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DOPPS Background

Trends from the Dialysis Outcomes Practice Patterns Study-DOPPS in Vascular Access Use in Haemodialysis. Anna Marti Monros , Ronald L Pissoni , Douglas S. Fuller, Joan Fort, Francesco Locatelli , Lawrence Spergel , David Goodkin , Hal Morgenstern, Friedrich K Port.

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DOPPS Background

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  1. Trends from the Dialysis Outcomes Practice Patterns Study-DOPPS in Vascular Access Use in Haemodialysis. Anna Marti Monros, Ronald L Pissoni, Douglas S. Fuller, Joan Fort, Francesco Locatelli, Lawrence Spergel, David Goodkin, Hal Morgenstern, Friedrich K Port.

  2. DOPPS Background • DOPPS is an international prospective study of hemodialysis practices and patient outcomes. • DOPPS uses random sampling of facilities & patients to provide nationally representative statistics. • Data collected at >300 dialysis units across 12 countries in 4 study phases since 1996. • Here we report country trends in vascular access use from 3 cross-sections of HD patients in each country (N=27,145) from 2002-2010.

  3. VA Use inCountries with Decreasing Fistula Use & Increasing Catheter Use Prevalent cross-sections of patients on dialysis >90 days at time of study entry; weighted by facility sampling fraction; DOPPS 2 (2002-2004), DOPPS 3 (2005-2008), DOPPS 4 (2009-2011)

  4. Distribution of VA Types inCountries with Stable or Increasing Fistula Use Prevalent cross-sections of patients on dialysis >90 days at time of study entry; weighted by facility sampling fraction; DOPPS 2 (2002-2004), DOPPS 3 (2005-2008), DOPPS 4 (2009-2011);

  5. Trend Towards Greater Catheter Use Seen Even in Younger Patients in Some Countries • − Age 18-69 − Prevalent cross-sections of patients on dialysis >90 days at time of study entry; weighted by facility sampling fraction; DOPPS 2 (2002-2004), DOPPS 3 (2005-2008), DOPPS 4 (2009-2011)

  6. Trend Towards Greater Catheter Use Seen Even in Non-diabetic Younger Patients • − Age 18-69, without diabetes − Prevalent cross-sections of patients on dialysis >90 days at time of study entry; weighted by facility sampling fraction; DOPPS 2 (2002-2004), DOPPS 3 (2005-2008), DOPPS 4 (2009-2011)

  7. DOPPS 4: Some Countries Show Small Differences in VA Use in Older vs Younger Pts Prevalent cross-sections of patients on dialysis >90 days at time of study entry; weighted by facility sampling fraction; DOPPS 2 (2002-2004), DOPPS 3 (2005-2008), DOPPS 4 (2009-2011)

  8. Summary (I) • In DOPPS, Japan has consistently displayed the highest AV fistula (AVF) use [92-93%, since 2002], with <2% of pts using a catheter • The US, led by the Fistula First Initiative, has shown the largest % rise in AVF use from 34% in 2002 to 60% by 2010 • AVF use increased in Aus-NZ and the UK to 78% and 74%, respectively, while remaining at ~80% in France • Catheter use has either remained stable or declined in Japan, France, UK and US

  9. Summary (II) • In other countries, catheter use has increased substantially from 2002-2010: • to 49% and 39% catheter use in Canada and Belgium • >2-fold rise to 20-24% in Italy and Spain • doubling in Germany to 12% • Shifts from AVF to catheter were seen in Belgium, Canada, Italy, Spain, and Germany even among non-diabetic 18-69 yr old pts indicating that these trends extend even to younger pts

  10. Conclusions • Substantial changes in VA use have been seen across some countries during the last decade • In some nations, VA improvement programs have resulted in increases in AVF use • Concerns are raised by the large rises in CATH use in some countries even among younger pts with lower comorbidity burden • Greater CATH use has been linked with higher mortality; future analyses will evaluate changes in practices with changes in clinical outcomes

  11. Acknowledgements • Our thanks to DOPPS study coordinators, medical directors, and participating patients for their dedicated contributions to DOPPS. • The DOPPS would not be possible without the generous financial support of the following companies for their strong commitment to independent scientific research to improve patient care: • Amgen (since 1996) • Kyowa Hakko Kirin (since 1999, in Japan) • Abbott Laboratories (since 2009) • Sanofi Renal (since 2009) • Baxter Healthcare (since 2011) • Vifor Fresenius Medical Care Renal Pharma Ltd (since 2011) • Support from DOPPS sponsors is provided without restrictions on publications.

  12. Thanks.

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