Chronic kidney disease in public renal practices in Queensland, Australia, 2011–2018

Abstract

Aim To describe adults with (non‐dialysis) chronic kidney disease (CKD) in nine public renal practice sites in the Australian state of Queensland. Methods 7,060 persons were recruited to a CKD Registry in May 2011 and until start of kidney replacement therapy (KRT), death without KRT or June 2018, for a median period of 3.4 years. Results The cohort comprised 7,060 persons, 52% males, with a median age of 68 yr; 85% had CKD stages 3A to 5, 45.4% were diabetic, 24.6% had diabetic nephropathy, and 51.7% were obese. Younger persons mostly had glomerulonephritis or genetic renal disease, while older persons mostly had diabetic nephropathy, renovascular disease and multiple diagnoses. Proportions of specific renal diagnoses varied >2‐fold across sites. Over the first year, eGFR fell in 24% but was stable or improved in 76%. Over follow up, 10% started KRT, at a median age of 62 yr, most with CKD stages 4 and 5 at consent, while 18.8% died without KRT, at a median age of 80 yr. Indigenous people were younger at consent and more often had diabetes and diabetic kidney disease and had higher incidence rates of KRT. Conclusion The spectrum of characteristics in CKD patients in renal practices is much broader than represented by the minority who ultimately start KRT. Variation in CKD by causes, age, site and Indigenous status, the prevalence of obesity, relative stability of kidney function in many persons over the short term, and differences between those who KRT and die without KRT are all important to explore.

Albuminuria Screening in People With Type 2 Diabetes in a Managed Care Organization

“…DKD disproportionately affects African American and Hispanic adults and those aged >64 years. 17 , 18 , 19 , 20 In this study, African American adults made up twice as many of the population with diabetes as White adults, even though the distribution of African American adults and White adults in KPGA is roughly equal, reflective of the general Atlanta population. Our study reported that African American individuals had higher odds of being screened for ALB in 2020 than White members, and there was no difference in ALB screening between member races for the 2021 cohort.…”

Nephrology nurse practitioner model of care for chronic kidney disease: Lessons learned and informing future healthcare delivery

“…The focus of the NNP is on slowing progression of CKD, which in turn would delay the need to be managed by a nephrologist and also delay the need for burdensome kidney replacement therapies. The NNP was managing patients who were representative of the broader CKD patient population reported by Hoy et al 37 These patients were in less advanced CKD grades, obese, and had high rates of albuminuria or proteinuria. Our findings, along with other studies of NNPs in the Netherlands and Canada, provide an understanding of the benefits of NNPs in managing patients with CKD.…”

“…41 Hoy and colleagues analysed all patients enrolled in the CKD.QLD registry (n = 7,060) reporting similar changes in eGFR over time, indicating that in Australia NNP-led clinics may be similarly effective as nephrologist clinics in delaying progression of CKD in less severe patients. 37 Moreover, James and colleagues in Canada did find that patients with early CKD grades had similar outcomes whether managed by a nurse practitioner or nephrologist. 40 There is a wide agreement that blood pressure control in CKD reduces both cardiovascular risk and disease progression.…”

“…This registry was established for the purpose of CKD surveillance across 11 public hospitals in Queensland. 37 Data obtained from the registry included: demographic data (age, gender, ethnicity), cause of kidney failure, comorbidities, eGFR, body mass index (BMI), BP, albumin-creatinine ratio (ACR), protein-creatinine ratio (PCR), HbA1C, low density lipoprotein, and cholesterol levels.…”

Hospitalizations Among Adults With CKD in Public Renal Specialty Practices: A Retrospective Study From Queensland, Australia

“…We have recently described the characteristics of these patients demonstrating variation in CKD by causes, age, indigenous status, the number of comorbid conditions, the prevalence of obesity, and the differences between patients who started receiving KRT and patients who died without receiving KRT. 15 …”