Natural History of Cardiac and Peripheral Vascular Death In ESKD: An Australian And New Zealand Data Linkage Study

Main Article Content

Victor Khou
VictorNicole L De La Mat
Patrick J Kelly
Angela C Webster


Cardiovascular disease is a leading cause of death in patients with end-stage kidney disease (ESKD). However, ascertaining the impact of cardiovascular deaths has not been well characterised over long periods of follow-up and across different treatment states. Further insights into the lifetime risk of cardiovascular death are required to better inform clinical practice and economic planning.

Objectives and Approach
We performed a population-based cohort study on incident patients receiving ESKD treatment from the Australian and New Zealand Dialysis and Transplant registry (ANZDATA). Cardiac/vascular deaths were determined from ICD-10-AM codes listed in the underlying cause of death obtained via data linkage with the Australian National Death Index and New Zealand Mortality Collection database. We estimated mortality rates from cardiac/vascular death across time from ESKD treatment, and calculated probability of death and transplant status over time using multistate models.

Across 60,823 incident ESKD patients and 381,874 person-years of follow-up, 22% (7,551) of deaths were from cardiac/vascular disease. At 15 years from treatment, 15.6% of patients had died from cardiac/vascular causes, most of whom never received a transplant (13.6% vs 2.0% of cohort). Within the first year of dialysis, cardiac/vascular mortality was highest in the second month, at 3,632/100,000pys. Improvements in cardiac/vascular mortality with calendar year were only seen after 9 months of dialysis. Transplant recipients had consistently lower cardiac/vascular mortality rates (598/100,000 pys) compared to dialysis patients. However, comorbid cardiovascular disease was a risk factor for graft failure and death in transplant recipients (HR:1.52, 95% CI:1.42-1.62).

Conclusion / Implications
Despite improvements in cardiac/vascular outcomes over time, cardiovascular death remains common in ESKD, particularly in the first few months of treatment. A greater focus on secondary prevention in earlier stages of chronic kidney disease may improve outcomes in new ESKD patients.

Article Details

How to Cite
Khou, V., De La Mat, V. L., Kelly, P. J. and Webster, A. C. (2020) “Natural History of Cardiac and Peripheral Vascular Death In ESKD: An Australian And New Zealand Data Linkage Study”, International Journal of Population Data Science, 5(5). doi: 10.23889/ijpds.v5i5.1587.

Most read articles by the same author(s)