ORCID Profile
0000-0001-6103-1386
Current Organisations
University of Reims Champagne-Ardenne
,
University of Adelaide
,
South Australian Health and Medical Research Institute
,
Royal Australasian College of Physicians
,
Flinders Univeristy of SA
,
Country Health SA LHN
,
Central Northern Adelaide Renal & Transplantation Service
,
ANZDATA Registry
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Publisher: Springer Science and Business Media LLC
Date: 29-09-2012
DOI: 10.1007/S00467-012-2306-6
Abstract: Genetic etiology comprises a significant proportion of renal disease in childhood. Completion of the Human Genome Project and increased genetic testing has assisted with the increased recognition of a genetic basis to many renal disorders. Australia and New Zealand have a relatively stable but erse population, with eight major pediatric nephrology referral centers, which allow ascertainment of disease frequency. To determine prevalence, pediatric nephrologists at the eight centers in Australia and New Zealand were surveyed on their estimated number of patients with renal disease of genetic etiology over a 10-year period. Disease prevalence was calculated using combined national population data. The overall prevalence of genetic kidney disease in children in Australia and New Zealand is 70.6 children per million age-representative population. Congenital anomalies of the kidney and urinary tract (CAKUT) and steroid-resistant nephrotic syndrome (SRNS) are the most frequent, with a prevalence of 16.3 and 10.7, respectively, per million children. We find a similar prevalence of genetic renal disorders in Australia and New Zealand to those reported in other countries. This is likely to be due to inclusion of children with all forms of renal disease rather than being limited to those with renal impairment.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 27-08-2019
DOI: 10.2215/CJN.03200319
Abstract: The burden of infectious disease is high among kidney transplant recipients because of concomitant immunosuppression. In this study the incidence of infectious-related mortality and associated factors were evaluated. In this registry-based retrospective, longitudinal cohort study, recipients of a first kidney transplant in Australia and New Zealand between 1997 and 2015 were included. Cumulative incidence of infectious-related mortality was estimated using competing risk regression (using noninfectious mortality as a competing risk event), and compared with age-matched, populated-based data using standardized incidence ratios. Among 12,519 patients, (median age 46 years, 63% men, 15% diabetic, 6% Indigenous ethnicity), 2197 (18%) died, of whom 416 (19%) died from infection. The incidence of infection-related mortality during the study period (1997–2015) was 45.8 (95% confidence interval [95% CI], 41.6 to 50.4) per 10,000 patient-years. The incidence of infection-related mortality reduced from 53.1 (95% CI, 45.0 to 62.5) per 10,000 person-years in 1997–2000 to 43.9 (95% CI, 32.5 to 59.1) per 10,000 person-years in 2011–2015 ( P .001) Compared with the age-matched general population, kidney transplant recipients had a markedly higher risk of infectious-related death (standardized incidence ratio, 7.8 95% CI, 7.1 to 8.6). Infectious mortality was associated with older age (≥60 years adjusted subdistribution hazard ratio [SHR], 4.16 95% CI, 2.15 to 8.05 reference 20–30 years), female sex (SHR, 1.62 95% CI, 1.19 to 2.29), Indigenous ethnicity (SHR, 2.87 95% CI, 1.84 to 4.46 reference white), earlier transplant era (2011–2015: SHR, 0.39 95% CI, 0.20 to 0.76 reference 1997–2000), and use of T cell–depleting therapy (SHR, 2.43 95% CI, 1.36 to 4.33). Live donor transplantation was associated with lower risk of infection-related mortality (SHR, 0.53 95% CI, 0.37 to 0.76). Infection-related mortality in kidney transplant recipients is significantly higher than the general population, but has reduced over time. Risk factors include older age, female sex, Indigenous ethnicity, T cell–depleting therapy, and deceased donor transplantation. This article contains a podcast at edia odcast/CJASN/2019_08_27_CJN03200319.mp3
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-01-2013
Publisher: Elsevier BV
Date: 2013
DOI: 10.1038/KI.2012.304
Abstract: Socioeconomic disadvantage has been linked to reduced access to kidney transplantation. To understand and address potential barriers to transplantation, we used the Australia and New Zealand Dialysis and Transplant Registry and examined primary kidney-only transplantation among adult non-Indigenous patients who commenced chronic renal replacement therapy in Australia during 2000-2010. Socioeconomic status was derived from residential postcodes using standard indices. Among the 21,190 patients who commenced renal replacement therapy, 4105 received a kidney transplant (2058 from living donors (660 preemptive) or 2047 from deceased donors) by the end of 2010. Compared with the most socioeconomic disadvantaged quartile, patients from the most advantaged quartile were more likely to receive a preemptive transplant (relative rate 1.93), and more likely to receive a living-donor kidney (adjusted subhazard ratio 1.34) after commencing dialysis. Socioeconomic status was not associated with deceased-donor transplantation. Thus, the association between socioeconomic status and living- but not deceased-donor transplantation suggests that potential donors (rather than recipients) from disadvantaged areas may face barriers to donation. Although the deceased-donor organ allocation process appears essentially equitable, it differs between Australian states.
Publisher: Wiley
Date: 27-10-2013
DOI: 10.1111/PETR.12167
Abstract: PTLD is a potentially life-limiting complication of pediatric transplantation. Previous registry-based studies in renal transplantation have suggested a link between rhGH use and PTLD. In this study, demographic and transplant data on those aged <18 yr and transplanted between 1991 and 2008 were collected from the ANZDATA Registry. Associations between gender, age at time of transplant, recipient CMV and EBV status, use of monoclonal antibody therapy, and use of rhGH were studied as potential predictors of PTLD. Among 650 transplants, there were 20 cases (3.1%) of PTLD, with half presenting within two yr post-transplant. Eight patients exposed to rhGH at any time developed PTLD, and this association was not statistically significant (RR = 1.5[0.6-3.4], p = 0.36). On multivariate analysis, there were no significant predictors for PTLD. In this study, previously identified potential risk factors were not identified as significant predictors for the development of PTLD. Although limited s le size may affect our ability to infer safety, this large retrospective cohort study does not suggest an increased risk of PTLD in pediatric kidney transplant recipients who received rhGH treatment.
Publisher: SAGE Publications
Date: 07-2015
Abstract: The aim of the present study was to investigate the relationship between socio-economic status (SES) and peritoneal dialysis (PD)-related peritonitis. Associations between area SES and peritonitis risk and outcomes were examined in all non-indigenous patients who received PD in Australia between 1 October 2003 and 31 December 2010 (peritonitis outcomes). SES was assessed by deciles of postcode-based Australian Socio-Economic Indexes for Areas (SEIFA), including Index of Relative Socio-economic Disadvantage (IRSD), Index of Relative Socio-economic Advantage and Disadvantage (IRSAD), Index of Economic Resources (IER) and Index of Education and Occupation (IEO). 7,417 patients were included in the present study. Mixed-effects Poisson regression demonstrated that incident rate ratios for peritonitis were generally lower in the higher SEIFA-based deciles compared with the reference (decile 1), although the reductions were only statistically significant in some deciles (IRSAD deciles 2 and 4 – 9 IRSD deciles 4 – 6 IER deciles 4 and 6 IEO deciles 3 and 6). Mixed-effects logistic regression showed that lower probabilities of hospitalization were predicted by relatively higher SES, and lower probabilities of peritonitis-associated death were predicted by less SES disadvantage status and greater access to economic resources. No association was observed between SES and the risks of peritonitis cure, catheter removal and permanent hemodialysis (HD) transfer. In Australia, where there is universal free healthcare, higher SES was associated with lower risks of peritonitis-associated hospitalization and death, and a lower risk of peritonitis in some categories.
Publisher: Elsevier BV
Date: 2013
DOI: 10.1053/J.AJKD.2012.07.008
Abstract: There has been little study to date of daily variation in cardiac death in dialysis patients and whether such variation differs according to dialysis modality and session frequency. Observational cohort study using ANZDATA (Australia and New Zealand Dialysis and Transplant) Registry data. All adult patients with end-stage kidney failure treated by dialysis in Australia and New Zealand who died between 1999 and 2008. Timing of death (day of week), dialysis modality, hemodialysis (HD) session frequency, and demographic, clinical, and facility variables. Cardiac and noncardiac mortality. 14,636 adult dialysis patients died during the study period (HD, n = 10,338 peritoneal dialysis [PD], n = 4,298). Cardiac death accounted for 40% of deaths and was significantly more likely to occur on Mondays in in-center HD patients receiving 3 or fewer dialysis sessions per week (n = 9,503 adjusted OR, 1.26 95% CI, 1.14-1.40 P < 0.001 compared with the mean odds of cardiac death for all days of the week). This daily variation in cardiac death was not seen in PD patients, in-center HD patients receiving more than 3 sessions per week (n = 251), or home HD patients (n = 573). Subgroup analyses showed that deaths related to hyperkalemia and myocardial infarction also were associated with daily variation in risk in HD patients. This pattern was not seen for vascular, infective, malignant, dialysis therapy withdrawal, or other deaths. Limited covariate adjustment. Residual confounding and coding bias could not be excluded. Possible type 2 statistical error due to limited s le size of home HD and enhanced-frequency HD cohorts. Daily variation in the pattern of cardiac deaths was observed in HD patients receiving 3 or fewer dialysis sessions per week, but not in PD, home HD, and HD patients receiving more than 3 sessions per week.
Publisher: Elsevier BV
Date: 12-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2021
Abstract: This study examined patient and center factors associated with arteriovenous fistula/graft access use at hemodialysis commencement. Arteriovenous access use at hemodialysis commencement varied four-fold from 15% to 62% (median 39%) across centers. There is substantial variability in arteriovenous access use across centers. Commencing hemodialysis (HD) with an arteriovenous access is associated with superior patient outcomes compared with a catheter, but the majority of patients in Australia and New Zealand initiate HD with a central venous catheter. This study examined patient and center factors associated with arteriovenous fistula/graft access use at HD commencement. We included all adult patients starting chronic HD in Australia and New Zealand between 2004 and 2015. Access type at HD initiation was analyzed using logistic regression. Patient-level factors included sex, age, race, body mass index (BMI), smoking status, primary kidney disease, late nephrologist referral, comorbidities, and prior RRT. Center-level factors included size transplant capability home HD proportion incident peritoneal dialysis (average number of patients commencing RRT with peritoneal dialysis per year) mean weekly HD hours average blood flow and achievement of phosphate, hemoglobin, and weekly Kt/V targets. The study included 27,123 patients from 61 centers. Arteriovenous access use at HD commencement varied four-fold from 15% to 62% (median 39%) across centers. Incident arteriovenous access use was more likely in patients aged 51–72 years, males, and patients with a BMI of kg/m 2 and polycystic kidney disease but use was less likely in patients with a BMI of .5 kg/m 2 , late nephrologist referral, diabetes mellitus, cardiovascular disease, chronic lung disease, and prior RRT. Starting HD with an arteriovenous access was less likely in centers with the highest proportion of home HD, and no center factor was associated with higher arteriovenous access use. Adjustment for center-level characteristics resulted in a 25% reduction in observed intercenter variability of arteriovenous access use at HD initiation compared with the model adjusted for only patient-level characteristics. This study identified several patient and center factors associated with incident HD access use, yet these factors did not fully explain the substantial variability in arteriovenous access use across centers.
Publisher: Wiley
Date: 02-05-2020
DOI: 10.1111/NEP.13570
Abstract: Involving consumers (patients, carers and family members) across all stages of research is gaining momentum in the nephrology community. Scientific meetings present a partnership opportunity with consumers for dissemination of research findings. The Better Evidence and Translation in Chronic Kidney Disease (BEAT-CKD) research collaboration, in partnership with Kidney Health Australia, convened two consumer sessions at the 54th Australian and New Zealand Society of Nephrology Annual Scientific Meeting held in September 2018. The educational objectives, topics and session formats were informed by members of the Better Evidence and Translation-Chronic Kidney Disease Consumer Advisory Board (which at the time comprised 36 consumers from around Australia with varied experience of kidney disease). Patients, health professionals and researchers facilitated and presented at the sessions. In-person and live-streaming attendance options were available, with over 400 total participants across the two sessions. Sessions were also video recorded for dissemination and later viewing. Evaluations demonstrated consumers found the presentations informative, relevant and accessible. Attendees indicated strong interest in participating in similar sessions at future scientific meetings. We propose a framework for partnering with consumers as organisers, facilitators, speakers and attendees at scientific meetings in nephrology.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2013
DOI: 10.2215/CJN.08770812
Abstract: This study aimed to evaluate dialysis and transplant outcomes of patients with ESRD secondary to ANCA-associated vasculitis (AAV). All ESRD patients who commenced renal replacement therapy in Australia and New Zealand between 1996 and 2010 were included. Outcomes were assessed by Kaplan–Meier, multivariable Cox regression, and competing-risks regression survival analyses. Of 36,884 ESRD patients, 228 had microscopic polyangiitis (MPA) and 221 had granulomatosis with polyangiitis (GPA). Using competing-risks regression, compared with other causes of ESRD, MPA patients (hazard ratio [HR], 0.89 95% confidence interval [95% CI], 0.73–1.08 P =0.24) and GPA patients (HR, 0.94 95% CI, 0.74–1.19 P =0.62) experienced comparable survival on dialysis. Forty-six MPA patients (21%) and 47 GPA (20%) patients received 98 renal allografts. Respective 10-year first graft survival rates in MPA, GPA, and non-AAV patients were 50%, 62%, 70%, whereas patient survival rates were 68%, 85% and 83%, respectively. Compared with non-AAV patients, MPA transplant recipients had higher risks of graft failure (HR, 1.87 95% CI, 1.07–3.25 P =0.03) and death (HR, 1.94 95% CI, 1.02–3.69 P =0.04), whereas GPA transplant recipients experienced comparable renal allograft survival (HR, 0.91 95% CI, 0.43–1.93 P =0.81) and patient survival (HR, 0.58 95% CI, 0.23–2.27 P =0.58). AAV recurrence was observed in two renal allografts (2%). Compared with ESRD patients without AAV, those with GPA have comparable renal replacement therapy outcomes, whereas MPA patients have comparable dialysis survival but poorer renal transplant allograft and patient survival rates.
Publisher: Oxford University Press (OUP)
Date: 23-08-2012
DOI: 10.1093/NDT/GFS361
Abstract: Socio-economic disadvantage has been linked to higher incidence of end-stage kidney disease in developed countries. Associations between socio-economic status (SES) and incidence of renal replacement therapy (RRT) have not been explored for different kidney diseases, genders or age groups in a country with universal access to healthcare. We investigated the incidence of non-indigenous patients commencing RRT in Australia in 2000-09, using the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Patient postcodes were grouped into deciles using a standard SES index. We analysed incidence by five groups of kidney diseases, age groups, gender and geographic remoteness. Incidence of RRT decreased with increasing area advantage. Differences were most evident for the most disadvantaged areas [markedly increased burden incident rate ratio (IRR) 1.27 95% confidence interval (CI) 1.18-1.38] and most advantaged decile (decreased burden, IRR 0.76 95% CI 0.72-0.81), compared with decile 5. Patients with diabetic nephropathy showed the greatest disparities: residents of the most disadvantaged decile were 2.38 (95% CI 2.09-2.71) times more at risk than the most advantaged decile. Congenital and genetic kidney diseases showed lesser gradients-the most disadvantaged decile was 1.28 times (95% CI 0.98-1.68) more at risk. SES was not associated with incidence for patients older than 69 years. These SES gradients existed, despite all Australians having access to healthcare. Diseases associated with lifestyle show the greatest gradients with SES.
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1111/AJT.15656
Abstract: In 2016, Australia began reporting the Kidney Donor Performance Index (KDPI) with all deceased donor kidney transplant offers despite this not being used in organ allocation rules, offering a unique opportunity to explore the "labeling effect" of KDPI reporting. We reviewed all kidneys retrieved for transplant in Australia from 2015 to 2018 and analyzed the association of KDPI reporting with organ nonutilization, number of offer declines, and donor/recipient age and longevity matching. Analyses were stratified by organ failure risk: higher risk (KDPI > 80%), standard risk (KDPI 20% to 79%), and lower risk (KDPI 0% to 20%). There was no significant difference in organ nonutilization post KDPI reporting either overall or for higher-risk kidneys. KDPI reporting was associated with an increase in offer declines for both higher-risk (incidence risk ratio 1.45, P = .007) and standard-risk (incidence risk ratio 1.22, P = .021) kidneys but not for lower-risk organs. There was a significant increase in recipient age and expected posttransplant survival score for higher-risk kidneys but no differences among other groups. We conclude that although KDPI reporting in Australia has been associated with an increased number of offer declines for higher-risk kidneys, this has not resulted in increased nonutilization and may have contributed to more appropriate use of these organs.
Publisher: Elsevier BV
Date: 04-2013
DOI: 10.1016/J.TRRE.2013.01.003
Abstract: Transplant registries are a proven valuable source of data about transplantation. The inclusion of all transplants conducted in a region or country provides a different perspective from that of other observational studies. They allow examination of activity levels and trends, provide descriptions of outcomes which avoid the selection bias inherent in randomized clinical trials and facilitate hypothesis-generating studies. Examination of rare or unusual diseases and their outcomes is another area of strength. The models and structures of registries vary throughout the world. In Australia and New Zealand, kidney transplant outcomes are combined with dialysis in the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Deceased solid-organ donor activity is recorded in the Australia and New Zealand Organ Donor (ANZOD) Registry. Both of these registries are conducted and governed along similar lines. Key factors include strong clinical links in data collection and governance, and the involvement of contributors in a wide variety of activities and output.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2014
DOI: 10.2215/CJN.09730913
Publisher: Elsevier BV
Date: 04-2021
Publisher: Elsevier BV
Date: 07-2023
Publisher: Wiley
Date: 02-2021
DOI: 10.1111/AJR.12693
Publisher: Frontiers Media SA
Date: 14-07-2012
DOI: 10.1111/J.1432-2277.2012.01528.X
Abstract: The association between pretransplant dialysis modality and transplant outcomes remains inconsistent. The aim of this study is to address the association between alteration in dialysis modality and post-transplant outcomes. Using Australia and New Zealand Dialysis and Transplant Registry, primary live- and deceased-donor renal transplant recipients (RTR) between 1997 and 2009 were examined. Pre-emptive and multiple-organ transplants were excluded. The association between initial and pretransplant dialysis modality and transplant outcomes were examined. Of the 6701 RTR, 18.6% were initiated-maintained on peritoneal dialysis pretransplant (PD-PD), 9.2% were initiated on PD, but maintained on haemodialysis (HD) pretransplant (PD-HD), 63.3% were HD-HD and 8.9% were HD-PD. PD-HD [odds ratio(OR)1.44, 95% CI 1.21,1.72] and HD-HD (OR1.25, 95% CI 1.12,1.41) were associated with a significantly greater risk of slow graft function compared with the overall mean of the groups, whereas a change in initial dialysis modality from HD to pretransplant PD was associated with higher risk of overall graft failure [hazard ratio(HR)1.19, 95% CI 1.04,1.36) and recipient death (HR1.34, 95% CI 1.13,1.59). Our registry analysis suggest that dialysis modality pretransplant may affect transplant outcomes and future studies evaluating patient selection, choice of modality and/or potential interventions in the pre and post-transplant period may have a beneficial effect on post-transplant outcomes.
Publisher: CMA Joule Inc.
Date: 02-12-2013
DOI: 10.1503/CMAJ.131605
Publisher: Springer Science and Business Media LLC
Date: 19-10-2023
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2013
Publisher: SAGE Publications
Date: 2013
Abstract: The impact of climatic variations on peritoneal dialysis (PD)–related peritonitis has not been studied in detail. The aim of the current study was to determine whether various climatic zones influenced the probability of occurrence or the clinical outcomes of peritonitis. Using ANZDATA registry data, the study in cluded all Australian patients receiving PD between 1 October 2003 and 31 December 2008. Climatic regions were defined according to the Köppen classification. The overall peritonitis rate was 0.59 episodes per patient–year. Most of the patients lived in Temperate regions (65%), with others residing in Subtropical (26%), Tropical (6%), and Other climatic regions (Desert, 0.6% Grassland, 2.3%). Compared with patients in Temperate regions, those in Tropical regions demonstrated significantly higher overall peritonitis rates and a shorter time to a first peritonitis episode [adjusted hazard ratio: 1.15 95% confidence interval (CI): 1.01 to 1.31]. Culture-negative peritonitis was significantly less likely in Tropical regions [adjusted odds ratio (OR): 0.42 95% CI: 0.25 to 0.73] its occurrence in Subtropical and Other regions was comparable to that in Temperate regions. Fungal peritonitis was independently associated with Tropical regions (OR: 2.18 95% CI: 1.22 to 3.90) and Other regions (OR: 3.46 95% CI: 1.73 to 6.91), where rates of antifungal prophylaxis were also lower. Outcomes after first peritonitis episodes were comparable in all groups. Tropical regions were associated with a higher overall peritonitis rate (including fungal peritonitis) and a shorter time to a first peritonitis episode. Augmented peritonitis prophylactic measures such as antifungal therapy and exit-site care should be considered in PD patients residing in Tropical climates.
Publisher: Springer Science and Business Media LLC
Date: 09-08-2013
DOI: 10.1007/S00467-013-2572-Y
Abstract: Transplantation is the preferred treatment for children with end-stage kidney disease (ESKD). Pre-emptive transplants, those from live donors and with few human leukocyte antigen (HLA) mismatches provide the best outcomes. Studies into disparities in paediatric transplantation to date have not adequately disentangled different transplant types. We studied a retrospective cohort of 823 patients aged <18 years who started renal replacement therapy (RRT) in Australia 1990-2011, using the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). The primary outcomes were time to first kidney transplant and kidney donor type (deceased or living), analysed using competing risk regression. Caucasian patients were most likely to receive any transplant, due largely to disparities in live donor transplantation. No Indigenous patients received a pre-emptive transplant. Indigenous patients were least likely to receive a transplant from a live donor (sub-hazard ratio 0.41, 95 % confidence interval 0.20-0.82, compared to Caucasians). Caucasian recipients had fewer HLA mismatches, were less sensitised and were more likely to have kidney diseases that could be diagnosed early or progress slowly. Caucasian paediatric patients are more likely to receive optimum treatment--a transplant from a living donor and fewer HLA mismatches. Further work is required to identify and address barriers to live donor transplantation among minority racial groups.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-05-2023
DOI: 10.2215/CJN.0000000000000155
Abstract: Transplanted women have high rates of preecl sia. However, determinants of preecl sia and association with graft survival and function remain uncertain. We aimed to determine rates of preecl sia and its association with kidney transplant survival and function. This was a retrospective cohort study analyzing postkidney transplantation pregnancies (≥20 weeks gestation) from the Australia and New Zealand Dialysis and Transplant Registry (2000–2021). Graft survival was assessed in three models accounting for repeated pregnancies and episodes of preecl sia. Preecl sia status was captured in 357 of 390 pregnancies and occurred in 133 pregnancies (37%). The percentage of pregnancies reported to have preecl sia rose from 27% in 2000–2004 to 48% from 2018 to 2021. Reported prior exposure to calcineurin inhibitors was high overall and higher in women who had preecl sia (97% versus 88%, P = 0.005). Seventy-two (27%) graft failures were identified after a pregnancy, with a median follow-up of 8.08 years. Although women with preecl sia had higher median preconception serum creatinine concentration (1.24 [interquartile range, 1.00–1.50] versus 1.13 [0.99–1.36] mg/dl P = 0.02), in all survival models, preecl sia was not associated with higher death-censored graft failure. In multivariable analysis of maternal factors (age, body mass index, primary kidney disease and transplant-pregnancy interval, preconception serum creatinine concentration, era of birth event, and tacrolimus or cyclosporin exposure), only era and preconception serum creatinine concentration ≥1.24 mg/dl (odds ratio, 2.48 95% confidence interval [CI], 1.19 to 5.18) were associated with higher preecl sia risk. Both preconception eGFR ml/min per 1.73 m 2 (adjusted hazard ratio [HR], 5.55 95% CI, 3.27 to 9.44, P 0.001) and preconception serum creatinine concentration ≥1.24 mg/dl (adjusted HR, 3.06 95% CI, 1.77 to 5.27, P 0.001) were associated with a higher risk of graft failure even after adjusting for maternal characteristics. In this large and contemporaneous registry cohort, preecl sia was not associated with worse graft survival or function. Preconception kidney function was the main determinant of graft survival.
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1053/J.AJKD.2012.10.012
Abstract: To date, incidence data for kidney failure in Australia have been available for only those who start renal replacement therapy (RRT). Information about the total incidence of kidney failure, including non-RRT-treated cases, is important to help understand the burden of kidney failure in the community and the characteristics of patients who die without receiving treatment. Data linkage study of national observational data sets. All incident treated cases recorded in the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) probabilistically linked to incident untreated kidney failure cases derived from national death registration data for 2003-2007. Age, sex, and year. Kidney failure, a combination of incident RRT or death attributed to kidney failure (without RRT). Total incidence of kidney failure (treated and untreated) and treatment rates. There were 21,370 incident cases of kidney failure in 2003-2007. The incidence rate was 20.9/100,000 population (95% CI, 18.3-24.0) and was significantly higher among older people and males (26.1/100,000 population 95% CI, 22.5-30.0) compared with females (17.0/100,000 population 95% CI, 14.9-19.2). There were similars number of treated (10,949) and untreated (10,421) cases, but treatment rates were influenced highly by age. More than 90% of cases in all age groups between 5 and 60 years were treated, but this percentage decreased sharply for older people only 4% of cases in persons 85 years or older were treated (ORs for no treatment of 115 [95% CI, 118-204] for men ≥80 years and 400 [95% CI, 301-531] for women ≥80 years compared with women who were <50 years). Cross-sectional design, reliance on accurate coding of kidney failure in death registration data. Almost all Australians who develop kidney failure at younger than 60 years receive RRT, but treatment rates decrease substantially above that age.
Publisher: Elsevier BV
Date: 02-2013
DOI: 10.1111/AJT.12054
Publisher: MDPI AG
Date: 30-06-2023
DOI: 10.3390/LIFE13071492
Abstract: Background: Diabetic kidney disease (DKD), a common cause of CKD and kidney failure, is usually diagnosed clinically. However, there is little evidence comparing the performance of a clinical diagnosis to biopsy-proven diagnosis. Purpose of the study: Diagnostic performance of a clinical diagnosis was determined in a group of patients with diabetes and chronic kidney disease who underwent kidney biopsy after an initial clinical diagnosis. Methods: A data analysis of 54 patients who were part of a study cohort for a prospective analysis of cardiovascular and kidney outcomes and who had undergone kidney biopsy after an initial clinical diagnosis of DKD or non-DKD (NDKD) at enrolment was used. We determined the sensitivity, specificity, and positive and negative predictive values of a clinical diagnosis of DKD. Results: A total of 37 of 43 patients clinically diagnosed with DKD also had biopsy-proven DKD, whilst only 1 of 11 patients who had clinically diagnosed NDKD had biopsy-proven DKD. Sensitivity was 97.4%, specificity was 62.5%, positive predictive value 86%, and negative predictive value 90.9%. Comparable values were obtained when analysis was restricted to those with primary rather than secondary diagnosis of DKD or when restricted to those with only DKD found at biopsy. Conclusion: A clinical diagnosis of DKD has high sensitivity and is unlikely to overlook cases but may lead to overdiagnosis.
Publisher: Oxford University Press (OUP)
Date: 25-11-2013
DOI: 10.1093/NDT/GFS492
Abstract: There are few reports regarding the long-term renal replacement therapy (RRT) outcomes of amyloidosis. In this retrospective, multi-centre, multi-country registry analysis, all patients with and without amyloidosis who commenced RRT for end-stage renal failure (ESRF) in Australia and New Zealand between 1963 and 2010 were included. Of 58 422 patients who underwent RRT during the study period, 490 (0.8%) had ESRF secondary to amyloidosis. The median survival of amyloidosis patients on dialysis (2.09 years, 95% CI 1.85-2.32 years) was significantly inferior to that of patients with other causes of ESRF (4.45 years, 95% CI 4.39-4.51 years) (log-rank score 242, P < 0.001). The survival of amyloidosis patients receiving peritoneal dialysis (1.9 years, 95% CI 1.58-2.22) was comparable with those receiving haemodialysis (2.17 years, 95% CI 1.89-2.45) (P = 0.18). Fifty-three (13.8%) amyloidosis patients died of amyloidosis complications. Forty-six patients underwent renal transplantation with first graft survival rates of 45% at 5 years and 26% at 10 years. Nine (16.4%) patients experienced amyloidosis recurrence in their allografts, which led to graft failure in six patients. ESRF patients with amyloidosis experienced inferior median first renal allograft survival (4.55 years, 95% CI 1.96-7.15 versus 10.7 years, 95% CI 10.5-11.0, P = 0.001) and transplant patient survival (6.03 years, 95% CI 2.71-9.36 versus 16.8 years, 95% CI 16.4-17.1, P < 0.001) compared with patients with other causes of ESRF. Respective 10-year patient survival rates were 37 and 69%. Amyloidosis was associated with poor patient survival following dialysis and/or renal transplantation, poor renal allograft survival and a significant incidence of disease recurrence in the allograft. An appreciable proportion of amyloid ESRF patients died of amyloidosis-related complications.
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1111/AJT.16898
Abstract: Deceased donor kidneys are a scarce community resource therefore, the principles underpinning organ allocation should reflect societal values. This study aimed to elicit community and healthcare professional preferences for principles guiding the allocation of kidneys from deceased donors and compare how these differed across the populations. A best-worst scaling survey including 29 principles in a balanced incomplete block design was conducted among a representative s le of the general community (n = 1237) and healthcare professionals working in transplantation (n = 206). Sequential best-worst multinomial logistic regression was used to derive scaled preference scores (PS) (range 0-100). Thematic analysis of free text responses was performed. Five of the six most valued principles among members of the community related to equity, including priority for the longest waiting (PS 100), difficult to transplant (PS 94.5) and sickest (PS 93.9), and equitable access for men and women (PS 94.0), whereas the top four principles for healthcare professional focused on maximizing utility (PS 89.9-100). Latent class analysis identified unmeasured class membership among community members. There are discordant views between community members and healthcare professionals. These should be considered in the design, evaluation, and implementation of deceased donor kidney allocation protocols.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2020
Abstract: Patients with hemodialysis central venous catheters (HD CVCs) are susceptible to health care-associated infections, particularly hemodialysis catheter-related bloodstream infection (HD-CRBSI), which is associated with high mortality and health care costs. There have been few systematic attempts to reduce this burden and clinical practice remains highly variable. This manuscript will summarize the challenges in preventing HD-CRBSI and describe the methodology of the REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach (REDUCCTION) trial. The REDUCCTION trial is a stepped-wedge cluster randomized trial of a suite of clinical interventions aimed at reducing HD-CRBSI across Australia. It clusters the intervention at the renal-service level with implementation randomly timed across three tranches. The primary outcome is the effect of this intervention upon the rate of HD-CRBSI. Patients who receive an HD CVC at a participating renal service are eligible for inclusion. A customized data collection tool allows near-to-real-time reporting of the number of active catheters, total exposure to catheters over time, and rates of HD-CRBSI in each service. The interventions are centered around the insertion, maintenance, and removal of HD CVC, informed by the most current evidence at the time of design (mid-2018). A total of 37 renal services are participating in the trial. Data collection is ongoing with results expected in the last quarter of 2020. The baseline phase of the study has collected provisional data on 5385 catheters in 3615 participants, representing 603,506 days of HD CVC exposure. The REDUCCTION trial systematically measures the use of HD CVCs at a national level in Australia, accurately determines the rate of HD-CRBSI, and tests the effect of a multifaceted, evidence-based intervention upon the rate of HD-CRBSI. These results will have global relevance in nephrology and other specialties commonly using CVCs.
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1038/KI.2012.375
Abstract: There are few reports regarding outcomes of anti-glomerular basement membrane (GBM) disease in patients who underwent renal replacement therapy. To help define this we studied all patients with anti-GBM disease who started renal replacement therapy for end-stage renal disease (ESRD) in Australia and New Zealand (ANZDATA Registry) between 1963 and 2010 encompassing 449 in iduals (0.8 percent of all ESRD patients). The median survival on dialysis was 5.93 years with death predicted by older age and a history of pulmonary hemorrhage. Thirteen patients recovered renal function, although 10 subsequently experienced renal death after a median period of 1.05 years. Of the 224 patients who received their first renal allograft, the 10-year median patient and renal allograft survival rates were 86% and 63%, respectively. Six patients experienced anti-GBM disease recurrence in their allograft, which led to graft failure in two. Using multivariable Cox regression analysis, patients with anti-GBM disease had comparable survival on dialysis or following renal transplantation (hazard ratios of 0.86 and 1.03, respectively) compared to those with ESRD due to other causes. Also, renal allograft survival (hazard ratio of 1.03) was not altered compared to other diseases requiring a renal transplant. Thus, anti-GBM disease was an uncommon cause of ESRD, and not associated with altered risks of dialysis, transplant or first renal allograft survival. Death on dialysis was predicted by older age and a history of pulmonary hemorrhage.
Publisher: Springer Science and Business Media LLC
Date: 12-2013
Publisher: JMIR Publications Inc.
Date: 16-12-2022
DOI: 10.2196/39685
Abstract: Dialysis for end-stage kidney disease (ESKD) is the leading cause of hospitalization among Aboriginal and Torres Strait Islander in iduals in Australia. Poor oral health is commonly the only obstacle preventing Aboriginal and Torres Strait Islander people with ESKD in Australia from receiving kidney transplant. This study aims to improve access, provision, and delivery of culturally secure dental care for Aboriginal and Torres Strait Islander in iduals with ESKD in South Australia through the following objectives: investigate the facilitators of and barriers to providing oral health care to Aboriginal and Torres Strait Islander patients with ESKD in South Australia investigate the facilitators of and barriers to maintaining oral health among Aboriginal and Torres Strait Islander people with ESKD in South Australia facilitate access to and completion of culturally secure dental care for Aboriginal and Torres Strait Islander in iduals with ESKD and their families provide oral health promotion training for Aboriginal health workers (AHWs) at each of the participating Aboriginal Community Controlled Health Services, with a specific emphasis on oral health needs of patients with ESKD generate co-designed strategies to better facilitate access to and provision of culturally secure dental services for Aboriginal and Torres Strait Islander people living with ESKD and evaluate participant progress and AHW oral health training program. This collaborative study is ided into 3 phases: exploratory phase (baseline), intervention phase (baseline), and evaluation phase (after 6 months). The exploratory phase will involve collaboration with stakeholders in different sectors to identify barriers to providing oral health care the intervention phase will involve patient yarns, patient oral health journey mapping, clinical examinations, culturally secure dental care provision, and strategy implementation workshops and the evaluation phase will involve 6-month follow-up clinical examinations, participant evaluations of dental care provision, and AHW evaluation of oral health training. Stakeholder interviews were initiated in November 2021, and participant recruitment commenced in February 2022. The first results are expected to be submitted for publication in December 2022. Expected outcomes will identify the burden of oral disease experienced by Aboriginal and Torres Strait Islander people with ESKD in South Australia. Qualitative outcomes are expected to develop a deeper appreciation of the unique challenges regarding oral health for in iduals with ESKD. Through stakeholder engagement, responsive strategies and policies will be co-designed to address participant-identified and stakeholder-identified challenges to ensure accessibility to culturally secure dental services for Aboriginal and Torres Strait Islander in iduals with ESKD. PRR1-10.2196/39685
Publisher: Elsevier BV
Date: 10-2013
DOI: 10.1038/KI.2013.282
Abstract: Kidney transplant recipients of lower socioeconomic status (SES) or from lower-SES areas have comparatively poor graft survival. Whether this results in poorer patient survival after kidney transplantation was largely unknown. Begaj et al. demonstrate that kidney transplant recipients from deprived areas have higher mortality than patients from more advantaged areas in England. We found similar patterns in Australia. If such disparities are to be addressed, a better understanding of the mediating factors is required.
Publisher: Springer Science and Business Media LLC
Date: 25-06-2021
DOI: 10.1007/S15010-021-01599-5
Abstract: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69% at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23 85%), older adults (≥ 70 years: 61, 62, 65 90%), and women (66, 66, 64 90% vs. men 71, 70, 67 93%, each P 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men.
Publisher: Wiley
Date: 06-07-2017
DOI: 10.1111/NEP.12963
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2013
DOI: 10.2215/CJN.12361212
Abstract: The effect of biocompatible peritoneal dialysis (PD) solutions on PD-related peritonitis is unclear. This study sought to evaluate the relationship between use of biocompatible solutions and the probability of occurrence or clinical outcomes of peritonitis. The study included all incident Australian patients receiving PD between January 1, 2007, and December 31, 2010, using Australia and New Zealand Dialysis and Transplant Registry data. All multicompartment PD solutions of neutral pH were categorized as biocompatible solutions. The independent predictors of peritonitis and the use of biocompatible solutions were determined by multivariable, multilevel mixed-effects Poisson and logistic regression analysis, respectively. Sensitivity analyses, including propensity score matching, were performed. Use of biocompatible solutions gradually declined (from 7.5% in 2007 to 4.2% in 2010), with preferential use among smaller units and among younger patients without diabetes mellitus. Treatment with biocompatible solution was associated with significantly greater overall rate of peritonitis (0.67 versus 0.47 episode per patient-year incidence rate ratio, 1.49 95% confidence interval [CI], 1.19 to 1.89) and with shorter time to first peritonitis (hazard ratio [HR], 1.48 95% CI, 1.17 to 1.87), a finding replicated in propensity score–matched cohorts (HR, 1.36 95% CI, 1.09 to 1.71). In an observational registry study, use of biocompatible PD solutions was associated with higher overall peritonitis rates and shorter time to first peritonitis. Further randomized studies adequately powered for a primary peritonitis outcome are warranted.
Location: Australia
Location: Australia
No related grants have been discovered for Stephen McDonald.