TY - JOUR
T1 - Incident haemodialysis and outcomes in the Top End of Australia
AU - Hughes, Jaquelyne T.
AU - Majoni, Sandawana W.
AU - Barzi, Federica
AU - Harris, Tegan M.
AU - Signal, Selina
AU - Lowah, Gwendoline
AU - Kapojos, Jola
AU - Abeyaratne, Asanga
AU - Sundaram, Madhivanan
AU - Goldrick, Paul
AU - Jones, Sarah L.
AU - McFarlane, Robert
AU - Campbell, Lewis T.
AU - Stephens, Dianne
AU - Cass, Alan
PY - 2020
Y1 - 2020
N2 - Objective: The Northern Territory has the highest incidence of haemodialysis care for end-stage kidney disease in Australia. Although acute kidney injury (AKI) is a recognised risk for chronic kidney disease (CKD), the effect of AKI causing incident haemodialysis ( i HD) is unknown. Audits identifying antecedents of i HD may inform health service planning. Thus, the aims of this study were to describe: (1) the development of an i HD recording system involving patients with AKI and CKD and (2) the incidence, patient characteristics and mortality for patients with dialysis-requiring AKI. Methods: A retrospective data linkage study was conducted using eight clinical and administrative datasets of adults receiving i HD during the period from July 2011 to December 2012 within a major northern Australian hospital for AKI without CKD (AKI), AKI in people with pre-existing CKD (AKI/CKD) and CKD (without AKI). The time to death was identified by the Northern Territory Register of deaths. Results: In all, 121 i HD treatments were provided for the cohort, whose mean age was 51.5 years with 53.7% female, 68.6% Aboriginal ethnicity and 46.3% with diabetes. i HD was provided for AKI (23.1%), AKI/CKD (47.1%) and CKD (29.8%). The 90-day mortality rate was 25.6% (AKI 39.3%, AKI/CKD 22.8%, CKD 19.4%). The 3-year mortality rate was 45.5% (AKI 53.6%, AKI/CKD 22.8%, CKD 19.4%). The time between requesting data from custodians and receipt of data ranged from 15 to 1046 days. Conclusion: AKI in people with pre-existing CKD was a common cause of i HD. Health service planning and community health may benefit from AKI prevention strategies and the implementation of sustainable and permanent linkages with the datasets used to monitor prospective incident haemodialysis. What is known about the topic?: AKI is a risk factor for CKD. The Northern Territory has the highest national incidence rates of dialysis-dependent end-stage kidney disease, but has no audit tool describing outcomes of dialysis-requiring AKI. What does this paper add?: We audited all i HD and showed 25.6% mortality within the first 90 days of i HD and 45.5% overall mortality at 3 years. AKI in people with pre-existing CKD caused 47.1% of i HD. What are the implications for practitioners?: Health service planning and community health may benefit from AKI prevention strategies and the implementation of sustainable and permanent linkages with the datasets used to monitor prospective incident haemodialysis.
AB - Objective: The Northern Territory has the highest incidence of haemodialysis care for end-stage kidney disease in Australia. Although acute kidney injury (AKI) is a recognised risk for chronic kidney disease (CKD), the effect of AKI causing incident haemodialysis ( i HD) is unknown. Audits identifying antecedents of i HD may inform health service planning. Thus, the aims of this study were to describe: (1) the development of an i HD recording system involving patients with AKI and CKD and (2) the incidence, patient characteristics and mortality for patients with dialysis-requiring AKI. Methods: A retrospective data linkage study was conducted using eight clinical and administrative datasets of adults receiving i HD during the period from July 2011 to December 2012 within a major northern Australian hospital for AKI without CKD (AKI), AKI in people with pre-existing CKD (AKI/CKD) and CKD (without AKI). The time to death was identified by the Northern Territory Register of deaths. Results: In all, 121 i HD treatments were provided for the cohort, whose mean age was 51.5 years with 53.7% female, 68.6% Aboriginal ethnicity and 46.3% with diabetes. i HD was provided for AKI (23.1%), AKI/CKD (47.1%) and CKD (29.8%). The 90-day mortality rate was 25.6% (AKI 39.3%, AKI/CKD 22.8%, CKD 19.4%). The 3-year mortality rate was 45.5% (AKI 53.6%, AKI/CKD 22.8%, CKD 19.4%). The time between requesting data from custodians and receipt of data ranged from 15 to 1046 days. Conclusion: AKI in people with pre-existing CKD was a common cause of i HD. Health service planning and community health may benefit from AKI prevention strategies and the implementation of sustainable and permanent linkages with the datasets used to monitor prospective incident haemodialysis. What is known about the topic?: AKI is a risk factor for CKD. The Northern Territory has the highest national incidence rates of dialysis-dependent end-stage kidney disease, but has no audit tool describing outcomes of dialysis-requiring AKI. What does this paper add?: We audited all i HD and showed 25.6% mortality within the first 90 days of i HD and 45.5% overall mortality at 3 years. AKI in people with pre-existing CKD caused 47.1% of i HD. What are the implications for practitioners?: Health service planning and community health may benefit from AKI prevention strategies and the implementation of sustainable and permanent linkages with the datasets used to monitor prospective incident haemodialysis.
KW - acute kidney injury
KW - end-stage kidney disease
KW - health services
KW - Indigenous Australian
UR - http://www.scopus.com/inward/record.url?scp=85064486971&partnerID=8YFLogxK
UR - http://purl.org/au-research/grants/NHMRC/1092576
U2 - 10.1071/AH18230
DO - 10.1071/AH18230
M3 - Article
C2 - 30995950
AN - SCOPUS:85064486971
SN - 0156-5788
VL - 44
SP - 234
EP - 240
JO - Australian Health Review
JF - Australian Health Review
IS - 2
ER -