The incidence of cardiac surgery in adults with treated kidney failure in Australia: a retrospective cohort study

Dominic Keuskamp; Christopher E. Davies; Robert A. Baker; Kevan R. Polkinghorne; Christopher M. Reid; Julian A. Smith; Lavinia Tran; Jenni Williams-Spence; Rory Wolfe; Stephen P. Mcdonald

doi:10.1071/AH24188

RESEARCH ARTICLE (Open Access)

The incidence of cardiac surgery in adults with treated kidney failure in Australia: a retrospective cohort study

Dominic Keuskamp ^A ^B ^* , Christopher E. Davies ^A ^B , Robert A. Baker ^C ^D , Kevan R. Polkinghorne ^E ^F ^G , Christopher M. Reid ^F ^H , Julian A. Smith ^I ^J , Lavinia Tran ^F , Jenni Williams-Spence ^F , Rory Wolfe ^F and Stephen P. Mcdonald ^A ^B ^K

+ Author Affiliations

- Author Affiliations

^A Australia & New Zealand Dialysis & Transplant Registry (ANZDATA), South Australian Health & Medical Research Institute (SAHMRI), Adelaide, SA, Australia.

^B Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, SA, Australia.

^C College of Medicine & Public Health, Flinders University, Bedford Park, SA, Australia.

^D Cardiac Surgery Quality & Outcomes Department, Flinders Medical Centre, Bedford Park, SA, Australia.

^E Department of Nephrology, Monash Health, Clayton, Vic, Australia.

^F School of Public Health & Preventive Medicine, Monash University, Melbourne, Vic, Australia.

^G Department of Medicine, Monash University, Melbourne, Vic, Australia.

^H School of Population Health, Curtin University, Bentley, WA, Australia.

^I Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Clayton, Vic, Australia.

^J Department of Cardiothoracic Surgery, Monash Health, Clayton, Vic, Australia.

^K Central & Northern Adelaide Renal & Transplantation Services (CNARTS), Royal Adelaide Hospital, Adelaide, SA, Australia.

^* Correspondence to: dominic@anzdata.org.au

Australian Health Review 49, AH24188 https://doi.org/10.1071/AH24188

Submitted: 9 July 2024 Accepted: 4 December 2024 Published: 7 January 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Objective

Kidney failure increases people’s risk of cardiovascular disease, sometimes requiring cardiac surgery. The aim of this study was to estimate the risk of cardiac surgery for adults with treated kidney failure in comparison with the general population in Australia.

Methods

We performed a population-based retrospective cohort study by linking data between the Australia and New Zealand Dialysis and Transplant Registry and the Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database, for 2010–2019. Age–sex-standardised surgery risk relative to the general population was estimated for adults receiving long-term dialysis and kidney transplant recipients, and subpopulations defined by procedure type, comorbidity, clinical status and dialysis-related factors.

Results

Among 1541 adults receiving treatment for kidney failure at the time of cardiac surgery in 2010–2019, the prevalence of comorbidity and risk factors was usually highest in those receiving dialysis, followed by transplant recipients and the general population (n = 113,126). For all major cardiac surgical procedure types, the incidence of surgery for adults receiving dialysis and transplant recipients exceeded that for the general population (e.g. isolated coronary artery bypass grafting relative rates 15.3 [95% CI 13.7–17.0] and 2.0 [1.6–2.6] respectively). Relative incidence was especially high for the dialysis cohorts with insulin-treated diabetes and those with body mass index <25 kg/m².

Conclusions

Adults with treated kidney failure had a higher risk of cardiac surgery than the general population in Australia in 2010–2019, especially when associated with diabetes. Data linkage between clinical quality registries enabled estimation of the extent of cardiac surgical burden.

Keywords: aortic valve replacement, cardiac surgery, coronary artery bypass graft, dialysis, incidence, kidney failure, kidney replacement therapy, kidney transplant.

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