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Abstract: FR-PO834

Cause of Death in Patients on Renal Replacement Therapy Varies Across Australia, New Zealand, and Malaysia - Results from the Study of Heart and Renal Protection-Extended Review (SHARP-ER)

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Talbot, Ben, The University of New South Wales, Sydney, New South Wales, Australia
  • Sukkar, Louisa, The University of New South Wales, Sydney, New South Wales, Australia
  • Smyth, Brendan, The University of New South Wales, Sydney, New South Wales, Australia
  • Jun, Min, The University of New South Wales, Sydney, New South Wales, Australia
  • Jardine, Meg J., The University of New South Wales, Sydney, New South Wales, Australia
  • Cass, Alan, Menzies School of Health Research, Darwin, Northern Territory, Australia
  • Walker, Robert J., University of Otago, Dunedin, New Zealand
  • Reith, Christina A., CTSU, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
  • Seong, Hooi Lai, Sultanah Aminah Hospital Johor Baru, Malaysia, Johor Bahru, Malaysia
  • Gallagher, Martin P., The University of New South Wales, Sydney, New South Wales, Australia
Background

The mortality rate among dialysis patients is high with regional variability. 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). We compared survival and cause of death between countries in dialysis patients in the SHARP-ER cohort.

Methods

Eligible participants in Australia, New Zealand and Malaysia alive at the end of SHARP were identified and extended 5-year follow up data collected. Cause of death was determined using registry data (national death index in Australia and New Zealand and national death registry in 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 participants in total. Of these, 526 were receiving chronic dialysis and were included in the analysis. 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 Australasia (Australia and New Zealand combined; RR 4.56, p=0.002, 95% CI 1.75-11.85) following adjustment. Crude rates of infectious death by country were: 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 Australia, New Zealand and Malaysia but causes of death differed. This suggests a need for region specific interventions.

Funding

  • Government Support - Non-U.S.