow-up (pyfu). At censor date, there were 17,415 admission episodes totalling 77,208 bed days.
The top 3 causes of hospital admission using MDC coding were “disorders of the circulatory system” (n = 3,193, 18.3%), “disorders of kidney and urinary tract” (n = 2,603, 14.9%) and “digestive system disorders” (n = 1,497, 8.6%). Using ICD-10 disease codes, the top 3 categories of hospital admission were “cardiovascular disease” (n = 3539, 20.3%) with CCF the commonest diagnosis, “infection” (n = 2123, 12.1%) and “renal disease” excluding chronic RRT, urological problems, infections and neoplasia (n = 1586, 9.1%).
The “cardiovascular disease” admission rate was approximately 46 per 1000pyfu.
Conclusions: Despite improvements in cardiovascular risk management and regardless of method of definition, cardiovascular disease remains the principal cause of hospital admission in patients with DM and CKD receiving specialist renal care, in keeping with previous literature from the general CKD population.
Nephrologist, Logan hospital and Metro South Nephrology and Transplant service.
Senior Lecturer and PhD candidate, University of Queensland.