B TALBOT1, L SUKKAR1,2, B SMYTH1,2, M JUN1, M JARDINE1, A CASS3, R WALKER4, C REITH5, L HOOI6, M GALLAGHER1
1The George Institute for Global Health, The University of New South Wales, Sydney, Australia, 2Sydney School of Public Health, The University of Sydney , Sydney, Australia, 3Menzies School of Health Research, Charles Darwin University, Darwin, Australia, 4Dunedin School of Medicine, University of Otago, Otago, New Zealand, 5Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom, 6Sultanah Aminah Hospital, Johor Bahru, Malaysia
Background: The mortality rate among dialysis patients is high with regional variability.
Aim: To compare survival and cause of death between countries in dialysis patients in the SHARP-ER cohort.
Method: The Study of Heart and Renal Protection-Extended Review (SHARP-ER) comprised extended 5-year follow up of eligible participants in Australia, New Zealand and Malaysia alive at the end of SHARP (a randomised double-blind trial of simvastatin and ezetimibe vs. placebo in chronic kidney disease). Cause of death was compared using registry data (national death index (Australia, New Zealand) and national death registry (Malaysia)) for participants receiving chronic dialysis (haemodialysis or peritoneal dialysis) at the beginning of the extended review period. Multivariate survival analysis and multinomial logistic regression were conducted to assess for differences.
Results: The cohort comprised 1136 eligible participants of whom 526 were receiving dialysis. During the 5 year follow up 203 died (38.6%). Median age was lowest in Malaysia (56.2 years, [50.4-63.8] followed by New Zealand (60.4 years [55.5-67.3]) and Australia (66.1 years [55.3-75.8]). Treating country did not significantly affect survival following adjustment for age, gender and dialysis modality. Cardiovascular disease was the most common cause of death (New Zealand 52.4%, Australia 43.2%, Malaysia 32.6%). Infectious causes of death were significantly more common in Malaysia versus Australia/New Zealand (RR 4.56, p=0.002, 95% CI 1.75-11.85) following adjustment for age, gender and modality (Crude rates: Malaysia 31.8%, New Zealand 9.5%, Australia 6.8%). Peritoneal dialysis was also associated with an increased risk of infectious death (RR 3.64, p==0.017, 95%CI 1.26-10.48) following adjustment.
Conclusion: In the SHARP-ER cohort, survival on dialysis was comparable between countries but causes of death differed. This suggests a need for region specific interventions.
Ben is an advanced trainee in nephrology who has completed most of his training in the United Kingdom but moved to Australia in 2015 to gain some experience of health care provision in Australia. He has worked as an advanced trainee at Concord Repatriation and General Hospital and is currently completing a PhD under the supervision of Martin Gallagher at the Gorge Institute for Global Health and University of New South Wales. His interests include the use of novel datasets to improve outcomes in chronic kidney disease, particularly in resource poor environments.