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

Vascular Access: ANZDATA 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 Europe –USRDS –DOPPS

Graft As First Access Incident Hemodialysis USRDS USRDS Annual Report 2006

Fistula As First Access Incident Hemodialysis USRDS USRDS Annual Report 2006

Catheter As First Access Incident Hemodialysis USRDS USRDS Annual Report 2006

Moist L, Chang S, Polkinghorne K, McDonald S. In Press Am J Kidney Diseases 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 Trends in Incident Vascular Access: ANZDATA (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

Vascular Access: Incident Cohort

Unadjusted & Adjusted Incident Rates: Incident Cohort *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 Moist L, Chang S, Polkinghorne K, McDonald S. In Press Am J Kidney Diseases

Unadjusted & Adjusted Incident Rates: 6-8 Months After Starting Dialysis *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 Moist L, Chang S, Polkinghorne K, McDonald S. In Press Am J Kidney Diseases

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

2006 Data

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 MacDonald Dr Sean Chang ANZDATA Registry Renal Units in Australia and New Zealand