ORCID Profile
0000-0002-5754-4821
Current Organisations
International Water Management Institute
,
Monash University
,
Alfred Health
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Publisher: AMPCo
Date: 08-2012
DOI: 10.5694/MJA11.11329
Abstract: The publication of the Australasian Creatinine Consensus Working Group's position statements in 2005 and 2007 resulted in automatic reporting of estimated glomerular filtration rate (eGFR) with requests for serum creatinine concentration in adults, facilitated the unification of units of measurement for creatinine and eGFR, and promoted the standardisation of assays. New advancements and continuing debate led the Australasian Creatinine Consensus Working Group to reconvene in 2010. The working group recommends that the method of calculating eGFR should be changed to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula, and that all laboratories should report eGFR values as a precise figure to at least 90 mL/min/1.73 m(2). Age-related decision points for eGFR in adults are not recommended, as although an eGFR < 60 mL/min/1.73 m(2) is very common in older people, it is nevertheless predictive of significantly increased risks of adverse clinical outcomes, and should not be considered a normal part of ageing.If using eGFR for drug dosing, body size should be considered, in addition to referring to the approved product information. For drugs with a narrow therapeutic index, therapeutic drug monitoring or a valid marker of drug effect should be used to in idualise dosing. The CKD-EPI formula has been validated as a tool to estimate GFR in some populations of non-European ancestry living in Western countries. Pending publication of validation studies, the working group also recommends that Australasian laboratories continue to automatically report eGFR in Aboriginal and Torres Strait Islander peoples. The working group concluded that routine calculation of eGFR is not recommended in children and youth, or in pregnant women. Serum creatinine concentration (preferably using an enzymatic assay for paediatric patients) should remain as the standard test for kidney function in these populations.
Publisher: Springer Science and Business Media LLC
Date: 11-02-2016
Publisher: Springer Science and Business Media LLC
Date: 03-05-2017
Publisher: Springer Science and Business Media LLC
Date: 17-06-2021
DOI: 10.1186/S12913-021-06612-Z
Abstract: Rates of end-stage kidney disease in Australia are highest in the Northern Territory (NT), with the burden of disease heaviest in remote areas. However, the high cost of delivering dialysis services in remote areas has resulted in centralisation, requiring many people to relocate for treatment. Patients argue that treatment closer to home improves health outcomes and reduces downstream healthcare use. Existing dialysis cost studies have not compared total health care costs associated with treatment in different locations. To estimate and compare, from a payer perspective, the observed health service costs (all cause hospital admissions, emergency department presentations and maintenance dialysis) associated with different dialysis models in urban, rural and remote locations. Using cost weights attributed to diagnostic codes in the NT Department of Health’s hospital admission data set (2008–2014), we calculated the mean (SD) total annual health service costs by dialysis model for 995 dialysis patients. Generalized linear modeling with bootstrapping tested the marginal cost differences between different explanatory variables to estimate ‘best casemix’/‘worst casemix’ cost scenarios. The mean annual patient hospital expenditure was highest for urban models at $97 928 (SD $21 261) and $43 440 (SD $5 048) and lowest for remote at $19 584 (SD $4 394). When combined with the observed maintenance dialysis costs, expenditure was the highest for urban models at $148 510 (SD $19 774). The incremental cost increase of dialysing in an urban area, compared with a rural area, for a relocated person from a remote area, was $5 648 more and increased further for those from remote and very remote areas to $10 785 and $15 118 respectively. This study demonstrates that dialysis treatment in urban areas for relocated people has health and cost implications that maybe greater than the cost of remote service delivery. The study emphasises the importance of considering all health service costs and cost consequences of service delivery models. Relocation for dialysis treatment has serious health and economic consequences. Relocated people have low dialysis attendance and high hospital costs in urban areas. While remote dialysis service models are more expensive than urban models, the comparative cost differences are significantly reduced when all health service costs are included. The delivery of equitable and accessible dialysis service models requires a holistic approach that incorporates the needs of the patient hence dialysis cost studies must consider the full range of cost impacts beyond the dialysis treatments alone.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2017
Publisher: Springer Science and Business Media LLC
Date: 19-05-2011
Publisher: Wiley
Date: 04-04-2014
DOI: 10.1111/DME.12426
Abstract: It has been proposed that the Chronic Kidney Disease Epidemiology Collaboration formula estimates glomerular filtration rate more accurately than the Modification of Diet in Renal Disease formula. With the very high incidence of diabetes and end-stage kidney disease in Indigenous Australians, accurate estimation of glomerular filtration rate is vital in early detection of kidney disease. We aimed to assess the performance of the Chronic Kidney Disease Epidemiology Collaboration, Modification of Diet in Renal Disease and Cockcroft-Gault formulas in Indigenous Australians with and without diabetes. Indigenous Australians with (n = 224) or without (n = 340) Type 2 diabetes had a reference glomerular filtration rate measure using plasma disappearance of iohexol (measured glomerular filtration rate) over 4 h. Serum creatinine was measured by an enzymatic method. Performance was assessed by bias (measured glomerular filtration rate - estimated glomerular filtration rate) and accuracy (percentage of estimated glomerular filtration rate within 30% of measured glomerular filtration rate). The median measured glomerular filtration rate (interquartile range) in participants with or without diabetes was 97 (68-119) and 108 (90-122) ml min(-1) 1.73 m(-2) , respectively. The Chronic Kidney Disease Epidemiology Collaboration formula had smaller bias and greater accuracy than the Modification of Diet in Renal Disease and Cockcroft-Gault formulas overall, for participants both with and without diabetes. However, for estimated glomerular filtration rate > 90 ml min(-1) 1.73 m(-2) , the Chronic Kidney Disease Epidemiology Collaboration formula had greater bias in participants with diabetes, underestimating measured glomerular filtration rate by 7.4 vs. 1.0 ml min(-1) 1.73 m(-2) in those without diabetes. The Chronic Kidney Disease Epidemiology Collaboration formula was less accurate across the whole range of estimated glomerular filtration rates in participants with vs. those without diabetes (87.1% vs. 93.3%). The Chronic Kidney Disease Epidemiology Collaboration formula outperforms the Modification of Diet in Renal Disease and Cockcroft-Gault formulas overall in Indigenous Australians with and without diabetes. However, the Chronic Kidney Disease Epidemiology Collaboration formula has greater bias in people with diabetes compared with those without diabetes, especially in those with normal renal function.
Publisher: Springer Science and Business Media LLC
Date: 16-07-2014
Publisher: AMPCo
Date: 03-2015
DOI: 10.5694/MJA14.00664
Abstract: To compare mortality rates for Indigenous and non-Indigenous Australians commencing renal replacement therapy (RRT) over time and by categories of remoteness of place of residence. An observational cohort study of Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) data on Indigenous and non-Indigenous Australians registered with ANZDATA who commenced RRT from 1 January 1995 to 31 December 2009 and were followed until 31 December 2011. Five-year all-cause mortality for Indigenous and non-Indigenous patients in three cohorts (1995-1999, 2000-2004 and 2005-2009) and five remoteness (of place of residence) categories. Indigenous patients were younger, more likely to have diabetes, be referred late and be from a more remote area than non-Indigenous patients. Age and comorbid conditions increased with successive cohorts for both groups. Unadjusted analysis (using the log-rank test) showed an increased risk of death for Indigenous patients in the 1995-1999 (P = 0.02) and 2000-2004 (P = 0.03) cohorts, but not for the 2005-2009 cohort (P = 0.7). However, a Cox proportional hazards model adjusted for covariates (age, sex, late referral and comorbid conditions [diabetes, coronary artery disease, peripheral vascular disease, cerebrovascular disease, lung disease], and body mass index 30 kg/m(2)) showed the following Indigenous:non-Indigenous hazard ratios (with 95% CIs) for major capital cities: 1995-1999, 1.47 (1.21-1.79) 2000-2004, 1.35 (1.12-1.63) and 2005-2009, 1.37 (1.14-1.66). Although unadjusted analysis suggests that the survival gap between Indigenous and non-Indigenous patients receiving RRT has closed, there remains a significant disparity in survival after adjusting for the variables considered in our study.
Publisher: Springer Science and Business Media LLC
Date: 24-02-2022
DOI: 10.1186/S12913-022-07628-9
Abstract: Aboriginal people in the Northern Territory (NT) suffer the heaviest burden of kidney failure in Australia with most living in remote areas at time of dialysis commencement. As there are few dialysis services in remote areas, many Aboriginal people are required to relocate often permanently, to access treatment. Missing dialysis treatments is not uncommon amongst Aboriginal patients but the relationship between location of dialysis service and dialysis attendance (and subsequent hospital use) has not been explored to date. To examine the relationships between location of dialysis service, dialysis attendance patterns and downstream health service use (overnight hospital admissions, emergency department presentations) among Aboriginal patients in the NT. Using linked hospital and dialysis registry datasets we analysed health service activity for 896 Aboriginal maintenance dialysis patients in the NT between 2008 and 2014. Multivariate linear regression and negative binomial regression analyses explored the associations between dialysis location, dialysis attendance and health service use. We found missing two or more dialysis treatments per month was more likely for Aboriginal people attending urban services and this was associated with a two-fold increase in the rate of hospital admissions and more than three-fold increase in ED presentations. However, we found higher dialysis attendance and lower health service utilisation for those receiving care in rural and remote settings. When adjusted for age, time on dialysis, region, comorbidities and residence pre-treatment, among Aboriginal people from remote areas, those dialysing in remote areas had lower rates of hospitalisations (IRR 0.56 P 0.001) when compared to those who relocated and dialysed in urban areas. There is a clear relationship between the provision and uptake of dialysis services in urban, rural and remote areas in the NT and subsequent broader health service utilisation. Our study suggests that the low dialysis attendance associated with relocation and care in urban models for Aboriginal people can potentially be ameliorated by access to rural and remote models and this warrants a rethinking of service delivery policy. If providers are to deliver effective and equitable services, the full range of intended and unintended consequences of a dialysis location should be incorporated into planning decisions.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 13-04-2016
DOI: 10.2215/CJN.09770915
Abstract: Indigenous Australians experience a heavy burden of CKD. To address this burden, the eGFR Follow-Up Study recruited and followed an Indigenous Australian cohort from regions of Australia with the greatest ESRD burden. We sought to better understand factors contributing to the progression of kidney disease. Specific objectives were to assess rates of progression of eGFR in Indigenous Australians with and without CKD and identify factors associated with a decline in eGFR. This observational longitudinal study of Indigenous Australian adults was conducted in sites. The baseline cohort was recruited from community and primary care clinic sites across five strata of health, diabetes status, and kidney function. Participants were then invited to follow up at 2–4 years if unavailable, vital status, progression to RRT, and serum creatinine were obtained from medical records. Primary outcomes were annual eGFR change and combined renal outcome (first of ≥30% eGFR decline with follow-up eGFR ml/min per 1.73 m 2 , progression to RRT, or renal death). Participants ( n =550) were followed for a median of 3.0 years. Baseline and follow-up eGFR (geometric mean [95% confidence interval], 83.9 (80.7 to 87.3) and 70.1 (65.9 to 74.5) ml/min per 1.73 m 2 , respectively. Overall mean annual eGFR change was −3.1 (−3.6 to −2.5) ml/min per 1.73 m 2 . Stratified by baseline eGFR (≥90, 60–89, ml/min per 1.73 m 2 ), annual eGFR changes were −3.0 (−3.6 to −2.4), −1.9 (−3.3 to −0.5), and −5.0 (−6.5 to −3.6) ml/min per 1.73 m 2 . Across baseline eGFR categories, annual eGFR decline was greatest among adults with baseline albumin-to-creatinine ratio (ACR) mg/g (30 mg/mmol). Baseline determinants of the combined renal outcome (experienced by 66 participants) were higher urine ACR, diabetes, lower measured GFR, and higher C-reactive protein. The observed eGFR decline was three times higher than described in nonindigenous populations. ACR was confirmed as a powerful predictor for eGFR decline across erse geographic regions.
Publisher: Wiley
Date: 07-05-2007
DOI: 10.1111/J.1440-1797.2007.00798.X
Abstract: Kidney transplant units in Australia are confined to large hospitals in major metropolitan areas, yet this may limit access and diminish outcomes in people who do not live in these large centres. The authors examined the viability of a kidney transplant unit located in northern Australia (NA), with particular emphasis on recipient outcomes and the number of donors. 'Northern Australia' was arbitrarily defined as 'north of the tropic of Capricorn' for Queensland and Western Australia and included the entire Northern Territory. Data on donors and transplant recipients were provided by ANZDATA and ANZOD registries, identified by postcode. Between 1998 and 2004 in NA there were 163 deceased donor kidneys and 97.5% of available organs were transplanted. There were no Aboriginal/Torres Strait Islander (ATSI) donors from NA. Recipients from NA in this time included 55 patients receiving living grafts and 156 receiving deceased donor grafts, of whom 36% were ATSI, making up half of the total ATSI transplanted in Australia during this time period. Compared with the rest of Australia, NA recipients were older, waited longer on dialysis, had longer ischaemic times and a greater number of human leucocyte antigen mismatches, and were more likely to be diabetic and obese. Despite the longer cold ischaemic time in NA recipients, no difference in immediate graft function was seen. ATSI recipients in NA, when compared with their southern Australian counterparts, had poorer patient survival (HR=3.19, 95% CI 1.44-7.08, P<0.001), but equivalent graft survival (HR=1.67, 95% CI 0.95-2.95, P=not significant) on multivariate analysis. Key factors that would influence feasibility of a Northern Australian transplant unit include adequate staffing, and support services in addition to currently available resources. Current donor numbers in NA are adequate for past recipients of kidney transplant, but may not cover future needs without a significant increase in donor rate. A transplant unit situated in northern Australian would require significant resources to ensure long-term viability and its effect on outcomes is uncertain.
Publisher: Elsevier BV
Date: 04-2014
Abstract: To examine the variation of chronic disease mortality by remoteness areas of Australia, including states and territories. Australian Bureau of Statistics (ABS) death registration data, by Statistical Local Area (SLA), were used to identify chronic disease mortality by remoteness category for states and territories and Australia. The analysis used multiple cause of death for six common chronic diseases: diabetes, ischaemic heart disease, stroke, hypertension, chronic obstructive pulmonary disease and renal disease. ABS correspondence files were used to adjust the SLA level death records and population. The chronic disease mortality rate for Australian residents living in a very remote area (512 per 100,000 persons) was respectively 1.3, 1.4, 1.5, and 1.6 times higher than Remote, Outer Regional, Inner Regional and Major Cities categories. This pattern was consistent for the two age groups of 35–64 years and 65 years and over, all six chronic diseases and all states and territories except Victoria. This study shows that chronic disease mortality increases with increasing relative remoteness. The results highlight the importance and opportunity to redress poorer health outcomes for rural and remote area populations. The study is limited by absence of reliable Indigenous identification in national death data.
Publisher: Wiley
Date: 17-12-2017
DOI: 10.1111/NEP.12956
Abstract: To describe the detailed associations of albuminuria among a contemporary cohort of Aboriginal and Torres Strait Islander people to inform strategies for chronic kidney disease prevention and management. A cross-sectional analysis of Indigenous participants of the eGFR Study. Clinical, biochemical and anthropometric measures were collected (including body-circumferences, blood pressure (BP) triglycerides, HbA1c, liver function tests, creatinine urine- microscopic-haem, albumin: creatinine ratio (ACR), prescriptions- angiotensin converting enzyme inhibitor or angiotensin receptor II antagonist (ACEI/ARB). Albuminuria and diabetes were defined by an ACR>3.0 mg/mmol, and HbA1c≥48 mmol/mol or prior history respectively. Waist: hip ratio (WHR), and estimated glomerular filtration rate (eGFR) were calculated. ACR was non-normally distributed a logarithmic transformation was applied (in base 2), with each unit increase in log2-albuminuria representing a doubling of ACR. 591 participants were assessed (71% Aboriginal, 61.6% female, mean age 45.1 years, BMI 30.2 kg/m Albuminuria is associated with diabetes, central obesity and haematuria. High ACEI/ARB prescribing for adults with diabetes and albuminuria was observed. Further understanding of the links between fat deposition, haematuria and albuminuria is required.
Publisher: MDPI AG
Date: 06-11-2019
Abstract: Background: Aboriginal people in rural and remote areas of the Northern Territory of Australia have suffered longstanding issues of homelessness and profound health and social inequities. The town and region of Katherine are particularly impacted by such inequities and have the highest rates of homelessness in Australia, composed almost entirely of Aboriginal people who represent 51% of the total population of 24,000 people. The region is serviced by a 60-bed hospital, and a small cohort of frequent attenders (FAs) represent 11% of the Emergency Department (ED) case load. The vast majority of FAs are Aboriginal and have very high burdens of social inequity and homelessness. FAs are a challenge to efficient and effective use of resources for most hospitals around the world, and investment in programs to address underlying social and chronic health issues contributing to frequent attendance have been demonstrated to be effective. Methods: These are the interim findings of a prospective cohort study using five sources of linked health and related data to evaluate a community-based case management pilot in a culturally competent framework to support frequent attenders to the Katherine Hospital ED. FAs were defined as people with six or more presentations in 12 preceding months. The intervention composed of a community-based case management program with a multi-agency service delivery addressing underlying vulnerabilities contributing to ED presentations. Results: Among this predominantly Aboriginal cohort (91%), there were high rates of homelessness (64%), food insecurity (60%) and alcohol misuse (64%), limited access to transport, and complex comorbidities (average of 2.8 chronic conditions per client). Following intervention, there was a statistically significant reduction in ED presentations (IRR 0.77, 95% CI 0.69–0.85), increased engagement with primary health care (IRR 1.90, 95% CI 1.78–2.03), and ambulance utilisation (IRR 1.21, 95% CI 1.07–1.38). Reductions in hospital admissions (IRR 0.93, 95% CI 0.77–1.10) and aeromedical retrievals (IRR 0.67, 95% CI 0.35–1.20) were not statistically significant. Conclusions: This study demonstrates the short-term impacts of community-led case management extending beyond the hospital setting, to address causes of recurrent ED presentations among people with complex social and medical backgrounds. Improving engagement with primary care is a particularly important outcome given the national impetus to reduce preventable hospital admissions.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2016
Publisher: Wiley
Date: 10-2008
DOI: 10.1111/J.1542-4758.2008.00306.X
Abstract: Leakage of hemodialysis catheter-locking solutions into the circulation has been reported in in vitro and in vivo studies, although there have been few reports of serious clinical adverse events. We describe a case of heparin leak from a hemodialysis catheter, which caused significant clinical bleeding requiring multiple transfusions and may have ultimately been responsible for the patient's death after transplantation.
Publisher: Wiley
Date: 30-05-2021
DOI: 10.1002/HPJA.364
Publisher: Springer Science and Business Media LLC
Date: 18-08-2020
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.JDIACOMP.2019.02.005
Abstract: Glomerular hyperfiltration is not able to be detected in clinical practice. We assessed whether hyperfiltration is associated with albuminuria progression among Indigenous Australians at high risk of diabetes and kidney disease to determine its role in kidney disease progression. Longitudinal observational study of Indigenous Australians aged ≥18 years recruited from >20 sites, across diabetes and/or kidney function strata. At baseline, iohexol clearance was used to measure glomerular filtration rate (mGFR) and hyperfiltration was defined as (i) a mGFR of ≥125 mL/min/1.73 m 407 in iduals (33% men, mean age 47 years) were followed-up for a median of 3 years. At baseline, 234 had normoalbuminuria and 173 had albuminuria. Among participants with normoalbuminuria, those with mGFR ≥125 mL/min/1.73 m Although not available for assessment in current clinical practice, hyperfiltration may represent a marker of subsequent albuminuria progression among in iduals who have not yet developed albuminuria.
Publisher: AMPCo
Date: 04-2015
DOI: 10.5694/MJAC14.00664
Publisher: Elsevier BV
Date: 11-2008
Publisher: Springer Science and Business Media LLC
Date: 22-10-2015
Publisher: Elsevier BV
Date: 04-2015
Publisher: Wiley
Date: 08-01-2017
DOI: 10.1111/NEP.12965
Publisher: Wiley
Date: 09-2018
DOI: 10.5694/MJA18.00304
Abstract: To compare the likelihood of Indigenous and non-Indigenous Australians being placed on the waiting list for transplantation of a kidney from a deceased donor to compare the subsequent likelihood of transplantation. Observational cohort study analysis of data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry for patients aged 18-60 years at the start of renal replacement therapy, who commenced renal replacement therapy in Australia between 28 June 2006 and 31 December 2016. Time to wait-listing time to kidney transplantation after wait-listing. 10 839 patients met the inclusion criteria, of whom 2039 (19%) were Indigenous Australians 217 Indigenous and 3829 non-Indigenous patients were active on the waiting list at least once during the study period. The hazard ratio (HR) for wait-listing (Indigenous v non-Indigenous patients, adjusted for patient- and disease-related factors) in the first year of renal replacement therapy varied with age and remoteness (range, 0.11 [95% CI, 0.07-0.15] to 0.36 [95% CI, 0.16-0.56]) in subsequent years the adjusted HR was 0.90 (95% CI, 0.50-1.6). The adjusted HR for transplantation during the first year of wait-listing did not differ significantly from 1.0 for subsequent years of wait-listing, however, the adjusted HR was 0.40 (95% CI, 0.29-0.55). Disparities between Indigenous and non-Indigenous patients with end-stage kidney disease in access to kidney transplantation are not explained by patient- or disease-related factors. Changes in policy and practice are needed to reduce these differences.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-10-2006
Publisher: Wiley
Date: 02-2018
DOI: 10.1111/NEP.13233
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1016/J.CLINBIOCHEM.2016.11.024
Abstract: The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation that combines creatinine and cystatin C is superior to equations that include either measure alone in estimating glomerular filtration rate (GFR). However, whether cystatin C can provide any additional benefits in estimating GFR for Indigenous Australians, a population at high risk of end-stage kidney disease (ESKD) is unknown. Using a cross-sectional analysis from the eGFR Study of 654 Indigenous Australians at high risk of ESKD, eGFR was calculated using the CKD-EPI equations for serum creatinine (eGFRcr), cystatin C (eGFRcysC) and combined creatinine and cystatin C (eGFRcysC+cr). Reference GFR (mGFR) was determined using a non-isotopic iohexol plasma disappearance technique over 4h. Performance of each equation to mGFR was assessed by calculating bias, % bias, precision and accuracy for the total population, and according to age, sex, kidney disease, diabetes, obesity and c-reactive protein. Data were available for 542 participants (38% men, mean [sd] age 45 [14] years). Bias was significantly greater for eGFRcysC (15.0mL/min/1.73m Cystatin C based eGFR equations may not perform well in populations with high levels of chronic inflammation. CKD-EPI eGFR based on serum creatinine remains the preferred equation in Indigenous Australians.
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/AH16156
Abstract: Objective The aim of the present study was to evaluate the potential effects of different health intervention strategies on demand for renal replacement therapy (RRT) services in the Northern Territory (NT). Methods A Markov chain simulation model was developed to estimate demand for haemodialysis (HD) and kidney transplantation (Tx) over the next 10 years, based on RRT registry data between 2002 and 2013. Four policy-relevant scenarios were evaluated: (1) increased Tx (2) increased self-care dialysis (3) reduced incidence of end-stage kidney disease (ESKD) and (4) reduced mortality. Results There were 957 new cases of ESKD during the study period, with most patients being Indigenous people (85%). The median age was 50 years at onset and 57 years at death, 12 and 13 years younger respectively than Australian medians. The prevalence of RRT increased 5.6% annually, 20% higher than the national rate (4.7%). If current trends continue (baseline scenario), the demand for facility-based HD (FHD) would approach 100 000 treatments (95% confidence interval 75 000–121 000) in 2023, a 5% annual increase. Increasing Tx (0.3%), increasing self-care (5%) and reducing incidence (5%) each attenuate demand for FHD to ~70 000 annually by 2023. Conclusions The present study demonstrates the effects of changing service patterns to increase Tx, self-care and prevention, all of which will substantially attenuate the growth in FHD requirements in the NT. What is known about the topic? The burden of ESKD is projected to increase in the NT, with demand for FHD doubling every 15 years. Little is known about the potential effect of changes in health policy and clinical practice on demand. What does this paper add? This study assessed the usefulness of a stochastic Markov model to evaluate the effects of potential policy changes on FHD demand. What are the implications for practitioners? The scenarios simulated by the stochastic Markov models suggest that changes in current ESKD management practices would have a large effect on future demand for FHD.
Publisher: Springer Science and Business Media LLC
Date: 06-11-2013
Publisher: Elsevier BV
Date: 10-2012
Publisher: Elsevier BV
Date: 02-2021
Publisher: Cureus, Inc.
Date: 28-04-2020
DOI: 10.7759/CUREUS.7879
Publisher: Oxford University Press (OUP)
Date: 03-07-2015
DOI: 10.1093/NDT/GFV230
Abstract: Hyperfiltration (HF) has been linked to the development of diabetic kidney disease (DKD), but the causative or predictive role of HF in the pathogenesis of DKD still remains unclear. To date, there have been no studies of HF in Indigenous Australians, a population with high rates of both diabetes and end-stage kidney disease. We aimed to compare the characteristics and frequency of HF in Indigenous Australians with and without type 2 diabetes. Indigenous Australian participants, recruited across five pre-defined strata of health, diabetes status and kidney function, had a reference glomerular filtration rate (GFR) measured using plasma disappearance of iohexol [measured GFR(mGFR)] over 4 h. HF was defined in various ways: (i) mGFR > 144 mL/min/1.73 m(2), which is mGFR > 1.96 × SD above the mean of the mGFR in non-diabetic participants with normal albuminuria and normal renal function (mGFR > 90 mL/min/1.73 m(2)) (ii) age-corrected mGFR (>144 mL/min/1.73 m(2)) to account for the effect of ageing on GFR in subjects over 40 years of age with cut-off 1 mL/min/1.73 m(2) lower for every year (iii) mGFR > 144 mL/min, without correction for body surface area or age, as well as (iv) mGFR > 125 mL/min/1.73 m(2), without adjustment for age. A total of 383 Indigenous participants, 125 with and 258 without diabetes, with mGFR > 90 mL/min/1.73 m(2) were studied. The proportion of participants with HF was 7% using mGFR > 144 mL/min/1.73 m(2), 11% using the age-adjusted definition, 19% using mGFR > 144 mL/min and 27% using mGFR > 125 mL/min/1.73 m(2). Diabetes was more common in participants with HF (40-74%) compared with normofiltering participants (28-31%), regardless of the definition of HF. HF exists in Indigenous Australians with and without diabetes. A greater proportion of participants had diabetes in HF group compared with normofiltration group. Long-term follow-up of this cohort is necessary to determine if HF plays a role in the development of DKD and non-DKD.
Publisher: Wiley
Date: 07-2018
DOI: 10.1111/NEP.13073
Abstract: We assessed associations between cardiometabolic risk factors and estimated glomerular filtration rate (eGFR) decline according to baseline albuminuria to identify potential treatment targets in Indigenous Australians. The eGFR Follow-up Study is a longitudinal cohort of 520 Indigenous Australians. Linear regression was used to estimate associations between baseline cardiometabolic risk factors and annual Chronic Kidney Disease Epidemiology Collaboration eGFR change (mL/min per 1.73m After a median of 3 years follow-up, progressive declines of the age- and sex-adjusted mean eGFR were observed across albuminuria categories (-2.0 [-2.6 to -1.4], -2.5 [-3.7 to -1.3] and -6.3 [-7.8 to -4.9] mL/min per 1.72m Over a 3 year period, marked eGFR decline was observed with greater baseline albuminuria. Cardiometabolic risk factors were not strong predictors for eGFR decline in Indigenous Australians without albuminuria. Longer follow-up may elucidate the role of these predictors and other mechanisms in chronic kidney disease progression in this population.
Publisher: Springer Science and Business Media LLC
Date: 18-01-2023
DOI: 10.1007/S00125-023-05868-W
Abstract: The aim of this work was to investigate the risk of developing chronic kidney disease (CKD) or end-stage kidney disease (ESKD) following a pregnancy complicated by gestational diabetes mellitus (GDM) or pre-existing diabetes among Aboriginal women in the Northern Territory (NT), Australia. We undertook a longitudinal study of linked healthcare datasets. All Aboriginal women who gave birth between 2000 and 2016 were eligible for inclusion. Diabetes status in the index pregnancy was as recorded in the NT Perinatal Data Collection. Outcomes included any stage of CKD and ESKD as defined by ICD-10 coding in the NT Hospital Inpatient Activity dataset between 2000 and 2018. Risk was compared using Cox proportional hazards regression. Among 10,508 Aboriginal women, the mean age was 23.1 (SD 6.1) years 731 (7.0%) had GDM and 239 (2.3%) had pre-existing diabetes in pregnancy. Median follow-up was 12.1 years. Compared with women with no diabetes during pregnancy, women with GDM had increased risk of CKD (9.2% vs 2.2%, adjusted HR 5.2 [95% CI 3.9, 7.1]) and ESKD (2.4% vs 0.4%, adjusted HR 10.8 [95% CI 5.6, 20.8]). Among women with pre-existing diabetes in pregnancy, 29.1% developed CKD (adjusted HR 10.9 [95% CI 7.7, 15.4]) and 9.9% developed ESKD (adjusted HR 28.0 [95% CI 13.4, 58.6]). Aboriginal women in the NT with GDM or pre-existing diabetes during pregnancy are at high risk of developing CKD and ESKD. Pregnancy presents an important opportunity to identify kidney disease risk. Strategies to prevent kidney disease and address the social determinants of health are needed.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2016
Publisher: Springer Science and Business Media LLC
Date: 19-02-2010
Publisher: Wiley
Date: 27-04-2014
DOI: 10.1111/HDI.12173
Abstract: Use of erythropoiesis-stimulating agents (ESAs) has improved the management of anemia in patients on maintenance hemodialysis (MHD). Iron deficiency and inflammation cause ESAs resistance and are both common among indigenous people of Northern Australia. As part of quality assurance in our Renal Anaemia Management program, we observed that there was use of higher doses of ESAs and adjuvant iron therapy in our MHD patients. This study aimed to explore the relationship among iron studies, inflammation, ESA responsiveness, and ESAs and iron requirements in indigenous patients on MHD from the Top End of Northern Australia. We performed a retrospective cohort analysis of anemia management in a cohort of our patients on MHD. We extracted data for 178 indigenous and 19 non-indigenous patients from 1 March 2009 to 28 February 2010 from the Renal Anaemia Management database, which collects data prospectively in MHD patients. Ninety-nine percent of the whole s le had a ferritin level above the international guidelines threshold of >500 µg/L. Indigenous patients had higher ferritin (1534 ± 245.5 µg/L vs. 1013 ± 323.3 µg/L, P = 0.002). C-reactive protein (CRP) was high in 56.9% of the total cohort. One hundred percent of those with normal CRP had high ferritin (>500 µg/L). C-reactive protein was higher in indigenous than in non-indigenous patients. Erythropoiesis-stimulating agents hyporesponsiveness was higher in indigenous patients (P < 0.0001). There was no significant difference in ESAs hyporesponsiveness among different levels of CRP (P = 0.116), ferritin (P = 0.408), and transferrin saturation (P = 0.503). Indigenous patients required higher total iron dose (2820.30 [2000-4350] vs. 2336.12 [1912-2900], P = 0.02). There was no significant relationship between the high ferritin and CRP. In indigenous dialysis patients, iron therapy and ESAs use are higher. The high iron use is due to a lack of published evidence to guide the administration of iron in patients with high ferritin. The high ferritin and ESAs resistance could not be fully explained by inflammation and need further evaluation. Further studies are required to determine the safe use of iron and management of ESAs resistance in our hemodialysis population.
Publisher: Oxford University Press (OUP)
Date: 05-01-2007
DOI: 10.1093/NDT/GFL722
Publisher: Springer Science and Business Media LLC
Date: 25-06-2019
Publisher: Informa UK Limited
Date: 31-10-2017
Publisher: Wiley
Date: 21-07-2019
DOI: 10.1111/NEP.13629
Abstract: Lower socioeconomic status (SES) has been associated with increased dialysis mortality. This study aimed to determine if the quality of care (QOC) delivered to dialysis patients varied by SES. All non-Indigenous adults commencing haemodialysis (HD) or peritoneal dialysis (PD) registered with the Australia and New Zealand Dialysis and Transplant Registry between 2002 and 2012 were included. Each patient's location at dialysis start was classified into SES quartiles of advantaged to disadvantaged. Guidelines were used to determine attainment of adequate QOC at 6-<18 months and 18-<30 months after dialysis start, using logistic regression models. QOC measures included pre-dialysis phosphate, calcium, haemoglobin, transferrin saturation and ferritin. HD-related parameters included single pool Kt/V and percentage with functioning arteriovenous fistula/graft. PD-related parameters included weekly Kt/V and percentage transferring to HD. Of 19 486 commencing dialysis, the median age was 65 years (interquartile range 53-74), 62.2% were male and 85.1% were Caucasian. At 6-<18 months after dialysis start, there were no significant differences by SES in attainment of biochemical targets, PD or HD adequacy. The disadvantaged quartile was less likely to achieve haemoglobin targets (odds ratio 0.88, 0.80-0.96, P = 0.01) or have a functioning arteriovenous fistula or graft (odds ratio 0.79, 0.68-0.92, P = 0.003) compared with the most advantaged group. Vascular access differences persisted at 18-<30 months. Other than vascular access, area-level SES has minimal impact on QOC attainment among non-Indigenous dialysis patients in Australia. Increased mortality in lower SES groups may be due to pre-dialysis factors and other variables such as health-related behaviours, lifestyle and literacy.
Publisher: Wiley
Date: 19-07-2007
DOI: 10.1111/J.1445-5994.2007.01407.X
Abstract: Australian brown snake (genus Pseudonaja) envenoming causes a venom-induced consumptive coagulopathy (VICC). A proportion of cases go on to develop thrombotic microangiopathy characterized by thrombocytopenia, microangiopathic haemolytic anaemia (MAHA) and acute renal failure (ARF). The aim of the study was to define better the natural history and empirical treatments for thrombotic microangiopathy in brown snake envenoming. A review of brown snake bites recruited to the Australian Snakebite Project (ASP), a national multicentre study of snake envenoming was undertaken. Serial data are recorded on clinical effects and laboratory results, including measurement of venom concentrations. We describe cases of thrombotic microangiopathy and compare these to cases without thrombotic microangiopathy. From 32 cases of brown snake envenoming with severe VICC, four (13%) developed thrombotic microangiopathy, we also included two cases of thrombotic microangiopathy from prior to ASP. All six developed severe thrombocytopenia (<20 x 10(-9)/L), worst 3 days after the bite and resolving over a week, MAHA with fragmented red blood cells on the blood film and five developed anuric ARF requiring dialysis and lasting 2-8 weeks. All six received antivenom, which was delayed compared with other brown snake-envenoming cases. Four were treated with plasmapheresis. The severity and recovery of the thrombocytopenia, anaemia and renal function were similar with and without plasmapheresis. The median length of stay for MAHA cases was 14 days (interquartile range (IQR) 12-14) compared to 1.8 days (IQR 1.3-2) for all other cases. Thrombotic microangiopathy resulting from brown snake bite appears to have a good prognosis and management should focus on early antivenom therapy and supportive care including dialysis. The role of plasmapheresis is yet to be defined.
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.CLINBIOCHEM.2018.01.011
Abstract: Being able to estimate kidney decline accurately is particularly important in Indigenous Australians, a population at increased risk of developing chronic kidney disease and end stage kidney disease. The aim of this analysis was to explore the trend of decline in estimated glomerular filtration rate (eGFR) over a four year period using multiple local creatinine measures, compared with estimates derived using centrally-measured enzymatic creatinine and with estimates derived using only two local measures. The eGFR study comprised a cohort of over 600 Aboriginal Australian participants recruited from over twenty sites in urban, regional and remote Australia across five strata of health, diabetes and kidney function. Trajectories of eGFR were explored on 385 participants with at least three local creatinine records using graphical methods that compared the linear trends fitted using linear mixed models with non-linear trends fitted using fractional polynomial equations. Temporal changes of local creatinine were also characterized using group-based modelling. Analyses were stratified by eGFR (<60 60-89 90-119 and ≥120ml/min/1.73m Mean age of the participants was 48years, 64% were female and the median follow-up was 3years. Decline of eGFR was accurately estimated using simple linear regression models and locally measured creatinine was as good as centrally measured creatinine at predicting kidney decline in people with an eGFR<60 and an eGFR 60-90ml/min/1.73m Short term estimates of kidney function decline can be reliably derived using an easy to implement and simple to interpret linear mixed effect model. Locally measured creatinine did not differ to centrally measured creatinine, thus is an accurate cost-efficient and timely means to monitoring kidney function progression.
Publisher: Wiley
Date: 26-08-2022
DOI: 10.1111/IMJ.15632
Abstract: The factors affecting the outcomes among Indigenous kidney transplant recipients is not fully understood. We conducted a retrospective case control study to identify risk factors beyond those explained by the ANZDATA registry. To identify the risk factors for loss of kidney transplant function or death among Indigenous kidney transplant recipients. Cases were defined as all Indigenous Australian kidney transplant recipients from 1 January 2005 to 31 December 2015 from the major hospitals in the Northern Territory (NT) and South Australia (SA) who experienced graft loss (including patient death) up to 2‐years post‐transplant. Controls (matched 4:1) were defined as all indigenous kidney transplant recipients during the same period with functioning transplants at 2‐years post‐transplant operation. Matching was done on gender and diabetes status. Regression analysis adjusted for age was used for comparing cases and controls. There were 17 cases and 68 matched controls. Among cases, the odds ratio for more than one hospital admission episode (compared with ≤1 episode) in the 2‐year pretransplant period was 6.2 (95% confidence interval, 1.2–32.5). However, there were no significant differences in the frequency of comorbidities at renal replacement therapy start, cardiovascular intervention pretransplant, pretransplant infection screening, age and gender of the donors, frequency of admission episodes where an infection was documented, the total length of inpatient stay or admission to intensive care unit during pretransplant hospital admission between cases and controls. Early graft loss was associated with a higher frequency of hospital admissions in the 2‐years pretransplant period. In contrast, other measured factors in the pretransplant period did not predict these adverse outcomes.
Publisher: Springer Science and Business Media LLC
Date: 19-08-2019
Publisher: Wiley
Date: 04-2005
DOI: 10.1111/J.1440-1797.2005.00380.X
Abstract: Measurement of blood flow within native arteriovenous fistula during haemodialysis is recommended to detect incipient fistula failure. In the present study the value of such flow measurements was assessed in a group of patients on maintenance haemodialysis, with access via native arteriovenous fistulas. Flow was measured using the 'on-line' thermodilution technique, on three separate occasions, and correlated with subsequent fistula failure within 6 months. Of the 53 patients studied, there were six failures (three thromboses and three inadequate dialysis filtration rates). Flow rates in patients who progressed to fistula failure were significantly less than flow rates in patients whose fistulas did not fail (U = 13.0, P < 0.0003). Failure was no more common in one type of fistula than another (type fistula: F = 0.29, P = 0.88 flow predicting failure: F = 7.22, P = 0.010). Receiver operating characteristic (ROC) curve analyses confirmed flow measurement to be a useful predictor of fistula failure (area under ROC curve 0.91). The optimal threshold of 576 mL/min flow gave a sensitivity of 89% and a specificity of 81%. Measurement of access resistance was less useful in predicting failure (area under ROC curve 0.87). Measurement of fall in flow from the previous measurement was of no use (area under ROC curve 0.535). On-line thermodilution measurement of flow within established native arteriovenous fistula is useful in surveillance and early prediction of fistula failure. Fistula flow <576 mL/min may indicate incipient native fistula failure, and should prompt further investigation.
Publisher: Springer Science and Business Media LLC
Date: 15-01-2018
Publisher: Wiley
Date: 27-10-2011
DOI: 10.1111/J.1440-1797.2011.01487.X
Abstract: Plasma cell-rich rejection is a distinct histological phenomenon associated with poor renal allograft outcomes. Aboriginal and Torres Straight Islander (ATSI) transplant recipients have poorer allograft survival and higher rates of acute rejection. We sought to determine whether a higher incidence of plasma cell-rich infiltrates (PCIR) could account for poorer survival. Renal transplant biopsies performed in recipients from the Northern Territory of Australia between 1985 and 2007 were reviewed and correlated with outcome. Biopsies were designated PCIR positive when plasma cells constituted >10% of the interstitial infiltrate. Four hundred and seventy-seven biopsies from 177 recipients (108 ATSI) were performed. Median graft survival was shorter for recipients with PCIR: 4.0 years (interquartile range 2.18-6.41) versus 5.4 years (2.0-9.99) (P = 0.013). ATSI recipients had higher rates of plasma cell-rich rejection (RR 1.76, 95% CI 1.43-2.17, P 20% (RR 1.29, 95% CI 1.03-1.56, P = 0.025), ≥5 human leukocyte antigen mismatches (RR 1.91, 1.41-2.58, p 10 infections RR 5.11, 1.69-15.5, P = 0.004), and subsequent death from septicaemia (RR 1.6, 1.17-2.18, P = 0.003). PCIR is associated with infection and markers of chronic immunological stimulation but does not independently contribute to inferior renal allograft outcomes, even in ATSI recipients.
Publisher: Wiley
Date: 09-2012
DOI: 10.1111/J.1445-5994.2012.02850.X
Abstract: Secondary amyloidosis (AA) is an established consequence of many chronic inflammatory conditions. In the developed world, it is most often the result of rheumatological disease. However, the relative frequency of underlying causes may be different in indigenous populations. We present a case series of three remote-living, Indigenous Australians found to have pathologically confirmed amyloidosis and renal impairment at diagnosis. The presence of an underlying inflammatory condition was unclear in two cases. The remaining case had established bronchiectasis and suffered rapidly progressive renal impairment at a young age.
Publisher: American Diabetes Association
Date: 24-01-2018
DOI: 10.2337/DC17-1919
Abstract: To examine the association between soluble tumor necrosis factor receptor 1 (sTNFR1) levels and kidney disease progression in Indigenous Australians at high risk of kidney disease. This longitudinal observational study examined participants aged ≥18 years recruited from & sites across diabetes and/or kidney function strata. Baseline measures included sTNFR1, serum creatinine, urine albumin-to-creatinine ratio (uACR), HbA1c, C-reactive protein (CRP), waist-to-hip ratio, systolic blood pressure, and medical history. Linear regression was used to estimate annual change in estimated glomerular filtration rate (eGFR) for increasing sTNFR1, and Cox proportional hazards were used to estimate the hazard ratio (HR) and 95% CI for developing a combined renal outcome (first of a ≥30% decline in eGFR with a follow-up eGFR & mL/min/1.73 m2, progression to renal replacement therapy, or renal death) for increasing sTNFR1. Over a median of 3 years, participants with diabetes (n = 194) in the highest compared with the lowest quartile of sTNFR1 experienced significantly greater eGFR decline (−4.22 mL/min/1.73 m2/year [95% CI −7.06 to −1.38] P = 0.004), independent of baseline age, sex, eGFR, and uACR. The adjusted HR (95% CI) for participants with diabetes per doubling of sTNFR1 for the combined renal outcome (n = 32) was 3.8 (1.1–12.8 P = 0.03). No association between sTNFR1 and either renal outcome was observed for those without diabetes (n = 259). sTNFR1 is associated with greater kidney disease progression independent of albuminuria and eGFR in Indigenous Australians with diabetes. Further research is required to assess whether TNFR1 operates independently of other metabolic factors associated with kidney disease progression.
Publisher: Hindawi Limited
Date: 2017
DOI: 10.1155/2017/5490963
Abstract: Objective . To determine the significance of high serum ferritin observed in Indigenous Australian patients on maintenance haemodialysis in the Northern Territory, we assessed the relationship between ferritin and transferrin saturation (TSAT) as measures of iron status and ferritin and C-reactive protein (CRP) as markers of inflammation. Methods . We performed a retrospective cohort analysis of data from adult patients (≥18 years) on maintenance haemodialysis ( months) from 2004 to 2011. Results . There were 1568 patients. The mean age was 53.9 (11.9) years. 1244 (79.3%) were Indigenous. 44.2% ( n = 693 ) were male. Indigenous patients were younger (mean age [52.3 (11.1) versus 57.4 (15.2), p 0.001 ]) and had higher CRP [14.7 mg/l (7–35) versus 5.9 mg/l (1.9–17.5), p 0.001 ], higher median serum ferritin [1069 µ g/l (668–1522) versus 794.9 µ g/l (558.5–1252.0), p 0.001 ], but similar transferrin saturation [26% (19–37) versus 28% (20–38), p = 0.516 ]. We observed a small positive correlation between ferritin and TSAT ( r 2 = 0.11 , p 0.001 ), no correlation between ferritin and CRP ( r 2 = 0.001, p 0.001 ), and positive association between high serum ferritin and TSAT ( p 0.001 ), Indigenous ethnicity ( p 0.001 ), urea reduction ratio ( p = 0.001 ), and gender ( p 0.001 ) after adjustment in mixed regression analysis. Conclusion . Serum ferritin and TSAT may inadequately reflect iron status in this population. The high ferritin was poorly explained by inflammation.
Publisher: Massachusetts Medical Society
Date: 08-10-2009
DOI: 10.1056/NEJMC0905777
Publisher: Wiley
Date: 12-2004
DOI: 10.1111/J.1440-1797.2004.00345.X
Abstract: The provision of specialist-level care for patients with chronic kidney disease in rural and remote areas is a significant challenge. There are well-recognized barriers to care in these areas but in addition there is a widely held view that the responsibility for chronic kidney disease falls to nephrologists, despite the lack of nephrologists in remote regions and the high burden of disease. This article describes how in Central Australia specialists and remote-based primary carers have adapted their usual roles and found new ways of working together to provide high-quality specialist-level care for remote chronic kidney disease patients. We are evolving a model where chronic kidney disease is no longer nephrologists' business but is everybody's business, with primary carers providing much of the routine specialist-level care.
Publisher: Oxford University Press (OUP)
Date: 19-04-2022
DOI: 10.1093/NDT/GFAC155
Abstract: Early recognition of hospital-acquired acute kidney injury (AKI) may improve patient management and outcomes. This multicentre study was conducted at three hospitals (H1—intervention H2 and H3—controls) served by a single laboratory. The intervention bundle [an interruptive automated alerts (aAlerts) showing AKI stage and baseline creatinine in the eMR, a management guide and junior medical staff education] was implemented only at H1. Outcome variables included length-of-stay (LOS), all-cause in-hospital mortality and management quality. Over 6 months, 639 patients developed AKI (265 at H1 and 374 at controls), with 94.7% in general wards 537 (84%) patients developed Stage 1, 58 (9%) Stage 2 and 43 (7%) Stage 3 AKI. Median LOS was 9 days (IQR 4–17) and was not different between intervention and controls. However, patients with AKI stage 1 had shorter LOS at H1 [median 8 versus 10 days (P = 0.021)]. Serum creatinine had risen prior to admission in most patients. Documentation of AKI was better in H1 (94.8% versus 83.4% P = 0.001), with higher rates of nephrology consultation (25% versus 19% P = 0.04) and cessation of nephrotoxins (25.3 versus 18.8% P = 0.045). There was no difference in mortality between H1 versus controls (11.7% versus 13.0% P = 0.71). Most hospitalized patients developed Stage 1 AKI and developed AKI in the community and remained outside the intensive care unit (ICU). The AKI eAlert bundle reduced LOS in most patients with AKI and increased AKI documentation, nephrology consultation rate and cessation of nephrotoxic medications.
Start Date: 2017
End Date: 2021
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2019
End Date: 2015
Funder: National Health and Medical Research Council
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