V DIWAN 1,2, J ZHANG 1,2, Z WANG 1,2, H HEALY H2,3, A CAMERON 2,3, AND ON BEHALF OF CKD.QLD COLLABORATIVE
1Faculty of Medicine, The University of Queensland, Herston, Brisbane, Australia, 2NHMRC CKD.CRE and CKD.QLD, Herston, Brisbane, Australia, 3Queensland Health, Herston, Brisbane, Australia
Aim: To profiles patients with CKD in Queensland’s public renal speciality system by Indigenous status.
Background: The costs of hospital admissions in Indigenous Queenslanders with preterminal CKD have not been defined.
Methods: Persons with CKD from Queensland’s ten public renal practices were recruited to the CKD.QLD registry from 2011, and followed until death, the start of kidney replacement therapy (KRT), or censor date of June 2018. Queensland Health supplied data on hospital admissions, deaths and KRT.
Results: Among 7,214 patients, 476 (6.6%) were Indigenous. They were younger than nonindigenous patients (58±13.7 vs 66.2±15.3) at recruitment, more often females (53.8% vs 45.6%), and higher proportions had diabetes (71% vs 46%) and diabetic nephropathy (49% vs 23.4%), They had 9% more hospital admissions per person year (py) of follow up, 16% greater length of stay and 36% greater costs. In Indigenous patients, principal causes of admissions by ICD10AM chapters in decreasing order of costs were circulatory system diseases, CKD/genitourinary related (includes dialysis preparations), respiratory, endocrine/metabolic (especially diabetes) and musculoskeletal, while in non-indigenous patients they were circulatory system diseases, external causes, rehabilitation /consultation/ discharge planning etc, respiratory and CKD/genitourinary related. Notable Indigenous vs nonindigenous differences in proportions of total costs included endocrine/metabolic especially diabetes (9.6% vs 5.6%), CKD/genitourinary related (10 vs 7.9%), and neoplasms (4.5% vs 7.1%). Indigenous patients had higher incidence rates per 100 py of ESKF (8.8 vs 5.2, p<0.0001) and KRT (5.7 vs 2.7, p<0.0001).
Conclusions: Despite their younger age, hospital costs were higher and renal outcomes worse in Indigenous CKD patients. Earlier diagnosis and outpatient management of diabetes and preparation for dialysis could mitigate hospital admission costs and CKD progression.
I work at CKD.QLD as research coordinator/manager, under the leadership of Prof Wendy Hoy, AO. My research focuses on CKD, related CVD complications, hospital admissions, cost and length of stay by various reasons of hospitalizations. My qualifications include a PhD (Pharmacology), Master and Bachelor in Pharmacy, and Certificate in Project management. After completing my PhD under the mentorship of A/Prof Glenda Gobe and Prof Lindsay Brown in 2013, I did my post-doc with A/Prof Ivan Sammut in Otago, NZ and returned to Brisbane in 2016 to work with QLD Health and then started with CKD.QLD in 2018.