Dr Dominic Keuskamp1,2, Dr Christopher E Davies1,2, Professor Robert Baker3,4, Professor Kevan Polkinghorne5,6, Professor Christopher Reid6,7,8, Professor Julian Smith8,9,10, Ddr Lavinia Tran6,8, Dr Jenni Williams-Spence6,8, Professor Rory Wolfe6, Professor Stephen McDonald1,2,11
1Australia & New Zealand Dialysis & Transplant Registry, South Australian Health & Medical Research Institute, Adelaide, Australia, 2Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia, 3College of Medicine & Public Health, Flinders University, Bedford Park, Australia, 4Cardiac Surgery Quality & Outcomes Department, Flinders Medical Centre, Bedford Park, Australia, 5Department of Nephrology, Monash Medical Centre, Clayton, Australia, 6School of Public Health and Preventive Medicine, Monash University, Melbourne, South Australia, 7School of Population Health, Curtin University, Bentley, Australia, 8Australian & New Zealand Society of Cardiac & Thoracic Surgeons (ANZSCTS) Cardiac Surgery Database, Monash University, Melbourne, Australia, 9Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Clayton, Australia, 10Department of Cardiothoracic Surgery, Monash Health, Clayton, Australia, 11Central & Northern Adelaide Renal & Transplantation Services, Royal Adelaide Hospital, Adelaide, Australia
Aim: To describe incidence trends of Australian cardiac surgery procedures for adult patients receiving prior kidney replacement therapy (KRT).
Background: Kidney failure increases patients’ risk of cardiovascular disease, sometimes requiring cardiac surgery. The frequency and nature of surgeries for these patients are not well documented.
Methods: Data were linked probabilistically between the Australia & New Zealand Dialysis & Transplant Registry and the Australian & New Zealand Society of Cardiac & Thoracic Surgeons Cardiac Surgery Database. Age- and sex-standardised surgery rates for dialysis, kidney transplant and non-KRT populations were compared when the cardiac surgery patient population coverage in the Database was highest (2010-2019).
Results: Patients receiving KRT had cardiac surgery at a rate of up to 209 procedures per year, or 0.8% of the prevalent KRT population. Compared with the non-KRT population, surgeries for KRT patients were more likely to be for Aboriginal & Torres Strait Islander peoples, ‘urgent’ indications, and associated with diabetes, hypertension and hypercholesterolemia. Surgery was more common for KRT patients than for the non-KRT population (Relative Rate (RR) for dialysis patients: 16.4 (95% CI 14.5-18.3), RR for transplant patients: 3.9 (3.2-4.7)). Patients on dialysis for <30 days had a higher surgery rate (e.g., RR 2.62 (1.47-4.43) relative to those on dialysis for >30 days-1 year). Rates of coronary artery bypass graft, valve and combined surgeries were all elevated for dialysis patients (RRs 17.0 (14.7-19.6), 17.5 (13.0-22.7) and 17.8 (12.7-24.2) respectively compared to the non-KRT population), and were also elevated for transplant patients but to a lesser extent.
Conclusions: Patients receiving KRT, especially dialysis, have experienced higher rates of cardiac surgery than the general population. This has been consistent across all surgical indications.
Biography:
Dr Dominic Keuskamp is a Postdoctoral Research Fellow with the Australia & New Zealand Dialysis & Transplant (ANZDATA) Registry at the South Australian Health & Medical Research Institute. He manages several data linkage projects investigating population-level predictors and outcomes of kidney replacement therapy (KRT). His research also includes applications of spatial analysis to investigations of KRT.