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Background People with chronic kidney disease (CKD) have increased incidence and mortality of most cancer types. We hypothesized that the odds of presenting with advanced cancer may vary according to differences in estimated glomerular filtration rate (eGFR), that this could contribute to increased all-cause mortality and that sex differences may exist. Methods Data were from Secure Anonymised Information Linkage Databank, including people with de novo cancer diagnosis (2011–17) and two kidney function tests within 2 years prior to diagnosis to determine baseline eGFR (mL/min/1.73 m2). Logistic regression models determined the odds of presenting with advanced cancer by baseline eGFR. Cox proportional hazards models tested associations between baseline eGFRCr and all-cause mortality. Results eGFR <30 was associated with higher odds of presenting with advanced cancer of prostate, breast and female genital organs, but not other cancer sites. Compared with eGFR >75–90, eGFR <30 was associated with greater hazards of all-cause mortality in both sexes, but the association was stronger in females [female: hazard ratio (HR) 1.71, 95% confidence interval (CI) 1.56–1.88; male versus female comparison: HR 0.88, 95% CI 0.78–0.99]. Conclusions Lower or higher eGFR was not associated with substantially higher odds of presenting with advanced cancer across most cancer sites, but was associated with reduced survival. A stronger association with all-cause mortality in females compared with males with eGFR <30 is concerning and warrants further scrutiny. [ABSTRACT FROM AUTHOR]

Background People on the kidney waitlist are less informed about potential suspensions. Disparities may exist among those who are suspended and who return to the waitlist. We evaluated the patient journey after entering the waitlist, including suspensions and outcomes, and factors associated with these transitions. Methods We included all incident patients waitlisted for their first transplant from deceased donors in Australia from 2006 to 2019. We described all clinical transitions after entering the waitlist. We predicted the restricted mean survival time (unadjusted and adjusted) until first transplant by the number of prior suspensions. We evaluated factors associated with transitions using flexible survival models and clinical endpoints using Cox models. Results Of 8466 patients waitlisted and followed over 45 757.4 person-years (median 4.8 years), 6741 (80%) were transplanted, 381 (5%) died waiting and 1344 (16%) were still waiting. A total of 3127 (37%) people were suspended at least once. Predicted mean time from waitlist to transplant was 3.0 years [95% confidence interval (CI) 2.8–3.2] when suspended versus 1.9 years (95% CI 1.8–1.9) when never suspended. Prior suspension increased the likelihood of further suspensions 4.2-fold (95% CI 3.8–4.6) and returning to the waitlist by 50% (95% CI 36–65) but decreased the likelihood of transplantation by 29% (95% CI 62–82). Death risk while waiting was increased 12-fold (95% CI 8.0–18.3) when currently suspended. Australian non-Indigenous males were 13% [hazard ratio (HR) 1.13 (95% CI 1.04–1.23)] and Asian males 23% [HR 1.23 (95% CI 1.06–1.42)] more likely to return to the waitlist compared with females of the same ethnicity. Conclusion The waitlist journey was not straightforward. Suspension was common, impacted the chance of transplantation and meant waiting an average of 1 year longer until transplant. We have provided estimates for and factors associated with suspension, relisting and outcomes after waitlisting to support more informed discussions. This evidence is critical to further understand drivers of inequitable access to transplantation. [ABSTRACT FROM AUTHOR]

BackgroundTension lies between the need to increase access to organ transplantation and the equally urgent need to prevent inadvertent transmission of infectious diseases or cancer from organ donors. Biovigilance, or the evaluation of potential donors, is often time-pressured and may be based on incomplete information. ObjectiveThe Safety and Biovigilance in Organ Donation (SAFEBOD) study aims to improve estimates of infection and cancer transmission risk and explore how real-time data access could support decision-making. MethodsWe will link existing donor referral, actual donor, recipient, and health-outcome data sets from 2000-2015 in New South Wales. Organ donor data sets will include the Organ Donor Characterizing Risk-Profile of Donors Study, the National Organ Matching System, the Australian and New Zealand Organ Donor Register, and the Australian and New Zealand Living Donor Kidney Register. Recipient data sets will include the Australian and New Zealand Dialysis and Transplant Register, the Australian and New Zealand Cardiothoracic Register, the Australian and New Zealand Islet and Pancreas Register, and the Australian and New Zealand Liver Transplant Register. New South Wales health outcome data sets will include HIV and AIDS Notifications and Surveillance Data, the Notifiable Conditions Information Management System, Admitted Patient Data Collection, Emergency Department Data Collection, the Central Cancer Registry, and the Cause of Death Data Collection. We will link organ donors to transplant recipients and health outcomes data sets using probabilistic data-matching based on personal identifiers. Transmission and nontransmission events will be determined by comparing previous cases in donors and posttransplant cases in recipients. We will compare the perceived-risk at referral with the verified risk from linked health outcome data sets and the odds of cancer or contracting an infectious disease in organ recipients from donors based on their transmission-risk profile and estimate recipient survival by donor transmission risk group. ResultsData were requested from each of the listed registries in September 2018, and data collection is ongoing. Linked data from all listed data sets are expected to be complete in September 2020. ConclusionsThe SAFEBOD study will overcome current limitations in organ donation by accessing comprehensive information on referred organ donors and recipients in existing data sets. The study will provide robust estimates of disease transmission and nontransmission events based on recent data. It will also describe the agreement between perceived risk estimated at the time of referral and verified risk when all health outcome data are accessible. The improved understanding of transmission and nontransmission events will inform clinical decisions and highlight where current policies can be revised to broaden the acceptance of deceased donors. International Registered Report Identifier (IRRID)DERR1-10.2196/18282

Background: Despite diversity initiatives, inequities persist in medicine with negative implications for the workforce and patients. Little is known about workplace inequity in nephrology. Aim: To describe perceptions and experiences of bias by health professionals in the Australian and New Zealand Society of Nephrology (ANZSN), focussing on gender and race. Methods: A web‐based survey of ANZSN members recorded degree of perceived inequity on a Likert scale, ranging from 1 (none) to 5 (complete). Groups were compared using Mann–Whitney U‐test and logistic regression. Comments were synthesised using qualitative methods to explore themes of inequity and pathways to an inclusive future. Results: Of the 620 members of the ANZSN, there were 134 (22%) respondents, of whom 57% were women and 67% were White. The majority (88%) perceived inequities in the workforce. Perceived drivers of inequity were gender (84/113; 75%), carer responsibilities (74/113; 65%) and race (64/113; 56%). Half (74/131) had personally experienced inequity, based on gender in 70% (52/74) and race in 39% (29/75) with perceived discrimination coming from doctors, patients, academics and health administrators. White males were least likely (odds ratio 0.39; 95% confidence interval 0.18–0.90) to experience inequity. Dominant themes from qualitative analysis indicated that the major impacts of inequity were limited opportunities for advancement and lack of formal assistance for those experiencing inequities. Proposed solutions to reduce inequity included normalising the discourse on inequity at an organisational level, with policy changes to ensure diverse representation on committees and in executive leadership positions. Conclusions: Inequity, particularly driven by gender and race, is common for nephrology health professionals in Australia and New Zealand and impacts career progression. [ABSTRACT FROM AUTHOR]

Measures to control the COVID-19 pandemic have disrupted social networks and employment security worldwide. Longitudinal data in representative samples are required to understand the corresponding mental health impacts. We aimed to estimate the prevalence of depressive symptoms in Australian women raising young families during the first Victorian lockdown and to identify risk factors. Participants comprise 347 mothers of children aged 7 (mean age: 32·11 years [4·27]), from the Barwon Infant Study (BIS). Mothers had previously completed Edinburgh Postnatal Depression Scale (EPDS) at child ages zero, two, four. Following the lock down, mothers again completed EPDS along with questions regarding current household and employment demographics. Depressive symptoms were substantially more prevalent in the lockdown sample than at any prior assessment (EPDS10+; 30·6%); and were particularly high in women with previous poor mental health. Anticipated and actual job loss were twice as common relative to previous assessment (5% to 13%, p = 0 006) and (4% to 10%, p = 0 001) and were associated with depressive symptoms. While further studies are required to confirm causal associations, these findings highlight the need to support mental health during the COVID-19 pandemic, particularly in the context of employment insecurity and previous mental illness. KEY POINTS What is already known about this topic: Emerging reports from convenience samples demonstrate elevated depressive symptoms during the COVID-19 pandemic. Maternal mental health is important for child mental health. Representative, longitudinal data are needed to further improve targeting of policy and health service delivery to prevent a post-COVID-19 mental health crisis. What this topic adds: This early report from a population-derived cohort demonstrates high rates of depression symptomatology in mothers of school aged children following the first COVID-19 lockdown. A past history of depression and current threats to employment are identified as key risk factors for adverse mental health. Our findings are consistent with concerns regarding an increase in mental health burden in the wake of the COVID-19 pandemic but further studies are required to assess causality. Interventions and broader community resources to support the mental health of women of school aged children are required, and should target those with a history of depression and current threats to employment. [ABSTRACT FROM AUTHOR]

Background: Transplant recipients are at high‐risk of anal squamous cell cancer. We aimed to estimate the prevalence of high‐risk human papillomavirus (HPV) and high‐grade squamous intraepithelial lesion (HSIL) and assess characteristics associated with results Methods: We recruited kidney transplant recipients in a single‐center, 2015–2018. Participants completed a clinical questionnaire and received an anal‐swab sent for HPV‐DNA and cytological testing Results: A total of 97 (74%) of 125 recipients approached consented to participate. Participants were median 47 (IQR 40–55) years, 60% male and median 4.5 (IQR.9‐13) months‐since‐transplant. Of 86 assessable samples, at least one HPV genotype was detected in 15 (17%) participants; 1 (1%) HPV16, 8 (9%) other high‐risk HPV. Of 76 assessable cytology samples, 9 (12%) showed evidence of abnormality; 1 (1%) HSIL, 1 (1%) atypical‐squamous‐cells, cannot exclude HSIL. Both HSIL recipients had high‐risk HPV and biopsy confirmed HSIL. High‐risk HPV was detected in six (9%) recipients with normal cytology. History of sexually transmitted infection, and abnormal cervical pap smear in women, was associated with high‐risk HPV and HSIL Conclusions: High‐risk HPV and HSIL testing may identify kidney transplant recipients at higher risk of anal cancer. Longitudinal studies are needed to describe the natural history of anal cancer in transplant recipients. [ABSTRACT FROM AUTHOR]