Cardiovascular disease progression and its subsequent effect on morbity and mortality in australian patients with chronic kidney disease: a 10 year follow up

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The commonest cause of death in individuals with impaired renal function is cardiovascular disease (CVD) and in 2008 contributed to 2.3% of all deaths in Australia. According to current Australian Government predictions the incidence rate of treated end stage renal disease is projected to increase by nearly 80%—from 11 per 100,000 population in 2009 to 19 per 100,000 population in 2020. This is important as data from the Australian and New Zealand Dialysis and Transplant (ANZDATA) Registry report indicates that 40% of all deaths in patients receiving dialysis were due to CVD. This is replicated in findings from the United States Renal Data System (USRDS) where CVD mortality was 42.2%. Given this, it is now well recognised that the presence of CKD is a potent risk factor for CVD. Indeed individuals with CKD have a 10-fold to 20-fold greater risk of CVD than age- and sex-matched, healthy controls. Once on dialysis CKD patients are less likely to receive cardiovascular interventions and far more likely to die than in those without CKD. CVD risk in this population is partially attributable to an increased presence and severity of conventional CVD risk factors such as hypertension, diabetes mellitus, dyslipidaemia and smoking. Additionally however there are other risk factors specific to CKD such as anaemia, abnormal calcium and phosphate metabolism and chronic inflammation. Previous work carried out by our Group in this area was funded by an NHMRC Centre of Clinical Research Excellence Award (455832). The findings of this work have provided insights into the alterations in cardiovascular structure and function undergone in CKD and the pathophysiological factors underlying CVD risk. Despite the aggressive nurse-led risk factor intervention undertaken in the original study(LANDMARK1) there was little effect on cardiovascular structure, ventricular function or outcome after 2 years of follow-up. We have ascertained, through The Australia and New Zealand Dialysis and Transplant Registry, (ANZdata), that at least two thirds of the patients in this previous trial are now deceased and of those still living, a majority have proceeded to kidney transplant. We would access the ANZdata database for dates and cause of death of the deceased patients and renal transplant status. We would access the Nephrology database at the Princess Alexandra Hospital to ascertain MACE. We will analyse the baseline data for these patients to ascertain the main cardiovascular factors that predicted outcome.

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