V DIWAN1,2, S NIOGRET1,2, J JHANG1,2, Z WANG1,2, H HEALY2,3, G MITCHELL2,4, W HOY1,2, CKD.QLD Collaborative2
1Faculty of Medicine, The University of Queensland, Brisbane, Australia, 2NHMRC CKD.CRE and CKD.QLD, Brisbane, Australia, 3Queensland Health, Brisbane, Australia, 4Centre for Palliative Care Research and Education, The University of Queensland, Brisbane, Australia
Background: Cardiovascular disease (CVD) is the major cause of morbidity and mortality in chronic kidney disease (CKD) patients. We analysed CVD in context of hospital admissions and deaths in (preterminal) CKD patients in one of the nine public renal speciality practice sites participating in the CKD.QLD registry across the Australian state of Queensland
Methods: CKD patients from the MetroNorth Hospital (Brisbane) were followed from recruitment to the registry between May 2011 and June 2017 until start of kidney replacement therapy (KRT), death or June 2018, for a total of 6,483.8 person years (mean 4yrs). Queensland Health supplied data on hospital admissions, with ICD-10-AM codes, DRGs, total length of stay (TLOS, days) and costs, as well as start of KRT and deaths (international ICD-10 codes).
Results: Of 1,640 patients, 803 (49%) had one or more admission with a CVD diagnosis. Proportions with CVD were highest in those with renovascular disease, CKD stage 3B and age ≥75years. Among 11,043 total admissions, with TLOS 45,836 and total costs of $63 million, a CVD condition was the principal diagnosis in 1,279 (11.6%) admissions, occasioning 7,423 days TLOS (16.2%) and costing $11.8million (18.7%). Among categories of CVD as principal diagnosis, with some overlap, the cost impacts in decreasing rank order were heart failure ($4.82million), ischaemic heart disease ($2.36million), arrhythmia and conduction disorders ($1.21million), other circulatory system disorders ($1.2million), cerebrovascular disorders ($0.95million), valvular disorders (~$0.88million) and atherosclerosis (~$0.6million). Among 426 deaths, 251 (58.9%) were associated with CVD.
Conclusions: In this preterminal non-dialysis CKD cohort, almost half of patients had or acquired CVD costing almost 1/5th of the total cost. Among CVD categories, heart failure was responsible for highest admissions and cost.
Dr Vishal Diwan joined CKD.QLD in 2018. Vishal’s research interests have focused on kidney diseases and related cardiovascular complications. After completing his pharmacy and pharmacology training in India, received International Postgraduate Research Scholarship to pursue his PhD in Pharmacology from the University of Queensland under the supervision of A/Prof. Glenda Gobe and Prof. Lindsay Brown. He has completed post-doctoral work at the University of Otago with A/Prof. Ivan Sammut and worked as a clinical pharmacy/pharmacology lecturer at the University of Otago’s School of Pharmacy. Vishal returned to Brisbane in 2016 to work for Queensland health before joining the CKD.QLD.