SUN-046 CARDIAC MORTALITY IN PEOPLE WITH END STAGE KIDNEY DISEASE IN AUSTRALIA AND NEW ZEALAND; A COHORT STUDY FROM 1980 TO 2013

Abstract

The presence of cardiac disease is an important predictor of mortality in people with end-stage kidney disease (ESKD). Secondary prevention and treatment of cardiac events may be less effective in people with ESKD. We aimed to review the rates and standardised mortality ratios from cardiovascular disease for people with ESKD compared to the Australian and New Zealand general population. Cohort study of incident people with ESKD in Australia and New Zealand, 1980-2013. Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) was linked with Australian and New Zealand death registers to obtain date and cause of death. We estimated mortality rates for cardiovascular disease using ICD codes (Table 1) and standardised mortality ratios (SMRs with 95% confidence intervals [CI]) using indirect standardisation, by age, sex and calendar year to the general population. There were 60,823 participants contributing 381,874 person-years of follow-up. Overall, there were 6847 cardiac deaths, of which 5947 (86.9%) were from ischaemic heart disease. Cardiac mortality rates were higher in men (2002.5/100,000 person-years, 95%CI: 1944.5-2062.2) than women (1502.5/100,000person-years, 95%CI: 1443.6-1563.8), where rates in both sexes increased with age. The relative rate was higher in women (women: SMR 8.3, 95%CI: 8.0-8.6; men: SMR 5.6, 95%CI: 5.5-5.8). The burden of excess mortality was greatest for younger women with ESKD (aged 30-49 years: women SMR 59.7, 95%CI: 51.8-69.0; men SMR 17.7, 95%CI: 15.9-19.7) Subgroup analysis showed this was largely driven by ischaemic heart disease deaths (Figure 3).Table 1ICD 10 CodesICD 10 CodeGrouped outcomesI20-I25Ischaemic heart diseasesI34-I37Valvular diseasesI42-I43CardiomyopathyI44-I49ArrhythmiasI50Heart failure Open table in a new tab View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT) The cardiac mortality rates in the Australian and New Zealand ESKD population are substantially higher than the general population. Young women with ESKD have an excessive relative risk of dying from cardiac disease, in particular IHD, compared to young females in the general population.