Improving outcomes in chronic kidney disease and its associated comorbidities

Background: Chronic kidney disease (CKD) and its associated comorbidities such as diabetes and cardiovascular disease (CVD) are major drivers of death and disability around the world. Methods: This thesis by publication aims to examine the burden of CKD and diabetes in the community and explores the ways in which this burden can be ameliorated. These aims are achieved by various methodologies. A novel comprehensive population-based data linkage study is used to estimate CKD and diabetes incidence and associations as well as assesses health service delivery of proven cardioprotective treatments to mitigate the burden of CVD. An observational extension of a randomised controlled trial (RCT) cohort of people with CKD is used to investigate the legacy effect of statins on CVD. A narrative review examines the RCT evidence for the CV and kidney protection of novel glucose lowering agents for the treatment of diabetes. Systematic review and meta-analyses are used to examine treatment options to mitigate the effect of Acute kidney injury (AKI) a precursor of CKD. Results: This research program has demonstrated the high burden of CKD and diabetes in the community and identified risk factors that can be targeted to inform health service planning and resource allocation. New data is presented that demonstrates the significant missed opportunities in the use of cardioprotective therapies for CVD prevention. A literature review of glucose lowering agents showed CV and renal protection in people with and without pre-existing CVD. A systematic review of two currently used treatments for the management and prevention of AKI found no evidence for their continued use. Conclusions: Collectively the findings of this thesis have the potential to inform the design of strategies to target and readily implement solutions to improve health outcomes in CKD and diabetes