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Impending challenges of the burden of end‐stage kidney disease in Australia

Wai H Lim, David W Johnson, Stephen P McDonald, Carmel Hawley, Philip A Clayton, Matthew D Jose and Germaine Wong
Med J Aust 2019; 211 (8): . || doi: 10.5694/mja2.50354
Published online: 21 October 2019

Summary

  • Sex and age‐specific incidence rates of patients with treated end‐stage kidney disease (ESKD) in Australia are comparable to those in European countries, but substantially lower compared with those in the United States, Canada and many Asian countries.
  • The incidence rates of treated ESKD in Australia increase with advancing age; however, the incidence of ESKD is likely to be underestimated because a proportion of patients with ESKD (about 50%) remain untreated.
  • Late referral to nephrologists has reduced over the past decade, temporally associated with improved ESKD recognition. However, late referral still occurs in one in five Australians with ESKD.
  • One in two Australians with ESKD has diabetes, with up to 35% of cases directly attributed to diabetes.
  • Mortality rates for patients with ESKD remain substantially higher compared with the age‐matched general population, although there has been a significant improvement in survival over time.
  • Cardiovascular disease and cancer are the two most common causes of death in patients with ESKD.

  • 1 Sir Charles Gairdner Hospital, Perth, WA
  • 2 Princess Alexandra Hospital, Brisbane, QLD
  • 3 Centre for Health Services Research, University of Queensland, Brisbane, QLD
  • 4 South Australian Health and Medical Research Institute, ANZDATA Registry, Adelaide, SA
  • 5 University of Adelaide, Adelaide, SA
  • 6 University of Tasmania, Hobart, TAS
  • 7 Royal Hobart Hospital, Hobart, TAS
  • 8 Westmead Hospital, Sydney, NSW


Correspondence: wai.lim@health.wa.gov.au

Acknowledgements: 

We acknowledge the substantial contributions of the Australian and New Zealand nephrology community (physicians, surgeons, database managers, nurses, renal operators and patients), which provides information to, and maintains, the ANZDATA database. The data reported here have been supplied by the ANZDATA registry, the UK Renal Registry, USRDS and CORR. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of any organisation. Wai Lim is supported by a Clinical Research Fellowship from the Raine Medical Research Foundation (University of Western Australia and Department of Health Western Australia) and by a Don and Lorraine Jacquot Career Development Fellowship (Royal Australasian College of Physicians). David Johnson is supported by a National Health and Medical Research Council (NHMRC) Practitioner Fellowship. Germaine Wong is supported by an NHMRC Career Development Fellowship. The ANZDATA Registry is funded by the Australian Organ and Tissue Authority, the New Zealand Ministry of Health and Kidney Health Australia.

Competing interests:

No relevant disclosures.

  • 1. Bello AK, Levin A, Tonelli M, et al. Assessment of global kidney health care status. JAMA 2017; 317: 1864–1881.
  • 2. Neuen BL, Chadban SJ, Demaio AR, et al. Chronic kidney disease and the global NCDs agenda. BMJ Glob Health 2017; 2: e000380.
  • 3. Levin A, Tonelli M, Bonventre J, et al. Global kidney health 2017 and beyond: a roadmap for closing gaps in care, research, and policy. Lancet 2017; 390: 1888–1917.
  • 4. Luyckx VA, Tuttle KR, Garcia‐Garcia G, et al. Reducing major risk factors for chronic kidney disease. Kidney Int Suppl 2017; 7: 71–87.
  • 5. Australian and New Zealand Dialysis and Transplant Registry. 40th Report. Chapter 1: incidence of end stage kidney disease. Adelaide: ANZDATA Registry, 2018. https://www.anzdata.org.au/wp-content/uploads/2018/04/c01_incidence_2016_v1.0_20180409.pdf (viewed Aug 2019).
  • 6. Australian and New Zealand Dialysis and Transplant Registry. 41st Report. Chapter 1: incidence of end stage kidney disease. Adelaide: ANZDATA Registry, 2018. https://www.anzdata.org.au/wp-content/uploads/2018/11/c01_incidence_2017_v1.0_20181121.pdf (viewed Aug 2019).
  • 7. United States Renal Data System. USRDS annual data report: epidemiology of kidney disease in the United States. Chapter 1: incidence, prevalence, patient characteristics, and treatment modalities. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2018. https://www.usrds.org/2018/view/v2_01.aspx (viewed Aug 2019).
  • 8. United States Renal Data System. USRDS annual data report: epidemiology of kidney disease in the United States. Chapter 6: transplantation. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2018. https://www.usrds.org/2018/view/v2_06.aspx (viewed Aug 2019).
  • 9. United States Renal Data System. USRDS annual data report: epidemiology of kidney disease in the United States. Chapter 11: international comparisons. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2018. https://www.usrds.org/2018/view/v2_11.aspx (viewed Aug 2019).
  • 10. Canadian Organ Replacement Register Annual Report. CORR annual statistics: renal replacement therapy (dialysis and kidney transplantation) for ESKD, 2007 to 2016. Canadian Institute for Health Information, 2017. https://www.cihi.ca/en/access-data-reports/results?query=treatment+of+end+stage+organ+failure+&Search+Submit= (viewed Aug 2019).
  • 11. Byrne C, Caskey F, Castledine C, et al. The Renal Association — UK Renal Registry: 20th annual report. Nephron 2018; 139 (Suppl).
  • 12. Australian Bureau of Statistics. Australian demographic statistics, Jun 2017 — time series spreadsheets [Cat. No. 3101.0]. Canberra: ABS, 2017. http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3101.0Jun%202017?OpenDocument (viewed Aug 2019).
  • 13. Australian Bureau of Statistics. Australian demographic statistics, Jun 2016 — time series spreadsheets [Cat. No. 3101.0]. Canberra: ABS, 2016. http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3101.0Jun%202016?OpenDocument (viewed Aug 2019).
  • 14. Australian Bureau of Statistics. Deaths, Australia, 2017 [Cat. No. 3302.0]. Canberra: ABS, 2017. http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3302.02017?OpenDocument (viewed Sept 2018).
  • 15. Abraham G, Varughese S, Thandavan T, et al. Chronic kidney disease hotspots in developing countries in South Asia. Clin Kidney J 2016; 9: 135–141.
  • 16. Weaver VM, Fadrowski JJ, Jaar BG. Global dimensions of chronic kidney disease of unknown etiology (CKDu): a modern era environmental and/or occupational nephropathy? BMC Nephrol 2015; 16: 145.
  • 17. Stewart JH, McCredie MR, Williams SM, et al. Trends in incidence of treated end‐stage renal disease, overall and by primary renal disease, in persons aged 20–64 years in Europe, Canada and the Asia‐Pacific region, 1998–2002. Nephrology (Carlton) 2007; 12: 520–527.
  • 18. McDonald S, McCredie M, Williams S, Stewart J. Factors influencing reported rates of treated end‐stage renal disease. Adv Chronic Kidney Dis 2005; 12: 32–38.
  • 19. Htay H, Alrukhaimi M, Ashuntantang GE, et al. Global access of patients with kidney disease to health technologies and medications: findings from the Global Kidney Health Atlas project. Kidney Int Suppl 2018; 8: 64–73.
  • 20. See E, Alrukhaimi M, Ashuntantang G, et al. Global coverage of health information systems for kidney disease: availability, challenges and opportunities for development. Kidney Int Suppl 2018; 8: 74–81.
  • 21. Bello AK, Alrukhaimi M, Ashuntantang GE, et al. Global overview of health systems oversight and financing for kidney care. Kidney Int Suppl 2018; 8: 41–51.
  • 22. Osman M, Alrukhaimi M, Ashuntantang G, et al. Global Nephrology Workforce: gaps, threats, and opportunities towards sustainable provision of workforce for kidney care. Kidney Int Suppl 2018; 8: 52–63.
  • 23. Lunney M, Alrukhaimi M, Ashuntantang G, et al. Guidelines, policies, and barriers to kidney care: findings from a global survey. Kidney Int Suppl 2018; 8: 30–40.
  • 24. Sparke C, Moon L, Green F, et al. Estimating the total incidence of kidney failure in Australia including individuals who are not treated by dialysis or transplantation. Am J Kidney Dis 2013; 61: 413–419.
  • 25. Hemmelgarn BR, James MT, Manns BJ, et al. Rates of treated and untreated kidney failure in older vs younger adults. JAMA 2012; 307: 2507–2515.
  • 26. Powe NR, Tarver‐Carr ME, Eberhardt MS, Brancati FL. Receipt of renal replacement therapy in the United States: a population‐based study of sociodemographic disparities from the Second National Health and Nutrition Examination Survey (NHANES II). Am J Kidney Dis 2003; 42: 249–255.
  • 27. Liyanage T, Ninomiya T, Jha V, et al. Worldwide access to treatment for end‐stage kidney disease: a systematic review. Lancet 2015; 385: 1975–1982.
  • 28. Russ G; Australian and New Zealand Dialysis and Transplant Registry. 24th Annual Report 2001. Chapter 2: New patients commencing treatments in 2000. Adelaide: ANZDATA, 2001. https://www.anzdata.org.au/wp-content/uploads/2016/12/Ch.02-new-pts-2001.pdf (viewed Sept 2019).
  • 29. McDonald S, Chang S, Excell L; Australian and New Zealand Dialysis and Transplant Registry. 29th Annual Report 2006. Chapter 2: New patients commencing treatments in 2005. Adelaide: ANZDATA, 2006. https://www.anzdata.org.au/wp-content/uploads/2016/12/Ch02NewPatients-2.pdf (viewed Sept 2019).
  • 30. Grace B, Hurst K, McDonald S. Australian and New Zealand Dialysis and Transplant Registry. 34th Annual Report 2011. Chapter 2: New patients commencing treatments in 2010. Adelaide: ANZDATA, 2011. https://www.anzdata.org.au/wp-content/uploads/2016/12/2011c02_newpatients_v1.5.pdf (viewed Sept 2019).
  • 31. Zimmet PZ, James WP. The unstoppable Australian obesity and diabetes juggernaut. What should politicians do? Med J Aust 2006; 185: 187–188. https://www.mja.com.au/journal/2006/185/4/unstoppable-australian-obesity-and-diabetes-juggernaut-what-should-politicians.
  • 32. Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS Data Brief 2015; 219: 1–8.
  • 33. Kiberd B. The chronic kidney disease epidemic: stepping back and looking forward. J Am Soc Nephrol 2006; 17: 2967–2973.
  • 34. Byrne C, Caskey F, Castledine C, et al. The Renal Association — UK Renal Registry 19th annual report. Nephron 2017; 137 (Suppl).
  • 35. Saran R, Robinson B, Abbott KC, et al. US Renal Data System 2017 Annual Data Report: epidemiology of kidney disease in the United States. Am J Kidney Dis 2018; 71: A7.
  • 36. Australian and New Zealand Dialysis and Transplant Registry. 40th report. Chapter 2: prevalence of end stage kidney disease. Adelaide: ANZDATA Registry, 2018. https://www.anzdata.org.au/wp-content/uploads/2018/04/c02_prevalence_2016_v1.0_20180409.pdf (viewed Aug 2019).
  • 37. Australian and New Zealand Dialysis and Transplant Registry. 40th Report. Chapter 10: end stage kidney disease in Indigenous peoples of Australia and Aotearoa/New Zealand. Adelaide: ANZDATA Registry, 2018. https://www.anzdata.org.au/wp-content/uploads/2018/06/c10_indigenous_2016_v1.0_20181008.pdf (viewed Aug 2019).
  • 38. Li PK, Szeto CC. Success of the peritoneal dialysis programme in Hong Kong. Nephrol Dial Transplant 2008; 23: 1475–1478.
  • 39. Leung C, Cheung W, Li PK. Renal registry in Hong Kong — the first 20 years. Kidney Int Suppl 2011; 5: 33–38.
  • 40. Li PK, Chow KM, Van de Luijtgaarden MW, et al. Changes in the worldwide epidemiology of peritoneal dialysis. Nat Rev Nephrol 2017; 13: 90–103.
  • 41. Marron B, Ostrowski J, Torok M, et al. Type of referral, dialysis start and choice of renal replacement therapy modality in an international integrated care setting. PloS One 2016; 11: e0155987.
  • 42. Hyodo T, Hirawa N, Hayashi M, et al. Present status of renal replacement therapy at 2015 in Asian countries (Myanmar, Vietnam, Thailand, China, and Japan). Ren Replace Ther 2017; 3: 11.
  • 43. Jose MD, Johnson DW, Mudge DW, et al. Peritoneal dialysis practice in Australia and New Zealand: a call to action. Nephrology 2011; 16: 19–29.
  • 44. Cho Y, Htay H, Johnson DW. Centre effects and peritoneal dialysis‐related peritonitis. Nephrol Dial Transplant 2017; 32: 913–915.
  • 45. Htay H, Cho Y, Pascoe EM, et al. Multicenter registry analysis of center characteristics associated with technique failure in patients on incident peritoneal dialysis. Clin J Am Soc Nephrol 2017; 12: 1090–1099.
  • 46. Htay H, Cho Y, Pascoe EM, et al. Center effects and peritoneal dialysis peritonitis outcomes: analysis of a national registry. Am J Kidney Dis 2018; 71: 814–821.
  • 47. Australian and New Zealand Dialysis and Transplant Registry. 40th Report. Chapter 7: transplantation. Adelaide: ANZDATA Registry, 2018. https://www.anzdata.org.au/wp-content/uploads/2018/04/c07_transplant_2016_v1.0_20180509.pdf (viewed Aug 2019).
  • 48. Australian and New Zealand Organ Donation Registry. 2017 Annual report, section 2: overview of organ donation activity in Australia and New Zealand. Adelaide: ANZDATA Registry, 2017. https://www.anzdata.org.au/wp-content/uploads/2017/10/c02_donation_v1.0_20171026.pdf (viewed Aug 2019).
  • 49. Australian and New Zealand Dialysis and Transplant Registry. 41st Report. Chapter 7: kidney transplantation. Adelaide: ANZDATA Registry, 2018. https://www.anzdata.org.au/wp-content/uploads/2018/11/c07_transplant_2017_v1.0_20181220.pdf (viewed Aug 2019).
  • 50. Australian and New Zealand Dialysis and Transplant Registry. 40th Report. Chapter 8: kidney donation. Adelaide: ANZDATA Registry, 2018. https://www.anzdata.org.au/wp-content/uploads/2018/04/c08_donation_2016_v1.0_20180518.pdf (viewed Aug 2019).
  • 51. Pyart R, Wong E, Sharples E, et al. UK Renal Registry 20th annual report: chapter 3 demographic and biochemistry profile of kidney transplant recipients in the UK in 2016: national and centre‐specific analyses. Nephron 2018; 139 (Suppl): 75–104.
  • 52. Tushla L, Rudow DL, Milton J, et al. Living‐donor kidney transplantation: reducing financial barriers to live kidney donation — recommendations from a consensus conference. Clin J Am Soc Nephrol 2015; 10: 1696–1702.
  • 53. Khanal N, Lawton PD, Cass A, McDonald SP. Disparity of access to kidney transplantation by Indigenous and non‐Indigenous Australians. Med J Aust 2018; 209: 261–266. https://www.mja.com.au/journal/2018/209/6/disparity-access-kidney-transplantation-indigenous-and-non-indigenous.
  • 54. Australian and New Zealand Dialysis and Transplant Registry. 40th Report. Chapter 6: Australian transplant waiting list. Adelaide: ANZDATA Registry, 2018. https://www.anzdata.org.au/wp-content/uploads/2018/04/c06_waiting-list_2016v_1.0_20180504.pdf (viewed Aug 2019).
  • 55. Winkelmayer WC, Glynn RJ, Levin R, et al. Late nephrologist referral and access to renal transplantation. Transplantation 2002; 73: 1918–1923.
  • 56. Kazmi WH, Obrador GT, Khan SS, et al. Late nephrology referral and mortality among patients with end‐stage renal disease: a propensity score analysis. Nephrol Dial Transplant 2004; 19: 1808–1814.
  • 57. Cass A, Cunningham J, Snelling P, Ayanian JZ. Late referral to a nephrologist reduces access to renal transplantation. Am J Kidney Dis 2003; 42: 1043–1049.
  • 58. Cass A, Cunningham J, Snelling P, et al. Urban disadvantage and delayed nephrology referral in Australia. Health Place 2003; 9: 175–182.
  • 59. Baer G, Lameire N, Van Biesen W. Late referral of patients with end‐stage renal disease: an in‐depth review and suggestions for further actions. NDT Plus 2010; 3: 17–27.
  • 60. Arora P, Obrador GT, Ruthazer R, et al. Prevalence, predictors, and consequences of late nephrology referral at a tertiary care center. J Am Soc Nephrol 1999; 10: 1281–1286.
  • 61. Roderick P, Jones C, Drey N, et al. Late referral for end‐stage renal disease: a region‐wide survey in the south west of England. Nephrol Dial Transplant 2002; 17: 1252–1259.
  • 62. Roderick P, Jones C, Tomson C, Mason J. Late referral for dialysis: improving the management of chronic renal disease. QJM 2002; 95: 363–370.
  • 63. McDonald S, Chang S, Excell L; Australian and New Zealand Dialysis and Transplant Registry. 29th Annual Report. Chapter 2: New patients commencing treatment in 2005. Adelaide: ANZDATA, 2006. https://www.anzdata.org.au/wp-content/uploads/2016/12/Ch02NewPatients-2.pdf (viewed Sept 2019).
  • 64. Johnson DW, Jones GR, Mathew TH, et al. Chronic kidney disease and automatic reporting of estimated glomerular filtration rate: new developments and revised recommendations. Med J Aust 2012; 197: 224–225. https://www.mja.com.au/journal/2012/197/4/chronic-kidney-disease-and-automatic-reporting-estimated-glomerular-filtration.
  • 65. Johnson DW, Jones GR, Mathew TH, et al. Chronic kidney disease and measurement of albuminuria or proteinuria: a position statement. Med J Aust 2012; 197: 224–225. https://www.mja.com.au/journal/2012/197/4/chronic-kidney-disease-and-measurement-albuminuria-or-proteinuria-position.
  • 66. Foote C, Clayton PA, Johnson DW, et al. Impact of estimated GFR reporting on late referral rates and practice patterns for end‐stage kidney disease patients: a multilevel logistic regression analysis using the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). Am J Kidney Dis 2014; 64: 359–366.
  • 67. Carrero JJ, Hecking M, Chesnaye NC, Jager KJ. Sex and gender disparities in the epidemiology and outcomes of chronic kidney disease. Nat Rev Nephrol 2018; 14: 151–164.
  • 68. Ricardo AC, Yang W, Sha D, et al. Sex‐related disparities in CKD progression. J Am Soc Nephrol 2019; 30: 137–146.
  • 69. Piccoli GB, Alrukhaimi M, Liu ZH, et al; World Kidney Day Steering Committee. Women and kidney disease: reflections on World Kidney Day 2018: Kidney Health and Women's Health: a case for optimizing outcomes for present and future generations. Nephrol Dial Transplant 2018; 33: 189–193.
  • 70. Piccoli GB, Alrukhaimi M, Liu ZH, et al; World Kidney Day Steering Committee. Women and kidney disease: reflections on World Kidney Day 2018. Kidney Int 2018; 93: 278–283.
  • 71. Ashuntantang GE, Garovic VD, Heilberg IP, Lightstone L. Kidneys and women's health: key challenges and considerations. Nat Rev Nephrol 2018; 14: 203–210.
  • 72. Cass A, Lowell A, Christie M, et al. Sharing the true stories: improving communication between Aboriginal patients and healthcare workers. Med J Aust 2002; 176: 466–470.
  • 73. Devitt J, Anderson K, Cunningham J, et al. Difficult conversations: Australian Indigenous patients' views on kidney transplantation. BMC Nephrology 2017; 18: 310.
  • 74. Barraclough KA, Grace BS, Lawton P, McDonald SP. Residential location and kidney transplant outcomes in Indigenous compared with nonindigenous Australians. Transplantation 2016; 100: 2168–2176.
  • 75. Howson P, Irish AB, D'Orsogna L, et al. Allograft and patient outcomes between Indigenous and non‐Indigenous kidney transplant recipients. Transplantation 2019. https://doi.org/10.1097/tp.0000000000002891. [Epub ahead of print]
  • 76. Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351: 1296–1305.
  • 77. Tonelli M, Wiebe N, Culleton B, et al. Chronic kidney disease and mortality risk: a systematic review. J Am Soc Nephrol 2006; 17: 2034–2047.
  • 78. Keith DS, Nichols GA, Gullion CM, et al. Longitudinal follow‐up and outcomes among a population with chronic kidney disease in a large managed care organization. Arch Intern Med 2004; 164: 659–663.
  • 79. Roberts MA, Polkinghorne KR, McDonald SP, Ierino FL. Secular trends in cardiovascular mortality rates of patients receiving dialysis compared with the general population. Am J Kidney Dis 2011; 58: 64–72.
  • 80. United States Renal Data System. USRDS annual data report: epidemiology of kidney disease in the United States. Chapter 5: mortality. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2018. https://www.usrds.org/2018/view/v2_05.aspx (viewed Aug 2019).
  • 81. Australian and New Zealand Dialysis and Transplant Registry. 40th Report. Chapter 3: mortality in end stage kidney disease. Adelaide: ANZDATA Registry, 2018. https://www.anzdata.org.au/wp-content/uploads/2018/04/chapter03_mortality_2016_v1.0_20180411.pdf (viewed Aug 2019).
  • 82. McDonald S, Excell L, Livingston B. 29th Annual report. Chapter 3: Deaths. Adelaide: Australia and New Zealand Dialysis and Transplant Registry, 2006. https://www.anzdata.org.au/wp-content/uploads/2016/12/Ch03Deaths-1.pdf (viewed Aug 2019).
  • 83. Australian and New Zealand Dialysis and Transplant Registry. 41st Report. Chapter 3: mortality in end stage kidney disease. Adelaide: ANZDATA Registry, 2018. https://www.anzdata.org.au/wp-content/uploads/2018/11/c03_mortality_2017v1.0_20181122.pdf (viewed Aug 2019).
  • 84. McDonald S. 34th Annual report. Chapter 3: deaths. ANZDATA Registry, 2011. https://www.anzdata.org.au/wp-content/uploads/2016/12/2011c03_deaths_v1.5.pdf (viewed Aug 2019).
  • 85. Whitman IR, Feldman HI, Deo R. CKD and sudden cardiac death: epidemiology, mechanisms, and therapeutic approaches. J Am Soc Nephrol 2012; 23: 1929–1939.
  • 86. Pun PH, Lehrich RW, Smith SR, Middleton JP. Predictors of survival after cardiac arrest in outpatient hemodialysis clinics. Clin J Am Soc Nephrol 2007; 2: 491–500.
  • 87. Makar MS, Pun PH. Sudden cardiac death among hemodialysis patients. Am J Kidney Dis 2017; 69: 684–695.
  • 88. Palmer SC, Navaneethan SD, Craig JC, et al. HMG CoA reductase inhibitors (statins) for dialysis patients. Cochrane Database Syst Rev 2013; (9): CD004289.
  • 89. Holdaas H, Fellstrom B, Jardine AG, et al. Effect of fluvastatin on cardiac outcomes in renal transplant recipients: a multicentre, randomised, placebo‐controlled trial. Lancet 2003; 361: 2024–2031.
  • 90. Singh AK, Szczech L, Tang KL, et al. Correction of anemia with epoetin alfa in chronic kidney disease. N Engl J Med 2006; 355: 2085–2098.
  • 91. Baigent C, Landray M, Leaper C, et al. First United Kingdom Heart and Renal Protection (UK‐HARP‐I) study: biochemical efficacy and safety of simvastatin and safety of low‐dose aspirin in chronic kidney disease. Am J Kidney Dis 2005; 45: 473–484.
  • 92. Markossian T, Burge N, Ling B, et al. Controversies regarding lipid management and statin use for cardiovascular risk reduction in patients with CKD. Am J Kidney Dis 2016; 67: 965–977.
  • 93. Malhotra R, Nguyen HA, Benavente O, et al. Association between more intensive vs less intensive blood pressure lowering and risk of mortality in chronic kidney disease stages 3 to 5: a systematic review and meta‐analysis. JAMA Intern Med 2017; 177: 1498–1505.
  • 94. Heerspink HJ, Ninomiya T, Zoungas S, et al. Effect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: a systematic review and meta‐analysis of randomised controlled trials. Lancet 2009; 373: 1009–1015.
  • 95. Shlipak MG, Fried LF, Cushman M, et al. Cardiovascular mortality risk in chronic kidney disease: comparison of traditional and novel risk factors. JAMA 2005; 293: 1737–1745.
  • 96. Zoccali C, Mallamaci F, Tripepi G. Novel cardiovascular risk factors in end‐stage renal disease. J Am Soc Nephrol 2004; 15 (Suppl): S77–S80.
  • 97. Wanner C, Zimmermann J, Schwedler S, Metzger T. Inflammation and cardiovascular risk in dialysis patients. Kidney Int Suppl 2002; 80: 99–102.
  • 98. Cozzolino M, Mangano M, Stucchi A, et al. Cardiovascular disease in dialysis patients. Nephrol Dial Transplant 2018; 33 (Suppl): iii28–iii34.
  • 99. Yanik EL, Clarke CA, Snyder JJ, et al. Variation in cancer incidence among patients with ESRD during kidney function and nonfunction intervals. J Am Soc Nephrol 2016; 27: 1495–1504.
  • 100. Vajdic CM, McDonald SP, McCredie MR, et al. Cancer incidence before and after kidney transplantation. JAMA 2006; 296: 2823–2831.
  • 101. Au E, Wong G, Chapman JR. Cancer in kidney transplant recipients. Nat Rev Nephrol 2018; 14: 508–520.
  • 102. Au EH, Chapman JR, Craig JC, et al. Overall and site‐specific cancer mortality in patients on dialysis and after kidney transplant. J Am Soc Nephrol 2019. https://doi.org/10.1681/asn.2018090906. [Epub ahead of print]
  • 103. Stewart JH, Vajdic CM, van Leeuwen MT, et al. The pattern of excess cancer in dialysis and transplantation. Nephrol Dial Transplant 2009; 24: 3225–3231.
  • 104. Wong G, Hayward JS, McArthur E, et al. Patterns and predictors of screening for breast and cervical cancer in women with CKD. Clin J Am Soc Nephrol 2017; 12: 95–104.
  • 105. Lim WH, Badve SV, Wong G. Long‐term allograft and patient outcomes of kidney transplant recipients with and without incident cancer — a population cohort study. Oncotarget 2017; 8: 77771–77782.
  • 106. Holley JL. Screening, diagnosis, and treatment of cancer in long‐term dialysis patients. Clin J Am Soc Nephrol 2007; 2: 604–610.
  • 107. Johnson D, Fawcett K, Harvie B, et al. Chronic kidney disease (CKD) management in general practice, 3rd ed. Melbourne: Kidney Health Australia, 2015.
  • 108. Samal L, D'Amore JD, Bates DW, Wright A. Implementation of a scalable, web‐based, automated clinical decision support risk‐prediction tool for chronic kidney disease using C‐CDA and application programming interfaces. J Am Med Inform Assoc 2017; 24: 1111–1115.
  • 109. Hingwala J, Wojciechowski P, Hiebert B, et al. Risk‐based triage for nephrology referrals using the kidney failure risk equation. Can J Kidney Health Dis 2017; 4: 2054358117722782.
  • 110. Pefanis A, Botlero R, Langham RG, Nelson CL. eMAP:CKD: electronic diagnosis and management assistance to primary care in chronic kidney disease. Nephrol Dial Transplant 2018; 33: 121–128.

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