EPIDEMIOLOGY AND CLINICAL OUTCOMES

S. Sen¹, S.P. Mcdonald^2
1Central Northern Adelaide Renal & Transplantation Service, Royal Adelaide Hospital, Adelaide/SA/AUSTRALIA, ²Central Northern Adelaide Renal And Transplantation Service, Royal Adelaide Hospital, Adelaide/AUSTRALIA

Body: Introduction End stage kidney disease is associated with increased incidence, prevalence and mortality related to cardiovascular disease. The causes and rates of cardiac hospital separations for people receiving kidney replacement therapies (KRT) are not known in Australian populations. Methods KRT-related hospital separations were identified from the National Hospital Morbidity Dataset on the basis of ICD-10 codes for all admissions from 2002-2007 in Australia, excluding day-only haemodialysis. Separations were categorised by principal diagnosis of acute cardiac event (ACE), cardiac failure (CF), other cardiac (OC) and non-cardiac (NC) causes. Data was categorised by principal diagnosis (renal vs non-renal separation), KRT type, age, gender, type of cardiac disease, length of stay and mortality. Total patient numbers were obtained from the Australian Bureau of Statistics, and Australia and New Zealand Dialysis and Transplant Registry to calculate rates of events. Poisson regression analysis was used for testing of significance of difference in rates between groups. Results A total of 31303876 separations were coded in the study period, 29411210 for non-renal causes. Age/sex adjusted rates of ACE and CF were increased in all KRT recipients (p<0.001), however transplant recipients (Tx) had decreased ACE rates compared to other modalities (ACE RR - Tx 2.3, hemodialysis (HD) 4.6, peritoneal dialysis (PD) 3.6; CF RR - Tx 5.1, HD 6.6, PD 5.1). The RR for death in hospital was increased among all KRT recipients for NC, ACE and OC admissions (HD 3.8, 1.8, 2.1; PD 4.9, 3.7, 2.5; Tx 2.3, 3.0, 1.7; p<0.001). There was however no difference in the RR for in-hospital mortality for heart failure admissions (HD 0.8, PD 1.3, Tx 1.4; p>0.1). Average lengths of stay per admission were increased (p<0.001) in all groups, most pronounced in the PD group. Conclusion KRTs are associated with increased risk of hospital separation and in-hospital death for acute and other cardiac events compared to the general population. Tx is associated with a lower risk of separations for ACE than dialysis, but not heart failure. KRT however does not increase mortality rates in CF admission. This requires further investigation, but may be related to the differing pathophysiology of vascular disease in end stage kidney disease.

Disclosure: All authors have declared no conflicts of interest.