Dr Dominic Keuskamp1,2, Dr Christopher E Davies1,2, Associate Professor Philip A Clayton1,2,3, Dr David V Pilcher4,5,6, Shaila Chavan5, Dr Paul J Secombe5,6,7, Dr Sarah L Jones8,9, Dr Benjamin E Reddi2,10, Professor Stephen McDonald1,2,3
1Australia & New Zealand Dialysis & Transplant Registry, South Australian Health & Medical Research Institute, Adelaide, Australia, 2Faculty of Health & Medical Sciences, The University of Adelaide, Adelaide, Australia, 3Central & Northern Adelaide Renal & Transplantation Services, Royal Adelaide Hospital, Adelaide, Australia, 4Department of Intensive Care, Alfred Hospital, Melbourne, Australia, 5Centre for Resource Outcome & Evaluation, Australian & New Zealand Intensive Care Society, Camberwell, Australia, 6Australian & New Zealand Intensive Care Research Centre, School of Public & Preventive Medicine, Monash University, Melbourne, Australia, 7Intensive Care Unit, Alice Springs Hospital, Alice Springs, Australia, 8Intensive Care Unit, Northern Health, Epping, Australia, 9Department of Nephrology, Northern Health, Epping, Australia, 10Intensive Care Unit, Royal Adelaide Hospital, Adelaide, Australia
Aim: To describe the incidence of Australian intensive care unit (ICU) admissions for adult patients receiving prior chronic kidney replacement therapy (KRT).
Background: Kidney failure and its associated comorbidities commonly demand ICU admissions. The frequency and nature of admissions for these patients are not well defined.
Methods: Data were linked probabilistically between the Australia & New Zealand Dialysis & Transplant Registry, and years 2018-2020 of the Australian & New Zealand Intensive Care Society Adult Patient Database. Age- and sex-standardised admission rates for dialysis, kidney transplant and non-KRT populations were compared.
Results: Patients receiving KRT admitted to ICU in 2018-2020 numbered up to 2682 per year, or 10.2% of the prevalent KRT population. Compared with the non-KRT population, admissions were more likely to be for Aboriginal & Torres Strait Islander peoples, repeat admissions, non-elective and sourced from the hospital ward or emergency department. Admissions among the KRT group were associated with a higher severity of disease and risk of death, using the APACHE III score. Admissions were more common for KRT patients than for the non-KRT population (relative rate (RR) for dialysis patients: 35.6 (95% CI 33.5-37.9); RR for transplant patients: 8.9 (8.2-9.7)). Patients on dialysis for <30 days had a higher admission rate (e.g., RR 2.12 (1.60-2.78) relative to those on dialysis for >30 days-1 year). Rates of dialysis patient admissions for metabolic, cardiovascular and sepsis diagnoses were especially high (RRs 68.9 (58.9-79.9), 64.1 (56.0-72.9) and 64.0 (54.7-74.3) respectively). Rates for transplant patients were most elevated for sepsis diagnoses (RR 24.9 (19.9-30.8)).
Conclusions: Patients receiving KRT, especially dialysis, have experienced markedly higher ICU admission rates than the general population, with distinct diagnoses on admission.
Biography:
Dr Dominic Keuskamp is a Postdoctoral Research Fellow with the Australia & New Zealand Dialysis & Transplant (ANZDATA) Registry at the South Australian Health & Medical Research Institute. He manages several data linkage projects investigating population-level predictors and outcomes of kidney replacement therapy (KRT). His research also includes applications of spatial analysis to investigations of KRT.