264Burden of Metabolic Complications of Chronic Kidney Diseases in The Irish Health System

Abstract

Background: The prevalence of Chronic Kidney Disease (CKD) exceeds 15% in the Irish health system and is associated with adverse clinical outcomes. There is little data on the prevalence of CKD-associated metabolic complications which may contribute substantially to poor outcomes. The goal of this study was to describe the burden of common metabolic complications in CKD and assess the impact of deteriorating kidney function. Method(s): Utilising data from the National Kidney Disease Surveillance System, we conducted a cross sectional study of adult patients, age > 18 years, from the Midwest-Region in 2014 with data on serum creatinine measurements and metabolic indicators. The following definitions were used: anaemia: haemoglobin <13 g/dL & <12 g/dL in men and women; hyperkalaemia: K+ > 5.5 mmol/L; hypoalbuminaemia; serum albumin <35 g/L, metabolic acidosis: bicarbonate <22 mmol/L, and hyperphosphatemia: phosphate >1.5 mmol/L. Separate multivariable logistic regression models explored associations of estimated glomerular filtration rate (eGFR) with each metabolic complication expressed as adjusted odds ratio (OR). Result(s): There were 133,558 adults with average age 54.3 (+/-17.7) years and eGFR 87.9 (+/-21.1) ml/min/1.73 m 2. The prevalence of metabolic complications were as follows: metabolic acidosis (28.9%), anaemia (13.6%), hyperkalaemic (13.1%), hypoalbuminaemia (9.9%), and hyperphosphatemia (2.3%). In multivariate models adjusting for age and sex only, each 5 mL/min/1.73 m 2 fall in eGFR was associated with higher odds of anaemia, [OR 1.08 (95% CI; 1.07-1.09)]; hyperkalaemia [OR 1.09 (95% CI; 1.08-1.10], hypoalbu-minaemia, [OR 1.02 (1.01-1.03)], metabolic acidosis [OR 1.03 (95% CI; 1.02-1.04)], and hyperphosphatemia [OR 1.23 (95% CI; 1.21-1.26)]. Conclusion(s): The burden of CKD-related metabolic complications is high within the Irish health care system. Patients with declining eGFR are at increased risk for several serious but treatable metabolic complications. Early identification and treatment of these disorders may lead to improve patient outcomes.