Health outcomes and costs in Chronic and End-Stage Kidney Disease

Abstract

Chronic kidney disease (CKD) is common, with prevalence estimates of 10-16% globally. CKD is divided into five discreet stages, with Stage 1 the earliest stage and Stage 5 the most advanced. Research efforts have primarily focused on Stage 5 patients with end stage kidney disease (ESKD) treated with dialysis or transplantation. As a result, many important questions about the experience of those with early to moderate CKD remain incompletely understood. Understanding disease progression, quality-of-life and costs of early to moderate CKD are important to inform clinical treatment decisions as well as economic evaluations of prevention strategies and treatment options. Similarly, important questions remain in specific ESKD populations including what is the optimal treatment of atrial fibrillation in the haemodialysis population, and what are the pregnancy outcomes female transplant recipients of child bearing age. This thesis seeks to address these questions. This is a thesis by publication which contains six published, and one submitted, work. Chapter one is a general introduction. Chapter two used data from AusDiab, a national longitudinal cohort study of Australian adults, to investigate factors associated with disease progression and/or death in CKD. Chapter three used data from AusDiab to estimate the costs of early-to-moderate CKD in Australia. Chapter four explored longitudinal changes in quality-of-life in a community-based CKD cohort and assessed associations between baseline quality-of-life and CKD outcomes using AusDiab data. Chapter five used published literature to develop a Markov model decision analysis for the use of anti-coagulation (or not) in haemodialysis patients with non-valvular AF. Chapters 6 and 7 examined pregnancy outcomes for women with kidney transplants and compared these to the Australian general population. Chapter 8 reviewed the diagnosis and management of recurrent IgA nephropathy following kidney transplant. The final chapter is a discussion of the work.