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Incidence of Ischaemic Heart Disease in Men and Women With End-Stage Kidney Disease: A Cohort Study. Heart Lung Circ 2020; 29:1517-1526. [PMID: 32253129 DOI: 10.1016/j.hlc.2020.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/08/2019] [Accepted: 03/01/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND The incidence of ischaemic heart disease (IHD) has fallen consistently in the general population; attributed to effective primary prevention strategies. Differences in incidence have been demonstrated by sex. Whether this fall in incidence and sex differences is mirrored in people with end-stage kidney disease (ESKD) is unclear. We aimed to establish the relative risk of IHD events in the ESKD population. METHODS We performed a retrospective cohort study from 2000 to 2010 in people with ESKD in New South Wales. We performed data linkage of the Australia and New Zealand Dialysis and Transplant Registry and state wide hospital admission and death registry data and compared this to general population data. The primary outcome was the incidence rate, incidence rate ratio (IRR), and time-trend for any IHD event. We calculated these using indirect standardisation by IHD event. RESULTS 10,766 participants, contributed 44,149 years of observation time. Incidence rates were substantially higher than the general population for all IHD events (any IHD event: IRR 1.8, 95% confidence interval [CI] 1.7-1.9 for men, IRR 3.4, 95% CI 3.1-3.6 for women). Excess risk was higher in younger people (age 30-49 IRR 4.8, 95% CI 4.2-5.4), and in women with a three-fold increase risk overall and nearly a 10-fold increase in risk in young women (female age 30-49 years: IRR 9.8 95% CI 7.7-12.3), results were similar for angina and acute myocardial infarction. Ischaemic heart disease rates showed some decline for men over time, (ratio of IRR 0.93, 95% CI 0.90-0.95) but were stable for women (ratio of IRR 0.97, 95% CI 0.94-1.01). CONCLUSIONS People with ESKD have substantially higher rates of IHD than the general population, especially women, in whom no improvement appears evident over the past 10 years.
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Linking disease registries and nationwide healthcare administrative databases: the French renal epidemiology and information network (REIN) insight. BMC Nephrol 2020; 21:25. [PMID: 31992233 PMCID: PMC6988267 DOI: 10.1186/s12882-020-1692-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Record linkage is increasingly used in health research worldwide. Combining the patient information available in healthcare, administrative and clinical databases broadens the research perspectives, particularly for chronic diseases. Recent guidelines highlight the need for transparency on the used record linkage processes and the extracted data to be used by researchers. METHODS Therefore, the aim of this study was to describe the deterministic iterative approach used to link the French Epidemiology and Information Network (REIN), a French national End-Stage Renal Disease registry, with the Système National des Données de Santé (SNDS), a French nationwide medico-administrative healthcare database. RESULTS Among the 22,073 patients included in the REIN registry who started renal replacement therapy between 2014 and 2015 in France, 19,223 (87.1%) were matched with patients in the SNDS database. Comparison of matched and unmatched patients confirmed the absence of any major selection bias. Then, the record linkage was evaluated using the comorbidity status (diabetes). CONCLUSIONS This fast and efficient method of record linkage with pseudonymized data and without unique and direct identifier might inspire other research teams. It also opens the path for new research on chronic kidney disease.
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The Pre-Dialysis Care Trajectory of Chronic Kidney Disease Patients and the Start of Dialysis in Emergency: A Mixed Method Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16245010. [PMID: 31835428 PMCID: PMC6950758 DOI: 10.3390/ijerph16245010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/06/2019] [Accepted: 12/06/2019] [Indexed: 11/23/2022]
Abstract
Chronic Kidney Disease (CKD) is an important public health issue that requires early and close medical monitoring to start Renal Replacement Therapy (RRT) in the best conditions. However, in France, about 1/3 of patients start dialysis in emergency, despite the existence of CKD management guidelines. Using both quantitative and qualitative methods, we wanted to analyze the pre-dialysis care trajectory of patients with CKD and document the causes of Emergency dialysis Start (ES). To this aim, we designed a convergent mixed-method study. The quantitative component will analyze individual healthcare consumption and clinical data to identify the risk factors of ES by comparing the trajectories of patients who started dialysis in emergency in 2015 in France with those of patients who started in a planned manner and with the national recommendations. The qualitative component will explore the patients’ trajectories and identify barriers to a planned start using semi-structured interviews with patients who started dialysis in emergency and with their general practitioners and nephrologists. Using the strengths of a mixed methodology, this study will bring robust and valuable findings to improve the care of CKD patients.
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Lin R, Toussaint ND, Gallagher M, Cass A, Kotwal S. Hospitalized fracture rates amongst patients with chronic kidney disease in Australia using data linkage. Nephrology (Carlton) 2019; 25:475-482. [PMID: 31743530 DOI: 10.1111/nep.13681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 10/27/2019] [Accepted: 11/11/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Renal osteodystrophy leading to fractures in chronic kidney disease (CKD) is associated with significant hospitalization, morbidity, mortality and health care costs. There is a paucity of data on fractures in the CKD population in Australia. AIM To describe the trends and impact of hospitalized fractures in an Australian population of non-dialysis CKD patients. METHODS Retrospective observational data derived using data linkage. Fracture rates, trends in hospital admissions, comorbidity burden and mortality were analysed in a non-dialysis CKD population between 2000 and 2010 in the Australian state of New South Wales. Hospitalized patients with CKD and fractures were compared with CKD patients without fracture. RESULTS A total of 149 839 hospitalized patients with CKD were included, of whom 9898 (6.6%) experienced one or more fractures. Patients with fracture were older, more likely to be female with a higher comorbidity burden than those without. Hospital admissions involving fracture were longer than non-fracture admissions (14.3 vs 5.9 days, P < .0001) and patients were less likely to be discharged home (28.3% vs 80.9%, P < .0001). The 12-month mortality rate was high at 41%. CONCLUSION Australian non-dialysis CKD patients with hospitalized fractures were older, had a greater burden of disease, and have similar rates of fracture and associated mortality compared to international CKD cohorts. Implications of fracture requiring hospitalization are considerable, with longer admissions, greater healthcare costs, lower likelihood of discharge home and significant mortality. As fracture prevention in the CKD population evolves, treatment algorithms should account for those at greatest risk.
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Affiliation(s)
- Raymond Lin
- Renal and Metabolic Divisions, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine (RMH), University of Melbourne, Melbourne, Victoria, Australia
| | - Martin Gallagher
- Renal and Metabolic Divisions, The George Institute for Global Health, Newtown, New South Wales, Australia.,Concord Clinical School, Faculty of Medicine & Health, University of Sydney, Sydney, New South Wales, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Sradha Kotwal
- Renal and Metabolic Divisions, The George Institute for Global Health, Newtown, New South Wales, Australia.,Department of Nephrology, Prince of Wales Hospital, Sydney, New South Wales, Australia
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Sriravindrarajah A, Kotwal SS, Sen S, McDonald S, Jardine M, Cass A, Gallagher M. Impact of supplemental private health insurance on dialysis and outcomes. Intern Med J 2019; 50:542-549. [PMID: 31111611 DOI: 10.1111/imj.14375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/01/2019] [Accepted: 05/13/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The influence of health insurance systems on the treatment of end-stage kidney disease (ESKD) patients ispoorly understood. AIM We investigated how supplemental private health insurance (PHI) coverage impacted ESKD treatment modalitiesand patient outcomes. The influence of health insurance systems on the treatment of end-stage kidney disease (ESKD) patients is poorly understood. We investigated how supplemental private health insurance (PHI) coverage impacted ESKD treatment modalities and patient outcomes. METHODS All adult patients commencing ESKD treatment in New South Wales, Australia from 2000 to 2010 were identified using the Australia and New Zealand Dialysis and Transplant Registry. Data were linked to the state hospitalisation dataset to obtain insurance status, allowing the comparisons of mortality, ESKD treatment modality and health service utilisation between privately insured and public patients. RESULTS The cohort of 5737 patients included 38% (n = 2152) with PHI. At 1 year after ESKD treatment initiation, PHI patients had lower mortality (hazard ratio 0.84, 95% confidence interval (CI) 0.74-0.95, P = 0.01), were more likely to be receiving home haemodialysis (HD) (odds ratio (OR) 1.38, 95% CI 1.01-1.89, P = 0.04), to have been transplanted (OR 1.75, 95% CI 1.25-2.46, P = 0.001) and used fewer hospital days (incidence rate ratio 0.85, 95% CI 0.74-0.96, P = 0.01). After adjustment, PHI patients were more likely to initiate ESKD treatment with facility-based HD (OR 1.22, 95% CI 1.01-1.46, P = 0.03) but were less likely to be started on peritoneal dialysis (OR 0.81, 95% CI 0.67-0.98, P = 0.03). CONCLUSION Our findings suggest that supplemental PHI in Australia is associated with lower-risk ESKD treatment attributes and improved health outcomes. A greater understanding of the treatment pathways that deliver these outcomes may inform treatment for the broader ESKD treatment population.
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Affiliation(s)
- Arunan Sriravindrarajah
- Concord Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Nepean Hospital, Sydney, New South Wales, Australia
| | - Sradha S Kotwal
- The George Institute of Global Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Nephrology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Shaundeep Sen
- Concord Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Nephrology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Stephen McDonald
- Adelaide Medical School, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia.,ANZDATA Registry, SA Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Meg Jardine
- The George Institute of Global Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Nephrology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Martin Gallagher
- Concord Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,The George Institute of Global Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Nephrology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
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Kotwal S, Webster AC, Cass A, Gallagher M. Comorbidity recording and predictive power of comorbidities in the Australia and New Zealand dialysis and transplant registry compared with administrative data: 2000-2010. Nephrology (Carlton) 2016; 21:930-937. [DOI: 10.1111/nep.12694] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/06/2015] [Accepted: 11/26/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Sradha Kotwal
- The George Institute for Global Health; University of Sydney
| | - Angela C Webster
- Sydney School of Public Health; The University of Sydney
- Centre for Transplant and Renal Research; Westmead Hospital; Westmead
| | - Alan Cass
- Menzies School of Health Research; Charles Darwin University; Darwin
| | - Martin Gallagher
- The George Institute for Global Health; University of Sydney
- Concord Clinical School; University of Sydney; Sydney, Australia
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Kotwal S, Webster AC, Cass A, Gallagher M. A review of linked health data in Australian nephrology. Nephrology (Carlton) 2016; 21:457-66. [DOI: 10.1111/nep.12721] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/09/2015] [Accepted: 01/05/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Sradha Kotwal
- The George Institute for Global Health; The University of Sydney
| | - Angela C Webster
- Sydney School of Public Health; The University of Sydney
- Centre for Transplant and Renal Research; Westmead Hospital
| | - Alan Cass
- Menzies School of Health Research; Charles Darwin University; Darwin
| | - Martin Gallagher
- The George Institute for Global Health; The University of Sydney
- Concord Clinical School; The University of Sydney; Sydney Australia
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