Publications
2024
Island medicine longitudinal cohort study: Rapid rise in chronic kidney disease in rural and remote communities
Matthew Jose, Laura Cuthbertson, James Burgess, Kim Jose, Tim Saunder, Alex Kitsos, Jan Radford, Rajesh Raj
Abstract
Aim
To determine the change in incidence and prevalence of chronic kidney disease (CKD) in rural and remote communities over the last decade.
Methods
We examined the change in age-standardized incidence and prevalence in Tasmania between 2010 and 2020, using a linked dataset that included any adult with a creatinine test taken in a community laboratory during the study period (n = 581 513; 87.8% of the state's adult population). We defined CKD as two measures of eGFR <60 mL/min per 1.73 m2, at least 3 months apart.
Results
State-wide age-standardized prevalence of CKD increased by 28% in the decade to 2020, from 516 to 659 per 10 000 population. Prevalence in men increased 31.3% and women 24.8%. The greatest increase in age-standardized prevalence was seen in rural or remote communities with an increase of 36.6% overall, but with considerable variation by community (range + 0.4% to +88.3%). The increase in the actual number of people with CKD in the decade to 2020 was 67%, with the number of women increasing by 58% and men by 79%.
Conclusion
The age-standardized prevalence of CKD in rural and remote regions has increased considerably over the past decade, likely compounded by limited access to primary and secondary healthcare. These findings highlight the need to ensure healthcare resources are directed to areas of greatest need.
2022
Competing risks of death and kidney failure in a cohort of Australian adults with severe chronic kidney disease
Matthew Jose, Rajesh Raj, Kim Jose, Alex Kitsos, Tim Saunder, Charlotte McKercher, Jan Radford
Abstract
Objective
To examine the competing risks of death (any cause) and of kidney failure in a cohort of Australian adults with severe chronic kidney disease.
Design
Population‐based cohort study; analysis of linked data from the Tasmanian Chronic Kidney Disease study (CKD.TASlink), 1 January 2004 – 31 December 2017.
Participants
All adults in Tasmania with incident stage 4 chronic kidney disease (estimated glomerular filtration rate [eGFR], 15‒29 mL/min/1.73 m2).
Main Outcome Measures
Death or kidney failure (defined as eGFR below 10 mL/min/1.73 m2 or initiation of dialysis or kidney transplantation) within five years of diagnosis of stage 4 chronic kidney disease.
Results
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, 0.15–0.22); 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, 0.35–0.43); 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).
Conclusion
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.
2021
Island medicine: using data linkage to establish the kidney health of the population of Tasmania, Australia
Matthew Jose, Rajesh Raj, Kim Jose, Alex Kitsos, Tim Saunder, Charlotte McKercher, Jan Radford
Abstract
Objective
To report (using linked laboratory data) the incidence, prevalence and geographic variation of chronic kidney disease (CKD) across the whole island population of Tasmania, Australia.
Methods
A retrospective cohort study (the Tasmanian Chronic Kidney Disease study (CKD.TASlink)) using linked data from five health and two pathology datasets from the island state of Tasmania, Australia between 1/1/2004 and 31/12/2017. We used data on 460,737 Tasmanian adults (aged 18 years and older, representing 86.8% of the state's population) who had a serum creatinine measured during the study period. We defined CKD as per Kidney Disease Outcomes Quality Initiative, requiring two measures of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2, at least three months apart. Kidney replacement therapy (KRT) included dialysis or kidney transplantation.
Results
We identified 56,438 Tasmanians with CKD during the study period, equating to an age-standardised annual incidence of 1.0% and a prevalence of 6.5%. These figures were higher in women, older Tasmanians and people living in the North-West region of Tasmania. Testing for urinary albumin:creatinine ratio is increasing, with 28.5% of women and 30.8% of men with stage 3 CKD having both an eGFR and uACR in 2017. Use of KRT was consistently seen in >65% of Tasmanians with eGFR <15 mL/min/1.73m2.
Conclusion
There is geographic and gender variation in the incidence and prevalence of CKD, but it is reassuring to see that the majority of people with end-stage kidney failure are actually receiving treatment with dialysis or transplantation.
2020
Chronic Kidney Disease in Tasmania: Protocol for a Data Linkage Study
Tim Saunder, Alex Kitsos, Jan Radford, Kim Jose, Charlotte McKercher, Rajesh Raj, Nadine Wiggins, Brian Stokes, Matthew Jose
Abstract
Background
Chronic kidney disease (CKD) is a significant and growing health burden globally. Tasmania has the highest state prevalence for non-Indigenous Australians and it has consistently had the lowest incidence and prevalence of dialysis in Australia.
Objective
To examine the gap between the high community prevalence of CKD in Tasmania and the low use of dialysis.
Methods
This is a retrospective cohort study using linked data from 5 health and 2 pathology data sets from the island state of Tasmania, Australia. The study population consists of any person (all ages including children) who had a blood measurement of creatinine with the included pathology providers between January 1, 2004, and December 31, 2017. This study population (N=460,737) includes within it a CKD cohort, which was detected via pathology or documentation of kidney replacement therapy (KRT; dialysis or kidney transplant). Kidney function (estimated glomerular filtration rate [eGFR]) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Individuals with 2 measures of eGFR<60 mL/min/1.73 m2, at least 90 days apart, were identified as having CKD and were included in the CKD cohort. Individuals treated with dialysis or transplant were identified from the Australia and New Zealand Dialysis and Transplant Registry.
Results
The study population consisted of 460,737 people (n=245,573 [53.30%] female, mean age 47.4 years) who were Tasmanian residents aged 18 years and older and were followed for a median of 7.8 years. During the later 5 years of the study period, 86.79% (355,622/409,729) of Tasmanian adults were represented. The CKD cohort consisted of 56,438 people (ie, 12.25% of the study population; 53.87% (30,405/56,438) female, mean age 69.9 years) followed for a median of 10.4 years with 56,039 detected via eGFR and 399 people detected via documentation of KRT. Approximately half (227,433/460,737, 49.36%) of the study population and the majority of the CKD cohort (41,448/56,438, 73.44%) had an admission episode. Of the 55,366 deaths recorded in the study population, 45.10% (24,970/55,366) had CKD.
Conclusion
Whole-of-population approaches to examine CKD in the community can be achieved by data linkage. Over this 14-year period, CKD affected 12.25% (56,438/460,737) of Tasmanian adult residents and was present in 45.10% (24,970/55,366) of deaths.
Conference Abstracts
2025
Comparing the healthcare burden of dialysis versus conservative care in the final years as an aid to clinical care decision making
Poster Presentation at the Australasian Association for Academic Primary Care 2025 Conference
Jan Radford, Kim Jose, Rajesh Raj, Georgia McGrath, Tim Saunders, Matthew Jose
Supporting older consumers with kidney failure make informed decisions about treatment options
Presentation at the 2025 Menzies Institute for Medical Research, College of Health and Medicine Forum.
Kim Jose, Jan Radford, Rajesh Raj, Lisa Shelverton, Carolyn Baker, Georgia McGrath, Matthew Jose
Codesigning with older consumers new resources to support informed decisions about management of kidney failure using data from the CKD.TASlink study
Abstract presented at the Australia, New Zealand Society of Nephrology, 2025 Conference
Kim Jose, Jan Radford, Rajesh Raj, Lisa Shelverton, Carolyn Baker, Matthew Jose
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The last 1000 days with Chronic Kidney Disease: the health care burden
Presentation awarded a Kidney Health Australia Clinical Science Award at the 2021 Australian and New Zealand Society of Nephrology Conference.
Matthew Jose, Laura Cuthbertson, Sarah McBride, Kim Jose, Tim Saunder, Alex Kitsos, Jan Radford, Rajesh Raj
2021
The rise and rise of Chronic Kidney Disease in regional, rural and remote communities. A statewide report using data linkage
Presentation awarded a Kidney Health Australia Clinical Science Award at the 2021 Australian and New Zealand Society of Nephrology Conference.
Matthew Jose, Laura Cuthbertson, Sarah McBride, Kim Jose, Tim Saunder, Alex Kitsos, Jan Radford, Rajesh Raj