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, Australia, Australia, 5ANZDATA, Adelaide, Australia, 6Renal unit, CNAHS, Adelaide, Australia
Background: Patients with Diabetes Mellitus (DM) and chronic kidney disease have increased morbidity but its extent in those receiving kidney specialist care albeit not on kidney replacement therapy (KRT) is unclear.
Aims: Quantify morbidity burden of patients with DM enrolled in the CKD.QLD registry by examining hospital admission data.
Methods: Registry patients with DM were studied (none on KRT at enrolment). Hospital admission episodes (HAE) and bed day usage (BD) between 23/3/2011 and 30/6/2016 were determined from Queensland Hospital Admission patient data collection. Follow-up was censored by death, kidney failure and relocation interstate/overseas. Negative binomial regression analysis was performed.
Results: 2355 patients underwent 10873 patient-years follow-up (pyfu) with mean 4.6y. Mean age was 67.7y (SD 12.2). 56% were male. 11.6% claimed Aboriginal and/or Torres Strait Islander ethnicity. At censor date, there were 17415 HAE totalling 77208 BD (i.e. rates of 1.6 HAE/pyfu and 8.5 BD/pyfu). 200 patients had no HAE during follow-up. Patients living in cities who were insulin treated, current smokers, with lower eGFR, higher proteinuria, anaemia and history of prior major adverse cardiovascular event (MACE) were at risk of higher HAE rate whereas patients on lipid lowering therapy (llt) were at lower risk. In contrast, older, male, city-dwelling Aboriginal and/or Torres Strait Islanders on insulin therapy with worse DM control, lower eGFR, higher proteinuria, anaemia and prior MACE were more likely to have higher BD rate. RAAS blocker therapy and llt conferred lower risk.
Conclusions: The hospital admission data supports high morbidity in the cohort. Higher baseline cardiovascular risk was associated with both higher hospital admission and bed day usage rates whilst lipid lowering therapy was associated with lower risk of both.
Director of nephrology, Logan hospital.
Nephrologist, Metro South Nephrology and Transplant service.
Senior lecturer and PhD candidate, University of Queensland