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Competing risks of death and kidney failure in a cohort of Australian adults with severe chronic kidney disease


Jose, MD and Raj, R and Jose, K and Kitsos, A and Saunder, T and McKercher, C and Radford, J, Competing risks of death and kidney failure in a cohort of Australian adults with severe chronic kidney disease, Medical Journal of Australia pp. 1-19. ISSN 0025-729X (2021) [Refereed Article]

Copyright Statement

Copyright 2021 Medical Journal of Australia

DOI: doi:10.5694/mja2.51361



To examine the competing risks of death (any cause) and of kidney failure in a cohort of Australian adults with severe chronic kidney disease.


Population-based cohort study; analysis of linked data from the Tasmanian Chronic Kidney Disease study (CKD.TASlink), 1 January 2004 31 December 2017.


All adults in Tasmania with incident stage 4 chronic kidney disease (estimated glomerular filtration rate [eGFR], 15‒29mL/min/1.73m2).

Main outcome measures

Death or kidney failure (defined as eGFR below 10mL/min/1.73m2 or initiation of dialysis or kidney transplantation) within five years of diagnosis of stage 4 chronic kidney disease.


We included data for 6825 adults with incident stage 4 chronic kidney disease (mean age, 79.3 years; SD, 11.1 years), including 3816 women (55.9%). The risk of death increased with age under 65 years: 0.18 (95% CI, 0.150.22); 65‒74 years: 0.39 (95% CI, 0.36‒0.42); 75‒84 years, 0.56 (95% CI, 0.54‒0.58); 85 years or older: 0.78 (95% CI, 0.77‒0.80) while that of kidney failure declined under 65 years: 0.39 (95% CI, 0.350.43); 65‒74 years: 0.12 (95% CI, 0.10‒0.14); 75‒84 years: 0.05 (95% CI, 0.04‒0.06); 85 years or older: 0.01 (95% CI, 0.01‒0.02). The risk of kidney failure was greater for people with macroalbuminuria and those whose albumin status had not recently been assessed. The risks of kidney failure and death were greater for men than women in all age groups (except similar risks of death for men and women under 65 years of age).


For older Australians with incident stage 4 chronic kidney disease, the risk of death is higher than that of kidney failure, and the latter risk declines with age. Clinical guidelines should recognise these competing risks and include recommendations about holistic supportive care, not just on preparation for dialysis or transplantation.

Item Details

Item Type:Refereed Article
Keywords:nephrology, data linkage, chronic kidney disease, guidelines
Research Division:Biomedical and Clinical Sciences
Research Group:Clinical sciences
Research Field:Nephrology and urology
Objective Division:Health
Objective Group:Clinical health
Objective Field:Treatment of human diseases and conditions
UTAS Author:Jose, MD (Professor Matthew Jose)
UTAS Author:Raj, R (Dr Rajesh Raj)
UTAS Author:Jose, K (Dr Kim Jose)
UTAS Author:Kitsos, A (Mr Alex Kitsos)
UTAS Author:Saunder, T (Mr Timothy Saunder)
UTAS Author:McKercher, C (Dr Charlotte McKercher)
ID Code:148588
Year Published:2021
Web of Science® Times Cited:1
Deposited By:Menzies Institute for Medical Research
Deposited On:2022-01-25
Last Modified:2022-03-07

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