SAT-243 THE CKD.QLD REGISTRY: CHARACTERISTICS AND COURSE OF CHRONIC KIDNEY DISEASE (CKD) PATIENTS IN PUBLIC NEPHROLOGY CARE IN QUEENSLAND, AUSTRALIA

Abstract

Stemming the rise of end stage kidney failure (ESKF) depends on understanding, preventing and modifying its preterminal stages of CKD. We describe people with CKD in public renal practices in Queensland, Australia, who have enrolled in the CKD.QLD registry. Queensland has a vast area of 1,730,648 km2, a population of over 5 million, both of great diversity, and an excellent public health system - Queensland Health. CKD patients enrol in the registry with informed consent and are followed until death, start of renal replacement therapy (RRT), discharge or specified censor dates. Enrolment started in 2011, and has embraced adult nephrology services across Queensland Health Hospital and Health Services. Through a data-linkage collaboration, Queensland Health has supplied data on all hospital admissions, public and private, of CKD.QLD patients for five years retrospective from mid 2017. 9,005 patients have enrolled, with a total follow up of about 30,000 person years. Median age at enrolment was 68 years, 54% were male, and most had CKD stages 3A to 5. 50.8% were obese, compared with 20.8% of the Australian population, and, within the CKD cohort, obesity was powerfully associated with several serious complications. Dominant primary renal diseases were glomerulonephritis (GN) and genetic disease (GRD) in younger subjects, and diabetic disease (DN) and renal vascular (RV) disease in older people. 48% of subjects had multiple renal diagnosis. There was >2-fold variation in frequency of GN, DN and RV among some sites, and a >6-fold variation in proportions with diagnoses of uncertain or unknown etiology. Proportions of diagnoses also differed by socioeconomic status and by ethnic group, including Indigenous status. Older subjects more often had advanced renal disease, multiple renal diagnoses and more comorbidities. Renal function deteriorated over one and two years in 25%, but was stable or improved in 75%. CKD stages 4 and 5, overt proteinuria/albuminuria, diabetic nephropathy, male gender and acute kidney injury (AKI) were significant predictors of progression. Up to June 2016, the incidence per 100 person years of RRT was 2.79 (CI 3.4-4.0), and of death without RRT was 5.2 (CI 4.8-5.5). Mean (SD) age at start of RRT was 58.5 (15 years) and of death without RRT was 76.7 (10.6 years). Among the first 1,083 persons who died without receiving RRT, 19% were due to ESKF, while chronic renal failure and CKD were documented in an additional 50%. Cardiovascular events were recorded in 69% of these deaths, with other conditions also prominent. 10% of CKD.QLD patients were responsible for 60% of hospital admissions and 70% of expenditures, exclusive of dialysis. Underlying diabetic nephropathy and superimposed AKI were especially associated with such “high end” usage. There is great variation in CKD by age and in CKD cause by region. Progression over the short term is not inevitable. Subjects who start RRT and those who die without RRT are different populations. These data underline need for several pathways of care. Associations of obesity with CKD prevalence and complications, and of AKI with hospitalisations and progression in CKD patients, indicate major opportunities for prevention and better management.