V KHOU1, N L DE LA MATA1, P J KELLY1, P MASSON2, E O’LONE1, R L MORTON3, A C WEBSTER1,4
1Sydney School of Public Health, University Of Sydney, Sydney, Australia, 2Centre for Nephrology, University College London, London, United Kingdom, 3NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia, 4Centre for Renal and Transplant Research, Westmead Hospital, Westmead, Sydney, Australia
Aim: To describe cardiac/vascular death (specifically cardiac and peripheral vascular deaths excluding stroke) across the natural history of kidney failure (KF) using a lifespan approach.
Background: Although cardiovascular disease is common in patients with KF, strategies for secondary prevention and cardiac screening in kidney transplantation are inconsistent and largely unsupported by high-quality evidence. Further insights into the lifetime risk of cardiac/vascular death in KF are required to better inform clinical practice, health service provision and research design.
Methods: We performed a population-based cohort study of incident patients commencing kidney replacement therapy (KRT) in Australia and New Zealand. Cardiac/vascular deaths were identified using data linkage to national death registers. We estimated the probability of death and kidney transplant using multi-state models, and calculated rates of graft failure and cause-specific cardiac/vascular death across demographic factors and cardiovascular comorbidities.
Results: Among 60 823 incident patients receiving KRT followed over 381 874 person-years, 22% (7551) of deaths were from cardiac/vascular disease. At 15 years from KRT initiation, 15.6% of patients had died from cardiac/vascular causes, who were less likely to have received a kidney transplant (13.6% vs 2.0%). Within the first year of dialysis, cardiac/vascular mortality peaked in the second month and showed little improvement across calendar year. Cardiovascular disease was also a risk factor for composite graft failure and death in transplant recipients (HR:1.52, 95% CI:1.42-1.62).
Conclusions: Despite improvements in cardiac/vascular outcomes over time, cardiovascular death remains common in KF, particularly in the first few months of treatment. A greater focus on early secondary prevention and pre-emptive kidney transplantation may improve outcomes in new patients with KF.
Victor is a medical doctor and MPhil candidate at the Sydney School of Public Health. He completed his undergraduate degree at the University of Sydney, where he developed an interest in statistical analysis while completing a Bachelor of Science (Advanced). While studying a Doctor of Medicine at Sydney Medical School, he was able to apply his mathematical background to several research projects, which he has continued following his graduation. Victor’s current research focuses on causes of death in patients with kidney failure. His research interests include cohort studies, data linkage and survival analysis techniques.