C E DAVIES1,2, S P MCDONALD1,2,3, D KEUSKAMP1,2, M LORIMER4, K DANSIE1,2, S RAINBIRD4, P LEWIS4, S GRAVES4, I HARRIS4
1Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia, 2Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia, 3Central Northern Adelaide Renal and Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, Australia, 4Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), South Australian Health & Medical Research Institute (SAHMRI), Adelaide, Australia
Aim: To compare the rates of primary hip and knee replacements in patients receiving dialysis and with a kidney transplant (kidney replacement therapy, KRT) against the non-KRT population.
Background: End stage kidney disease is associated with various types of bone and joint disease. KRT patients may also have an elevated risk through an increased risk of falls or from corticosteroid use. Rates of total joint replacement may therefore be increased.
Methods: Data on adult Australians from 2003-2016 were linked between the Australia and New Zealand Dialysis and Transplant Registry and the Australian Orthopaedic Association National Joint Replacement Registry. Ratios of age and sex standardised rates based on a Poisson distribution were used to account for the different population structures.
Results: 1,382 primary hip and 602 primary knee replacements were identified among KRT patients. Compared to the non-KRT population, dialysis and transplant patients had more than twice the rate of primary hip replacement. (Relative Rate for dialysis patients (RR) 2.76 (95% CI: 2.29-3.30)), (RR for transplant patients 2.00 (95% CI: 1.74, 2.29)). Primary hip replacements for the diagnosis of osteonecrosis occurred at a particularly high relative rate for both dialysis (RR 24.04 (95% CI: 13.33-38.31)) and transplant patients (RR 27.65 (95% CI: 20.23-36.54)). Primary knee replacement procedures occurred at a lower rate for dialysis patients than in the non-KRT population (RR 0.40 (95% CI: 0.34-0.48)), with the rate for transplant patients no different to the non-KRT population (RR 0.87 (95% CI: 0.75-1.01)).
Conclusions: KRT patients experience higher rates of hip replacements than the general population, particularly for osteonecrosis. Dialysis patients experience lower rates of knee replacements.
Dr Christopher Davies is the Lead Biostatistician at the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) within the South Australian Health and Medical Research Institute. At ANZDATA, Christopher provides statistical support for the generation of regular reports and the extraction of data for custom external requests. Christopher also conducts analyses for ANZDATA research projects and in collaboration with those in the nephrology community. Christopher completed a PhD in Statistics at the University of Adelaide, focussing on group-based trajectory modelling. His research interests include methods for comparing centres, and for longitudinal data.