Haemodialysis Vascular Access Recent Trends From ANZDATA Dr

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Haemodialysis Vascular Access: Recent Trends From ANZDATA Dr Kevan Polkinghorne Monash Medical Centre ANZSN

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

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 – 31 st 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 • Significant changes in vascular access practice patterns seen in US and

International trends • Significant changes in vascular access practice patterns seen in US and Europe – USRDS – DOPPS

Graft As First Access Incident Hemodialysis USRDS Annual Report 2006

Graft As First Access Incident Hemodialysis USRDS Annual Report 2006

Fistula As First Access Incident Hemodialysis USRDS Annual Report 2006

Fistula As First Access Incident Hemodialysis USRDS Annual Report 2006

Catheter As First Access Incident Hemodialysis USRDS Annual Report 2006

Catheter As First Access Incident Hemodialysis USRDS Annual Report 2006

Aims & Methods Key Questions: Are the recent trends in international catheter rates seen

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, Mc. Donald S. In Press Am J Kidney Diseases

Trends in Incident Vascular Access: ANZDATA 2000 -2004 (1) Incident Cohort: Patients who commenced

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, Mc. Donald S. In Press Am J Kidney Diseases

Moist L, Chang S, Polkinghorne K, Mc. Donald S. In Press Am J Kidney

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

Moist L, Chang S, Polkinghorne K, Mc. Donald S. In Press Am J Kidney

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

Vascular Access: Incident Cohort 2000 -2004 Moist L, Chang S, Polkinghorne K, Mc. Donald

Vascular Access: Incident Cohort 2000 -2004 Moist L, Chang S, Polkinghorne K, Mc. Donald S. In Press Am J Kidney Diseases

Unadjusted & Adjusted Incident Rates: Incident Cohort 2000 - 2004 *p< 0. 05 compared

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 Moist L, Chang

Vascular Access Use 6 -8 Months After Starting Dialysis 2000 -2003 Moist L, Chang S, Polkinghorne K, Mc. Donald 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 Moist L, Chang S, Polkinghorne K,

Actual Vascular Access at First Haemodialysis 2003 -2005 Moist L, Chang S, Polkinghorne K, Mc. Donald S. In Press Am J Kidney Diseases

Moist L, Chang S, Polkinghorne K, Mc. Donald S. In Press Am J Kidney

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

Prevalent Vascular Access 2000 -2005 Moist L, Chang S, Polkinghorne K, Mc. Donald S.

Prevalent Vascular Access 2000 -2005 Moist L, Chang S, Polkinghorne K, Mc. Donald S. In Press Am J Kidney Diseases

2006 Data

2006 Data

Conclusions • Catheter rates have increased significantly over the last 6 years • Rates

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 • • • Dr Louise Moist Dr Stephen Mac. Donald Dr Sean Chang

Acknowledgements • • • Dr Louise Moist Dr Stephen Mac. Donald Dr Sean Chang ANZDATA Registry Renal Units in Australia and New Zealand

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