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. 2012 Dec 3:13:164.
doi: 10.1186/1471-2369-13-164.

End-stage kidney disease due to haemolytic uraemic syndrome--outcomes in 241 consecutive ANZDATA registry cases

Wen Tang  1 , Janaki Mohandas, Stephen P McDonald, Carmel M Hawley, Sunil V Badve, Neil Boudville, Fiona G Brown, Philip A Clayton, Kathryn J Wiggins, Kym M Bannister, Scott B Campbell, David W Johnson
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End-stage kidney disease due to haemolytic uraemic syndrome--outcomes in 241 consecutive ANZDATA registry cases

Wen Tang et al. BMC Nephrol. .

Abstract

Background: The aim of this study was to investigate the characteristics and outcomes of patients receiving renal replacement therapy for end-stage kidney disease (ESKD) secondary to haemolytic uraemic syndrome (HUS).

Methods: The study included all patients with ESKD who commenced renal replacement therapy in Australia and New Zealand between 15/5/1963 and 31/12/2010, using data from the ANZDATA Registry. HUS ESKD patients were compared with matched controls with an alternative primary renal disease using propensity scores based on age, gender and treatment era.

Results: Of the 58422 patients included in the study, 241 (0.4%) had ESKD secondary to HUS. HUS ESKD was independently associated with younger age, female gender and European race. Compared with matched controls, HUS ESKD was not associated with mortality on renal replacement therapy (adjusted hazard ratio [HR] 1.14, 95% CI 0.87-1.50, p = 0.34) or dialysis (HR 1.34, 95% CI 0.93-1.93, p = 0.12), but did independently predict recovery of renal function (HR 54.01, 95% CI 1.45-11.1, p = 0.008). 130 (54%) HUS patients received 166 renal allografts. Overall renal allograft survival rates were significantly lower for patients with HUS ESKD at 1 year (73% vs 91%), 5 years (62% vs 85%) and 10 years (49% vs 73%). HUS ESKD was an independent predictor of renal allograft failure (HR 2.59, 95% CI 1.70-3.95, p < 0.001). Sixteen (12%) HUS patients experienced failure of 22 renal allografts due to recurrent HUS. HUS ESKD was not independently associated with the risk of death following renal transplantation (HR 0.92, 95% CI 0.35-2.44, p = 0.87).

Conclusions: HUS is an uncommon cause of ESKD, which is associated with comparable patient survival on dialysis, an increased probability of renal function recovery, comparable patient survival post-renal transplant and a heightened risk of renal transplant graft failure compared with matched ESKD controls.

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Figures

Figure 1
Figure 1
Kaplan-Meier survival curves for HUS dialysis ESKD and matched control dialysis patients with other causes of ESKD in Australian and New Zealand dialysis patients 1963–2010
Figure 2
Figure 2
Kaplan-Meier death-censored first graft survival curves for HUS ESKD and matched control patients with other causes of ESKD undergoing renal transplantation in Australian and New Zealand between 1963 and 2010
Figure 3
Figure 3
Kaplan-Meier patient survival curves for HUS ESKD and matched control patients with other causes of ESKD undergoing first renal transplantation in Australian and New Zealand between 1963 and 2010
See this image and copyright information in PMC

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