Natural History of Cardiac and Peripheral Vascular Death In ESKD: An Australian And New Zealand Data Linkage Study

Introduction Cardiovascular disease is a leading cause of death in patients with end-stage kidney disease (ESKD). However, ascertaining the impact of cardiovascular deaths has not been well characterised over long periods of follow-up and across different treatment states. Further insights into the...

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Main Authors: Victor Khou, VictorNicole L De La Mat, Patrick J Kelly, Angela C Webster
Format: Article
Language:English
Published: Swansea University 2020-12-01
Series:International Journal of Population Data Science
Online Access:https://ijpds.org/article/view/1587
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spelling doaj-036993f583a44fad89d76747e4c393c42021-02-10T16:42:08ZengSwansea UniversityInternational Journal of Population Data Science2399-49082020-12-015510.23889/ijpds.v5i5.1587Natural History of Cardiac and Peripheral Vascular Death In ESKD: An Australian And New Zealand Data Linkage StudyVictor Khou0VictorNicole L De La Mat1Patrick J Kelly2Angela C Webster3Sydney School of Public HealthSydney School of Public HealthSydney School of Public HealthSydney School of Public Health; Centre for Renal and Transplant Research, Westmead Hospital Introduction Cardiovascular disease is a leading cause of death in patients with end-stage kidney disease (ESKD). However, ascertaining the impact of cardiovascular deaths has not been well characterised over long periods of follow-up and across different treatment states. Further insights into the lifetime risk of cardiovascular death are required to better inform clinical practice and economic planning. Objectives and Approach We performed a population-based cohort study on incident patients receiving ESKD treatment from the Australian and New Zealand Dialysis and Transplant registry (ANZDATA). Cardiac/vascular deaths were determined from ICD-10-AM codes listed in the underlying cause of death obtained via data linkage with the Australian National Death Index and New Zealand Mortality Collection database. We estimated mortality rates from cardiac/vascular death across time from ESKD treatment, and calculated probability of death and transplant status over time using multistate models. Results Across 60,823 incident ESKD patients and 381,874 person-years of follow-up, 22% (7,551) of deaths were from cardiac/vascular disease. At 15 years from treatment, 15.6% of patients had died from cardiac/vascular causes, most of whom never received a transplant (13.6% vs 2.0% of cohort). Within the first year of dialysis, cardiac/vascular mortality was highest in the second month, at 3,632/100,000pys. Improvements in cardiac/vascular mortality with calendar year were only seen after 9 months of dialysis. Transplant recipients had consistently lower cardiac/vascular mortality rates (598/100,000 pys) compared to dialysis patients. However, comorbid cardiovascular disease was a risk factor for graft failure and death in transplant recipients (HR:1.52, 95% CI:1.42-1.62). Conclusion / Implications Despite improvements in cardiac/vascular outcomes over time, cardiovascular death remains common in ESKD, particularly in the first few months of treatment. A greater focus on secondary prevention in earlier stages of chronic kidney disease may improve outcomes in new ESKD patients. https://ijpds.org/article/view/1587
collection DOAJ
language English
format Article
sources DOAJ
author Victor Khou
VictorNicole L De La Mat
Patrick J Kelly
Angela C Webster
spellingShingle Victor Khou
VictorNicole L De La Mat
Patrick J Kelly
Angela C Webster
Natural History of Cardiac and Peripheral Vascular Death In ESKD: An Australian And New Zealand Data Linkage Study
International Journal of Population Data Science
author_facet Victor Khou
VictorNicole L De La Mat
Patrick J Kelly
Angela C Webster
author_sort Victor Khou
title Natural History of Cardiac and Peripheral Vascular Death In ESKD: An Australian And New Zealand Data Linkage Study
title_short Natural History of Cardiac and Peripheral Vascular Death In ESKD: An Australian And New Zealand Data Linkage Study
title_full Natural History of Cardiac and Peripheral Vascular Death In ESKD: An Australian And New Zealand Data Linkage Study
title_fullStr Natural History of Cardiac and Peripheral Vascular Death In ESKD: An Australian And New Zealand Data Linkage Study
title_full_unstemmed Natural History of Cardiac and Peripheral Vascular Death In ESKD: An Australian And New Zealand Data Linkage Study
title_sort natural history of cardiac and peripheral vascular death in eskd: an australian and new zealand data linkage study
publisher Swansea University
series International Journal of Population Data Science
issn 2399-4908
publishDate 2020-12-01
description Introduction Cardiovascular disease is a leading cause of death in patients with end-stage kidney disease (ESKD). However, ascertaining the impact of cardiovascular deaths has not been well characterised over long periods of follow-up and across different treatment states. Further insights into the lifetime risk of cardiovascular death are required to better inform clinical practice and economic planning. Objectives and Approach We performed a population-based cohort study on incident patients receiving ESKD treatment from the Australian and New Zealand Dialysis and Transplant registry (ANZDATA). Cardiac/vascular deaths were determined from ICD-10-AM codes listed in the underlying cause of death obtained via data linkage with the Australian National Death Index and New Zealand Mortality Collection database. We estimated mortality rates from cardiac/vascular death across time from ESKD treatment, and calculated probability of death and transplant status over time using multistate models. Results Across 60,823 incident ESKD patients and 381,874 person-years of follow-up, 22% (7,551) of deaths were from cardiac/vascular disease. At 15 years from treatment, 15.6% of patients had died from cardiac/vascular causes, most of whom never received a transplant (13.6% vs 2.0% of cohort). Within the first year of dialysis, cardiac/vascular mortality was highest in the second month, at 3,632/100,000pys. Improvements in cardiac/vascular mortality with calendar year were only seen after 9 months of dialysis. Transplant recipients had consistently lower cardiac/vascular mortality rates (598/100,000 pys) compared to dialysis patients. However, comorbid cardiovascular disease was a risk factor for graft failure and death in transplant recipients (HR:1.52, 95% CI:1.42-1.62). Conclusion / Implications Despite improvements in cardiac/vascular outcomes over time, cardiovascular death remains common in ESKD, particularly in the first few months of treatment. A greater focus on secondary prevention in earlier stages of chronic kidney disease may improve outcomes in new ESKD patients.
url https://ijpds.org/article/view/1587
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