Projecting the future: modelling Australian dialysis prevalence 2021-30.

Objectives To project the prevalence of people receiving dialysis in Australia for 2021-30 to inform service planning and health policy. Methods Estimates were based on data from 2011 to 2020 from the Australia & New Zealand Dialysis & Transplant (ANZDATA) Registry and the Australian Bureau of Statistics. We projected dialysis and functioning kidney transplant recipient populations for the years 2021-30. Discrete-time, non-homogenous Markov models were built on probabilities for transition between three mutually exclusive states (Dialysis, Functioning Transplant, Death), for five age groups. Two scenarios were employed - stable transplant rate vs a continued increase - to assess the impact of these scenarios on the projected prevalences. Results Models projected a 22.5-30.4% growth in the dialysis population from 14 554 in 2020 to 17 829 ('transplant growth') - 18 973 ('transplant stable') by 2030. An additional 4983-6484 kidney transplant recipients were also projected by 2030. Dialysis incidence per population increased and dialysis prevalence growth exceeded population ageing in 40-59 and 60-69 year age groups. The greatest dialysis prevalence growth was seen among those aged ≥70 years. Conclusion Modelling of the future prevalence of dialysis use highlights the increasing demand on services expected overall and especially by people aged ≥70 years. Appropriate funding and healthcare planning must meet this demand.

NAVKIDS2 trial: a multi-centre, waitlisted randomised controlled trial of a patient navigator intervention in children with chronic kidney disease - statistical analysis plan and update to the protocol.

BACKGROUND: This update summarises key changes made to the protocol since the publication of the original protocol for the NAVKIDS2 trial of patient navigators for children with chronic kidney disease (CKD) experiencing social disadvantage and provides the statistical analysis plan (SAP) which has not previously been published. METHODS/DESIGN: The original protocol was published in BMC Nephrology ( https://doi.org/10.1186/s12882-019-1325-y ) prior to the commencement of trial recruitment. During the course of the trial, some key methodological changes needed to be made including changes to eligibility criteria (addition of patients with CKD stages 1-2, broadening of financial status eligibility criterion, addition of patients living in rural/remote areas, modification of age eligibility to 0-16 years, addition of limits related to the language spoken by family, guidance regarding families with multiple eligible children), changes to sites, reduction of sample size, addition of virtual options for consent and study procedures in response to the COVID-19 pandemic, removal of staggered recruitment across sites, addition of outcomes, and changes to the timing and number of assessments. This update summarises the changes made and their rationale and provides the detailed plan for statistical analysis of the trial. These changes have been finalised prior to the completion of study follow-up and the commencement of data analysis. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618001152213 . Prospectively registered on 12 July 2018.

Renal tract

Chronic kidney disease (CKD) affects 850 million people worldwide1 and an estimated one in 10 adult Australians (2.4 million people).2 At the bottom of the 'CKD iceberg', one in three adult Australians is at risk of CKD.2 At the tip of the iceberg, over 26,000 Australians are currently receiving kidney replacement therapy with dialysis or transplantation.3 The burden of kidney disease is particularly high in Aboriginal and Torres Strait Islander peoples, with critical gaps in access to kidney care, particularly transplantation.4 There is much more to be done to address the burden of CKD in our community, as outlined in a recently published national strategy.5 Thankfully, Australians have been mostly spared the large additional burden of significant kidney failure due to COVID-19 that will have long-term implications for kidney disease care in other countries.6 In April 2021, AJGP focused on chronic kidney disease management. [...]all episodes of AKI, even if renal function is fully recovered, should spark medication review, the development of management plans for future episodes of intercurrent illness and ongoing monitoring for CKD. Thia and Saluja provide a framework for evaluating pain arising from the renal tract and managing kidney stones, which are the most likely culprit.10 Finally, O'Connor et al clarify current approaches to haematuria in general practice, with a focus on identifying those at most risk of malignancy or underlying kidney disease.11 A key practice point is that all these clinical presentations provide an excellent opportunity for the general practitioner to engage with the patient about their kidney health and identify those at risk of CKD.