J ZHANG1,2, V DIWAN1,2, Z WANG1,2, S VENUTHURUPALLI2,3, H HEALY2,4, W HOY1,2
1University of Queensland, Brisbane, Australia, 2NHMRC CKD.CRE and CKD.QLD, Brisbane, Australia, 3Kidney Health Service, Toowoomba Hospital, Toowoomba, Australia, 4Kidney Health Service, Royal Brisbane and Women’s Hospital, Brisbane, Australia
Aim: To explore mortality, cardiovascular event (CVE) rates and costs in patients with chronic kidney disease (CKD) with and without anaemia.
Anaemia, a common complication of CKD, is associated with excess premature deaths and CVEs.
Methods: Adults with CKD from two sites of the CKD.QLD Registry (for pre-dialysis CKD patients in the Queensland public health system) – Toowoomba (TWMBA, n=1,054) and MetroNorth (MN, n=1,643), were characterised at consent and followed until start of renal replacement therapy (RRT), death or censor date (June 2018). Mean follow-up was 3.4 and 4.0 yrs respectively.
Results: At consent (TWMBA/MN), 43.2% and 47.4% patients were anaemic (WHO and KDIGO criteria). More males than females were anaemic (47% vs 39%/51% vs 43% etc). Anaemic patients were older (67 vs 61yr/70 vs 62 yr) and had more advanced CKD. Patients with diabetic nephropathy had the highest prevalence of anaemia (56.5%/58.8%). Over the follow-up period, adjusted for age, sex, BMI, CKD stage, primary diagnosis and proteinuria/albuminuria, hazard ratios (CI 95%) of patients with moderate (females/males: Hb 80-109 g/l/110-119 g/l) and severe anaemia (Hb <80 g/l) vs no anaemia for CVE, RRT, and death without RRT (TWMBA/MN) were 1.6 (1.2-2.1), 3.4 (1.8-6.1) and 1.8 (1.2-2.9)/1.7 (1.4-2.1) and 3.0 (1.9-4.8) and 2.0 (1.5-2.6). Patients with anaemia had more hospital admissions (median: 9 vs 2/5 vs 2), length-of-stay (55 vs 8 days/40 vs 7 days) over follow-up and greater hospitalisation costs (average per 100 person-year) vs without anaemia ($62,564 vs $8,549 / $47,716 vs $9,372, all p<0.001).
Conclusions: Anaemia is associated with increased risk of CVE, progression to RRT, and mortality in CKD patients, and with greater hospital utilisation and costs.
Supported by AstraZeneca.
Dr Jenny Zhang is a Research Fellow with Centre for Chronic Disease, Faculty of Medicine of The University of Queensland. She has experience in health service research in chronic diseases with a strong background in quantitative research methodology and data analysis.