ANZDATA Vascular Access Dr K Polkinghorne Department of

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ANZDATA: Vascular Access Dr K Polkinghorne Department of Nephrology Monash Medical Centre Melbourne ©

ANZDATA: Vascular Access Dr K Polkinghorne Department of Nephrology Monash Medical Centre Melbourne © ANZDATA Registry

ANZDATA: Vascular Access • Data collected at each survey since 30 September 1999: •

ANZDATA: Vascular Access • Data collected at each survey since 30 September 1999: • Access in use at each survey • Declotting and revision events • Revision method • Access at first dialysis not collected © ANZDATA Registry

Aims 1. Determine the proportion of native fistulas in use at the start of

Aims 1. Determine the proportion of native fistulas in use at the start of treatment 2. Identify factors associated with: • AVG placement • Catheter placement 3. Identify any differences in access use according to treatment location at a state level © ANZDATA Registry

Vascular Access at First Dialysis • Access at first dialysis not collected • Time

Vascular Access at First Dialysis • Access at first dialysis not collected • Time on dialysis can be calculated • Therefore can group new patients from the last 5 surveys according to time on dialysis • Estimate access at first use according to time on dialysis © ANZDATA Registry

Figure 13. 1 Percentage Synthetic Fistulae/Grafts March 2002 (Number of Patients) Diabetic Queensland *

Figure 13. 1 Percentage Synthetic Fistulae/Grafts March 2002 (Number of Patients) Diabetic Queensland * Non Diabetic (784) 19. 1% (162) 14. 7% (622) (1628) 25. 8% (224) 27. 7% (1404) (117) 46. 6% (15) 41. 1% (102) (1452) 9. 2% (260) 10. 4% (1192) Tasmania (106) 4. 5% (22) 4. 7% (84) South Australia (363) 13. 5% (59) 9. 2% (304) Northern Territory (182) 8. 3% (72) 4. 5% (110) Western Australia (496) 14% (128) 14. 1% (368) (5128) 16. 2% New South Wales Aust. Capital Territory Victoria Australia (942) 17. 5% (4186) * Data unavailable for 10 patients New Zealand (761) 17. 5% (240) 16. 1% (521) © ANZDATA Registry

Figure 13. 2 Percentage of Non Native Access n = Number of Patients Australia

Figure 13. 2 Percentage of Non Native Access n = Number of Patients Australia (n=5138) New Zealand (n=761) Grafts Catheters Total HD Population 17. 3% 8. 3% 16. 5% 19. 1% Diabetics 16. 2% 11. 2% 17. 5% 28. 3% Female 24. 2% 10. 2% 27. 0% 24. 3% © ANZDATA Registry

© ANZDATA Registry

© ANZDATA Registry

© ANZDATA Registry

© ANZDATA Registry

Figure 13. 4 Access Intervention in Previous Six Months n = Number of Patients

Figure 13. 4 Access Intervention in Previous Six Months n = Number of Patients Revision of Access Declotting of Access Native Grafts Catheters n=5128 7. 9% 21. 6% 23. 7% 3. 4% 16. 7% 21. 8% Diabetics n=942 8. 4% 24. 8% 26. 4% 3. 2% 21. 5% 22. 6% Female n=2096 9. 3% 19. 6% 26. 1% 3. 3% 14. 3% 24. 2% n=761 4. 7% 17. 6% 6. 5% 3. 4% 15. 2% 9. 5% Australia New Zealand © ANZDATA Registry

Vascular Access - Duration on Dialysis 100% 80% 60% 40% 20% 0% 0 -29

Vascular Access - Duration on Dialysis 100% 80% 60% 40% 20% 0% 0 -29 30 -59 60 -89 90 -119 120 -149 150 -179 180+ Number of Days on Dialysis Native AVF Synthetic AVG Central Venous Catheter © ANZDATA Registry

Vascular Access - Stratified by Late Referral N Y N Y 100% Late Referral

Vascular Access - Stratified by Late Referral N Y N Y 100% Late Referral 80% 60% 40% 20% 0% 0 -29 Native AVF 30 -59 60 -89 90 -119 120 -149 150 -179 Synthetic AVG 180+ Days Central Venous Catheter © ANZDATA Registry

Vascular Access - Prevalence • 4978 adult patients on Haemodialysis at 30 September 2001

Vascular Access - Prevalence • 4978 adult patients on Haemodialysis at 30 September 2001 • Access in Use: • Native AVF • Synthetic AVG • Catheter 3567 872 287 (75. 5%) (18. 5%) (6. 0%) • Patients on dialysis <90 days were excluded © ANZDATA Registry

Demographics - AVG versus AVF * Adjusted for gender, age, time on dialysis, BMI,

Demographics - AVG versus AVF * Adjusted for gender, age, time on dialysis, BMI, hypertension, CAD, PVD, CVD, diabetes, smoking. © ANZDATA Registry

Co-morbidities - AVG versus AVF * Adjusted for gender, age, time on dialysis, BMI,

Co-morbidities - AVG versus AVF * Adjusted for gender, age, time on dialysis, BMI, hypertension, CAD, PVD, CVD, diabetes, smoking © ANZDATA Registry

Demographics - Catheter versus AVF * Adjusted for gender, age, time on dialysis, late

Demographics - Catheter versus AVF * Adjusted for gender, age, time on dialysis, late referral, diabetes, CAD, PVD, CVD, BMI, smoking, hypertension © ANZDATA Registry

Co-morbidities - Catheter versus AVF * Adjusted for gender, age, time on dialysis, late

Co-morbidities - Catheter versus AVF * Adjusted for gender, age, time on dialysis, late referral, diabetes, CAD, PVD, CVD, BMI, smoking, hypertension © ANZDATA Registry

Late Referral According to State © ANZDATA Registry

Late Referral According to State © ANZDATA Registry

Location - AVG versus AVF * Adjusted for gender, age, time on dialysis, late

Location - AVG versus AVF * Adjusted for gender, age, time on dialysis, late referral, diabetes, CAD, PVD, CVD, BMI, smoking, hypertension © ANZDATA Registry

Location - Catheter versus AVF * Adjusted for gender, age, time on dialysis, hypertension,

Location - Catheter versus AVF * Adjusted for gender, age, time on dialysis, hypertension, CAD, CVD, PVD, late referral, diabetes, smoking, BMI © ANZDATA Registry

Declotting and Revision Risk* * For the 6 month period 30 March - 31

Declotting and Revision Risk* * For the 6 month period 30 March - 31 September 2001 © ANZDATA Registry

Summary • Only 50% of patients starting haemodialysis have a functioning Native AVF •

Summary • Only 50% of patients starting haemodialysis have a functioning Native AVF • By 90 days, native fistula use is similar to the overall rate • Late referral is an important factor and its effect persists to 150 days post haemodialysis commencement © ANZDATA Registry

Summary • Females, older age and BMI>30 are associated with increased AVG use •

Summary • Females, older age and BMI>30 are associated with increased AVG use • Type I but not Type II Diabetes Mellitus was associated with AVG & catheter use • PVD and CVD both associated with increased AVG and Catheter use © ANZDATA Registry

Summary • There are significant regional differences in AVG and catheter use • These

Summary • There are significant regional differences in AVG and catheter use • These differences may reflect differing surgical practice and other factors not controlled for in the analysis © ANZDATA Registry

Acknowledgements • Monash Medical Centre • P G Kerr • R C Atkins •

Acknowledgements • Monash Medical Centre • P G Kerr • R C Atkins • ANZDATA Registry • S Mc. Donald • B Livingston • Grants • NHMRC © ANZDATA Registry

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