Open Access Research article

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

Wen Tang123, Janaki Mohandas13, Stephen P McDonald14, Carmel M Hawley13, Sunil V Badve13, Neil Boudville15, Fiona G Brown16, Philip A Clayton178, Kathryn J Wiggins19, Kym M Bannister1, Scott B Campbell13 and David W Johnson1103*

Author Affiliations

1 ANZDATA Registry, Adelaide, Australia

2 Division of Nephrology, Peking University Third Hospital, Beijing, China

3 Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia

4 Department of Nephrology and Transplantation services, University of Adelaide at Central Northern Adelaide Renal and Transplantation Services, Adelaide, Australia

5 School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, The University of Western Australia, Perth, Australia

6 Department of Nephrology, Monash Medical Centre, Melbourne, VIC, Australia

7 Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia

8 School of Public Health, University of Sydney, Sydney, Australia

9 Department of Nephrology, Royal Melbourne Hospital, Parkville, VIC, Australia

10 Department of Renal Medicine,Princess Alexandra Hospital, Level 2, Ambulatory Renal and Transplant Services Building, Ipswich Road, Woolloongabba, Brisbane, Qld, 4102, Australia

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BMC Nephrology 2012, 13:164  doi:10.1186/1471-2369-13-164

Published: 3 December 2012

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.

Keywords:
Haemolytic uraemic syndrome; Kidney Failure; Chronic; Outcomes; Renal function recovery; Renal transplantation; Thrombotic microangiopathy