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Analgesic Nephropathy and Renal Replacement Therapy in Australia: Trends, Comorbidities and Outcomes

Sean Haw Chang^*, Timothy Hamish Mathew, and Stephen Peter McDonald^*

^* Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, School of Medicine, University of Adelaide, and Department of Nephrology and Transplantation, Queen Elizabeth Hospital, and Kidney Health Australia, Adelaide, South Australia, Australia

Correspondence: Dr. Sean Haw Chang, ANZDATA Registry, Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, South Australia 5011, Australia. Phone: +61-8-8222-6809; Fax: +61-8-8222-6402; E-mail: seanhaw{at}hotmail.com, sean{at}anzdata.org.au

Background and objectives: This study examined age-specific incidence and prevalence of renal replacement therapy attributed to analgesic nephropathy from 1971 through 2005 and adjusted comorbidity prevalence and survival of patients who had analgesic nephropathy and were on renal replacement therapy (compared with control subjects without diabetes).

Design, setting, participants, & measurements: This retrospective cohort study, using data from the Australia and New Zealand Dialysis and Transplant registry, included all patients who were aged 35 to 84 yr and started long-term renal replacement therapy in Australia from 1971 through 2006.

Results: Of 31,654 incident renal replacement therapy patients, 10.2% had analgesic nephropathy. Incidence and prevalence of renal replacement therapy attributed to analgesic nephropathy decreased earlier and faster among younger (age <55 yr) patients. Prevalence of analgesic nephropathy among 75- to 84-yr-old renal replacement therapy patients is still increasing. Compared with control subjects without diabetes, comorbidities (coronary artery, cerebrovascular, peripheral vascular, and chronic lung diseases) were more prevalent among patients with analgesic nephropathy at renal replacement therapy start. All-cause, cardiovascular, infection, and cancer mortality were higher among patients who had analgesic nephropathy and were on renal replacement therapy. For both comorbidities and mortality, the associations were stronger in younger patients.

Conclusions: Trends in renal replacement therapy attributed to analgesic nephropathy differed by age. Patients with analgesic nephropathy have more comorbidities and poorer survival on renal replacement therapy, especially among younger patients.