Haemodialysis vascular access recent trends from anzdata
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Haemodialysis Vascular Access: Recent Trends From ANZDATA. Dr Kevan Polkinghorne Monash Medical Centre ANZSN September 2007. Vascular Access: ANZDATA 2000 - 2005. Vascular access type is an important indicator of quality of care in haemodialysis

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Haemodialysis Vascular Access: Recent Trends From ANZDATA

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Haemodialysis vascular access recent trends from anzdata

Haemodialysis Vascular Access: Recent Trends From ANZDATA

Dr Kevan Polkinghorne

Monash Medical Centre

ANZSN September 2007


Vascular access anzdata 2000 2005

Vascular Access: ANZDATA 2000 - 2005

  • Vascular access type is an important indicator of quality of care in haemodialysis

  • Collection of vascular access data by ANZDATA commenced in 1999:

    • Initially access in use at the end of survey period collected

    • 31st Oct 2003 – Access at first haemodialysis added

  • Now 6+ years of data available for analysis enabling assessment of trends in vascular access use in the “guidelines era”


International trends

International trends

  • Significant changes in vascular access practice patterns seen in US and Europe

    • USRDS

    • DOPPS


Graft as first access incident hemodialysis usrds

Graft As First Access Incident Hemodialysis USRDS

USRDS Annual Report 2006


Fistula as first access incident hemodialysis usrds

Fistula As First Access Incident Hemodialysis USRDS

USRDS Annual Report 2006


Catheter as first access incident hemodialysis usrds

Catheter As First Access Incident Hemodialysis USRDS

USRDS Annual Report 2006


Aims methods

Aims & Methods

Key Questions:

Are the recent trends in international catheter rates seen in ANZDATA?

What are the characteristics of incident patients who use catheters?

Moist L, Chang S, Polkinghorne K, McDonald S. In Press Am J Kidney Diseases


Trends in incident vascular access anzdata 2000 2004

Trends in Incident Vascular Access: ANZDATA 2000 -2004

(1) Incident Cohort:Patients who commenced dialysis

within 60 days of the survey period 2000, 2002, & 2004

(2) 6-8 Month Cohort:Patients on dialysis 6-8 months

after commencement 2000, 2001, 2002, & 2003

(3) Prevalent Cohort:All patients on haemodialysis 2000, 2002, 2004, & 2005

Moist L, Chang S, Polkinghorne K, McDonald S. In Press Am J Kidney Diseases


Haemodialysis vascular access recent trends from anzdata

Moist L, Chang S, Polkinghorne K, McDonald S. In Press Am J Kidney Diseases


Haemodialysis vascular access recent trends from anzdata

Moist L, Chang S, Polkinghorne K, McDonald S. In Press Am J Kidney Diseases


Vascular access incident cohort 2000 2004

Vascular Access: Incident Cohort 2000 -2004

Moist L, Chang S, Polkinghorne K, McDonald S. In Press Am J Kidney Diseases


Unadjusted adjusted incident rates incident cohort 2000 2004

Unadjusted & Adjusted Incident Rates: Incident Cohort 2000 - 2004

*p< 0.05 compared to 2000

Adjusted for age, sex, race, body mass index, late referral, smoking status, etiology of end stage renal disease, history of diabetes, coronary artery disease, peripheral vascular disease, cerebrovascular disease and hypertension


Vascular access use 6 8 months after starting dialysis 2000 2003

Vascular Access Use 6-8 Months After Starting Dialysis 2000 -2003

Moist L, Chang S, Polkinghorne K, McDonald S. In Press Am J Kidney Diseases


Unadjusted adjusted incident rates 6 8 months after starting dialysis 2000 2004

Unadjusted & Adjusted Incident Rates: 6-8 Months After Starting Dialysis 2000 - 2004

*p< 0.05 compared to 2000

Adjusted for age, sex, race, body mass index, late referral, smoking status, etiology of end stage renal disease, history of diabetes, coronary artery disease, peripheral vascular disease, cerebrovascular disease and hypertension


Actual vascular access at first haemodialysis 2003 2005

Actual Vascular Access at First Haemodialysis 2003 -2005

Moist L, Chang S, Polkinghorne K, McDonald S. In Press Am J Kidney Diseases


Haemodialysis vascular access recent trends from anzdata

Moist L, Chang S, Polkinghorne K, McDonald S. In Press Am J Kidney Diseases


Prevalent vascular access 2000 2005

Prevalent Vascular Access 2000-2005

Moist L, Chang S, Polkinghorne K, McDonald S. In Press Am J Kidney Diseases


2006 data

2006 Data


Conclusions

Conclusions

  • Catheter rates have increased significantly over the last 6 years

  • Rates increased not just in incident patients but also prevalence patients

  • Increased rates not accounted for by differences in comorbidity

  • Trends has continued into 2006 and “similar for PD and HDx units”


Acknowledgements

Acknowledgements

  • Dr Louise Moist

  • Dr Stephen MacDonald

  • Dr Sean Chang

  • ANZDATA Registry

  • Renal Units in Australia and New Zealand


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