Dialysis outcomes of elderly indigenous and non-indigenous Australians

Charlotte Mckercher, Hoi Wong Chan, Philip A. Clayton, Stephen Mcdonald, Matthew D. Jose

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Aim: Whilst increasing numbers of elderly people in Australia are commencing dialysis, few Indigenous patients are aged ≥65 years and their outcomes are unknown. We compared the long-term survival, mortality hazards and causes of death between elderly Indigenous and elderly non-Indigenous dialysis patients. Methods: This was a retrospective cohort study of adults aged ≥65 years who commenced dialysis in Australia from 2001-2011, identified from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Indigenous (n = 263) and non-Indigenous (n = 10713) patients were followed until death, loss to follow-up, recovery of renal function or 31 December 2011. Mortality was compared using a multivariate Cox proportional-hazards model with age, gender, body mass index, smoking, primary renal disease, comorbidities, late referral and initial treatment modality as predictive variables. Results: Median follow-up was 26.9 months (interquartile range 11.3-48.8 months). Overall 166 Indigenous and 6265 non-Indigenous patients died during the 11-year follow-up period. Mortality rates per 100 patient-years were 23.9 for Indigenous patients and 21.2 for non-Indigenous patients. The overall 1-, 3- and 5-year survival rates were 81%, 49% and 27% for Indigenous patients and 82%, 55% and 35% for non-Indigenous patients respectively. Indigenous patients had a 20% increased risk of mortality compared with non-Indigenous patients (adjusted hazard ratio 1.20, 95% confidence interval, 1.02, 1.41; P = 0.02). 'Social deaths' (predominantly dialysis withdrawal) and cardiac deaths were the main causes of death for both groups. Conclusion: Among elderly dialysis patients in Australia, Indigenous status remains an important factor in predicting survival.

LanguageEnglish
Pages610-616
Number of pages7
JournalNephrology
Volume19
Issue number10
DOIs
Publication statusPublished - 1 Jan 2014
Externally publishedYes

Keywords

  • Dialysis
  • End-stage kidney disease
  • Epidemiology
  • High risk populations

ASJC Scopus subject areas

  • Nephrology

Cite this

Mckercher, Charlotte ; Chan, Hoi Wong ; Clayton, Philip A. ; Mcdonald, Stephen ; Jose, Matthew D. / Dialysis outcomes of elderly indigenous and non-indigenous Australians. In: Nephrology. 2014 ; Vol. 19, No. 10. pp. 610-616.
@article{4909fc44e84448f1a49262b3ca0ed64f,
title = "Dialysis outcomes of elderly indigenous and non-indigenous Australians",
abstract = "Aim: Whilst increasing numbers of elderly people in Australia are commencing dialysis, few Indigenous patients are aged ≥65 years and their outcomes are unknown. We compared the long-term survival, mortality hazards and causes of death between elderly Indigenous and elderly non-Indigenous dialysis patients. Methods: This was a retrospective cohort study of adults aged ≥65 years who commenced dialysis in Australia from 2001-2011, identified from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Indigenous (n = 263) and non-Indigenous (n = 10713) patients were followed until death, loss to follow-up, recovery of renal function or 31 December 2011. Mortality was compared using a multivariate Cox proportional-hazards model with age, gender, body mass index, smoking, primary renal disease, comorbidities, late referral and initial treatment modality as predictive variables. Results: Median follow-up was 26.9 months (interquartile range 11.3-48.8 months). Overall 166 Indigenous and 6265 non-Indigenous patients died during the 11-year follow-up period. Mortality rates per 100 patient-years were 23.9 for Indigenous patients and 21.2 for non-Indigenous patients. The overall 1-, 3- and 5-year survival rates were 81{\%}, 49{\%} and 27{\%} for Indigenous patients and 82{\%}, 55{\%} and 35{\%} for non-Indigenous patients respectively. Indigenous patients had a 20{\%} increased risk of mortality compared with non-Indigenous patients (adjusted hazard ratio 1.20, 95{\%} confidence interval, 1.02, 1.41; P = 0.02). 'Social deaths' (predominantly dialysis withdrawal) and cardiac deaths were the main causes of death for both groups. Conclusion: Among elderly dialysis patients in Australia, Indigenous status remains an important factor in predicting survival.",
keywords = "Dialysis, End-stage kidney disease, Epidemiology, High risk populations",
author = "Charlotte Mckercher and Chan, {Hoi Wong} and Clayton, {Philip A.} and Stephen Mcdonald and Jose, {Matthew D.}",
year = "2014",
month = "1",
day = "1",
doi = "10.1111/nep.12317",
language = "English",
volume = "19",
pages = "610--616",
journal = "Nephrology",
issn = "1320-5358",
publisher = "Wiley-Blackwell",
number = "10",

}

Dialysis outcomes of elderly indigenous and non-indigenous Australians. / Mckercher, Charlotte; Chan, Hoi Wong; Clayton, Philip A.; Mcdonald, Stephen; Jose, Matthew D.

In: Nephrology, Vol. 19, No. 10, 01.01.2014, p. 610-616.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Dialysis outcomes of elderly indigenous and non-indigenous Australians

AU - Mckercher, Charlotte

AU - Chan, Hoi Wong

AU - Clayton, Philip A.

AU - Mcdonald, Stephen

AU - Jose, Matthew D.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Aim: Whilst increasing numbers of elderly people in Australia are commencing dialysis, few Indigenous patients are aged ≥65 years and their outcomes are unknown. We compared the long-term survival, mortality hazards and causes of death between elderly Indigenous and elderly non-Indigenous dialysis patients. Methods: This was a retrospective cohort study of adults aged ≥65 years who commenced dialysis in Australia from 2001-2011, identified from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Indigenous (n = 263) and non-Indigenous (n = 10713) patients were followed until death, loss to follow-up, recovery of renal function or 31 December 2011. Mortality was compared using a multivariate Cox proportional-hazards model with age, gender, body mass index, smoking, primary renal disease, comorbidities, late referral and initial treatment modality as predictive variables. Results: Median follow-up was 26.9 months (interquartile range 11.3-48.8 months). Overall 166 Indigenous and 6265 non-Indigenous patients died during the 11-year follow-up period. Mortality rates per 100 patient-years were 23.9 for Indigenous patients and 21.2 for non-Indigenous patients. The overall 1-, 3- and 5-year survival rates were 81%, 49% and 27% for Indigenous patients and 82%, 55% and 35% for non-Indigenous patients respectively. Indigenous patients had a 20% increased risk of mortality compared with non-Indigenous patients (adjusted hazard ratio 1.20, 95% confidence interval, 1.02, 1.41; P = 0.02). 'Social deaths' (predominantly dialysis withdrawal) and cardiac deaths were the main causes of death for both groups. Conclusion: Among elderly dialysis patients in Australia, Indigenous status remains an important factor in predicting survival.

AB - Aim: Whilst increasing numbers of elderly people in Australia are commencing dialysis, few Indigenous patients are aged ≥65 years and their outcomes are unknown. We compared the long-term survival, mortality hazards and causes of death between elderly Indigenous and elderly non-Indigenous dialysis patients. Methods: This was a retrospective cohort study of adults aged ≥65 years who commenced dialysis in Australia from 2001-2011, identified from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Indigenous (n = 263) and non-Indigenous (n = 10713) patients were followed until death, loss to follow-up, recovery of renal function or 31 December 2011. Mortality was compared using a multivariate Cox proportional-hazards model with age, gender, body mass index, smoking, primary renal disease, comorbidities, late referral and initial treatment modality as predictive variables. Results: Median follow-up was 26.9 months (interquartile range 11.3-48.8 months). Overall 166 Indigenous and 6265 non-Indigenous patients died during the 11-year follow-up period. Mortality rates per 100 patient-years were 23.9 for Indigenous patients and 21.2 for non-Indigenous patients. The overall 1-, 3- and 5-year survival rates were 81%, 49% and 27% for Indigenous patients and 82%, 55% and 35% for non-Indigenous patients respectively. Indigenous patients had a 20% increased risk of mortality compared with non-Indigenous patients (adjusted hazard ratio 1.20, 95% confidence interval, 1.02, 1.41; P = 0.02). 'Social deaths' (predominantly dialysis withdrawal) and cardiac deaths were the main causes of death for both groups. Conclusion: Among elderly dialysis patients in Australia, Indigenous status remains an important factor in predicting survival.

KW - Dialysis

KW - End-stage kidney disease

KW - Epidemiology

KW - High risk populations

UR - http://www.scopus.com/inward/record.url?scp=84907814797&partnerID=8YFLogxK

U2 - 10.1111/nep.12317

DO - 10.1111/nep.12317

M3 - Article

VL - 19

SP - 610

EP - 616

JO - Nephrology

T2 - Nephrology

JF - Nephrology

SN - 1320-5358

IS - 10

ER -