M JOSE1, R RAJ1, K JOSE2, C MCKERCHER2, A KITSOS1, T SAUNDER1, J RADFORD1
1School of Medicine, University of Tasmania, 2Menzies Institute for Medical Research, University of Tasmania.
Aim: To identify chronic kidney disease (CKD), associated risk factors and outcomes in Tasmania.
Background: Knowledge of CKD in Australia has arisen from landmark studies using random population samples of limited size or from primary care datasets of limited coverage. We examined CKD in the community using a whole-of-state approach.
Methods: We linked five health (public hospital admissions and emergency presentations, ANZDATA, cancer and death registries) and two pathology (community and hospital) datasets. The study population (n=460,737 or 86.8% of the state’s adult population) includes any adult with a creatinine test during 1/1/2004-31/12/2017. We defined CKD as two measures of eGFR<60mL/min/1.73m2, at least 3-months apart. Individual addresses were geocoded and reported by communities of approximately 5,000 (Statistical Area 2). River plots, referencing Kidney Health Australia clinical action plans, were constructed to demonstrate individual outcomes. Findings were disseminated using various approaches including electronic dashboards and consumer infographics
Results: We identified 56,438 adults with CKD, equating to an age-standardised annual incidence of 1% and prevalence of 6.5%. There were significant age, gender and geographic differences in screening for, and detection of CKD, diabetes and hyperlipidaemia. Progression of CKD over a mean 6.1 years of follow-up was faster in men and those >60 years.
Compared to adults without CKD, those with CKD were more likely to have an admission to hospital (relative risk (RR) 1.6), a cardiovascular event (RR 5.6), a cardiovascular procedure (RR 4.8) and more likely to die (RR 5.9). Throughout the period, at least 65% of those with an eGFR<15mL/min/1.73m2 received kidney replacement therapy.
Conclusions: This state-wide data linkage study has provided the most comprehensive population and individual information about CKD for any Australian state.
Matthew Jose is a bushwalker, photographer and mountain runner, who in his spare time works as Professor of Medicine for the University of Tasmania, a Renal Physician at the Royal Hobart Hospital and is Co-Convenor of the CARI Kidney Stones working group, the Patient Mentor Working Group of the NIKTT and a member of the ANZDATA Executive Committee.