Kidney Week

Abstract: TH-PO346

Effect of Centre and Patient Related Factors on Uptake of Haemodiafiltration in Australia and New Zealand: A Cohort Study Using ANZDATA

Session Information

• Dialysis: Dialysate and Clearance
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Mac, Kathy, Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia

Kathy Mac,

• Hedley, James, University of Sydney, Camperdown, New South Wales, Australia

James Hedley,

• Lee, Vincent W.S., Westmead Hospital, Westmead, New South Wales, Australia

Vincent W.S. Lee,

• Agar, John W. MacD., University Hospital Geelong, Geelong, Victoria, Australia

John W. MacD. Agar,

• Hawley, Carmel M., Princess Alexandra Hospital, Brisbane, Queensland, Australia

Carmel M. Hawley,

• Johnson, David W., Princess Alexandra Hospital, Brisbane, Queensland, Australia

David W. Johnson,

• See, Emily J., Princess Alexandra Hospital, Brisbane, Queensland, Australia

Emily J. See,

• Polkinghorne, Kevan, Monash Medical Centre and Monash University, Melbourne, Victoria, Australia

Kevan Polkinghorne,

• Rabindranath, Kannaiyan Samuel, Waikato Hospital, Hamilton, New Zealand

Kannaiyan Samuel Rabindranath,

• Sud, Kamal, Nepean Hospital, Castle Hill, New South Wales, Australia

Kamal Sud,

• Webster, Angela C., University of Sydney, Camperdown, New South Wales, Australia

Angela C. Webster,

Background

We described the use of haemodiafiltration (HDF) in Australia and New Zealand over time, and any patient or centre-related associations with use of HDF.

Methods

We included all incident patients commencing haemodialysis in Australia and New Zealand between 2000-2014. The primary outcome was commencement of HDF over time, which was evaluated using multivariable logistic regression stratified by country.

Results

Of 27,433 patients starting haemodialysis, 3,339 (14.4%) of 23,194 patients in Australia and 810 (19.1%) of 4,239 in New Zealand received HDF. Uptake increased over time in both countries but was more rapid in New Zealand. In Australia, HDF use was more likely in males (OR 1.13, 95%CI 1.03-1.24, p=0.009) with BMI>30 kg/m²(OR 1.46, 95%CI 1.33-1.61), and less likely in older patients ( reference <40 years; 40-54 years OR 0.85, 95% confidence interval [CI] 0.72-0.99; 55-69 years OR 0.79, 95% CI 0.67-0.91; >70 years OR 0.48, 95% CI 0.41-0.56)
and those with chronic lung disease (OR 0.84, 95%CI 0.76-0.94, p<0.001), cerebrovascular disease (OR 0.76, 95%CI 0.67-0.85, p<0.001) or peripheral vascular disease (OR 0.77, 95%CI 0.70-0.85, p<0.001). Larger centres (defined by number of new patients/year) were more likely to prescribe HDF: 36-147/year OR 26.75 (95%CI 18.54-38.59); 17-35/year OR 7.51 (95%CI 5.35-10.55); 7-16/year OR 3.00 (95%CI 2.19-4.13; <6/year reference. HDF was used more in private dialysis clinics (public OR 0.13, 95%CI 0.05-0.32). In New Zealand, where there is no private dialysis, HDF use was more likely in Maori and Pacific Islanders (OR 1.32, 95%CI 1.05 – 1.66) compared to Caucasians and less likely in males (OR 0.76, 95%CI 0.62 – 0.94, p=0.01). In both countries, centres with higher HD:PD patient ratios were significantly more likely to prescribe HDF. Centre differences explained 36% of variability in HDF uptake in Australia and 48% in New Zealand.

Conclusion

HDF uptake has increased over time, and was associated with similar centre characteristics, but different patient characteristics in each country.