Haemodialysis Vascular Access: Recent Trends From ANZDATA

1. Haemodialysis Vascular Access: Recent Trends From ANZDATA Dr Kevan Polkinghorne Monash Medical Centre ANZSN September 2007

2. 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”

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

4. Graft As First Access Incident Hemodialysis USRDS USRDS Annual Report 2006

5. Fistula As First Access Incident Hemodialysis USRDS USRDS Annual Report 2006

6. Catheter As First Access Incident Hemodialysis USRDS USRDS Annual Report 2006

7. 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

8. 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

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

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

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

12. 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

13. 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

14. 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

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

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

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

18. 2006 Data

24. 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”

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