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Abstract: FR-PO252

The End of the CKD Journey - Who Starts Renal Replacement Therapy and Who Dies Without It Among CKD Patients in Public Renal Speciality Practices in Queensland, Australia

Session Information

Category: CKD (Non-Dialysis)

  • 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Hoy, Wendy E., NHMRC CKD.CRE & CKD.QLD, Brisbane, Queensland, Australia
  • Zhang, Jianzhen, NHMRC CKD.CRE & CKD.QLD, Brisbane, Queensland, Australia
  • Wang, Zaimin, The University of Queensland, Brisbane, Queensland, Australia
  • Cameron (Salisbury), Anne, NHMRC CKD.CRE & CKD.QLD, Brisbane, Queensland, Australia
  • Healy, Helen G., NHMRC CKD.CRE & CKD.QLD, Brisbane, Queensland, Australia
  • Mallett, Andrew John, NHMRC CKD.CRE & CKD.QLD, Brisbane, Queensland, Australia
  • Venuthurupalli, Sree Krishna, Toowoomba Hospital, Toowoomba, Queensland, Australia

Group or Team Name

  • NHMRC CKD.CRE and CKD.QLD Collaborative
Background

Persons with CKD who start renal replacement therapy (RRT) in Australia are well characterised, but the characteristics and outcomes of those who do not start RRT are less well understood. We examined the fate of patients with CKD in selected public renal specialty clinics in Queensland (in the CKD.QLD registry) and compare those who started renal replacement therapy (RRT) with those who died without RRT.

Methods

6,371 patients in CKD.QLD (54% males, mostly CKD stages 3b, 4 and 5), were followed from date of informed consent until the start of RRT, death, or a censor date of June 30, 2016. Outcomes and causes of death were ascertained from Queensland Health records. Median follow-up (IQR) was 2.8 (3) years, with a total of 15,714 person years.

Results

By the censor date, 605 (9.5%) patients had started RRT, at a median (IQR) age of 63 (20) years and 837 (13.1%) had died without RRT, at median (IQR) age 78 years (14). RRT incidence rates per 100 person years for males and females respectively were 3.8 vs 2.7, p=0.001, and death rates were 5.8 vs 4.8, p=0.001. Among deaths without RRT, 377 (45.5%) mentioned terminal ESKF or chronic renal failure, an additional 193 (23.3%) mentioned CKD, and 57 (6.9%) mentioned AKI, with no gender differences.

Conclusion

Most of these patients with relatively advanced CKD experienced a “renal death” (started RRT or died with ESKF). Rates were higher for males. More died without RRT than started RRT. They were relatively distinct populations: average ESKF-free survival was 15 years longer for patients who did not start RRT (78 vs 63 years). About half the deaths without RRT were ESKF deaths, while another 30% mentioned a renal diagnosis. Ascertainment renal failure and CKD in death certificates was very good.

Funding

  • Government Support - Non-U.S.