Incident haemodialysis and outcomes in the Top End of Australia

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.