Abstract
INTRODUCTION: Glomerular diseases are rare but associated with substantial morbidity. Existing studies focus mainly on kidney failure and mortality, often overlooking multisystem complications. This first Australian population-based study uses linked routinely collected health data to estimate incidence, prevalence, and long-term outcomes, capturing cardiovascular, thrombotic, infectious, and healthcare burdens. METHODS: We conducted a population-based cohort study of adults ≥45 years in New South Wales, Australia (2005-2009, n = 267,357), using the 45 and Up Study with probabilistic data linkage via CHeReL and the Sax Institute. Glomerular disease was identified using nephrology specialist reviews, ICD-10-AM codes, kidney biopsy procedure codes, and the Australian and New Zealand Dialysis and Transplant (ANZDATA) registry. Age-standardised glomerular disease prevalence and incidence were estimated. Kaplan-Meier curves and Cox regression models evaluated all-cause mortality, major cardiovascular events (MACE; composite of acute myocardial infarction [AMI], stroke, and all-cause mortality), venous thromboembolism (VTE), and any hospitalised infection. Sub-distribution hazard models assessed kidney replacement therapy (KRT) risk, accounting for the competing risk of death. RESULTS: We identified 365 participants with glomerular disease (n = 195 prevalent, n = 170 incident; 67% male, mean age 65 years). The age-standardised prevalence and incidence of glomerular disease was 89/100,000 persons and 12/100,000 person-years-at-risk, respectively. After a median follow-up of 6 years, prevalent disease participants had a higher adjusted risk (HR; 95% CI; all p values <0.001) of all-cause mortality (2.18; 1.60-2.99), KRT (31.3; 12.7-77.2), MACE (2.17; 1.59-2.96), AMI (3.84; 2.05-7.20), stroke (3.58; 1.69-7.56), VTE (2.93; 1.76-4.89), and any hospitalised infection (2.92; 2.42-3.54). The 5-year risk of complications was comparable between prevalent and incident cases. Hospitalisation burden was also significantly higher among glomerular disease participants (p < 0.001). CONCLUSIONS: Using linked data, this study reveals the substantial multisystem burden of glomerular diseases, including kidney failure, death, cardiovascular events, infections, and hospitalisations in adults aged 45 and over.