ABSOLUTE AND RELATIVE MORTALITY IN PEOPLE RECEIVING DIALYSIS ACROSS FOUR DECADES IN AUSTRALIA, NEW ZEALAND AND THE USA.
Neeru Agarwal1, Amy Kang2,3, Kristy Robledo1, Kris Rogers6, Angus Ritchie4,5, Meg Jardine1,5 1NHMRC Clinical Trials Centre, University Of Sydney, Camperdown, New South Wales, Australia2The George Institute for Global Health, Sydney, New South Wales, Australia3Department of Renal Medicine, Prince of Wales Hospital, Randwick, New South Wales, Australia4Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia5Concord Repatriation General Hospital, Concord West, New South Wales, Australia6School of Public Health, University of Technology, Ultimo, New South Wales, Australia
Abstract
Aim: To assess the trends in absolute mortality (AM) and relative mortality (RM) in dialysis patients compared with the general populations across Australia, New Zealand (NZ), and the United States of America (USA).
Background: Survival for patients receiving maintenance dialysis continues to be poorer than age-matched individuals.
Methods: Age band-specific long-term prevalence and all-cause mortality counts were extracted for Australia and NZ (1982-2021), and the USA (1980-2020) from their respective publicly available kidney and national population registries. Yearly AM rates were calculated as the number of deaths divided by the corresponding population. RM was calculated as the ratio of dialysis to general AM. Trends in mortality were modelled using a Poisson regression with splines and analysed within R (Version 4.1.1).
Results: The dialysis population grew 8-9-fold over four decades with prevalence that was generally twice as high in the USA as in Australia and NZ for each age group. AM decreased in Australia and NZ across all age groups in both the dialysis and general populations over four decades. Over this time in the USA, overall dialysis AM decreased, but in 2020, AM increased by approximately 20% in both the dialysis and general populations. Across all countries, overall RM increased to a peak in the early 2000s (23-25), reflecting in part an increase in older dialysis patients. RM then fell to 20-21 by 2020.
Conclusions: Over the last four decades, dialysis AM and RM have improved within Australia, NZ, and the USA other than the impact of COVID-19 in the USA population. Relative longitudinal trends of mortality can inform assessments of the impact of practice and policy.
Biography
Dr Neeru Agarwal is a PhD Candidate at the NHMRC Clinical Trials Centre, University of Sydney. She is a Nephrologist with an interest in researching the use of routinely collected electronic healthcare data to understand kidney disease.