AustraliaandNewZealandDialysisandTransplantRegistry
Thirsty Sixth Annual Report
2013
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ANZDATA Registry 2013 Report _____________________________________________________________________________________
Edited by
Philip Clayton Stephen McDonald
Kylie Hurst
Funded by Australian Organ and Tissue Authority
New Zealand Ministry of Health Kidney Health Australia
Supported by AMGEN Australia Pty Ltd
Novartis Pharmaceuticals Pty Ltd Pfizer Pty Ltd
Roche Products Pty Ltd Sanofi-Aventis Australia Pty Ltd
2013 Thirty Sixth
Annual Report
2013 Annual Report - 36th Edition
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ANZDATA Registry 2013 Report _____________________________________________________________________________________
Funding ANZDATA Registry is funded by
Australian Organ and Tissue Authority New Zealand Ministry of Health Kidney Health Australia Supported by Unrestricted Research Grants from AMGEN Australia Pty Ltd Novartis Pharmaceuticals Pty Ltd Pfizer Pty Ltd Roche Products Pty Ltd Sanofi-Aventis Australia Pty Ltd Coordinating Centre ANZDATA Registry 9th Floor - East Wing DX800 MP 117 Royal Adelaide Hospital North Terrace Adelaide, South Australia, 5000 Phone +61 8 8222 0949 Fax +61 8 8222 0985 Email [email protected] Web www.anzdata.org.au Prof G Russ Chair of ANZDATA Executive A/Prof S McDonald ANZDATA Executive Officer / Editor Dr P Clayton Amgen Fellow in Epidemiology / Editor Ms K Hurst Registry Manager / Editor Dr N Briggs Biostatistician Ms A Gulyani Biostatistician Ms H Dent Biostatistician Dr B Grace Research Fellow Ms M Kandamby Data Systems Manager Ms Lauren Bell Senior Project Officer Ms C Leitch Administration Ms B Martin Administration Ms M Steventon Administration Ms A Farmer Administration Ms J Adams Administration Printed in Adelaide, South Australia, 2014
© Copyright 2013 by the ANZDATA Registry
Acknowledgments ANZDATA Registry offers its most grateful appreciation to everyone who helped make this 36th Annual Report possible, especially the professionals and the staff of all the Renal Units and Tissue Typing Laboratories, upon whose reporting of data this enterprise ultimately depends. Suggested Citation
An example of suggested citation for this report is as follows:
.. [Author’s name] .. Peritoneal Dialysis .. [page numbers] .. ANZDATA Registry Report 2013 Australia and New Zealand Dialysis and Transplant Registry Adelaide, South Australia. Editors: Philip Clayton, Stephen McDonald, Kylie Hurst Publications based upon ANZDATA Registry information reported here or supplied upon request, must include the citation as noted above and the following notice:
The data reported here have been supplied by the Australia and New Zealand Dialysis and Transplant Registry. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the Australia and New Zealand Dialysis and Transplant Registry.
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ANZDATA Registry 2013 Report _____________________________________________________________________________________
The ANZDATA Registry has great pleasure in presenting the 2013 Annual Report. This is the 36th Annual Report from the Registry and covers data collected until the 31st December 2012. The Report is a result of the commitment and involvement of renal units throughout Australia and New Zealand. This commitment is a reflection of the enormous time and work from staff of these units. Participation of 100% of units in Australia and New Zealand continues and we are confident that all the patients who have received renal replacement therapy in Australia and New Zealand in this time period are included. This year’s Report includes some incremental improvements. The analyses of PD technique failure in chapter 5 have been substantially revised and now clearly demonstrate infection as the leading cause of technique failure. The kidney transplant waiting list data reported in chapter 7 now includes stock and flow by state and blood group, along with survival after wait-listing. Finally, chapter 10 (cancer) has been completely re-written. Further major changes to the Report are planned for next year. Similar to last year’s Report, the Appendices are provided as spreadsheets to facilitate analyses by end-users and are accessible from our website. Timely, accurate and complete data reporting is an ongoing challenge for the Registry and has presented a particular difficulty this year. Several items of the Survey now have a substantial proportion of missing data, and these are identified in the relevant figures. In particular, immunosuppression data were incompletely reported in 2012, and to avoid presenting a misleading picture these data have been withheld from chapter 8. We aim to complete collection of these data for inclusion in the next report. The Registry is currently modernising its database software. This is a large undertaking that we expect to be complete towards the end of 2014. The new database will allow web-based real-time entry of all data collected by the Registry. The role of Executive Officer of the Registry continues to be filled by Professor Stephen McDonald. Once again, he provides the intellectual and academic leadership of the Registry and has been the driving force in the dissemination of data and its analyses, both nationally and internationally.
Following completion of his time as the Epidemiology Fellow, Dr Philip Clayton has joined the Executive as Editor of the Annual Report. Professor Steven Chadban has also joined the Executive as the immediate past Chair of the ANZDATA Registry Steering Committee. Dr Namrata Khanal has joined the Registry as the new Epidemiology Fellow. We are greatly indebted to Amgen who continue to make the commitment through the funding of this position. For 11 years now this position has proven to be a major stimulus for the academic output of the Registry. Dr Blair Grace provided much analysis of the ANZDATA database throughout 2012-13; part of his salary support arose from a collaborative NHMRC funded project supervised by Professor McDonald. Mrs Kylie Hurst enters her third year as Manager of the ANZDATA Registry and we acknowledge the pivotal role that she has played in generating new ideas and innovations in the way the Registry functions. Christina Leitch continues to provide administrative support. Biostatistical expertise has been provided by Nancy Briggs, Hannah Dent and Aarti Gulyani. Professor Matthew Jose has taken over from Professor Chadban as the Chair of the ANZDATA Registry Steering Committee. His enthusiasm and ongoing interest in the Registry and its operations and output are acknowledged. The members of the ANZDATA Registry Committees and Working Groups are listed on page vii of this report. The Executive gratefully acknowledges the involvement and contribution of these many individuals. Major funding for the Registry has been provided from the Australian Commonwealth Department of Ageing through the Australian Organ and Tissue Donation and Transplant Authority, Kidney Health Australia and the New Zealand Ministry of Health. We also gratefully acknowledge industry support which in 2013 consisted of non-tied grants from AMGEN Australia, Novartis Pharmaceuticals, Pfizer, Roche Products and Sanofi-Aventis Australia. GRAEME R RUSS CHAIR ANZDATA EXECUTIVE July 2014
INTRODUCTION
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Page Contents iii
ANZDATA Committees v
Privacy vi
Guidelines for Data Release viii
Contributing Authors ix
Definitions and Methods x
Parent Hospitals, Transplanting Hospitals, Satellite Haemodialysis Units
xiii
Publications 2012 xviii
Data Collection Form xxii
Summary xxvi
Chapter 1 Stock and Flow 1-1
Blair Grace, Kylie Hurst, Stephen McDonald, Philip Clayton
Chapter 2 New Patients 2-1
Blair Grace, Stephen McDonald, Kylie Hurst, Philip Clayton
Intake of Patients and Age of New Patients 2-2
State of Origin of New Patients 2-3
Incidence Rates New RRT by State 2-4
Incidence Rates New RRT by Age Group 2-5
Late Referral 2-6
Co-morbid Conditions 2-8
Primary Renal Disease of New Patients 2-10
Miscellaneous Causes of ESRD and Biopsy of New Patients
2-11
Chapter 3 Deaths 3-1
Stephen McDonald
Introduction 3-2
Death Rates During Renal Replacement Therapy 3-3
Survival by Age & Comorbidity 3-4
Dialysis Mortality Rates 3-5
Cause of Deaths 3-6
Withdrawal from Dialysis 3-8
Chapter 4 Method and Location of Dialysis 4-1
Nancy Briggs, Kylie Hurst, Stephen McDonald, Philip Clayton
Australia - Method and Location of Dialysis 4-2
New Zealand - Method and Location of Dialysis 4-4
Home RRT Modalities by Country 4-5
Home Dialysis Over Time 4-7
Chapter 5 Haemodialysis 5-1
Kevan Polkinghorne, Nancy Briggs, Namrata Khanal, Kylie Hurst, Philip Clayton
Stock and Flow 5-2
Blood Flow Rates 5-6
Duration of Dialysis 5-7
Outcomes Among Haemodialysis Patients 5-10
Membrane Type and Surface Areas 5-14
Anaemia 5-15
Haemoglobin 5-16
Ferritin and Transferrin Saturation 5-18
Serum Calcium 5-20
Serum Phosphate 5-21
Calcium-Phosphate 5-22
Urea Reduction Ratio 5-23
Vascular Access at First Treatment 5-25
Prevalent Haemodialysis Access 5-28
Obesity Among Incident Haemodialysis Patients 5-32
Obesity Among Prevalent Haemodialysis Patients 5-34
Home Haemodialysis 5-36
Technique Failure 5-39
Chapter 6 Peritoneal Dialysis 6-1
Neil Boudville, Hannah Dent, Stephen McDonald, Kylie Hurst, Philip Clayton
Stock and Flow 6-2
Peritoneal Dialysis Fluids 6-8
Outcomes Among Peritoneal Dialysis Patients 6-11
Peritoneal Dialysis Technique Survival 6-14
Technique Failure 6-16
Peritonitis 6-17
Page Chapter 6 Peritoneal Dialysis (contd.) 6-1
Australian Peritonitis Registry 6-20
Antibiotic Treatment 6-22
Outcomes 6-23
Haemoglobin 6-25
Ferritin and Transferrin Saturation 6-27
Serum Calcium 6-29
Serum Phosphate 6-30
Calcium-Phosphate 6-31
Chapter 7 Transplant Waiting List 7-1
Philip Clayton, Blair Grace, Jeremy Chapman, Jenni Wright, Stephen McDonald
Data from the National Organ Matching Scheme (Australia)
Chapter 8 Transplantation 8-1
Philip Clayton, Wai Lim, Kylie Hurst
Transplants Performed in 2012 8-2
Transplant Rate of Patients Dialysed 8-4
Age of Recipients Transplanted in 2012 8-5
Ethnicity of Transplant Recipients 8-6
Australian Regional Transplantation Activity 8-7
Functioning Transplants 8-8
Rates of Graft Loss 8-12
Immunosuppression 8-14
Use of Antibody Therapy 8-16
Rejection Rates 8-18
Primary Deceased Donor Survival 8-19
Deceased Second-Subsequent Survival 8-22
Primary Living Donor Survival 8-24
Living Second-Subsequent Survival 8-27
Chapter 9 Kidney Donation 9-1
Philip Clayton
Deceased Kidney Donors 9-2
Living Kidney Donors 9-4
Chapter 10 Cancer Report 10-1
Germaine Wong, Blair Grace, Philip Clayton, Jonathon C. Craig
Introduction and Cumulative Incidence of all Cancers 10.2
Frequency of Site-Specific Cancers 10.5
Novel Risk Factors for Cancer Development After Kidney Transplantation
10.6
Chapter 11 Paediatric Report 9-1
Sean Kennedy, Nancy Briggs, Hannah Dent, Stephen McDonald, Kylie Hurst, Philip Clayton,
Incidence and Prevalence 1991-2012 11-2
Causes of ESKD in Children and Adolescents 11-3
Modality of Treatment 11-4
Dialysis Delivery and Adequacy 11-4
Biochemical Outcomes 11-6
Vascular Access 11-7
PD Technique Survival by Age Category 11-8
Chapter 12 End-Stage Kidney Disease Among Indigenous Peoples of Australia and NZ
12-1
Stephen McDonald, Matthew Jose, Kylie Hurst
Introduction and New Patients 12-2
Incidence Rates 12-3
New Transplants 12-6
Prevalent Patients 12-8
Dialysis Modality 12-9
eGFR at Treatment Start 12-10
Incidence and Prevalence by State/Territory 12-11
Geographical Distribution 12-15
Late Referral and Vascular Access 12-18
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ANZDATA REGISTRY EXECUTIVE COMMITTEE Professor Steven Chadban - Chair A/Professor Stephen McDonald - Executive Officer Mrs Kylie Hurst - Registry Manager
ANZDATA REGISTRY STEERING COMMITTEE (2012 MEMBERS) Professor Steven Chadban (Chair) Professor Graeme Russ (Secretary / Chair ANZDATA Executive) Professor Stephen McDonald (Executive Officer) Ms Kylie Hurst (Executive Officer) A/Professor Timothy Mathew (Medical Director) Dr Grant Pidgeon (New Zealand Representative / Head of Renal Medicine) Dr Phillip Clayton (Fellow in Epidemiology) Dr Scott Campbell (Project Manager - Transplantation) Dr Matthew Jose (Project Manager - Indigenous Interest Group) A/Professor Kevan Polkinghorne (Project Manager - Haemodialysis) Dr Germaine Wong (Project Manager - Cancer Epidemiology) Dr Sean Kennedy (Paediatric Group) Dr Wai Lim Dr Helen Pilmore Dr Nicholas Gray A/Professor Robyn Langham Ms Cathy Hill (Nursing Representative)
Transplant Working Group A/Professor Scott Campbell (Project Manager) A/Professor Stephen McDonald Professor Graeme Russ Professor Steven Chadban Dr Wai Lim
Cancer Working Group Dr Angela Webster (Project Manager) Dr Germaine Wong (Fellow in Cancer Epidemiology) A/Professor Stephen McDonald Professor Jonathon Craig Professor Randall Faull Professor Adrian Hibberd Dr Rob Carroll
Peritoneal Dialysis Working Work Dr Neil Boudville (Project Manager) Professor David Johnson A/Professor Stephen McDonald A/Professor Kym Bannister Dr Sunil Badve Dr Philip Clayton Ms Monique Borlace
Paediatric Working Group Dr Steven McTaggart (Project Manager) A/Professor Stephen McDonald Dr Paul Henning Dr Lily Johnstone Dr Sean Kennedy
Haemodialysis Working Group A/Professor Kevan Polkinghorne (Project Manager) A/Professor Stephen McDonald A/Prof Rowan Walker Professor Richard Allan Dr Mark Marshall Dr Vincent Lee
Indigenous Interest Group Dr Matthew Jose (Project Manager) A/Professor Stephen McDonald A/Professor Johan Rosman A/Professor Mark Thomas Professor John Collins Dr Karen Barraclough Dr Greg Perry Dr Natasha Rogers Dr Jacqueline Hughes Dr Paul Lawton Ms Lesley Salem
ANZDATA REGISTRY WORKING GROUPS (2012 MEMBERSHIP)
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PRIVACY ASPECTS OF DATA COLLECTION
In December 2001 changes to the Commonwealth Privacy Act were introduced which have led to changes to the collection of personal information. Essentially these extend to the private sector a number of changes based around 10 “National Privacy Principles” (NPP’s). A detailed exposition of these can be found at the Privacy Commissioner’s website (www.privacy.gov.au). Briefly, however, health information is treated as “sensitive” information, which must usually be collected and handled with consent of the person, unless certain conditions are met. Patients are entitled to view the information the Registry holds about them, and request alterations if the data is thought to be inaccurate.
Each Australian State has also enacted similar provisions which cover practice and patients in public hospitals.
ANZDATA does not release data identifiable by patient name. Results are published/released in tabular or graphic format only. Requests for data are met using deindentified data only. On occasion, when data identifying particular hospitals is involved, consent from the Director of the relevent renal unit is sought prior to the release of information.
ANZDATA spent some time during 2002 formulating an appropriate response to these issues including seeking advice from a variety of sources. The approach taken has been that of a “opt-out” consent, whereby patients are distributed information outlining the nature and purpose of the information collected, offered an opportunity to view that data and ask questions, and the opportunity to request withdrawal of part or all of their data. This approach is explicitly suggested for Registries by the Privacy Commissioner in his “Guidelines for the Health Sector”. To this end ANZDATA has circulated to all participating hospitals a patient information sheet (see opposite), for each hospital to use (or a locally modified version if appropriate) to inform patients.
At the time of data collection each unit is asked to certify that they have complied with measures under the relevant privacy measures.
Tissue Typing Data and Transplant Waiting List data are collected in each Tissue Typing Laboratory and entered into the National Organ Matching System database. These data are transmitted to ANZDATA for inclusion in the ANZDATA database and for this Report.
PRIVACY
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ANZDATA REGISTRY AUSTRALIA AND NEW ZEALAND DIALYSIS AND TRANSPLANT REGISTRY
C/- Royal Adelaide Hospital Phone: (08) 8222.0949 North Terrace, Fax: (08) 8222.0985 Adelaide, 5000 Email: [email protected] South Australia Web: http://www.anzdata.org.au
Important Privacy Information As part of routine medical care of people receiving treatment with dialysis or kidney transplantation, your kidney specialist collects certain information about the patients they treat. All kidney specialists throughout Australia and New Zealand report this information every twelve months to the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). ANZDATA collects the information for the purpose of monitoring treatments and performing analyses to improve quality of care for people with kidney failure.
1. What is ANZDATA ?
ANZDATA is an organization set up by Kidney Health Australia and the Australia and New Zealand Society of Nephrology to monitor dialysis and transplant treatments. ANZDATA is funded by the Australian and New Zealand Governments and Kidney Health Australia.
2. What information is collected about you ?
This information includes your name, age, gender, racial origin, hospital of treatment, some aspects of your medical condition (such as whether you have diabetes) and details about the type of kidney treatment you are receiving (dialysis or transplant).
We DO NOT collect details about your address, telephone number, medical insurance, or non-medical matters such as occupation, income, etc.
3. Is personal data ever released ?
The identity of people in the database IS NOT released publicly nor in any reports. Measures have been put into place to ensure the security of all collected information.
4. What is this information used for ?
The information is used primarily for quality assurance, investigating patterns of kidney disease, and planning appropriate health services. We release reports on a variety of topics, including an Annual Report examining the rates and treatment of kidney failure in Australia and New Zealand. We also have a major role in ensuring the quality of patient care by sending to each kidney unit each year a report outlining their activity. These reports also compare the outcome of the treatment they provide with that of other units throughout the two countries.
Reports are also produced at a state and national level, and from time to time analyses are also produced for renal units, government health departments and industry concentrating on particular aspects of renal failure management e.g. peritoneal dialysis, transplantation, haemodialysis.
5. Can you see what personal information ANZDATA collects and the reports that it produces ?
Individuals are able to view their own information on request. You can request alterations if you believe it is inaccurate. You may also opt not to have your treatment included in this database, and you should let your kidney specialist know if this is the case. You can also choose not to have some information (eg racial origin)recorded. However, if your information is not included in the Registry, the ability to compare results in Australia and New Zealand or to analyse the results of different treatment methods and for different patient types (eg diabetics) will be compromised.
The national reports and much other material produced by ANZDATA are available free on the Internet at www.anzdata.org.au, or they can be sent to you on request to the address above. Your kidney specialist will also have copies of many of the reports.
If you wish to discuss any of the issues raised here, please let your doctor know or telephone the ANZDATA
Registry direct on [08] 8222 0949. You may also write to us (ANZDATA Registry, C/- Royal Adelaide Hospital, DX800, Mail Point 117, North Terrace, Adelaide, SA. 5000) or send us an e-mail ([email protected]).
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GUIDELINES FOR DATA RELEASE
The policy for release of data to investigators, renal units and others was revised during 2013 and is summarised on the Website. ANZDATA encourages the analysis, use and citation of its data, and receives many data requests annually which vary in size and complexity. At times these overwhelm the limited resources within the Registry, and must be prioritised. Generally, formal requests for data are preceded by a period of consultation with a member of the Registry staff. Requests are welcome from Renal Physicians, other staff members of Renal Units, Charitable Bodies, Academic Institutions, Government Departments and Industry. Requests dealing with identifiable Hospital data (i.e. data which identifies outcomes of an individual hospital) will only be fulfilled with the explicit consent of the Heads of the relevant Hospital Units. Individual patient identified data (names) is not released.
ATTRIBUTION OF PUBLICATIONS
The policy on attribution of publications which incorporate ANZDATA sourced data was revised during 2002, following a period of consultation with participating physicians.
Where a member of a participating unit has analysed data provided by ANZDATA and subsequently prepared a manuscript, then “ANZDATA Registry” should be acknowledged as a secondary institution in addition to the author’s Hospital or University. This applies whether the primary data analysis is performed by the author or by ANZDATA staff. Where the author is an ANZDATA office holder or staff member then the primary attribution should be “ANZDATA Registry”.
Where ANZDATA data is only a minor portion of the work, then it may be more appropriate to acknowledge the source explicitly in the “Acknowledgements” section.
In both cases the disclaimer on page ii of this report should be included.
In all cases the source and treatment of the data should be made clear in the “Methods” section. Preferably the abstract (and keywords if applicable) should also include “ANZDATA” which would allow for searching Registry publications.
POLICY
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Dr Neil Boudville Head of Department Renal Medicine Sir Charles Gardiner Hospital, Hospital Avenue Nedlands, Western Australia, 6009 Dr Nancy Briggs Biostatistician ANZDATA Registry Royal Adelaide Hospital, North Terrace Adelaide, South Australia, 5000 Professor Steven Chadban Chair - ANZDATA Registry Nephrologist and Transplant Physician Royal Prince Alfred Hospital, Missenden Road Camperdown, New South Wales, 2000 Professor Jeremy Chapman OAM Director of Medicine & Cancer Services Westmead Hospital Cnr Hawkesbury Road & Darcy Road Westmead, New South Wales, 2145 NOMS Chairman Dr Philip Clayton Epidemiologist / ANZDATA Registry Royal Adelaide Hospital, North Terrace Adelaide, South Australia, 5000 Dr Blair Grace ANZDATA Registry / Research Fellow Royal Adelaide Hospital, North Terrace Adelaide, South Australia, 5000 Mrs Aarti Gulyani Biostatistician ANZDATA Registry Royal Adelaide Hospital, North Terrace Adelaide, South Australia, 5000 Mrs Hannah Dent Biostatistician ANZDATA Registry Royal Adelaide Hospital, North Terrace Adelaide, South Australia, 5000 Mrs Kylie Hurst ANZDATA Registry Manager Royal Adelaide Hospital, North Terrace Adelaide, South Australia, 5000 Dr Matthew Jose Nephrologist Department of Nephrology Royal Hobart Hospital Hobart, Tasmania, 7000 Dr Sean Kennedy Paediatric Nephrologist Nephrology Department Sydney Children’s Hospital Randwick, NSW, 2031
CONTRIBUTING AUTHORS
Dr Namrata Khanal Epidemiology Fellow ANZDATA Registry Royal Adelaide Hospital, North Terrace Adelaide, South Australia, 5000 Dr Wai Lim Nephrologist Sir Charles Gardiner Hospital, Hospital Avenue Nedlands, Western Australia, 6009 Associate Professor Stephen McDonald Executive Officer, ANZDATA Nephrologist Royal Adelaide Hospital, North Terrace Adelaide, South Australia, 5000 Dr Steven McTaggart Paediatric Nephrologist Queensland Child and Adolescent Renal service Mater Children’s Hospital Raymond Terrace South Brisbane, Qld 4101 Associate Professor Kevan Polkinghorne Nephrologist Department of Nephrology Monash Medical Centre Clayton Road, Clayton, Victoria, 3168
Professor Graeme Russ Chair ANZDATA Executive Co-Director Renal Unit Royal Adelaide Hospital, North Terrace Adelaide, South Australia, 5000 Dr Germaine Wong Fellow in Cancer Epidemiology ANZDATA Registry Royal Adelaide Hospital, North Terrace Adelaide, South Australia, 5000 Jenni Wright Senior Analyst Transplant Systems Australian Red Cross Blood Service 70 O’Riordan Street Alexandria, New South Wales, 2015
CONTRIBUTING AUTHORS
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A number of definitions given below are used throughout this report unless otherwise stated. 1. Wording Throughout this report ‘treatment’ refers to renal replacement therapy, including haemodialysis, peritoneal dialysis and transplantation. In places the word “graft” (or “allograft”) is used for kidney transplant.
HD = haemodialysis CAPD = continuous ambulatory peritoneal dialysis APD = automated peritoneal dialysis ESKD = end stage kidney disease 2. Data collection ANZDATA collects information from all renal units in Australia and New Zealand. Data collection occurs at two time points. Key events (new patients, deaths, transplants) are notified as they occur, with units requested to send this at least monthly. This can occur either via a web-based interface or paper submission. An extensive cross-sectional survey is then performed twelve monthly (for data to 31st December). Currently this is by a paper-based system, with manual completion of the form and manual data entry. No formal audit mechanism is in place at this stage.
For kidney transplants, HLA matching and panel reactive antibodies are obtained direct from the National Organ Matching System.
Monthly summaries are distributed to the contributing units. Results contained in this (and other reports) are based on a final database locked and prepared after the end of year survey returns are received. 3. Inclusion criteria Included in the Registry are all patients resident in Australia or New Zealand receiving renal replacement therapy where the intention to treat is long-term, ie medical opinion is that renal function will not recover. Cases of acute renal failure are excluded. People who move overseas permanently are censored at date of last treatment (or departure in the case of transplant recipients). 4. Modality attribution For survival analysis the initial mode of dialysis is generally determined at 90 days after first treatment, to allow for early changes and maturation of access. Other transfers (between modalities, or from satellite to hospital haemodialysis etc.) are not analysed if less than 30 days, except for transfers between dialysis centres to which a 60 day rule is applied to allow for holiday movements. 5. Underlying renal disease This is recorded by the treating hospital according to a modified EDTA coding system (details on back of survey form).
6. Deaths Death rate is predominantly reported as number of patients died/total number of years of treatment of all patients treated at any time during the year. It is expressed as deaths per 100 patient years (pt yrs) at risk.
7. Comorbid conditions These are recorded by the treating hospital. No formal definitions are supplied; the treating clinician is asked to record whether the patient has coronary artery disease, chronic lung disease, cerebrovascular disease, peripheral vascular disease or diabetes according to their clinical opinion on a yes / suspected / no basis.
8. Transplant Waiting List The active transplant waiting list is based on data from the National Organ Matching System (Australia) cross-checked with ANZDATA.
9. Derived measures
9.1 Haemoglobin Haemoglobin is recorded as the last available measurement before the end of the survey period.
9.2 Erythropoietic agents Erythropoietin agent use is recorded as “yes” if these agents were used at any time during the survey period.
9.3 Iron studies Iron studies are requested within the last three months of the survey period.
9.4 Estimated creatinine clearance Where creatinine clearance is estimated from serum creatinine at entry or post transplantation, the 4-variable MDRD formula is used [1]
eGFR = 186 x Cr^-1.154 x age^-0.203 x 1.212 if black x 0.742 if female (where Cr is creatinine in mg/dL and age is age in years)
The weight term used for this is lean body mass, calculated using the equation LBW=(0.9*[height-152])+(50 if male, 45.5 if female) [2]
9.5 Urea reduction ratio / Kt/V Results are requested in one of these formats, using the stop flow method on a mid-week dialysis. Single pool Kt/V is collected, along with the method used. For conversion of URR to Kt/V urea the formula used [3] is
Kt/V = 0.023*PRU - 0.284 (note that PRU = percent reduction in urea and not URR).
DEFINITIONS AND METHODS
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9.6 Body mass index Body mass index (BMI) is calculated as weight (kg) (height (m))2
The categories used are : underweight <20 kg/m2 , normal 20-24.9 kg/m2, overweight 25-29.9 kg/m2, obese >=30 kg/m2 9.7 Peritoneal dialysis measures These are the standard measures, often calculated by computerised patient management programs.
9.7.1 Residual renal function The measure used is the arithmetic mean of urea and creatinine clearance from a 24-hour urine collection and serum creatinine and urea.
9.7.2 Peritoneal equilibration test The ratio of dialysate to plasma glucose is used, following a 4 hour dwell of a 2 litre 2.5% bag of dialysate, performed within 6 months after initiation of peritoneal dialysis.
10. Rates and Measures
10.1 Incidence rates Except where otherwise stated, quoted incidence rates are per calendar year, and are expressed per million population.
10.2 Prevalence rates Except where otherwise specified, prevalence rates are point prevalence rates at 31st December 2011.
10.3 Population denominator
All populations used in this report were stratified by age and sex.
Australian populations were taken from the Australian Bureau of Statistics (ABS).
All populations used were for 30 June of each year, except for total New Zealand populations, where data for 31 December were readily available, and all websites were accessed 20th September 2012.
Population data for each Australian state and territory came from ABS 3101.0 series (4)
Population data for Indigenous Australians were taken from ABS 3238.0(5), using series A (the most conservative estimates) for populations after 2006.
Populations serviced by the Greater Southern Area Health Service were estimated by the South Eastern Region of NSW. These estimates were taken from ABS 3235.0(6)
All New Zealand population estimates were taken from Statistics New Zealand (SNZ). Total populations were taken from NZ Infoshare (7) and Maori populations were taken from NZ Infoshare Maori population estimates (8).
Estimates of resident Pacific People populations after were taken from (9) for years 2006 onwards. Prior to this, populations of Pacific people before 2006 were only available for years 1996, 2001 (and 2006), and we used linear interpolation to estimate populations for each age and sex group for the years 1997-2001 and 2002-2005.
10.4 Survival rates For transplant recipients, survival rates exclude those who were transplanted overseas or were recipients of multiple organ grafts.
Graft survival (unless otherwise qualified) includes both cessation of graft function (ie return to dialysis) and patient death.
Rates for patient survival for fixed periods for transplantation are calculated according to the life-table method and thus include an adjustment to the risk-set of ½ of those censored without failure over the interval to create an “average” risk set.
10.5 Graft survival For outcomes of kidney transplants, graft failure includes both loss of graft function (ie return to dialysis) and death of patients (with graft function). Calculations of patient survival for transplant recipients includes all subsequent modalities (i.e. deaths after graft failure are included). Patients transplanted overseas are excluded from calculations.
10.6 Dialysis Survival Patient and technique survivals for haemodialysis and peritoneal dialysis are based on the dialysis modality at 90 days after first treatment for patients not transplanted during that period. Patients are followed up until they are either transplanted (at which point they are censored) or until they have a ‘permanent’ change of dialysis modality or until death or most recent follow up date. A ‘permanent’ change of dialysis is defined as any change in excess of 30 days.
Peritonitis survivals are calculated from first peritoneal dialysis (ignoring all earlier treatments) to date of first peritonitis episode. If there were no episodes of peritonitis then calculation is censored at change of treatment from peritoneal dialysis to haemodialysis or transplantation. Peritoneal dialysis includes automated peritoneal and continous ambulatory peritoneal dialysis. Excluded are patients who had peritonitis before commencing peritoneal dialysis.
10.8 Death and other event rates Rates are expressed per 100 person years at risk (unless otherwise stated). Some analyses include survival of all patients,
others exclude the first 90 days of followup. This is stated in the individual analyses.
10.9 Age standardisation All rates are crude, not age-standardised. The age distribution of the populations for Australia and New Zealand
DEFINITIONS AND METHODS
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Can be obtained by contacting the Registry.
10.10 Peritonitis rates Peritonitis rates are present using episodes of peritonitis reported during periods of peritoneal dialysis - episodes reported prior to commencement of peritoneal dialysis (for example between Tenckhoff catheter insertion and commencement of peritoneal dialysis) are not included in these calculations.
11. Database Data is stored on a relational database using Oracle version 9I.
12. Statistics Statistical analyses were performed using Stata version 12.
13. References
1) Levey A, Greene T, Kusek J, Beck G. A simplified equation to predict glomerular filtration rate from serum creatinine (abstract). J Am Soc Nephrol. 2000 May 20;11(11):155A.
2) Zasadny KR, Wahl RL: Standardized uptake values of normal tissues at PET with 2-[fluorine-18]-fluoro-2-deoxy-D-glucose: variation with body weight and method for correction. Radiology 1993: 189;847-850.
3) Basile C, Casino F, Lopez T: Percent reduction in blood urea concentration during dialysis estimates Kt/V in a simple and accurate way. Am J Kidney Dis 1990: 15;40-45.
4) http://www.abs.gov.au/AUSSTATS/[email protected]/DetailsPage/3101.0Jun%202011?OpenDocument
5) http://www.abs.gov.au/AUSSTATS/[email protected]/DetailsPage/3238.01991%20to%202021?OpenDocument
6) http://www.abs.gov.au/AUSSTATS/[email protected]/DetailsPage/3235.02011?OpenDocument
7) http://www.stats.govt.nz/infoshare/SelectVariables.aspx?pxID=59949f0f-e948-429b-8ed7-7d702c1b39c0
8) http://www.stats.govt.nz/~/media/Statistics/browse-categories/population/estimates-projections/national-pop-estimates/Maori-population-estimates-30-June-19912011.xls
9) http://nzdotstat.stats.govt.nz/wbos/Index.aspx?DataSetCode=TABLECODE31
DEFINITIONS AND METHODS
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HOSPITALS
Parent hospitals, transplanting unit and satellite dialysis units together with their state and unit codes are listed below. In some cases, these have combined as part of a regional network and this is also indicated. The definition of a ‘parent hos-pital’ is a pragmatic one, and refers to units which offer a full range of dialysis services (i.e. can commence patients on dialysis, have on-site nephrologist presence and can deal with patients of all degrees of complexity).
In contrast, satellite units provide haemodialysis treatments to selected patients, usually with lower staff ratios and no on-site nephrologist.
NOTE: The states listed below are in no particular order.
QUEENSLAND (STATE CODE 4)
PARENT HOSPITALS Unit Code
Allamanda Private Hospital (Fresenius) ALLA
Bundaberg Base Hospital BUND Cairns Base Hospital CAIR Chermside Dialysis Unit (Fresenius) CHER Child and Adolescent Renal Service CARS Gold Coast Hospital GOLD Greenslopes Private Hospital (Baxter) GREN Hervey Bay Hospital HERV John Flynn Hospital FLYN Mackay Base Hospital MACK Princess Alexandra Hospital PSAH Queensland Renal Transplant Service QRTS Rockhampton Base Hospital ROCK Royal Brisbane Hospital RBSH St Andrew’s Dialysis Clinic (Diaverum) GSTA Sunshine Coast Health District Caloundra Private Hospital CALO Nambour General Hospital NAMB
Nambour Selangor Private Hospital NPRV
The Townsville Hospital TOWN Toowoomba Hospital TWMB Wesley Private Hospital WSLY
TRANSPLANTING UNIT Unit Code
Queensland Renal Transplantation Service QRTS
Princess Alexandra Hospital (Adult and Paediatric) Director of Transplantation
Dr Tony Griffin Ipswich Road Woolloongabba 4102
SATELLITE DIALYSIS UNITS Unit Code Atherton Private Hospital ATHR
Cairns Home Training Unit CHTR
Cairns Private Hospital Satellite CPRV
Caloundra Public Hospital CAPU
Cooktown Satellite COOK
East Street Self Care Dialysis Unit EAST
Gympie Satellite GYMP
Home Hill Satellite HILL
Innisfail Hospital INNI
Ipswich Satellite IPSW
Kingaroy Satellite KROY
Logan Satellite LOGN
Maryborough Hospital MARY
Mossman Satellite MOSS
Mt. Isa Satellite MTIS
Noosa Satellite NOOS
North Lakes Dialysis Unit NLAK
North Ward Satellite NWAR
Palm Island Satellite PISL
Redcliffe Satellite REDC
Redlands Satellite REDL
St Vincent’s Robina Satellite STVR
AUSTRALIAN CAPITAL TERRITORY (ACT) (STATE CODE 9)
PARENT HOSPITALS Unit Code
The Canberra Hospital CANB
SATELLITE DIALYSIS UNITS Unit Code
Canberra Community Satellite CSAT
Northside Dialysis Clinic (Fresenius) NSID
TASMANIA (STATE CODE 7)
PARENT HOSPITALS Unit Code
Launceston General Hospital LAUN
Royal Hobart Hospital RHBT
SATELLITE DIALYSIS UNITS Unit Code
Launceston Community Centre Satellite LCCS
North West Renal Unit, Burnie NWRU
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SOUTH AUSTRALIA (STATE CODE 5)
PARENT HOSPITALS Unit Code
Flinders Medical Centre FMDC
Central Northern Adelaide Transplant Service CNAR
The Queen Elizabeth Hospital QEZB
Royal Adelaide Hospital RADL
Women’s and Children’s Hospital WCHL
TRANSPLANTING UNIT Unit Code Central Northern Adelaide Transplant Service CNAR Royal Adelaide Hospital Director - Professor Graeme Russ North Terrace Adelaide 5000
Women’s and Children’s Hospital WCHL Director - Dr Paul Henning 72 King William Road North Adelaide 5006
SATELLITE DIALYSIS UNITS Unit Code Berri Satellite BERI Ceduna Hospital CEDU Clare Satellite CLAR Hampstead Rehabilitation Satellite HAMP Hartley Private Hospital (Fresenius) HART Port Lincoln Satellite Centre LINC
Lyell McEwin Satellite LMCK
Millicent Hospital MILL Maitland Hospital MLAN Modbury Satellite (Fresenius) MSAT Mount Gambier Satellite MTGA Murray Bridge Hospital MURR Noarlunga Satellite NOAR Payneham Satellite (Baxter) PAYN Port Augusta Hospital PTAG Port Piri Satellite PIRI Victor Harbour Satellite VHAR Wayville Satellite Centre WAYV Whyalla Satellite Centre WHYA
NORTHERN TERRITORY (STATE CODE 1)
PARENT HOSPITALS Unit Code
Alice Springs Hospital ALIC
Royal Darwin Hospital DARW
SATELLITE DIALYSIS UNITS Unit Code Flynn Drive Satellite FDVE
Katherine Dialysis Unit KATH Nightcliff Community Centre NTCL Palmerston Satellite PTON Tennant Creek Hospital TENN Tiwi Dialysis Centre TIWI
WESTERN AUSTRALIA (STATE CODE 6)
PARENT HOSPITALS Unit Code
Fremantle Hospital FREM
Princess Margaret Hospital for Children PMHC
Royal Perth Hospital RLPT
Sir Charles Gairdner Hospital SCGH
TRANSPLANTING UNIT Unit Code Princess Margaret Hospital for Children PMHC Director - Dr Ian Hewitt Roberts Road Subiaco 6008
Royal Perth Hospital RLPT Director - Dr Kevin Warr Wellington Street Perth 6001
Sir Charles Gairdner Hospital SCGH Director - Dr Harry Moody Verdun Street Nedlands 6009
SATELLITE DIALYSIS UNITS Unit Code Albany ALBA Armadale Satellite ARMA Bunbury Satellite BUNB Busselton Satellite BUSS Cannington Dialysis Clinic (Diaverum) CANN Derby Satellite DERB Geraldton Hospital GRLD Joondalup Satellite JOON Hollywood Private Hospital HPRH Kalgoorlie Dialysis Unit KALG Kimberley Dialysis Centre KIMB Melville Satellite MELV Midland Private Dialysis Centre (Baxter) MIDL Murdoch STJM Peel Health Campus MAND Port Hedland Dialysis Unit (Pilbara) PTHD Rockingham Satellite RHAM Spearwood Satellite SPEA Stirling Dialysis Clinic (Diaverum) STIR
St. John of God Private Hospital
Subiaco SJOG
HOSPITALS
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PARENT HOSPITALS Unit Code Alfred Hospital ALFD
Austin Health AUST Bendigo Hospital BEND
Eastern Health Integrated Renal Services EHRS
Epworth Hospital EPWT Forest Hill Dialysis Centre (Fresenius) FORE Geelong Hospital GLNG Kew Private Dialysis Centre KEWP Malvern Dialysis Centre (Fresenius) MALV Monash Medical Centre – Adult MMCA Monash Medical Centre – Paediatric MMCP
North West Dialysis Service NWDS Royal Melbourne Hospital RMBH Royal Children’s Hospital RCHL St. Vincent’s Hospital SVIN Western Health WSTH
Diamond Valley Dialysis Clinic (Diaverum) GDIA
North Melbourne Dialysis Clinic (Diaverum) NMDC
TRANSPLANTING UNIT Unit Code
Alfred Hospital ALFD
Director - Professor Napier Thomson Commercial Road Prahran 3181
Austin Health AUST Director - Dr David Power Burgundy Road Heidelberg 3084
Monash Medical Centre (Paediatric) MMCP Director - Dr Amanda Walker 246 Clayton Road Clayton 3165
Monash Medical Centre (Adult) MMCA Director - Professor Peter Kerr 246 Clayton Road Clayton 3165
Royal Children’s Hospital RCHL Director - Dr Colin Jones Flemington Road Parkville 3052 Royal Melbourne Hospital RMBH Director - Professor Gavin Becker Parkville 3052
St. Vincent’s Hospital SVIN Director - Professor Robyn Langham 41 Victoria Parade Fitzroy 3065
SATELLITE DIALYSIS UNITS Unit Code
Coburg Satellite COBG Cohuna Hospital COHU Colac Hospital COLA Corryong Satellite CORR Craigieburn Satellite CRAI Cranbourne Satellite CRAN Dandenong Satellite DAND Daylesford Hospital DAYL Donald Hospital DONA Eastern Health Incentre Dialysis EHUB Echuca Hospital ECHU Edenhope Hospital EDEN Epping Dialysis Unit EPPG Frankston Satellite FRAN Goulburn Valley Hospital GVAL Hamilton Hospital HAML Hastings Hospital HSTG Heidelberg Hospital HEDG Horsham Satellite HORS Kyabram Satellite KYAB Kyneton Hospital KYNE Latrobe Regional Satellite LATR Mansfield District Hospital MANS Maroondah Satellite MARO Maryborough Hospital MRYB Melton Hospital MELT Mildura Hospital MILD Moorabbin Satellite MOOR Myrtleford Hospital MYRT Newcomb Satellite NCOM Nhill Hospital Satellite NHIL Northern Hospital Satellite NSAT North East Kidney Service NEKS Orbost Hospital ORBO Peter James Centre PJAM Portland District Health PORT Robinvale Hospital ROBV Rosebud Hospital ROSE Sale Hospital SALE Sandringham Satellite SNDR Seymour Hospital SEYM South Geelong Satellite SGEO St. George’s Hospital SGRU Sunbury Satellite SUNB Sunshine Satellite Centre SUNS Swan Hill Hospital SWAN Terang Hospital TERA Wagga Hospital WAGG Wangaratta Hospital WANG Warnnambool Hospital WARN Werribee Mercy Hospital WERR Western Gippsland Hospital WGIP Williamstown Satellite WILL Wodonga Regional Health Service WDGA Wonthaggi Hospital WONT Yarawonga District Hospital YARA Yarram Hospital YARM
Caulfield General Medical Centre CAUL Casterton Hospital CAST
VICTORIA (STATE CODE 3)
SATELLITE DIALYSIS UNITS Unit Code Broadmeadows Satellite BRDM Brunswick Satellite BRUN Casey Hospital CASE
HOSPITALS
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TRANSPLANTING UNIT Unit Code
John Hunter Hospital HUNT
Director of Transplantation -
Professor Adrian Hibberd
Lookout Road
New Lambton Heights
Newcastle 2304
Prince of Wales Hospital POWH
Director - Professor Bruce Pussell
Barker Street
Randwick 2031
Royal North Shore Hospital RNSH
Director - Dr Bruce Cooper
Pacific Highway
St Leonards 2065
Statewide Renal Services SWRS
Royal Prince Alfred Hospital RPAH
Director of Transplantation - Professor Steven Chadban
Missenden Road
Camperdown 2050
NEW SOUTH WALES (STATE CODE 2)
SATELLITE DIALYSIS UNITS Unit Code
Armidale Hospital ARMD
Auburn Satellite AUBN
Ballina Hospital BLNA
Bankstown Hospital BANK
Bathurst Satellite Dialysis Centre BATH
Bega Satellite BEGA
Blacktown Regional Dialysis BLAK
Bondi Dialysis Unit (Diaverum) BOND
Brewarrina Hospital BREW
Broken Hill Hospital BROK
Campbelltown Satellite CAMP
Concord Repatriation Satellite Unit CRSU
Condobolin Hospital COND
Coonamble Hospital COON
Dame Eadith Walker DEWE
Eora Satellite EORA
Fairfield Satellite FAIR
Forbes Hospital FORB
Gilgandra Satellite GILG
Gosford Satellite GOSS
Goulburn Satellite (Fresenius) GLBN
Grafton Hospital GRFT
Griffith Base Hospital GRIF
Invarell Satellite INVR
Lakehaven Satellite LAKE
Lanceley Cottage LANC
Liverpool Community Centre LCOM
Maitland Hospital MAIT
Mona Vale Satellite MNVL
Moree Satellite MORE
Moruya Satellite (Fresenius) MORU
Muswellbrook MUSW
Concord Hospital CONC
PARENT HOSPITALS Unit Code Dubbo Base Hospital DUBB East Coast Renal Service Prince of Wales Hospital POWH St. George Hospital STGH St. Vincent’s Hospital STVI Sydney Children’s Hospital SCHL Wollongong Hospital WGNG Gosford Hospital GOSF John Hunter Hospital HUNT Lindfield Dialysis Unit (Diaverum) LIND Lismore Hospital LISM Lismore Private Dialysis Clinic LPDC Macleay Dialysis Centre - Kempsey MACL Manning Rural Referral Hospital MANN Mater Misericordiae Hospital MATR Mayo Private - Taree MAYO Newcastle Nephrocare NCAS Port Macquarie Base Hospital PTMQ Port Macquarie Private Hospital PMPH Royal North Shore Hospital RNSH South West Sydney Renal Services SSYD Liverpool Hospital LVPL Statewide Renal Services SWRS Royal Prince Alfred Hospital RPAH Sydney Adventist Hospital SADV Tamworth Hospital TAMW The Children’s Hospital at Westmead NEWC The Tweed Hospital TWHD Western Renal Network Nepean Hospital NEPN Orange Hospital ORAN
Westmead Hospital WEST
Sydney Children’s Hospital SCHL
Director - Dr Andrew Rosenberg
C/- Department of Nephrology
Prince of Wales Hospital
Barker Street
Randwick 2031
The Children’s Hospital at Westmead NEWC
Director - Dr Stephen Alexander
Cnr Hawkesbury and Hainsworth Street
Westmead 2145
Westmead Hospital WEST
Director - Professor Jeremy Chapman
Cnr Hawkesbury and Darcy Road
Westmead 2145
TRANSPLANTING UNIT (CONT) Unit Code
HOSPITALS
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Norfolk Island Hospital NORF
Penrith Community Dialysis Centre PCDC
Shellharbour SHEL
Shoalhaven Satellite (Nowra) SHOA
Singleton Satellite SING
Sutherland Hospital SUTH
Sydney Dialysis Centre SYDC
Taree Community Dialysis NITA
Wagga Wagga Base Hospital WAGG
Wansey Satellite WANS
Wellington Hospital WGTN
Wollongong Satellite WSAT
SATELLITE DIALYSIS UNITS Unit Code
NEW SOUTH WALES (CONT)
NEW ZEALAND (CODE 8)
PARENT HOSPITALS Unit Code
Auckland City Hospital AUCK
Starship Children’s Hospital STAR
Christchurch Hospital CHCH
Dunedin Hospital DUND
Hawkes Bay Hospital HAWK
Middlemore Hospital MIDM
Palmerston North Hospital PALM
Taranaki Base Hospital TARA
Waikato Hospital WKTO
Wellington Hospital WELN
Whangarei Area Hospital WHAN
Waitemata WMAT
TRANSPLANTING UNIT Unit Code
Auckland City Hospital AUCK
Director - Dr Ian Dittmer
Park Road
Grafton, Auckland
Christchurch Hospital CHCH
Director - Dr David McGregor
Riccarton Avenue
Christchurch
Starship Children’s Hospital STAR
Director - Dr William Wong
Park Road
Grafton, Auckland
Wellington Hospital WELN
Director - Dr Grant Pidgeon
Riddiford Street
Newtown, Wellington South
SATELLITE DIALYSIS UNITS Unit Code
Auckland Home Training Unit AHOM
Bay of Islands Hospital BAYI
Carrington Satellite CARR
Grafton Training Unit GRAF
Greenlane Hospital GLNE
Kaitaia Hospital KAIT
Kawakawa Hospital KAWA
Manukau Satellite MANU
Nephrocare NEPH
Nelson Hospital NELS
Porirua Community Dialysis PORI
Rotarua Hospital ROTO
Tauranga Hospital TAUR
Waitakere Satellite WAIT
HOSPITALS
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Publications in peer-reviewed journals based substantially on data from ANZDATA and released during the period of data covered by this report and during 2011 are listed below.
PUBLICATIONS
2013 Tang W, Bose B, McDonald SP, Hawley CM, Badve SV, Boudville N, et al. The Outcomes of Patients with ESRD and ANCA-Associated Vasculitis in Australia and New Zealand. Clin J Am Soc Nephrol. 2013 May;8(5):773-80. McDonald SP, Russ GR. Australian registries-ANZDATA and ANZOD. Transplantation reviews (Orlando, Fla). 2013 Apr;27(2):46-9. Shahir AK, Briggs N, Katsoulis J, Levidiotis V. An observational outcomes study from 1966-2008, examining pregnancy and neonatal outcomes from dialysed women using data from the ANZDATA Registry. Nephrology (Carlton, Vic). 2013 Apr;18(4):276-84. Marshall MR, van der Schrieck N, Lilley D, Supershad SK, Ng A, Walker RC, et al. Independent community house hemodialysis as a novel dialysis setting: an observational cohort study. Am J Kidney Dis. 2013 Apr;61(4):598-607. Sparke C, Moon L, Green F, Mathew T, Cass A, Chadban S, et al. Estimating the total incidence of kidney failure in Australia including individuals who are not treated by dialysis or transplantation. Am J Kidney Dis. 2013 Mar;61(3):413-9. Tang W, McDonald SP, Hawley CM, Badve SV, Boudville NC, Brown FG, et al. Anti-glomerular basement membrane antibody disease is an uncommon cause of end-stage renal disease. Kidney Int. 2013 Mar;83(3):503-10. Vacher-Coponat H, McDonald S, Clayton P, Loundou A, Allen RDM, Chadban SJ. Inferior early posttransplant outcomes for recipients of right versus left deceased donor kidneys: an ANZDATA registry analysis. Am J Transplant. 2013 Feb;13(2):399-405. Tang W, McDonald SP, Hawley CM, Badve SV, Boudville N, Brown FG, et al. End-stage renal failure due to amyloidosis: outcomes in 490 ANZDATA registry cases. Nephrol Dial Transplant. 2013 Feb;28(2):455-61. Lim WH, Clayton P, Wong G, Campbell SB, Cohney S, Russ GR, et al. Outcomes of Kidney Transplantation From Older Living Donors. Transplantation. 2013 Jan 15;95(1):106-13. Grace BS, Clayton PA, Cass A, McDonald SP. Transplantation rates for living- but not deceased-donor kidneys vary with socioeconomic status in Australia. Kidney Int. 2013 Jan;83(1):138-45. Krishnasamy R, Badve SV, Hawley CM, McDonald SP, Boudville N, Brown FG, et al. Daily Variation in Death in Patients Treated by Long-term Dialysis: Comparison of In-Center Hemodialysis to Peritoneal and Home Hemodialysis. Am J Kidney Dis. 2013 Jan;61(1):96-103. Cho Y, Badve SV, Hawley CM, McDonald SP, Brown FG, Boudville N, et al. Effects of climatic region on peritonitis risk, microbiology, treatment, and outcomes: a multicenter registry study. Perit Dial Int. 2013 Jan;33(1):75-85. Hibberd AD, Trevillian PR, Wlodarczyk JH, Kemp DG, Stein AM, Gillies AHB, et al. Effect of immunosuppression for primary renal disease on the risk of cancer in subsequent renal transplantation: a population-based retrospective cohort study. Transplantation Journal. 2013 Jan;95(1):122-7. Wong G, Turner RM, Chapman JR, Howell M, Lim WH, Webster AC, et al. Time on dialysis and cancer risk after kidney transplantation. Transplantation Journal. 2013 Jan;95(1):114-21.
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Grace BS, Kennedy SE, Clayton PA, McDonald SP. Racial disparities in paediatric kidney transplantation. Pediatr Nephrol. 2013 Aug 9. Le Page AK, Mackie FE, McTaggart SJ, Kennedy S. Cytomegalovirus & Epstein Barr Virus Serostatus as a predictor of the long term Outcome of Kidney Transplantation. Nephrology (Carlton). 2013 Aug 8. doi: 10.1111/nep.12149. Gallagher MP, Kelly PJ, Jardine M, Perkovic V, Cass A, Craig JC, et al. Long-term cancer risk of immunosuppressive regimens after kidney transplantation. J Am Soc Nephrol. 2010 May;21(5):852–8. Wyld ML, et al., Pregnancy outcomes for kidney transplant recipients.Am J Transplant. 2013 Jesudason S, et al., Pregnancy Outcomes According to Dialysis Commencing Before or After Conception in Women with ESRD.Clin J Am Soc Nephrol. 2013 Longmore DK, et al., Post-transplant lymphoproliferative disorder: no relationship to recombinant human growth hormone use in Australian and New Zealand pediatric kidney transplant recipients.Pediatr Transplant. 2013 Grace BS, et al., Does equal care give equal outcomes?Kidney Int. 2013 Grace BS, et al., Racial disparities in paediatric kidney transplantation.Pediatr Nephrol. 2014 Le Page AK, et al., Cytomegalovirus & Epstein Barr Virus Serostatus as a predictor of the long term Outcome of Kidney Transplantation.Nephrology (Carlton). 2013 Gray NA, et al., Data quality of the Australia and New Zealand Dialysis and Transplant Registry: a pilot audit.Nephrology (Carlton). 2013 McDonald SP, et al., Australian registries-ANZDATA and ANZOD.Transplant Rev (Orlando). 2013 Shahir AK, et al., An observational outcomes study from 1966-2008, examining pregnancy and neonatal outcomes from dialysed women using data from the ANZDATA Registry.Nephrology (Carlton). 2013 Jesudason S, Grace BS, McDonald SP, Pregnancy Outcomes According to Dialysis Commencing Before or After Conception in Women with ESRD. Clin J Am Soc Nephrol. 2013 Nov 14. [Epub ahead of print], PMID: 24235285 [PubMed - as supplied by publisher] Wyld ML, Clayton PA, Jesudason S, Chadban SJ, Alexander SI, Pregnancy outcomes for kidney transplant recipients. Am J Transplant. 2013 Dec;13(12):3173-82. doi: 10.1111/ajt.12452. Epub 2013 Oct 8. PMID: 24266970 [PubMed - in process] Longmore DK, Conwell LS, Burke JR, McDonald SP, McTaggart SJ, Post-transplant lymphoproliferative disorder: No relationship to recombinant human growth hormone use in Australian and New Zealand pediatric kidney transplant recipients. Pediatr Transplant. 2013 Dec;17(8):731-6. doi: 10.1111/petr.12167. PMID: 24164826 [PubMed - in process] Cho Y, Badve SV, Hawley CM, McDonald SP, Brown FG, Boudville N, Bannister KM, Clayton PA, Johnson DW, Association of Biocompatible Peritoneal Dialysis Solutions with Peritonitis Risk, Treatment, and Outcomes. Clin J Am Soc Nephrol. 2013 Aug 15. [Epub ahead of print] PMID: 23949232 [PubMed - as supplied by publisher] Grace BS, Kennedy SE, Clayton PA, McDonald SP, Racial disparities in paediatric kidney transplantation. Pediatr Nephrol. 2013 Aug 9. [Epub ahead of print] PMID: 23928908 [PubMed - as supplied by publisher] Le Page AK, Mackie FE, McTaggart SJ, Kennedy S, Cytomegalovirus & Epstein Barr Virus Serostatus as a predictor of the long term Outcome of Kidney Transplantation. Nephrology (Carlton). 2013 Aug 8. doi: 10.1111/nep.12149. [Epub ahead of print] PMID: 23927085 [PubMed - as supplied by publisher] Gray NA, Mahadevan K, Campbell VK, Noble EP, Anstey CM, Data quality of the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA): a pilot audit. Nephrology (Carlton). 2013 Jul 11. doi: 10.1111/nep.12126. [Epub ahead of print] PMID: 23841726 [PubMed - as supplied by publisher]
PUBLICATIONS
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Tang W, Bose B, McDonald SP, Hawley CM, Badve SV, Boudville N, et al. The Outcomes of Patients with ESRD and ANCA-Associated Vasculitis in Australia and New Zealand. Clin J Am Soc Nephrol. 2013 May;8(5):773-80. McDonald SP, Russ GR. Australian registries-ANZDATA and ANZOD. Transplantation reviews (Orlando, Fla). 2013 Apr;27(2):46-9. Shahir AK, Briggs N, Katsoulis J, Levidiotis V. An observational outcomes study from 1966-2008, examining preg-nancy and neonatal outcomes from dialysed women using data from the ANZDATA Registry. Nephrology (Carlton, Vic). 2013 Apr;18(4):276-84. Marshall MR, van der Schrieck N, Lilley D, Supershad SK, Ng A, Walker RC, et al. Independent community house hemodialysis as a novel dialysis setting: an observational cohort study. Am J Kidney Dis. 2013 Apr;61(4):598-607. Sparke C, Moon L, Green F, Mathew T, Cass A, Chadban S, et al. Estimating the total incidence of kidney failure in Australia including individuals who are not treated by dialysis or transplantation. Am J Kidney Dis. 2013 Mar;61(3):413-9. Tang W, McDonald SP, Hawley CM, Badve SV, Boudville NC, Brown FG, et al. Anti-glomerular basement mem-brane antibody disease is an uncommon cause of end-stage renal disease. Kidney Int. 2013 Mar;83(3):503-10. Vacher-Coponat H, McDonald S, Clayton P, Loundou A, Allen RDM, Chadban SJ. Inferior early posttransplant out-comes for recipients of right versus left deceased donor kidneys: an ANZDATA registry analysis. Am J Transplant. 2013 Feb;13(2):399-405. Tang W, McDonald SP, Hawley CM, Badve SV, Boudville N, Brown FG, et al. End-stage renal failure due to amy-loidosis: outcomes in 490 ANZDATA registry cases. Nephrol Dial Transplant. 2013 Feb;28(2):455-61. Lim WH, Clayton P, Wong G, Campbell SB, Cohney S, Russ GR, et al. Outcomes of Kidney Transplantation From Older Living Donors. Transplantation. 2013 Jan 15;95(1):106-13. Grace BS, Clayton PA, Cass A, McDonald SP. Transplantation rates for living- but not deceased-donor kidneys vary with socioeconomic status in Australia. Kidney Int. 2013 Jan;83(1):138-45. Krishnasamy R, Badve SV, Hawley CM, McDonald SP, Boudville N, Brown FG, et al. Daily Variation in Death in Patients Treated by Long-term Dialysis: Comparison of In-Center Hemodialysis to Peritoneal and Home Hemodial-ysis. Am J Kidney Dis. 2013 Jan;61(1):96-103. Cho Y, Badve SV, Hawley CM, McDonald SP, Brown FG, Boudville N, et al. Effects of climatic region on peritonitis risk, microbiology, treatment, and outcomes: a multicenter registry study. Perit Dial Int. 2013 Jan;33(1):75-85. Hibberd AD, Trevillian PR, Wlodarczyk JH, Kemp DG, Stein AM, Gillies AHB, et al. Effect of immunosuppression for primary renal disease on the risk of cancer in subsequent renal transplantation: a population-based retrospec-tive cohort study. Transplantation Journal. 2013 Jan;95(1):122-7. Wong G, Turner RM, Chapman JR, Howell M, Lim WH, Webster AC, et al. Time on dialysis and cancer risk after kidney transplantation. Transplantation Journal. 2013 Jan;95(1):114-21.
PUBLICATIONS
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DATA COLLECTION FORM
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Kylie Hurst
Philip Clayton
Stephen McDonald
2013
ANNUAL REPORT SUMMARY
2013 Annual Report—36th Edition
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Chapter 1 - Stock and Flow There were 20,766 (919 per million population) receiving
renal replacement therapy (RRT) at 31st Dec 2012.
Of these 9320 (413 per million) had a functioning kidney transplant and 11,446 (507 per million) were receiving dialysis treatment.
Chapter 7 - Transplant Waiting list There were 1087 active patients on the deceased donor
kidney waiting list at the 1Jan and 1065 active on 31 Dec 2012. 736 were made active during the year and 153 were taken off the list, 6 died.
The numbers of both dialysis patients and transplants vary with age; As expected, numbers listed 65 years or older are much lower than for younger age groups, and the proportion removed from the list is higher.
Chapter 2 - New Patients 2534 people commenced RRT in Australia in 2012(112 per
million per year).
Incidence rates have stabilized over the past five years.
The mean age of patients entering programs in Australia in 2012 was 60 years and the median 62 years.
36% of all new patients had diabetic nephropathy attributed as their Cause of end stage renal disease, 19% had glomerulonephritis and 12% hypertension.
Chapter 8 - Transplantation The 845 transplant operations performed in 2012 represent a
slight increase over 2011. This was primarily driven by an increase in the number of deceased donor kidney transplants, offsetting a continuing fall in living donor numbers.
The 2012 numbers represent a transplant rate of 37 per million population per year, unchanged from 2011.
The median age of transplant recipients in 2012 was 49 years.
There have been 20,704 transplant operations performed on 17,135 patients since 1963. Of these, 9320 grafts were functioning at 31st December 2012.
Chapter 3 - Deaths The mortality rate per 100 patient years was 12.7 for
dialysis dependent patients and 1.8 for those with a functioning kidney transplant.
Of the 1,440 deaths among dialysis dependent patients in 2012, 34% were due to withdrawal from treatment, 31% were due to cardiovascular causes, 8% to infection.
In Australia there is steady improvement in mortality rates in most age groups over time.
Chapter 9 - Kidney Donation In Australia there has been a large increase in the number
of deceased donors since 2008, driven by an increase in expanded criteria (ECD) and in particular cardiac death (DCD) donors.
In Australia the mean deceased donor age has increased steadily from 36 years in 1993 to 46 years in 2012.
There were 238 living donor kidney transplants performed in 2012 in Australia, representing 28% of all transplant operations.
The proportion of all primary living donor transplants performed “pre-emptively” in Australia was 36%.
Chapter 4 - Method and Location of Dialysis There has been an increase of 411 (4%) in the total
number of prevalent dialysis patients.
Twelve percent of all prevalent dialysis patients were using automated peritoneal dialysis, a further 7% continuous ambulatory peritoneal dialysis, 22% hospital based haemodialysis, 49% satellite haemodialysis and 9% home haemodialysis.
Chapter 10 - Cancer Report There is now consistent evidence showing an increased
risk of cancer by at least 1.5 and 2-fold for people on dialysis and with kidney transplants, respectively.
Cancer is also second to cardiovascular disease as the major cause of mortality and morbidity in these patients.
Cancer can occur de novo or recur after transplantation.
Chapter 5 - Haemodialysis
There were 9,219 patients receiving HD treatment at 31st December 2012, an increase of 3%; of these 28% were hospital based, 61% were in satellite centres and11% at home.
A total of 1,788 patients received HD for the first time during the year, a slight increase from previous years.
There were 539 transplant operations to people receiving HD treatment, 6% of all HD patients dialysing and 8% of those patients < 65 years.
Chapter 11 - Paediatric Report Overall, glomerulonephritis remains the most common
cause of ESKD in children and adolescents (29%) but causes vary significantly with age. In young children renal hypoplasia/dysplasia is the most common cause while glomerulonephritis is a common cause of ESKD in adolescents.
Around 20% of children and adolescents receive pre-emptive kidney transplants. Of the remainder, similar numbers commence renal replacement therapy with haemodialysis peritoneal dialysis.
Chapter 6 - Peritoneal Dialysis Peritoneal dialysis was used to treat 19% of all dialysis
patients in 2012 (APD-1374,CAPD-853,total 11,446).
There were 977 new peritoneal dialysis patients in the calendar year 2012; of these 658 patients (67%) started renal replacement therapy with peritoneal dialysis and 319 (33%) had previously been treated with haemodialysis or a transplant.
Median time to first peritonitis was 24 months, with 37% of patients completely free of peritonitis at three years
Chapter 12 - End-Stage Kidney Disease Among Indigenous Peoples of Australia and New Zealand
A total of 254 Aboriginal and Torres Strait Islander People commenced dialysis in Australia during 2012.
Over the period 2002-12 there was an increase in the number of transplants from deceased donors. Numbers from living donors remain extremely low.
AUSTRALIA
KEY SUMMARY POINTS
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Chapter 1 - Stock and Flow
There were 3,862 (877 per million population) receiving renal replacement therapy (RRT) at 31st Dec 2011
Of these 1481(336 per million) had a functioning kidney transplant and 2,381 (541 per million) were receiving dialy-sis treatment.
Chapter 7 - Transplant Waiting list We anticipate incorporating detailed NZ waiting list stack
and flow analyses in next year’s Report.
Chapter 2 - New Patients
477 people commenced RRT in New Zealand in 2011 (108 per million per year).
The mean age of patients entering programs in new Zea-land in 2011 was 57.5 years and the median 59.1 years.
42% of all new patients had diabetic nephropathy attribut-ed as their Cause of end stage renal disease, 24% had glomerulonephritis and 11% hypertension.
Chapter 8 - Transplantation The number of transplant operations (118) performed in
2011 represents a transplant rate of 27 per million popula-tion per year compared with 25 in 2010 .
The median age of transplant recipients in 2011 was 50 years.
There have been 3,746 operations performed on 3,188 patients since 1965 with 1,481 grafts still functioning at 31st
December 2011
Chapter 3 - Deaths
The mortality rate per 100 patient years was 15.5 for dialy-sis dependent patients and 2.8 for those with a functioning kidney transplant.
Of the 412 deaths among dialysis dependent patients in 2011, 25% were due to withdrawal from treatment, 32% were due to cardiovascular causes, 13% to infection.
Chapter 9 - Kidney Donation The deceased donor numbers are steady and the propor-
tion of ECD and DCD donors are much lower than in Aus-tralia.
In New Zealand the mean donor age in 2011 was 36 years.
The number of living donor transplants decreased by 5% (57 donors) in New Zealand in 2011.
The proportion of pre-emptive primary living donor trans-plants in New Zealand was 23% in 2011.
Chapter 4 - Method and Location of Dialysis There were 2381 prevalent dialysis patients in 2011 which
is stable compared to previous years.
Together, hospital haemodialysis and satellite dialysis accounted for 48% of patients in 2011, the same as the previous two years. Satellite haemodialysis numbers de-creased 9% in 2011 (368 patients), after increases of 5% (396 patients) in 2010 and 8% (413 patients) in 2009.
Chapter 10 - Cancer Report Refer to Australian Summary points
Chapter 11 - Paediatric Report Refer to Australian Summary points
Chapter 5 - Haemodialysis There were 1,591 patients receiving treatment at 31st
December 2011, Hospital based HD (44%), satellite HD (29%) and home HD (27%) have all remained the same for the past three years.
There were 62 HD patients who received transplants in 2011 (47 in 2010). Four patients ≥ 65 years were trans-planted.
There were 403 patients who received HD for the first time in 2011, similar to previous years. Seventy eight percent were having their initial dialysis treatment, 20% were previ-ously dialysing with peritoneal dialysis and 2% were failed transplants.
Chapter 12 - End-Stage Kidney Disease Among Indigenous Peoples of Australia and New Zealand
The number of Maori and Pacific People starting dialysis decreased in 2011 (126 patients and 94 patients) respec-tively.
The number of transplants to Maori and Pacific Peoples recipients remains stable.
Chapter 6 - Peritoneal Dialysis
Peritoneal dialysis accounted for 33% of all dialysis patients and 64% of all patients dialysing at home.
There were 239 new peritoneal dialysis patients in the calendar year 2011; of these 147 patients started renal replacement therapy with peritoneal dialysis and 90 had previously been treated with haemodialysis or a transplant.
The median time to first peritonitis was 19.4 months, with 31% of patients free of peritonitis at three years.
NEW ZEALAND
KEY SUMMARY POINTS
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ANZDATA Registry 2013 Report STOCK and FLOW _____________________________________________________________________________________
Blair Grace
Kylie Hurst
Stephen McDonald
Philip Clayton
CHAPTER 1
STOCK AND FLOW
2013 Annual Report—36th Edition
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STOCK and FLOW ANZDATA Registry 2013 Report _____________________________________________________________________________________
Figure 1.2
Prevalent Patients 2008 - 2012 (Number Per Million Population at 31st December)
2008 2009 2010 2011 2012
Australia Total 17824 (834) 18512 (850) 19210 (871) 19913 (892) 20766 (919)
No. Transplants • # 7654 (358) 8047 (370) 8506 (386) 8878 (398) 9320 (413)
No. Dialysis Patients 10170 (476) 10465 (481) 10704 (485) 11035 (494) 11446 (507)
Proportion Home * 31% 30% 29% 28% 29%
Proportion Satellite HD 46% 47% 50% 51% 49%
Proportion CAPD/APD 22% 21% 20% 19% 19%
New Zealand Total 3456 (810) 3685 (854) 3828 (876) 3872 (879) 3993 (901)
No. Transplants • # 1350 (316) 1404 (325) 1440 (330) 1483 (337) 1524 (344)
No. Dialysis Patients 2106 (493) 2281 (529) 2388 (547) 2389 (542) 2469 (557)
Proportion Home * 52% 52% 53% 51% 50%
Proportion Satellite HD 19% 18% 17% 15% 16%
Proportion CAPD/APD 36% 35% 35% 33% 31%
• Country of Residence # Patients lost to follow up are not included
* Proportion of all patients dialysing currently receiving home-based treatment (either PD or HD)
The number of new patients in Australia increased slightly to 2534 in 2012. While there is variation in this rate from year to year, the rate remains stable from 2007. Reflecting both the changes in numbers of new patients and higher number of transplants, the number of prevalent dialysis patients (people receiving dialysis at the end of 2012) has slowly increased.
In New Zealand there was greater variability reflecting a smaller population base.
Rates of new and prevalent patients are shown in Figures 1.1 to 1.2 respectively. Further data about stock and flow are shown in Figures 1.6 to 1.14.
The overall number of new transplants (845) increased by 2.5% in 2012 similar to the number of new transplants in 2010. Recent years have seen substantial changes in the mix of living verses deceased donor transplants. Further information is shown in the transplant chapter. In 2012, there were 238 live donor transplants reported, a 6% decrease after the 14% decrease in 2011 (255 transplants).
In New Zealand the number of new transplants remained similar in 2012 (108 transplants), and numbers of live donor transplants (54) have decreased (by 3) from 2011.
Figure 1.1
Patient Flow Summary 2008 - 2012 (Number Per Million Population at 31st December)
* Country of Transplant
2008 2009 2010 2011 2012
Australia
Total New Patients 2551 (119) 2431 (112) 2330 (106) 2496 (112) 2534 (112)
Total Transplants * 813 (38) 773 (35) 846 (38) 825 (37) 845 (37)
Living Donor Transplants 354 327 296 255 238
Subsequent Transplants 105 99 102 81 98
Total Deaths 1677 1692 1598 1726 1606
Dialysis Patients 1493 1538 1414 1502 1440
Transplant Patients 184 154 184 224 166
New Zealand
Total New Patients 497 (116) 584 (135) 515 (118) 485 (110) 513 (116)
Total Transplants * 122 (29) 121 (28) 110 (25) 118 (27) 108 (24)
Living Donor Transplants 69 67 60 57 54
Subsequent Transplants 11 12 6 8 9
Total Deaths 388 365 354 413 384
Dialysis Patients 360 331 319 369 355
Transplant Patients 28 34 35 44 29
Notes: Figures for total transplants are by country of transplant. Figures for transplant deaths are by country of residence at time of death.
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ANZDATA Registry 2013 Report STOCK and FLOW _____________________________________________________________________________________
Figure 1.3
0
200
400
600
New
pat
ient
s, N
Z
0
500
1000
1500
2000
2500
New
pat
ient
s, A
ustr
alia
1960 1970 1980 1990 2000 2010
Year
AustraliaNZ
New PatientsAustralia and New Zealand
Figure 1.5
-80
-40
0
40
80
Cha
nge
from
pre
viou
s ye
ar
0
200
400
600
New
pat
ient
s
1980 1990 2000 2010
Year
New patientsChange from previous year
New Patients and ChangeNew Zealand
Figure 1.4
-400
-200
0
200
400
Ch
an
ge
fro
m p
revi
ou
s ye
ar
0
500
1000
1500
2000
2500
Ne
w p
atie
nts
1980 1990 2000 2010
Year
New patientsChange from previous year
New Patients and ChangeAustralia
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STOCK and FLOW ANZDATA Registry 2013 Report _____________________________________________________________________________________
Figure 1.8
Prevalent Transplant/Dialysis Patients by Indigenous Racial Origin, 2008 - 2012
(Number Per Million Population Per Year) Race 2008 2009 2010 2011 2012
Aboriginal and Torres
Strait Islanders #
New Patients 251 (466) 196 (356) 206 (367) 256 (446) 254 (433)
Dialysis 1163 (2160) 1184 (2153) 1214 (2161) 1307 (2278) 1425 (2431)
Functioning Transplants * 159 (295) 160 (291) 177 (315) 190 (331) 193 (329)
Transplant Operations 31 (58) 24 (44) 28 (50) 28 (49) 20 (34)
Deaths 164 (305) 174 (316) 162 (288) 149 (260) 129 (220)
Māori ^
New Patients 157 (244) 177 (271) 155 (233) 129 (192) 167 (244)
Dialysis 689 (1072) 733 (1123) 761 (1146) 746 (1108) 773 (1130)
Functioning Transplants * 112 (174) 120 (184) 130 (196) 142 (211) 149 (218)
Transplant Operations 12 (19) 19 (29) 20 (30) 20 (30) 15 (22)
Deaths 152 (236) 126 (193) 114 (172) 131 (194) 128 (187)
Pacific People ^
New Patients 87 (274) 103 (315) 109 (325) 95 (275) 92 (261)
Dialysis 434 (1365) 490 (1500) 542 (1615) 568 (1646) 600 (1699)
Functioning Transplants * 83 (261) 85 (260) 86 (256) 88 (255) 89 (252)
Transplant Operations 10 (31) 6 (18) 9 (27) 9 (26) 7 (20)
Deaths 55 (173) 48 (147) 50 (149) 61 (177) 62 (176)
* By Transplanting Country # Aboriginal and Torres Strait Islanders Combined ^ Māori and Pacific People data collected from patients living in New Zealand only
The incidence rate among Australian Aboriginal, Māori and Pacific People is substantially higher than among non-indigenous people. Although interpretation is complicated by fluctuations from year to year, the incidence rate may have stabilised over the past 5-10 years after a steady rise since the 1980s. Compared with non-indigenous patients, lower rates of transplantation in indigenous patients contributes to higher rates of prevalent dialysis patients (Figure 1.8).
Figure 1.6
0
2,000
4,000
6,000
8,000
10,000
12,000
Num
ber
of p
atie
nts
2008 2009 2010 2011 2012
Dial Tx Dial Tx Dial Tx Dial Tx Dial Tx
Prevalent Dialysis and TransplantAustralia (at 31 December)
Home HD Hosp / Sat HD PD Functioning Tx
Figure 1.7
0
500
1,000
1,500
2,000
2,500
Num
ber
of p
atie
nts
2008 2009 2010 2011 2012
Dial Tx Dial Tx Dial Tx Dial Tx Dial Tx
Prevalent Dialysis and TransplantNew Zealand (at 31 December)
Home HD Hosp / Sat HD PD Functioning Tx
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ANZDATA Registry 2013 Report STOCK and FLOW _____________________________________________________________________________________
Figure 1.10
Prevalent Transplant and Dialysis Patients 1991 to 2012 Country of Transplant
(Number Per Million Population at 31 December)
Australia New Zealand Year Transplant # Dialysis Total Transplant # Dialysis Total
1991 3518 (204) 3138 (182) 6656 (385) 600 (172) 630 (180) 1230 (352)
1992 3729 (213) 3383 (193) 7112 (407) 671 (190) 674 (191) 1345 (381)
1993 3900 (221) 3703 (210) 7603 (430) 702 (197) 721 (202) 1423 (398)
1994 4095 (229) 4099 (230) 8194 (459) 729 (201) 784 (217) 1513 (418)
1995 4271 (236) 4518 (250) 8789 (486) 782 (213) 850 (231) 1632 (444)
1996 4483 (245) 4882 (267) 9365 (512) 822 (220) 934 (250) 1756 (471)
1997 4740 (256) 5190 (280) 9930 (536) 878 (232) 1017 (269) 1895 (501)
1998 4970 (266) 5536 (296) 10506 (562) 931 (244) 1126 (295) 2057 (539)
1999 5141 (272) 6019 (318) 11160 (590) 978 (255) 1230 (321) 2208 (576)
2000 5350 (279) 6409 (335) 11759 (614) 1020 (264) 1331 (345) 2351 (609)
2001 5572 (287) 6851 (353) 12423 (640) 1060 (273) 1462 (377) 2522 (650)
2002 5858 (298) 7263 (370) 13121 (668) 1113 (282) 1594 (404) 2707 (686)
2003 6089 (306) 7719 (388) 13808 (694) 1164 (289) 1711 (425) 2875 (714)
2004 6395 (318) 8004 (398) 14399 (715) 1218 (298) 1774 (434) 2992 (732)
2005 6656 (326) 8642 (424) 15298 (750) 1243 (301) 1878 (454) 3121 (755)
2006 6987 (338) 9263 (448) 16250 (785) 1256 (300) 1997 (477) 3253 (777)
2007 7251 (345) 9731 (463) 16982 (808) 1300 (307) 2071 (490) 3371 (797)
2008 7654 (358) 10170 (476) 17824 (834) 1350 (316) 2106 (493) 3456 (810)
2009 8047 (370) 10465 (481) 18512 (850) 1404 (325) 2281 (529) 3685 (854)
2010 8506 (386) 10704 (485) 19210 (871) 1440 (330) 2388 (547) 3828 (876)
2011 8878 (398) 11035 (494) 19913 (892) 1483 (337) 2389 (542) 3872 (879)
# Patients lost to follow-up are excluded
2012 9320 (413) 11446 (507) 20766 (919) 1524 (344) 2469 (557) 3993 (901)
Figure 1.9
National and State Stock and Flow 1-Jan-2012 to 31-Dec-2012 (31-Dec-2011 Figures)
State New Patients
Transplant Operations *
Deaths Dialysis
Dependent + Functioning
Transplants # * + Total Dialysis Transplant
Queensland 467 (451) 164 (154) 272 (315) 31 (47) 2085 (2012) 1810 (1717) 3895 (3729)
New South Wales 786 (780) 224 (217) 457 (482) 47 (80) 3707 (3574) 2640 (2524) 6347 (6098)
Aust. Capital Territory 64 (53) 16 (21) 36 (27) 4 (8) 269 (264) 226 (216) 495 (480)
Victoria 628 (602) 250 (255) 343 (338) 33 (38) 2792 (2704) 2493 (2352) 5285 (5056)
Tasmania 47 (52) 15 (23) 32 (23) 4 (1) 214 (204) 225 (221) 439 (425)
South Australia 202 (183) 78 (66) 114 (110) 26 (27) 733 (712) 952 (920) 1685 (1632)
Northern Territory 98 (83) 14 (11) 47 (49) 2 (4) 502 (464) 77 (68) 579 (532)
Western Australia 242 (292) 86 (87) 139 (158) 19 (19) 1144 (1101) 897 (860) 2041 (1961)
Australia 2534 (2496) 847 (834) 1440 (1502) 166 (224) 11446 (11035) 9320 (8878) 20766 (19913)
New Zealand 513 (485) 109 (121) 355 (369) 29 (44) 2469 (2389) 1524 (1483) 3993 (3872)
# Patients lost to follow-up are excluded * Resident State + Point Prevalence at 31 December
State by State rates are shown in Figure 1.9. Figures 1.10 to 1.14 deal with the number of prevalent dialysis and transplant patients, showing trends over the past 25 years (Figure 1.10) and state-by-state comparisons.
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STOCK and FLOW ANZDATA Registry 2013 Report _____________________________________________________________________________________
Figure 1.13
Comparison of Prevalent Transplant and Dialysis Dependent Patients 2008 - 2012
(Number Per Million Population at 31 December)
2008 2009 2010 2011 2012
Transplants #
Queensland 1505 (352) 1576 (361) 1649 (373) 1717 (384) 1810 (400)
New South Wales* 2195 (324) 2298 (335) 2435 (351) 2524 (361) 2640 (374)
Aust. Capital Territory* 199 (357) 199 (352) 213 (371) 216 (371) 226 (382)
Victoria 1914 (362) 2058 (381) 2210 (404) 2352 (425) 2493 (445)
Tasmania 181 (363) 194 (385) 206 (405) 221 (432) 225 (437)
South Australia 838 (525) 868 (538) 906 (556) 920 (562) 952 (578)
Northern Territory 74 (335) 67 (295) 69 (300) 68 (294) 77 (331)
Western Australia 748 (343) 787 (350) 818 (356) 860 (366) 897 (372)
Australia 7654 (358) 8047 (370) 8506 (386) 8878 (398) 9320 (413)
New Zealand 1350 (316) 1404 (325) 1440 (330) 1483 (337) 1524 (344)
#By Resident State and Country
Dialysis
Queensland 1885 (441) 1957 (448) 2004 (453) 2012 (450) 2085 (461)
New South Wales* 3363 (497) 3434 (501) 3494 (504) 3574 (511) 3707 (525)
Aust. Capital Territory* 235 (422) 239 (423) 245 (427) 264 (453) 269 (455)
Victoria 2486 (470) 2531 (469) 2616 (478) 2704 (489) 2792 (498)
Tasmania 179 (359) 199 (395) 192 (378) 204 (399) 214 (416)
South Australia 630 (394) 683 (423) 677 (415) 712 (435) 733 (445)
Northern Territory 398 (1801) 417 (1838) 441 (1915) 464 (2006) 502 (2159)
Western Australia 994 (456) 1005 (447) 1035 (451) 1101 (468) 1144 (475)
Australia 10170 (476) 10465 (481) 10704 (485) 11035 (494) 11446 (507)
New Zealand 2106 (493) 2281 (529) 2388 (547) 2389 (542) 2469 (557)
* NSW population excludes residents of the Southern Area Health Service * ACT population includes residents of the Southern Area Health Service
(Medical services in the ACT service this Southern Area Region) Transplanted patients lost to follow up have been excluded
There is substantial variation in prevalence of RRT and transplantation between states rates leading to differences between dialysis and transplantation (Figures 1.11 to 1.14). The proportionally large number per million population of dialysis patients in the Northern Territory reflects the higher proportion of indigenous population.
Figure 1.12
316
493
325
529
330
547
337
542
344
557
2008 2009 2010 2011 2012
Prevalent Patients per Million Population
New Zealand
Transplant Dialysis
Figure 1.11
358
476
370
481
386
485398
494413
507
2008 2009 2010 2011 2012
Prevalent Patients per Million Population
Australia
Transplant Dialysis
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ANZDATA Registry 2013 Report STOCK and FLOW _____________________________________________________________________________________
Comparison of Transplant and Dialysis Dependent Patients 2008 - 2012
Note: Y scales vary between states
Figure 1.14
357422
352423
371427
371453
382455
2008 2009 2010 2011 2012
Prevalent Patients per Million Population
Australian Capital Territory
Transplant Dialysis
324
497
335
501
351
504
361
511
374
525
2008 2009 2010 2011 2012
Prevalent Patients per Million Population
New South Wales
Transplant Dialysis
335
1801
295
1838
300
1915
294
2006
331
2159
2008 2009 2010 2011 2012
Prevalent Patients per Million Population
Northern Territory
Transplant Dialysis
352
441361
448373
453384
450400
461
2008 2009 2010 2011 2012
Prevalent Patients per Million Population
Queensland
Transplant Dialysis
525
394
538
423
556
415
562
435
578
445
2008 2009 2010 2011 2012
Prevalent Patients per Million Population
South Australia
Transplant Dialysis
363 359 385 395 405 378432
399437 416
2008 2009 2010 2011 2012
Prevalent Patients per Million Population
Tasmania
Transplant Dialysis
362
470
381
469404
478425
489445
498
2008 2009 2010 2011 2012
Prevalent Patients per Million Population
Victoria
Transplant Dialysis
343
456
350
447
356
451366
468
372
475
2008 2009 2010 2011 2012
Prevalent Patients per Million Population
Western Australia
Transplant Dialysis
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Blair Grace
Stephen McDonald
Kylie Hurst
Philip Clayton
CHAPTER 2
NEW PATIENTS (Commencing treatment in 2012)
2013 Annual Report - 36th Edition
2-2
NEW PATIENTS ANZDATA Registry 2013 Report _____________________________________________________________________________________
INTAKE OF NEW PATIENTS
There were 2534 patients who commenced treatment for end-stage renal failure in Australia in 2012, a rate of 112 per million population.
Incidence rates have stabilised over the past 5 years.
In New Zealand, the number of new patients commencing renal replacement treatment was 513, a rate of 116 per million of population. This rate has been essentially stable since 2007.
AGE OF NEW PATIENTS
In Australia in 2012, all age groups under 85 showed stable or decreased rates for acceptance of new patients compared with 2011 (Figure 2.2). The 85+ age group showed an increase compared with 2011.
The largest decrease was in the 75-79 year group, from 536 to 447 per million (Figure 2.4). The mean age of patients entering programs in Australia in 2012 was 60 years and the median 62 years (Figure 2.5).
In New Zealand, the mean age of patients entering was 56 years and the median 58 years (Figure 2.5).
The youngest age starting renal replacement therapy in Australia was under 1 year of age and the oldest patient was 99 years old.
In New Zealand, the youngest was 2 years of age and the oldest was 85 years old.
Figure 2.1
Annual Intake of New Patients 2008 - 2012 (Number Per Million Population)
2008 2009 2010 2011 2012
Queensland 534 (125) 490 (112) 451 (102) 451 (101) 467 (103)
New South Wales 814 (120) 766 (112) 722 (104) 780 (111) 786 (111)
Aust. Capital Territory 61 (109) 41 (73) 53 (92) 53 (91) 64 (108)
Victoria 539 (102) 549 (102) 575 (105) 602 (109) 628 (112)
Tasmania 54 (108) 58 (115) 47 (92) 52 (102) 47 (91)
South Australia 185 (116) 207 (128) 180 (110) 183 (112) 202 (123)
Northern Territory 90 (407) 72 (317) 65 (282) 83 (359) 98 (422)
Western Australia 274 (126) 248 (110) 237 (103) 292 (124) 242 (100)
Australia 2551 (119) 2431 (112) 2330 (106) 2496 (112) 2534 (112)
New Zealand 497 (116) 584 (135) 515 (118) 485 (110) 513 (116)
Figure 2.2
0
100
200
300
400
500
Pa
tien
ts p
er
mill
ion
po
pu
latio
n
2007 2008 2009 2010 2011 2012
Year
Total0-19 yrs
20-44 yrs45-64 yrs65-74 yrs75-84 yrs
85+ yrs
New PatientsAge Specific Rates - Australia
Figure 2.3
0
100
200
300
400
500
Pa
tien
ts p
er
mill
ion
po
pu
latio
n
2007 2008 2009 2010 2011 2012
Year
Total0-19 yrs
20-44 yrs45-64 yrs65-74 yrs75-84 yrs
85+ yrs
New PatientsAge Specific Rates - New Zealand
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ANZDATA Registry 2013 Report NEW PATIENTS _____________________________________________________________________________________
Within the older age groups in Australia, only the 65-69 and 75-79 year age groups decreased in numbers in 2012 (Figure 2.4).
In New Zealand there were decreases in the 65-69, 70-74, 80-84 and ≥85 age groups in 2012.
Rates in most age groups ≥70 years were higher in Australia than in New Zealand, particularly for those 75 years or older.
STATE OF ORIGIN OF NEW PATIENTS
The age at start of dialysis varied little between States (Figure 2.5) except in the Northern Territory. The highest acceptance rates were in the Northern Territory (410 per million) ( Figure 2.6).
Figure 2.5
Age and Gender of New Patients 1-Jan-2012 to 31-Dec-2012 Number of Patients
Age Groups Years
QLD (n=467)
NSW (n=786)
ACT (n=64)
VIC (n=628)
TAS (n=47)
SA (n=202)
NT (n=98)
WA (n=242) AUST
(n=2534) NZ
(n=513)
F M F M F M F M F M F M F M F M F M F M
00-04 1 0 1 4 0 0 2 3 0 0 0 2 0 0 0 0 4 9 0 1
05-14 3 4 7 6 0 0 1 3 0 0 0 0 0 0 0 1 11 14 3 5
15-24 10 7 3 15 0 0 4 9 0 0 2 1 0 0 2 3 21 35 11 10
25-34 13 15 17 25 3 1 15 10 1 0 5 6 4 6 5 9 63 72 5 18
35-44 13 35 20 38 2 5 24 32 2 2 12 17 13 7 3 19 89 155 15 30
45-54 32 35 44 74 1 4 30 56 1 5 14 22 21 11 17 29 160 236 40 67
55-64 53 70 70 98 4 10 56 89 4 4 12 31 12 14 19 30 230 346 51 109
65-74 34 58 88 103 6 10 61 110 6 8 13 25 3 2 17 33 228 349 38 69
75-84 24 41 49 102 5 13 31 81 3 10 14 24 1 2 9 33 136 306 13 27
>=85 5 14 5 17 0 0 3 8 1 0 0 2 0 2 6 7 20 50 1 0
Total 188 279 304 482 21 43 227 401 18 29 72 130 54 44 78 164 962 1572 177 336
Mean age 56.9 59.8 60.4 60.3 61.6 64.5 59.3 61.9 64.4 67.4 57.7 59.5 49.4 53.6 60.7 60.1 58.7 60.6 55.3 56.3
Mean age 58.6 60.3 63.5 61 66.2 58.9 51.3 60.3 59.9 55.9
Median age 61.3 63.6 65.4 63.8 70.8 59.5 51 61.1 62.3 58.3
Age range 0.6 - 92.1 0.7 - 98.1 32.4 - 84.6 0.3 - 89 33.7 - 85.5 0.3 - 90.1 27.1 - 99.7 5.9 - 89.9 0.3 - 99.7 2.3 - 85.4
Min.in.days 220 263 11813 96 12316 123 9896 2140 831
Figure 2.4
Acceptance of Elderly New Patients 2008 - 2012 (Number Per Million Population)
Country Age Groups 2008 2009 2010 2012
Australia
60-64 years 289 (257) 271 (232) 279 (231) 314 (246)
65-69 years 302 (364) 288 (333) 255 (281) 289 (289)
70-74 years 316 (478) 303 (446) 290 (414) 288 (390)
75-79 years 285 (517) 296 (537) 271 (491) 252 (447)
80-84 years 194 (458) 169 (392) 155 (353) 190 (423)
>=85 years 61 (172) 66 (179) 77 (200) 70 (166)
Total 1447 (367) 1393 (343) 1327 (317) 1403 (316)
New Zealand
60-64 years 65 (307) 72 (325) 93 (404) 82 (346)
65-69 years 65 (392) 75 (437) 70 (397) 62 (325)
70-74 years 51 (405) 66 (507) 48 (350) 45 (295)
75-79 years 29 (277) 49 (468) 33 (314) 27 (249)
80-84 years 7 (90) 16 (202) 18 (223) 13 (155)
>=85 years 0 (0) 4 (60) 3 (43) 1 (13)
Total 217 (290) 282 (364) 265 (331) 230 (271)
2011
289 (233)
292 (307)
278 (387)
299 (536)
161 (363)
63 (156)
1382 (320)
61 (257)
75 (416)
47 (324)
22 (208)
19 (230)
5 (68)
229 (278)
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NEW PATIENTS ANZDATA Registry 2013 Report _____________________________________________________________________________________
Figure 2.6 Incidence rates (95% confidence intervals) for new RRT patients by State. Note the Y axis scales for each State are different. ACT population data includes the adjacent area of NSW (serviced by Canberra).
90
100
110
120
130
140
New
RR
T (
per
mill
ion
per
year
)
2006 2007 2008 2009 2010 2011 2012
Year
New RRT Rates - Queensland
90
100
110
120
130
New
RR
T (
per
mill
ion
per
year
)
2006 2007 2008 2009 2010 2011 2012
Year
New RRT Rates - New South Wales
60
80
100
120
140
New
RR
T (
per
mill
ion
per
year
)
2006 2007 2008 2009 2010 2011 2012
Year
New RRT Rates - Australian Capital Territory
95
100
105
110
115
120
New
RR
T (
per
mill
ion
per
year
)
2006 2007 2008 2009 2010 2011 2012
Year
New RRT Rates - Victoria
80
100
120
140
160
New
RR
T (
per
mill
ion
per
year
)
2006 2007 2008 2009 2010 2011 2012
Year
New RRT Rates - South Australia
200
300
400
500
New
RR
T (
per
mill
ion
per
year
)
2006 2007 2008 2009 2010 2011 2012
Year
New RRT Rates - Northern Territory
90
100
110
120
130
140
New
RR
T (
per
mill
ion
per
year
)
2006 2007 2008 2009 2010 2011 2012
Year
New RRT Rates - Western Australia
60
80
100
120
140
160
New
RR
T (
per
mill
ion
per
year
)
2006 2007 2008 2009 2010 2011 2012
Year
New RRT Rates - Tasmania
INCIDENCE RATES FOR NEW RRT PATIENTS BY STATE
95
100
105
110
115
120
New
RR
T (
per
mill
ion
per
year
)
2006 2007 2008 2009 2010 2011 2012
Year
New RRT Rates - Victoria
2-5
ANZDATA Registry 2013 Report NEW PATIENTS _____________________________________________________________________________________
Figure 2.7 Incidence rates (95% confidence intervals) for new RRT patients by state and age groups. Note the Y axis scales for each state are different. ACT population data includes the adjacent area of NSW (serviced by Canberra).
0
200
400
600
New
RR
T (
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Year
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<25
New RRT Rates By Age GroupQueensland
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500
New
RR
T (
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New RRT Rates By Age GroupNew South Wales
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800
New
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T (
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New RRT Rates By Age GroupAustralian Capital Territory
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500
New
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T (
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<25
New RRT Rates By Age GroupTasmania
0
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600
New
RR
T (
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)
2006 2007 2008 2009 2010 2011 2012
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New RRT Rates By Age GroupSouth Australia
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1500
2000
New
RR
T (
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New
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New RRT Rates By Age GroupWestern Australia
INCIDENCE RATES FOR NEW RRT PATIENTS BY AGE GROUPS
0
100
200
300
400
500N
ew
RR
T (
pe
r m
illio
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er
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r)
2006 2007 2008 2009 2010 2011 2012
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New RRT Rates By Age GroupVictoria
2-6
NEW PATIENTS ANZDATA Registry 2013 Report _____________________________________________________________________________________
LATE REFERRAL
In total 21% of all new patients in Australia and 15% in New Zealand were referred “late” to nephrological care, i.e. less than three months before first treatment (Figure 2.8). There is some variation with age, and patterns differ between Australia and New Zealand (Figure 2.9). Late referral rates have been essentially stable for a number of years (Figure 2.10). Among the states/territories, the lowest rate was 2% in the Tasmania ranging to 35% in Northern Territory. Variation with racial origin is shown in Figure 2.11. Higher rates are seen among ATSI, Pacific People and Maori’s.
Figure 2.8
Late Referral of New Patients Number of Patients (% Patients)
Primary Renal Disease
QLD NSW ACT VIC TAS SA NT WA AUST NZ
LATE REFERRAL
Analgesic 2 2 0 2 0 0 0 0 6 3
Type 1 diabetes 2 9 0 5 0 1 0 3 20 1
Type 2 diabetes 27 42 4 32 0 7 25 13 150 24
Glomerulonephritis 19 39 3 30 0 5 2 14 112 17
Hypertension 16 21 4 15 0 2 4 9 71 10
Miscellaneous 26 49 1 33 1 4 1 8 123 16
Polycystic 2 6 0 1 0 2 0 0 11 2
Reflux 3 3 1 0 0 0 0 4 11 1
Uncertain 6 14 1 10 0 2 2 4 39 5
Subtotals 103 (22%) 185 (24%) 14 (22%) 128 (20%) 1 (2%) 23 (11%) 34 (35%) 55 (23%) 543 (21%) 79 (15%)
NOT LATE REFERRAL
Analgesic 8 15 0 2 0 4 0 0 29 1
Type 1 diabetes 23 31 3 21 2 10 2 5 97 11
Type 2 diabetes 93 172 16 174 11 51 39 62 618 209
Glomerulonephritis 58 88 8 107 9 44 3 39 356 86
Hypertension 45 71 8 48 5 16 3 28 224 37
Miscellaneous 64 100 5 63 8 21 2 13 276 38
Polycystic 25 29 3 31 5 13 2 4 112 24
Reflux 11 18 1 15 2 4 1 3 55 7
Uncertain 24 32 5 24 4 12 3 5 109 10
Subtotals 351 (75%) 556 (71%) 49 (77%) 485 (77%) 46 (98%) 175 (87%) 55 (56%) 159 (66%) 1876 (74%) 423 (82%)
Subtotals 13 (3%) 45 (6%) 1 (2%) 15 (2%) 0 (0%) 4 (2%) 9 (9%) 28 (12%) 115 (5%) 11 (2%)
Total (100%) 467 786 64 628 47 202 98 242 2534 513
NOTE; Diabetes Type 2 non insulin requiring and Diabetes Type 2 requiring insulin are now combined
MISSING / UNKNOWN
2-7
ANZDATA Registry 2013 Report NEW PATIENTS _____________________________________________________________________________________
Figure 2.10
Late Referral - All Modes of Treatment Including Pre-emptive Transplants 2008 to 2012
Country Years
2008 2009 2010 2011 2012
Australia
Not late referral 1996 (78%) 1921 (79%) 1806 (78%) 1925 (77%) 1876 (74%)
Late referral 554 (22%) 508 (21%) 518 (22%) 559 (22%) 543 (21%)
Missing / Undefined 1 (0%) 2 (0%) 6 (0%) 12 (0%) 115 (5%)
Total 2551 2431 2330 2496 2534
New Zealand
Not late referral 385 (77%) 486 (83%) 431 (84%) 379 (78%) 423 (82%)
Late referral 111 (22%) 97 (17%) 83 (16%) 105 (22%) 79 (15%)
Missing / Undefined 1 (0%) 1 (0%) 1 (0%) 1 (0%) 11 (2%)
Total 497 584 515 485 513
Notes: Late referral is not defined by px less than 90 days old in the 2012 figures.
Figure 2.11
Late Referral - All Modes of Treatment Including Pre-emptive Transplants
By Race 2008 to 2012
Country Race
Asian Aboriginal/TSI Caucasian Maori Pacific
People Other
Australia
Not Late Referred 852 (76%) 853 (73%) 7392 (78%) 85 (71%) 161 (72%) 181 (66%)
Late Referred 257 (23%) 296 (25%) 1975 (21%) 31 (26%) 61 (27%) 62 (22%)
Total 1116 1163 9444 119 224 276
New Zealand
Not Late Referred 177 (85%) - 901 (83%) 611 (78%) 396 (81%) 19 (83%)
Late Referred 32 (15%) - 184 (17%) 168 (21%) 89 (18%) 2 (9%)
Total 209 - 1091 785 486 23
Notes: Maori and Pacific Peoples who were resident and commenced treatment in Australia are also shown.
Missing/undefined 7 (1%) 14 (1%) 77 (1%) 3 (3%) 2 (1%) 33 (12%)
Missing/undefined 0 (0%) - 6 (1%) 6 (1%) 1 (0%) 2 (9%)
Figure 2.9
Late Referral - All Modes of Treatment Including Pre-emptive Transplants New Patients 1-Jan-2008 to 31-Dec-2012
Country Age Groups
Total 0-4 25-34 45-54 65-74 75-84 >=85
Australia
Not late referral 42 (72%) 421 (72%) 1512 (78%) 2280 (79%) 1773 (78%)
235 (70%) 9524 (77%)
Late referral 7 (12%) 149 (26%) 401 (21%) 602 (21%) 484 (21%) 100 (30%) 2682 (22%)
Total 58 582 1941 2901 2272 337 12342
New Zealand
Not late referral 6 (55%) 86 (76%) 437 (79%) 510 (84%) 193 (83%) 12 (92%) 2104 (81%)
Late referral 4 (36%) 27 (24%) 115 (21%) 91 (15%) 40 (17%) 1 (8%) 475 (18%)
Total 11 113 555 604 233 13 2594
15-24
175 (63%)
99 (35%)
280
48 (60%)
31 (39%)
80
35-44
854 (75%)
270 (24%)
1137
190 (75%)
61 (24%)
252
55-64
2157 (79%)
549 (20%)
2728
611 (86%)
95 (13%)
712
5-14
75 (71%)
21 (20%)
106
11 (52%)
10 (48%)
21
Unknown / Undefined 9 (16%) 10 (9%) 6 (2%) 12 (2%) 13 (1%) 28 (1%) 22 (1%) 19 (1%) 15 (1%) 2 (1%) 136 (1%)
Unknown / Undefined 1 (9%) 0 (0%) 1 (1%) 0 (0%) 1 (0%) 3 (1%) 6 (1%) 3 (0%) 0 (0%) 0 (0%) 15 (1%)
2-8
NEW PATIENTS ANZDATA Registry 2013 Report _____________________________________________________________________________________
CO-MORBID CONDITIONS
Co-morbid conditions at entry to RRT are shown in Figures 2.12 - 2.18. In Australia, the proportion of people with reported coronary artery disease, chronic lung disease and peripheral vascular disease at the onset of dialysis has decreased (Figure 2.13). See Appendix II and III for further analyses of co-morbid conditions.
Figure 2.12
Co-morbid Conditions at Entry to Program 2012 Number of Patients (% Patients)
Country
Chronic Lung
Disease
Coronary Artery
Disease
Peripheral Vascular Disease
Cerebro- Vascular Disease
Smoking Diabetes (Including
Diabetic Nephropathy )
Australia n=2534
Yes 306 (12%) 768 (30%) 409 (16%) 264 (10%) Current 297 (12%) Type 1 141 (6%)
Suspected 95 (4%) 164 (6%) 150 (6%) 77 (3%) Former 1055 (42%) Type 2 1049 (41%)
No 2133 (84%) 1602 (63%) 1975 (78%) 2193 (87%) Never 1091 (43%) No 1344 (53%)
Unknown 0 (0%) 0 (0%) 0 (0%) 0 (0%) Unknown 91 (4%) Unknown 0 (0%)
New Zealand n=513
Yes 65 (13%) 118 (23%) 68 (13%) 58 (11%) Current 77 (15%) Type 1 16 (3%)
Suspected 9 (2%) 31 (6%) 18 (4%) 18 (4%) Former 195 (38%) Type 2 276 (54%)
No 439 (86%) 364 (71%) 427 (83%) 437 (85%) Never 232 (45%) No 221 (43%)
Unknown 0 (0%) 0 (0%) 0 (0%) 0 (0%) Unknown 9 (2%) Unknown 0 (0%)
Figure 2.13
0
10
20
30
40
Per
cent
age
of a
ll pa
tient
s
2006 2007 2008 2009 2010 2011 2012
Year starting RRT
Coronary
Peripheral Vascular
Cerebrovascular
Lung
(Suspected cases included)
Comorbid Conditions at Entry to RRTAustralia
Figure 2.14
0
10
20
30
40
Per
cent
age
of a
ll pa
tient
s
2006 2007 2008 2009 2010 2011 2012
Year starting RRT
Coronary
Peripheral Vascular
CerebrovascularLung
(Suspected cases included)
Comorbid Conditions at Entry to RRTNew Zealand
2-9
ANZDATA Registry 2013 Report NEW PATIENTS _____________________________________________________________________________________
Figure 2.15 Figure 2.16
Figure 2.17 Figure 2.18
13
41
46
13
39
48
11
41
48
11
42
47
12
42
46
12
43
45
Per
cent
age
of a
ll pa
tient
s
2007 2008 2009 2010 2011 2012
Smoking Status at Entry to RRTAustralia
NeverFormer
Current17
36
47
16
34
50
15
38
47
13
38
49
17
41
42
15
39
46
Per
cent
age
of a
ll pa
tient
s2007 2008 2009 2010 2011 2012
Smoking Status at Entry to RRTNew Zealand
NeverFormer
Current
57
3
40
56
3
40
55
3
42
53
4
43
53
4
43
53
6
41
Per
cent
age
of a
ll pa
tient
s
2007 2008 2009 2010 2011 2012
Diabetes Status at Entry to RRTAustralia
Type 2 DMType 1 DM
Non-DM
53
2
44
49
3
47
47
2
51
44
2
53
51
4
45
43
3
54
Per
cent
age
of a
ll pa
tient
s
2007 2008 2009 2010 2011 2012
Diabetes Status at Entry to RRTNew Zealand
Type 2 DMType 1 DM
Non-DM
SMOKING STATUS AT ENTRY
DIABETES STATUS AT ENTRY
2-10
NEW PATIENTS ANZDATA Registry 2013 Report _____________________________________________________________________________________
PRIMARY RENAL DISEASE OF NEW PATIENTS The coding of primary renal disease in ANZDATA has remained unchanged for many years. During that time, a number of new disease entities have emerged, and the understanding of others considerably evolved. To better reflect this, a project is underway to review and modify the categories used to report primary renal disease in future reports. It is likely the introduction of these codes will be staged over several years.
AUSTRALIA
Diabetic nephropathy (36% of all new patients), continued as the most common primary renal disease (Figure 2.19).
Glomerulonephritis (19%) was the next most common primary disease, followed by hypertension (12%), polycystic kidney disease (5%) and reflux nephropathy (3%). IgA + mesangioproliferative GN (29% of all GN) was the most common histologically proven form of glomerulonephritis (Figure 2.20).
Miscellaneous diseases causing end stage renal failure are tabulated in Figure 2.21. A renal biopsy was performed in 73% of patients with glomerulonephritis and 13% of patients with type 2 diabetes (Figure 2.22).
NEW ZEALAND
Diabetic nephropathy (49%) was the most common cause of ESRD followed by glomerulonephritis (20%) and hypertension (11%).
IgA nephropathy and focal sclerosis are the most common forms of GN in New Zealand (causing end-stage kidney disease).
Figure 2.20
Types of Glomerulonephritis 1-Jan-2012 to 31-Dec-2012
Number (% of all GN) Australia New Zealand
Advanced GN (unclassified=end stage) 10 (2%) 3 (3%)
Extra and intra capillary GN (rapidly progressive) 5 (1%) 3 (3%)
Familial GN (including alports) 6 (1%) 2 (2%)
Focal and segmental proliferative GN 17 (3%) 1 (1%)
Focal sclerosing GN (including hyalinosis) 25 (5%) 6 (6%)
GN other (specify) 18 (4%) 4 (4%)
GN with systemic disease (specify) 7 (1%) 0 (0%)
Goodpastures with linear IgG and lung haemorrhage 10 (2%) 0 (0%)
Henoch-schonlein purpura 2 (0%) 0 (0%)
Membranous GN 23 (5%) 5 (5%)
Mesangial proliferative (IgA+) 144 (29%) 18 (17%)
Mesangial proliferative (IgA-) 7 (1%) 2 (2%)
Mesangial proliferative (no if studies) 4 (1%) 1 (1%)
Mesangiocapillary GN (dense deposit disease) 2 (0%) 0 (0%)
Mesangiocapillary GN (double contour) 10 (2%) 3 (3%)
Microscopic polyarteritis 6 (1%) 5 (5%)
Presumed GN (no biopsy) 122 (25%) 23 (22%)
Primary focal sclerosing GN/focal glomerular sclerosis 27 (6%) 20 (19%)
Proliferative GN with linear IgG and no lung haemorrhage 1 (0%) 3 (3%)
S.L.E. 18 (4%) 4 (4%)
Scleroderma 4 (1%) 0 (0%)
Secondary focal sclerosing GN 7 (1%) 0 (0%)
Wegeners granulomatosis 15 (3%) 2 (2%)
Total 490 105
Figure 2.19
Causes of ESRD 2009 - 2012 Number of Patients (% Patients)
Disease 2009 2010 2012
Australia
Glomerulonephritis 591 (24%) 499 (21%) 490 (19%)
Analgesic Nephropathy 42 (2%) 37 (2%) 35 (1%)
Polycystic Kidney Disease 177 (7%) 167 (7%) 132 (5%)
Reflux 80 (3%) 60 (3%) 66 (3%)
Hypertension 346 (14%) 320 (14%) 303 (12%)
Diabetic Nephropathy 782 (32%) 827 (35%) 913 (36%)
Miscellaneous 268 (11%) 290 (12%) 440 (17%)
Uncertain diagnosis 145 (6%) 130 (6%) 155 (6%)
Australia Total 2431 2330 2534
New Zealand
Glomerulonephritis 125 (21%) 111 (22%) 105 (20%)
Analgesic Nephropathy 2 (0%) 2 (0%) 4 (1%)
Polycystic Kidney Disease 34 (6%) 18 (3%) 27 (5%)
Reflux 9 (2%) 8 (2%) 8 (2%)
Hypertension 62 (11%) 58 (11%) 48 (9%)
Diabetic Nephropathy 279 (48%) 260 (50%) 249 (49%)
Miscellaneous 54 (9%) 41 (8%) 57 (11%)
Uncertain diagnosis 19 (3%) 17 (3%) 15 (3%)
NZ Total 584 515 513
2011
566 (23%)
32 (1%)
143 (6%)
56 (2%)
360 (14%)
886 (35%)
316 (13%)
137 (5%)
2496
114 (24%)
5 (1%)
28 (6%)
9 (2%)
51 (11%)
204 (42%)
53 (11%)
21 (4%)
485
2-11
ANZDATA Registry 2013 Report NEW PATIENTS _____________________________________________________________________________________
Figure 2.22
0
25
50
75
100
Bio
psy
ra
te (
%)
20032004
20052006
20072008
20092010
20112012
Year
GlomerulonephritisType 2 Diabetes
Biopsy RatesAustralia
0
25
50
75
100
Bio
psy
rate
(%
)
20032004
20052006
20072008
20092010
20112012
Year
GlomerulonephritisType 2 Diabetes
Biopsy RatesNew Zealand
Figure 2.21
Miscellaneous Causes of ESRD 1-Jan-2012 to 31-Dec-2012
Renal Disease Aust (440)
NZ (57)
Renal Disease Aust (440)
NZ (57)
LEAD NEPHROPATHY 1 0 MEDULLARY CYSTIC DISEASE 2 1
INTERSTITIAL NEPHRITIS 32 2 CALCULI 13 1
LOSS OF SINGLE KIDNEY (TRAUMA-SURGERY) 4 0
OXALOSIS 1 0 HAEMOLYTIC URAEMIC SYNDROME 8 1
CYSTINOSIS 1 0 CORTICAL NECROSIS 2 0
LITHIUM TOXICITY 20 2
POST PARTUM NEPHROPATHY 1 1 AMYLOID DISEASE 13 3
SARCOIDOSIS 4 0 PARAPROTEINAEMIA 28 3
CALCINEURIN INHIBITOR TOXICITY 7 3 (INCLUDING MULTIPLE MYELOMA) 2
PYELONEPHRITIS 3 1 LIGHT CHAIN NEPHROPATHY 3
GOUT 2 0 (NON MALIGNANT) 2
RENAL CELL CARCINOMA (GRAWITZ) 13 0
CONGENITAL RENAL HYPOPLASIA AND DYSPLASIA 11 2 TRANSITIONAL CELL CARCINOMA 3
MEGAURETER 2 0 URINARY TRACT
POSTERIOR URETHRAL VALVES 2 2
NEUROPATHIC BLADDER 3 0
SPINA BIFIDA OR MYELOMENINGOCOELE 4 2 REPORTED INCORRECTLY * 156 15
BLADDER NECK OBSTRUCTION 6 0 UNKNOWN/NOT REPORTED 60 12
OTHER LOWER URINARY TRACT ABNORMALITIES 1 0
URETERIC OBSTRUCTIVE NEPHROPATHY 10 0
OBSTRUCTIVE NEPHROPATHY 24 2
* Queries outstanding on 2012 new patient reporting of primary renal disease at time of data lock
(INCL. PROSTATOMEGALY)
(WITH 2ND.REFLUX)
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NEW PATIENTS ANZDATA Registry 2013 Report _____________________________________________________________________________________
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Stephen McDonald
CHAPTER 3
DEATHS
2013 Annual Report - 36th Edition
3-2
DEATHS ANZDATA Registry 2013 Report _____________________________________________________________________________________
INTRODUCTION
Observed survival for non-indigenous patients who started in the period 2003-2012 is shown in Figure 3.1. These data are censored at transplantation (that is, events after the date of first transplantation are not included in anal-yses). Survival after transplantation and survival of indigenous peoples during dialysis is covered in later chapters.
Crude unadjusted death rates for dialysis and transplantation are shown in Figure 3.2 for various groups. This is a different way of looking at the same question. This table includes all episodes of dialysis and transplantation (i.e. analyses are not censored at first transplant date), and deaths are attributed to the modality in use at the time of death. For this table, episodes of treatment include all people treated in 2012, regardless of year of first treatment.
Mortality rates are generally higher with older age, diabetes and coronary artery disease. The comparison between indigenous rates (and some other comparisons) will be subject to several confounders. Comparisons of mortality rates with the general population (stratified by gender) are shown in Figures 3.3 and 3.4.
Figure 3.1
Survival among People who Commenced Dialysis 2003 - 2012 (Non-Indigenous) % (95% CI)
Age at Start Time Point
(Number of Years from dialysis start)
Proportion Surviving Aust (95 % CI)
Proportion Surviving NZ (95 % CI)
0– 24 1 97 (95-98) 96 (90-99)
2 93 (90-95) 93 (85-97)
5 90 (86-93) 83 (64-92)
25—44 1 97 (96-98) 98 (96-99)
2 92 (90-93) 93 (89-96)
5 80 (78-83) 74 (65-81)
45—64 1 92 (91-92) 91 (89-92)
2 85 (84-85) 81 (78-84)
5 61 (59-62) 54 (49-58)
65—74 1 86 (85-87) 85 (82-87)
5 42 (41-44) 34 (30-39)
75—84 1 80 (79-81) 77 (72-81)
2 64 (63-66) 56 (51-61)
5 28 (26-29) 19 (15-24)
85 + 1 70 (66-74) 67 (46-80)
5 20 (15-24) 17 (5-34)
2 74 (72-75) 72 (69-76)
2 51 (47-56) 45 (28-61)
3-3
ANZDATA Registry 2013 Report DEATHS _____________________________________________________________________________________
Figure 3.2
Death Rates During Renal Replacement Therapy All Patients Included who Received Treatment During 2012
Group Dialysis
Mortality Rate (per 100 patient years, 95% CI)
Transplant Mortality Rate
(per 100 patient years, 95% CI)
Overall
Rate Confidence Intervals Rate Confidence Intervals
Per 100 patient years Lower Upper Per 100 patient
years Lower Upper
Australia 12.7 12.2 13.4 1.8 1.6 2.1
New Zealand 14.6 13.2 16.2 1.9 1.3 2.8
AGES (YEARS)
< 25 3.7 2.0 7.0 0.4 0.1 1.5
25—44 4.9 3.9 6.1 0.5 0.3 0.8
45—64 9.3 8.5 10.2 1.4 1.1 1.8
65—84 17.1 16.1 18.2 5.1 4.1 6.2
≥ 85 36.5 31.6 42.1 2.1 5.4 8.6
DIABETES (AT RRT START)
Non-diabetic 11.2 10.6 12.1 1.7 1.4 2.0
Type 1 12.1 9.6 16.8 2.7 1.7 4.4
Type 2 15.5 14.6 16.6 3.1 2.0 4.9
CORONARY ARTERY DISEASE (AT RRT START) No 9.9 9.3 10.6 1.7 1.5 2.0
Yes 19.0 17.8 20.3 3.1 2.0 4.7
INDIGENOUS
Non-Indigenous (Aus) 13.5 12.8 14.3 1.8 1.5 2.1
Non-Indigenous (NZ) 15.7 13.5 18.3 1.8 1.2 2.8
Aboriginal /Torres Strait Islanders 9.0 7.5 10.7 3.2 1.4 7.1
Maori (in Aus) 9.0 4.9 16.8 3.4 0.5 23.8
Maori (in NZ) 16.4 13.8 19.6 2.5 0.9 6.7
Pacific People (in Aus) 6.5 4.1 10.3 1.3 0.2 9.1
Pacific People (in NZ) 10.2 7.9 13.2 2.1 0.5 8.5
.001
.01
.1
.2
.4
.6
20 40 60 80 20 40 60 80
Female Male
Mor
talit
y pe
r ye
ar
Age (years)Stratified by gender
ANZDATA and ABS data for year 2012
vs. general populationMortality among prevalent dialysis patients
Figure 3.3 Figure 3.4
.001
.01
.1
.2
.4
.6
20 40 60 80 20 40 60 80
Female Male
Mo
rta
lity
pe
r ye
ar
Age (years)Stratified by gender
ANZDATA and ABS data for year 2012
vs. general populationMortality among prevalent transplant patients
3-4
DEATHS ANZDATA Registry 2013 Report _____________________________________________________________________________________
Figure 3.5
Survival of Dialysis Patients by Age
Age Groups at start of treatment
Median (25th and 75th centiles), years
Australia 0-24 years *
25-44 years * (5.35-*)
45-64 years 6.35 (3.09-*)
65-74 years 4.18 (1.90-7.23)
75-84 years 3 (1.31-5.32)
85+ years 2.03 (0.76-4.02)
New Zealand 0-24 years 9.64 (8.11-*)
25-44 years 7.28 (4.11-*)
45-64 years 5 (2.65-8.41)
65-74 years 3.65 (1.84-5.93)
75-84 years 2.61 (1.08-4.37)
85+ years 1.70 (0.96-3.58)
Figure 3.6
Survival by Age & Comorbidity Amongst Older Age Groups Median (25th and 75th centiles), years
Age Groups Any Vascular
Disease Diabetes Australia New Zealand
65-69 years No No 5.32 (2.04-*) 6.01 (2.67-7.68)
No Yes 3.95 (1.93-8.29) 5.23 (4.20-8.69)
Yes No 4.30 (2.08-7.04) 2.36 (0.87-4.81)
Yes Yes 4.31 (2.05-6.96) 4.03 (1.41-4.27)
70-74 years No No 5.37 (2.03-8.37) 3.40 (3.12-5.37)
No Yes 5.89 (3.23-8.38 ) 3.33 (2.27-4.41)
Yes No 3.46 (0.96-5.81) 2.55 (1.63-4.45)
Yes Yes 3.65 (1.80-5.97) 3.33 (1.78-4.88)
75-79 years No No 5.47 (2.14-8.31) 3.43 (3.43-3.43)
No Yes 5.59 (2.39-*) 3.92 (3.92-4.39)
Yes No 4.00 (1.85-6.35) 1.42 (0.57-2.43)
Yes Yes 3.08 (1.04-5.48) 2.97 (1.49-5.74)
80-84 years No No 3.41 (2.02-6.21) 2.69 (1.65-3.01)
No Yes 4.34 (2.70-6.17) 0.67 (0.67-0.67)
Yes No 2.28(1.02-4.90) 4.10 (1.04-4.10)
Yes Yes 2.37 (1.29-4.55) 2.82 (2.82-2.82)
85-89 years No No 2.25 (0.63-7.79) *
No Yes 2.39 (0.63-*) *
Yes No 2.17 (1.32-3.58) 1.38 (1.38-4.91)
Yes Yes 1.57 (0.36-6.09) *
Another perspective on survival during dialysis is presented in Figures 3.5 and 3.6. Median survival is the time to which 50% of people can expect to survive. Figure 3.5 shows the median survival of people who started dialysis treatment from 1 January 2003, by various categories.
These survival data are censored at the time of transplantation, and include those who started dialysis in the period 2003-2012. In addition to the median, the 25 and 75th centiles are included to give an indication of the range of observed surviv-als. Some figures are not observed - for example if half of a cohort have not yet died it is not possible to observe a median survival; in other groups the small numbers of events mean the median and 25th/75th centiles are the same. These occur-rences are indicated by * in the tables.
The survival amongst younger people are likely to be strongly affected by the selection bias (fitter people will be progres-sively transplanted and not be included in the analysis from that point).
Figure 3.6 shows the survival figures in more detail, categorised by the presence or absence of any vascular comorbidity and diabetes, with a particular focus on older groups.
The evolution of mortality rates over time is shown in Figures 3.7 and 3.8. In Australia, there is steady improvement in most groups over time. For New Zealand, the trends are less clear, in part reflecting the lower precision with smaller numbers.
3-5
ANZDATA Registry 2013 Report DEATHS _____________________________________________________________________________________
Figure 3.7
.1
.11
.12
.13
.14
.15
Mo
rta
lity
rate
pe
r ye
ar
2001- 2003- 2005- 2007- 2009- 2011-Year of dialysis start
(0-1) year
.08
.1
.12
.14
.16
Mo
rta
lity
rate
pe
r ye
ar
2001- 2003- 2005- 2007- 2009- 2011-Year of dialysis start
(1-2) years
.12
.14
.16
.18
Mo
rta
lity
rate
pe
r ye
ar
2001- 2003- 2005- 2007- 2009-Year of dialysis start
(2-3) years
.1
.15
.2
Mo
rta
lity
rate
pe
r ye
ar
2001- 2003- 2005- 2007-Year of dialysis start
(3-5) years
ANZDATA, censored at transplantation
Dialysis mortality rates in Australia
Figure 3.8
.06
.08
.1
.12
.14
.16
Mo
rta
lity
rate
pe
r ye
ar
2001- 2003- 2005- 2007- 2009- 2011-
Year of dialysis start
(0-1) year
.05
.1
.15
.2
Mo
rta
lity
rate
pe
r ye
ar
2001- 2003- 2005- 2007- 2009- 2011-
Year of dialysis start
(1-2) years
.1
.15
.2
.25
.3
Mo
rta
lity
rate
pe
r ye
ar
2001- 2003- 2005- 2007- 2009-
Year of dialysis start
(2-3) years
.1
.15
.2
.25
.3
Mo
rta
lity
rate
pe
r ye
ar
2001- 2003- 2005- 2007-
Year of dialysis start
(3-5) years
ANZDATA, censored at transplantation
Dialysis mortality rates in New Zealand
3-6
DEATHS ANZDATA Registry 2013 Report _____________________________________________________________________________________
This section contains a summary of trends in various areas. The focus on this section is on deaths reported during 2012. The cause of death reported to ANZDATA is not necessarily the same as that reported on the death certificate. In particular, ANZDATA specifically records a range of reasons for “withdrawal from treatment”. Clearly, the actual cause of death in these instances is uraemia, however the key issues presented here are the “cause” of the withdrawal, in many cases this is related to an underlying comorbidity (these figures are explored further on pages 3-8 and 3-9)
For the purposes of Figures 3.9 - 3.11, deaths were attributed to the modality in use at the time of death.
In both Australia and New Zealand, similar trends are seen although there is a larger proportion of deaths coded as “other” from New Zealand (Figure 3.9). A greater proportion of deaths due to cancer is seen among patients with kidney transplants, whereas among dialysis patients deaths to cardiovascular and infective causes predominate.
CAUSE OF DEATHS
Figure 3.9
0
20
40
60
80
100
HD PD Graft HD PD Graft
Australia New Zealand
Cardiovascular Withdrawal Cancer
Infection Other
Per
cent
Graph by country and dialysis modality at time of death
Deaths occurring during 2012
Cause of death
3-7
ANZDATA Registry 2013 Report DEATHS _____________________________________________________________________________________
The distribution of types of death changes with different age groups. Although one might expect the numbers of deaths reported as treatment withdrawals to increase with age, the proportion of deaths reported as related to with-drawal of dialysis is still substantial in a number of the younger age groups (among dialysis patients) (Figure 3.10)
Figure 3.10
020406080
100
020406080
100
0- 45- 65- 75- 0- 45- 65- 75- 0- 45- 65- 75-
0- 45- 65- 75- 0- 45- 65- 75- 0- 45- 65- 75-
Australia, HD Australia, PD Australia, Graft
New Zealand, HD New Zealand, PD New Zealand, Graft
Cardiovascular Withdrawal Cancer
Infection Other
Per
cent
Graph by country and dialysis modality at time of death
Deaths occurring during 2012
Cause of death
Figure 3.11
Modality at Time of Death and Age at Death – 2012
Cause of Death Haemodialysis Peritoneal Dialysis Transplant
0 - 44 45 - 64 65 - 74 ≥75 0 - 44 45 - 64 65 - 74 ≥75 0 - 44 45 - 64 65 - 74 ≥75
Australia
Cardiovascular 19 113 101 147 5 17 13 29 2 14 20 7
Withdrawal 15 67 88 248 2 13 20 34 2 3 7 4
Cancer 2 17 14 34 0 5 1 3 2 25 15 6
Infection 2 28 30 34 0 7 5 13 5 25 15 6
Other 14 73 58 110 7 8 17 27 2 15 11 7
New Zealand
Cardiovascular 11 41 24 14 0 24 16 13 1 4 2 5
Withdrawal 4 14 13 14 1 7 8 10 0 0 0 1
Cancer 1 3 3 0 0 2 3 1 0 5 3 1
Infection 3 8 3 5 1 3 5 1 0 2 1 0
Other 2 27 22 12 1 16 10 9 0 3 1 0
3-8
DEATHS ANZDATA Registry 2013 Report _____________________________________________________________________________________
WITHDRAWAL FROM DIALYSIS
During 2012 there were 503 deaths in Australia and 72 in New Zealand attributed to withdrawal from therapy. The vast ma-jority of these were among patients receiving dialysis therapy. “Psychosocial” reasons were the most commonly cited reason for withdrawal in patients receiving all modalities.
Figure 3.12 gives broad categories and 3.13 detailed breakdown of the causes for withdrawal. However, the coding of these categories is clearly somewhat subjective.
Figure 3.13
Death Due to Withdrawal - 2012 (Modality at Time of Death)
Withdrawal Haemodialysis Peritoneal Dialysis Transplant Total
Australia
Psychosocial 163 26 7 196
Patient refused further 20 4 4 28
Suicide 5 0 1 6
Cardiovascular comorbidity 81 13 0 94
Cerebrovascular comorbidity 43 10 1 54
Peripheral vascular comorbidity 31 2 0 33
Malignancy related withdrawal 63 11 0 77
Withdrawal due to dialysis 12 3 0 15
Total 418 69 16 503
New Zealand
Psychosocial 15 10 0 25
Suicide 0 0 0 0
Cardiovascular comorbidity 5 5 1 11
Cerebrovascular comorbidity 8 6 0 14
Peripheral vascular comorbidity 8 1 0 9
Malignancy related withdrawal 4 1 0 5
Withdrawal due to dialysis 1 1 0 2
Total 45 26 1 72
Patient refused further 4 2 0 6
Figure 3.12
Country at time of Death and Modality at Death Among Those Who Withdrew From Dialysis and Died in 2012
Cause of Death AUSTRALIA NEW ZEALAND
HD PD GRAFT HD PD GRAFT
Cardiovascular 380 64 43 90 53 12
Withdrawal 418 69 16 45 26 1
Cancer 67 9 48 7 6 9
Infection 94 25 24 19 10 3
Other 255 59 35 63 36 4
3-9
ANZDATA Registry 2013 Report DEATHS _____________________________________________________________________________________
Figure 3.14
Dialysis patients who withdrew by age at death time from first RRT-2012
Time from first RRT (years)
AUSTRALIA NEW ZEALAND
0 - 44 45 - 64 65 - 74 0 - 44 45 - 64 65 - 74
0 2 19 16 2 3 3
1 2 15 13 1 3 3
2 7 15 48 2 7 7
5 8 34 38 0 8 8
Total 19 83 115 5 21 21
Total
86
66
166
185
503
≥75
49
36
96
105
286
≥75
1
6
8
10
25
Total
9
13
24
26
72
Figure 3.14 show the breakdown of the dialysis group by age and by time from start of dialysis for those deaths which occurred in 2012. This area within ANZDATA has been previously been examined in some detail (Chan et al Clin J Am Soc Nephrol 2012; 7: 775-781), available at http://cjasn.asnjournals.org/content/7/5/775.full.
Figure 3.15
020406080
100
020406080
100
0- 45- 65- 75- 0- 45- 65- 75- 0- 45- 65- 75-
0- 45- 65- 75- 0- 45- 65- 75- 0- 45- 65- 75-
Australia, HD Australia, PD Australia, Graft
New Zealand, HD New Zealand, PD New Zealand, Graft
0- 1- 2- 5-
Years since RRT start
Per
cent
Graph by country at time of deathTime period from first renal replacement treatment to date of death
Deaths occurring during 2012
Time from RRT start to death
3-10
DEATHS ANZDATA Registry 2013 Report _____________________________________________________________________________________
This page is intentionally blank
Nancy Briggs
Kylie Hurst
Stephen McDonald
Philip Clayton
CHAPTER 4
METHOD AND LOCATION OF DIALYSIS
2013 Annual Report - 36th Edition
4-2
METHOD AND LOCATION OF DIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
During 20122 there was an increase of 411 (4%) in the total number of prevalent dialysis patients. There were 11,446 patients (507 per million) receiving dialysis treatment at 31st December 2012.
The distribution of these patients across the modalities continues to change (Figures 4.1 and 4.3). The majority (72%) of haemodialysis patients were out of hospital: 11% were dialysing at home and 61% in satellite centres.
Twelve percent of all prevalent dialysis patients were using automated peritoneal dialysis, a further 7% continuous ambulatory peritoneal dialysis, 22% hospital based haemodialysis, 49% satellite haemodialysis and 9% home haemodialysis.
For the first time in several years the proportion of patients receiving peritoneal dialysis (APD and CAPD) increased slightly in 2012, from 18.8 to 19.5%. Automated peritoneal dialysis increased in 2012 to 1374 patients, and continuous ambulatory peritoneal dialysis increased to 853 patients.
The number of patients receiving dialysis treatment rose in all State/Territories in 2012. The number of dialysis patients in relation to the population in each state is shown in Figure 4.2.
Fifty percent of all prevalent dialysis patients were 65 years or older, and 501 patients (4%) were 85 years or older.
Figure 4.2
Prevalence of Dialysis Dependent Patients By State 2008 - 2012 (per Million Population)
2008 2009 2010 2012
Queensland 1885 (441) 1957 (448) 2004 (453) 2085 (461)
New South Wales* 3363 (497) 3434 (501) 3494 (504) 3707 (525)
Aust. Capital Territory** 235 (422) 239 (423) 245 (427) 269 (455)
Victoria 2486 (470) 2531 (469) 2616 (478) 2792 (498)
Tasmania 179 (359) 199 (395) 192 (378) 214 (416)
South Australia 630 (394) 683 (423) 677 (415) 733 (445)
Northern Territory 398 (1801) 417 (1838) 441 (1915) 502 (2159)
Western Australia 994 (456) 1005 (447) 1035 (451) 1144 (475)
Australia 10170 (476) 10465 (481) 10704 (485) 11446 (507)
New Zealand 2106 (493) 2281 (529) 2388 (547) 2469 (557)
* NSW population excludes residents of the Southern Area Health Service
** ACT population includes residents of the Southern Area Health Service
(Medical services in the ACT service the Southern Area Region of NSW)
2011
2012 (450)
3574 (511)
264 (453)
2704 (489)
204 (399)
712 (435)
464 (2006)
1101 (468)
11035 (494)
2389 (542)
Figure 4.1
Method and Location of Dialysis 2008 - 2012
2008 2009 2010 2011 2012
Aust
Peritoneal Dialysis
APD 1271 1313 1279 1283 1374
CAPD 971 889 812 791 853
Total 2242 2202 2091 2074 2227
HD
Hospital 2327 2347 2315 2381 2552
Home 952 978 981 993 1048
Satellite 4649 4938 5317 5587 5619
Total 7928 8263 8613 8961 9219
NZ
Peritoneal Dialysis
APD 288 337 359 350 366
CAPD 475 463 473 442 406
Total 763 800 832 792 772
HD
Hospital 622 690 733 797 837
Home 331 378 425 432 469
Satellite 390 413 398 368 391
Total 1343 1481 1556 1597 1697
Mode of Treatment
AUSTRALIA
ANZDATA Registry 2013 Report METHOD AND LOCATION OF DIALYSIS _____________________________________________________________________________________
4-3
For those <15 years, peritoneal dialysis was used in 73%, compared with 23% for 15-24 years, 25% for 25-34 years, 19% for 65-84 years and 11% for ≥ 85 years.
Relative to State/Territory population, the highest prevalence rate of dialysis patients was in the Northern Territory (2,159 per million), with rates in other States/Territories ranging from 416 per million in Tasmania to 525 per million in New South Wales (Figure 4.2).
The age distribution of Patients is shown in Figure 4.4.
Figure 4.3
050010001500200025003000350040004500500055006000
0500
10001500200025003000350040004500500055006000
2008 2009 2010 2011 2012
Year
SAT HD 5619 (49%)HOSP HD 2552 (22%)CAPD 853 (7%)HOME HD 1048 (9%)
APD 1374 (12%)
Method N (%)
Australia, 2008-2012
Method and Location of Dialysis
Figure 4.4
16 24 150392
924
1685
25042791
2459
501
Number of PatientsTotal=11,446
Age Group
0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
31 December 2012
Prevalent Dialysis Patients (Australia)
11 9 49 121291
550
953
1606
2429
1187
Patients per Million(Overall Rate 507)
Age Group
0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
31 December 2012
Prevalent Dialysis Patients (Australia)
AUSTRALIA
4-4
METHOD AND LOCATION OF DIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
New Zealand data are shown in Figures 4.1, 4.2, 4.5 and 4.6.
There was an increase of 80 dialysis patients in 2012 (2,389 patients to 2,469), after an increase of only 1 patient for the previous year and 5% in 2010.
There were increases across all age groups between 15-84 in 2012.
Fifty percent of patients were treated with a form of home dialysis (of whom 31% were peritoneal dialysis patients). Numbers treated with automated peritoneal dialysis were similar in 2011 to 2010 (Figure 4.5)
In 2012, for the second year in a row continuous ambulatory peritoneal dialysis decreased.
Together, hospital haemodialysis and satellite dialysis accounted for 50% of patients in 2012, similar to the previous two years. Satellite haemodialysis numbers increased 3% in 2012 (391 patients).
In contrast to Australia a greater percentage of patients were at home. Of those not at home, a greater proportion were in hospital rather than satellite HD.
Figure 4.5
0
100
200
300
400
500
600
700
800
900
0
100
200
300
400
500
600
700
800
900
2008 2009 2010 2011 2012
Year
SATT HD 391 (16%)HOSP HD 837 (34%)CAPD 406 (16%)HOME HD 469 (19%)
APD 366 (15%)
Method N (%)
New Zealand, 2008-2012
Method and Location of Dialysis
Figure 4.6
2 4 63 130238
470
707591
246
18
Number of PatientsTotal=2,469
Age Group
0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
31 December 2012
Prevalent Dialysis Patients (New Zealand)
6 798
226401
760
1411
1720
1282
237
Patients per Million(Overall Rate 557)
Age Group
0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
31 December 2012
Prevalent Dialysis Patients (New Zealand)
NEW ZEALAND
ANZDATA Registry 2013 Report METHOD AND LOCATION OF DIALYSIS _____________________________________________________________________________________
4-5
Home RRT modalities by country The remainder of the chapter explores differences in home-based renal replacement therapies (peritoneal dialysis, home haemodialysis and transplantation). Figures 4.7 and 4.8 shown the distribution of prevalent re-nal replacement modality by country. Home dialysis therapies (HD and PD) are used more frequently in New Zealand, although the prevalence of transplantation is higher in Australia.
11%
5%
42%
41%
20%
12%
32%
35%
Australia New Zealand
PD Home HD
Other HD Graft
Modality at end of 2012
RRT Modality by Country
19%
9%
71%
31%
19%
50%
Australia New Zealand
PD Home HD
Other HD
Modality at end of 2012, dialysis only
Dialysis Modality by Country
Figure 4.7
Figure 4.8
4-6
METHOD AND LOCATION OF DIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
The variation in renal replacement therapy modality between states at the end of 2012 is shown in Figures 4.9 and 4.10. There is considerable variation in the pattern between states, both in the split of patients treated with kidney transplantation vs dialysis and between the differing modalities of dialysis.
0
20
40
60
80
100
Per
cent
QLD NSW/ACT VIC TAS SA NT WA NZ
at end of 2012
RRT Modality by State
APD CAPD Hospital HDHome HD Satellite HD Graft
Figure 4.9
0
20
40
60
80
100
Per
cent
QLD NSW/ACT VIC TAS SA NT WA NZ
at end of 2012
Dialysis Modality by State
PD Home HD Other HD
Figure 4.10
ANZDATA Registry 2013 Report METHOD AND LOCATION OF DIALYSIS _____________________________________________________________________________________
4-7
0
2,500
5,000
7,500
10,000
Num
ber
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Australia
0
500
1,000
1,500
2,000
2,500
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
New Zealand
Prevalent numbers at year's end
PD Home HD Other HD
Figure 4.11
Home Dialysis Over Time
There has been a growing interest in home therapies in recent years; the temporal trends in utilisation of home dialysis therapies are shown in Figure 4.11. For Australia, although there has been some increase in numbers over the last 10 years treated with both home haemodialysis and peritoneal dialysis, this in-crease is much less than the overall increase in number of prevalent patients, hence the proportion treat-ed at home has fallen. For New Zealand, there has been continued growth in home haemodialysis over the last 5-10 years, but it can be seen the proportion of patients treated at home is also falling over time.
The trends in home dialysis modality utilisation between states, and across age groups, are shown in Figures 4.11 - 4.15. There have been different patterns in utilisation of these therapies in different states. Perhaps the most striking example is WA where there has been a large increase in the numbers receiving home HD, whereas the numbers receiving PD treatment have been static. For both countries strong growth is seen in numbers of home HD patients in all age groups over 45 years. In contrast, numbers of people treated with PD are stable or in many cases falling.
4-8
METHOD AND LOCATION OF DIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
Figure 4.13
0102030
300350400450500
140160180200
0
100
200300
10203040
2030405060
05
1015
1015202530
200300400500
1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010
NT NSW VIC
QLD SA WA
TAS ACT NZ
Fre
quen
cy
Year
Number of Home HD Patients at End of 2012
Figure 4.12
010203040
200400600800
1000
250300350400450
200300400500
50
100
150
50100150200250
20304050
2030405060
200400600800
1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010
NT NSW VIC
QLD SA WA
TAS ACT NZ
Fre
quen
cy
Year
Number of PD Patients at End of 2012
ANZDATA Registry 2013 Report METHOD AND LOCATION OF DIALYSIS _____________________________________________________________________________________
4-9
15
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25
30
35
200
220
240
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600
50
100
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200
0
20
40
60
1990
2000
2010
1990
2000
2010
1990
2000
2010
0-24 25-44 45-64
65-74 75-100
Fre
quen
cy
Australia
5
10
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250
20
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0
5
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1990
2000
2010
1990
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1990
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0-24 25-44 45-64
65-74 75-100
Fre
quen
cy
New Zealand
Number of Home HD PatientsFigure 4.14
50
60
70
80
150
200
250
300
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600
800
1000
200
300
400
500
600
0
500
1990
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1990
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0-24 25-44 45-64
65-74 75-100
Fre
quen
cy
Australia
20
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0
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1990
2000
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1990
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1990
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0-24 25-44 45-64
65-74 75-100
Fre
quen
cy
New Zealand
Number of PD Patients
Figure 4.15
4-10
METHOD AND LOCATION OF DIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
Figure 4.17
Home Dialysis ≥65 years By Australian State and Country
Year Dialysis Australia New
Zealand NT NSW/ACT Vic Qld SA WA Tas Total
2008 PD 6 473 166 172 79 102 24 1022 280
Home HD 1 97 44 37 0 4 2 185 58
2009 PD 5 492 162 173 74 102 23 1031 298
Home HD 1 100 43 37 0 5 2 188 66
2010 PD 8 477 164 157 65 98 21 990 332
Home HD 1 102 47 41 3 8 4 206 70
2011 PD 5 461 168 145 60 100 25 964 317
Home HD 1 109 47 47 4 9 4 221 77
2012 PD 6 476 203 163 75 94 22 1039 305
Home HD 2 117 54 60 11 13 6 263 86
Figure 4.16
Home Modality (HD & PD) numbers by State
Current state PD Home HD Other HD Total
NT 411 240 1434 2085
NSW/ACT 950 477 2549 3976
Vic 457 206 2129 2792
Qld 33 15 166 214
SA 141 22 570 733
WA 30 33 439 502
Tas 205 55 884 1144
NZ 772 469 1228 2469
Total 2999 1517 9399 13915
Figure 4.17 shows in more detail the trend in each of the home modalities by state for patients ≥65 years.
Figure 4.16 shows the numbers of patients (of all ages) in each state performing home dialysis modalities, compared with other (satellite and hospital) HD.
Kevan Polkinghorne
Nancy Briggs
Namrata Khanal
Kylie Hurst
Philip Clayton
CHAPTER 5
HAEMODIALYSIS (including Home Haemodialysis)
2013 Annual Report - 36th Edition
5-2
HAEMODIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
Figure 5.1
Stock and Flow of Haemodialysis Patients 2008 - 2012
2008 2009 2010 2011 2012
Australia
Pa ents new to HD 2155 2078 2042 2184 2130
First dialysis treatment 1794 1725 1728 1848 1788
Previous dialysis (PD) 321 314 279 302 299
Failed transplant 40 39 35 34 43
Transplanted 534 495 546 521 539
Deaths 1197 1220 1151 1242 1214
Never transplanted 1134 1144 1083 1167 1138
Previous transplant 63 76 68 75 76
Transfer to PD 480 428 373 406 418
Pa ents dialysing at 31 December 7928 8263 8613 8961 9219
Pa ents dialysis at home at 31 December 952 978 981 993 1048
% of all home dialysis (HD and PD) pa‐ents
30% 31% 32% 32% 32%
New Zealand
Pa ents new to HD 394 429 402 411 410
First dialysis treatment 320 360 336 319 331
Previous dialysis (PD) 66 59 59 82 70
Failed transplant 8 10 7 10 9
Transplanted 69 61 50 65 45
Deaths 236 208 203 232 223
Never transplanted 219 195 180 222 216
Previous transplant 17 13 23 10 7
Transfer to PD 161 118 166 144 127
Pa ents dialysing at 31 December 1343 1481 1556 1597 1697
Pa ents dialysis at home at 31 December 331 378 425 432 469
% of all home dialysis (HD and PD) pa‐ents
30% 32% 34% 35% 38%
STOCK AND FLOW
NEW ZEALAND The annual stock and flow of HD patients during the period 2008-2012 is shown in Figures 5.1, 5.4 and 5.5.
There were 1,697 patients receiving treatment at 31st December 2012, a continuation of the trend from previous years.
Hospital based HD (49%), satellite HD (23%) and home HD (27%) proportions reflect increases in uptake of hospital based treatments and a decrease in satellite HD patients. Home HD remains unchanged.
New Zealand data are continued on page 4-5.
AUSTRALIA The annual stock and flow of HD patients during the period 2008-2012 is shown in Figures 5.1, 5.2 and 5.3.
There were 9,219 patients receiving HD treatment at 31st December 2012, an increase of 3%; of these 28% were hospital based, 61% were in satellite centres and 11% at home. Home haemodialysis data are presented in detail from page 5.36.
A total of 1,788 patients received HD for the first time during the year, a slight decrease from the previous year.
The proportion of all HD patients in each age group is shown in Figure 5.7. There were 2,484 people ≥ 75 years receiving haemodialysis, including 447 people ≥ 85 years, a rise of 7% from 2011, following a 7% rise for the previous year.
There were 539 transplant operations to people receiving HD treatment, 6% of all HD patients dialysing and 8% of those patients < 65 years.
There were 1,214 deaths in 2012.
5-3
ANZDATA Registry 2013 Report HAEMODIALYSIS _____________________________________________________________________________________
Figure 5.3
Stock and Flow of Haemodialysis Patients Australia 2008 - 2012 Number (%)
Age Groups 2008 2009 2010 2011 2012
New Patients *
00-14 years 13 (1%) 9 (0%) 14 (1%) 15 (1%) 20 (1%)
15-24 years 42 (2%) 45 (2%) 44 (2%) 46 (2%) 44 (2%)
25-34 years 101 (5%) 88 (4%) 76 (4%) 82 (4%) 109 (5%)
35-44 years 173 (8%) 179 (9%) 173 (8%) 198 (9%) 170 (8%)
45-54 years 345 (16%) 313 (15%) 315 (15%) 328 (15%) 359 (17%)
55-64 years 451 (21%) 451 (22%) 443 (22%) 490 (22%) 484 (23%)
65-74 years 541 (25%) 519 (25%) 485 (24%) 533 (24%) 492 (23%)
75-84 years 432 (20%) 416 (20%) 408 (20%) 429 (20%) 388 (18%)
>=85 years 57 (3%) 58 (3%) 84 (4%) 63 (3%) 64 (3%)
Total 2155 (17%) 2078 (16%) 2042 (16%) 2184 (17%) 2130 (17%)
Patients Dialysing
00-14 years 10 (0%) 9 (0%) 10 (0%) 10 (0%) 11 (0%) 15-24 years 88 (1%) 91 (1%) 100 (1%) 112 (1%) 112 (1%) 25-34 years 290 (4%) 292 (4%) 289 (3%) 283 (3%) 295 (3%) 35-44 years 693 (9%) 696 (8%) 697 (8%) 733 (8%) 723 (8%) 45-54 years 1275 (16%) 1315 (16%) 1314 (15%) 1336 (15%) 1352 (15%) 55-64 years 1725 (22%) 1790 (22%) 1871 (22%) 1945 (22%) 2014 (22%) 65-74 years 1896 (24%) 1989 (24%) 2072 (24%) 2141 (24%) 2228 (24%) 75-84 years 1684 (21%) 1771 (21%) 1869 (22%) 1982 (22%) 2037 (22%) >=85 years 267 (3%) 310 (4%) 391 (5%) 419 (5%) 447 (5%)
Total 7928 (16%) 8263 (16%) 8613 (17%) 8961 (18%) 9219 (18%)
Primary Renal Disease *
Glomerulonephritis 464 (22%) 508 (24%) 427 (21%) 477 (22%) 400 (19%) Analgesic Nephropathy 46 (2%) 41 (2%) 38 (2%) 27 (1%) 30 (1%) Hypertension 316 (15%) 280 (13%) 268 (13%) 316 (14%) 224 (11%) Polycystic Disease 125 (6%) 123 (6%) 136 (7%) 125 (6%) 104 (5%) Reflux Nephropathy 59 (3%) 61 (3%) 43 (2%) 51 (2%) 54 (3%) Diabetic Nephropathy 750 (35%) 687 (33%) 742 (36%) 796 (36%) 809 (38%) Miscellaneous 238 (11%) 245 (12%) 274 (13%) 276 (13%) 390 (18%) Uncertain 157 (7%) 133 (6%) 114 (6%) 116 (5%) 119 (6%)
Total 2155 (17%) 2078 (16%) 2042 (16%) 2184 (17%) 2130 (17%)
* New patients receiving first haemodialysis treatment
Figure 5.2
9219 Patients
0
2000
4000
6000
8000
10000
2008 2009 2010 2011 2012
Prevalent patientsNew patients
TransplantsPerm. TransferDeaths
Stock and Flow of Haemodialysis PatientsAustralia 2008-2012
5-4
HAEMODIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
Figure 5.5
Stock and Flow of Haemodialysis Patients New Zealand 2008 - 2012 Number (%)
Age Groups 2008 2009 2010 2012
New Patients *
00-14 years 5 (1%) 2 (0%) 1 (0%) 5 (1%)
15-24 years 19 (5%) 10 (2%) 12 (3%) 19 (5%)
25-34 years 15 (4%) 24 (6%) 12 (3%) 20 (5%)
35-44 years 34 (9%) 54 (13%) 41 (10%) 38 (9%)
45-54 years 84 (21%) 89 (21%) 99 (25%) 76 (19%)
55-64 years 117 (30%) 103 (24%) 113 (28%) 123 (30%)
65-74 years 89 (23%) 93 (22%) 82 (20%) 94 (23%)
75-84 years 30 (8%) 51 (12%) 39 (10%) 35 (9%)
>=85 years 1 (0%) 3 (1%) 3 (1%) 0 (0%)
Total 394 (3%) 429 (3%) 402 (3%) 410 (3%)
Patients Dialysing
00-14 years 3 (0%) 3 (0%) 4 (0%) 2 (0%)
15-24 years 38 (3%) 41 (3%) 45 (3%) 45 (3%)
25-34 years 76 (6%) 90 (6%) 90 (6%) 98 (6%)
35-44 years 149 (11%) 162 (11%) 165 (11%) 173 (10%)
45-54 years 275 (20%) 309 (21%) 331 (21%) 348 (21%)
55-64 years 373 (28%) 403 (27%) 431 (28%) 481 (28%)
65-74 years 293 (22%) 316 (21%) 323 (21%) 372 (22%)
75-84 years 126 (9%) 146 (10%) 152 (10%) 163 (10%)
>=85 years 10 (1%) 11 (1%) 15 (1%) 15 (1%)
Total 1343 (3%) 1481 (3%) 1556 (3%) 1697 (3%)
Primary Renal Disease *
Glomerulonephritis 72 (18%) 97 (23%) 89 (22%) 78 (19%)
Analgesic Nephropathy 1 (0%) 1 (0%) 0 (0%) 3 (1%)
Hypertension 30 (8%) 43 (10%) 36 (9%) 42 (10%)
Polycystic Disease 14 (4%) 18 (4%) 14 (3%) 16 (4%)
Reflux Nephropathy 9 (2%) 3 (1%) 6 (1%) 9 (2%)
Diabetic Nephropathy 204 (52%) 212 (49%) 207 (51%) 204 (50%)
Miscellaneous 49 (12%) 41 (10%) 38 (9%) 45 (11%)
Uncertain 15 (4%) 14 (3%) 12 (3%) 13 (3%)
Total 394 (3%) 429 (3%) 402 (3%) 410 (3%)
* New patients receiving first haemodialysis treatment
2011
1 (0%)
14 (3%)
19 (5%)
44 (11%)
83 (20%)
108 (26%)
100 (24%)
38 (9%)
4 (1%)
411 (3%)
1 (0%)
39 (2%)
90 (6%)
173 (11%)
334 (21%)
453 (28%)
341 (21%)
146 (9%)
20 (1%)
1597 (3%)
99 (24%)
2 (0%)
41 (10%)
20 (5%)
8 (2%)
177 (43%)
44 (11%)
20 (5%)
411 (3%)
Figure 5.4
1697 Patients
0
500
1000
1500
2000
2008 2009 2010 2011 2012
Prevalent patientsNew patients
TransplantsPerm. TransferDeaths
Stock and Flow of Haemodialysis PatientsNew Zealand 2008-2012
5-5
ANZDATA Registry 2013 Report HAEMODIALYSIS _____________________________________________________________________________________
Figure 5.6
0.92.1
5.1
8.0
16.9
22.7 23.1
18.2
3.0
Number of Patients = 2130
0
5
10
15
20
25
Per
cent
00-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 >=85
Age (%) of New Haemodialysis Patients 2012Australia
Figure 5.7
0.11.2
3.2
7.8
14.7
21.8
24.222.1
4.8
Number of Patients = 9219
0
5
10
15
20
25
Per
cent
00-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 >=85
Age (%) of Current Haemodialysis Patients31-Dec-2012 Australia
NEW ZEALAND (continued from page 5-2)
There were 410 patients who received HD for the first time in 2012, similar to previous years. Almost eighty one percent (80.7%) were dialysing for the first time, 17% were previously dialysing with peritoneal dialysis and the remaining 2% had failed transplants.
The modal age group for new HD patients was 55-64 years (30%), 11% were <35 years and 31% ≥ 65 years (Figures 5.5 and 5.8). The age distribution of the prevalent HD population was similar (Figure 5.9).
There were 45 HD patients who received transplants in 2012 (65 in 2011). Only one patient ≥ 65 years was transplanted in 2012 compared with four in 2011.
There were 223 deaths in 2012.
Figure 5.8
1.2
4.6 4.9
9.3
18.5
30.0
22.9
8.5
Number of Patients = 410
0
10
20
30
Per
cent
00-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 >=85
Age (%) of New Haemodialysis Patients 2012New Zealand
Figure 5.9
0.1
2.7
5.8
10.2
20.5
28.3
21.9
9.6
0.9
Number of Patients = 1697
0
10
20
30
Per
cent
00-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 >=85
Age (%) of Current Haemodialysis Patients31-Dec-2012 New Zealand
5-6
HAEMODIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
Figure 5.10
Blood Flow Rates (mls/minute) 2008 - 2012
Country No. Pts
*CVV HD excluded
NR**
Mls/Minute
<200 200-249 250-299 300-349 350-399 >400
Aust
2008 7927 0 3 52 350 1282 4340 1591 309
2009 8255 1 4 47 292 1208 4742 1630 331
2010 8599 3 10 39 296 1226 4986 1721 318
2011 8927 0 20 28 270 1247 5194 1890 278
2012 9219 0 447 53 221 1263 5193 1764 278
NZ
2008 1343 0 0 6 101 426 553 232 25
2009 1481 1 0 4 94 368 680 300 34
2010 1555 0 1 5 96 393 769 259 32
2011 1596 0 2 4 106 332 910 224 18
2012 1697 0 29 8 116 383 871 257 33
Figure 5.11
Blood Flow Rate by Type of Access December 2012
Blood Flow Rate
Australia New Zealand
AVF AVG CVC* NR** AVF AVG CVC NR**
<200 36 (0.5%) 2 (0.3%) 14 (1.1%) 1 (0.2%) 6 (0.5%) 0 (0.0%) 2 (0.5%) 0 (0.0%)
200-249 138 (2.0%) 21 (3.3%) 60 (4.8%) 2 (0.4%) 78 (6.3%) 2 (2.9%) 35 (9.3%) 1 (4.8%)
250-299 837 (12.2%) 101 (15.9%) 311 (24.8%) 14 (3.1%) 199 (16.2%) 22 (31.9%) 156 (41.3%) 6 (28.6%)
300-349 4003 (58.2%) 383 (60.3%) 722 (57.5%) 85 (18.8%) 661 (53.8%) 38 (55.1%) 166 (43.9%) 6 (28.6%)
350-399 1547 (22.5%) 106 (16.7%) 89 (7.1%) 22 (4.9%) 244 (19.9%) 4 (5.8%) 9 (2.4%) 0 (0.0%)
400+ 261 (3.8%) 14 (2.2%) 1 (0.1%) 2 (0.4%) 30 (2.4%) 2 (2.9%) 1 (0.3%) 0 (0.0%)
NR** 54 (0.8%) 8 (1.3%) 59 (4.7%) 326 (72.1%) 11 (0.9%) 1 (1.4%) 9 (2.4%) 8 (38.1%)
Total 6876 635 1256 452 1229 69 378 21
* Number of patients having C.V.V. HD not included. NR** - Not Reported
Figure 5.13
0.3 0.3 0.5
6.2 6.6 7.0
25.3
20.823.0
49.5
57.1
52.2
16.714.1
15.4
2.1 1.1 2.0
0
20
40
60
Per
cent
<200 200-249 250-299 300-349 350-399 >=400
Distribution of Blood Flow RatesPrevalent Haemodialysis
New Zealand
2012 (1668)2011 (1594)2010 (1554)
At 31 Dec
Figure 5.12
0.5 0.3 0.6
3.4 3.0 2.5
14.3 14.0 14.4
58.1 58.3 59.2
20.021.2
20.1
3.7 3.1 3.2
0
20
40
60
Pe
rce
nt
<200 200-249 250-299 300-349 350-399 >=400
Distribution of Blood Flow RatesPrevalent Haemodialysis
Australia
2012 (8772)2011 (8907)2010 (8586)
At 31 Dec
AUSTRALIA Blood flow rates in Australia showed a similar picture as in 2012. The proportion receiving a blood flow rate of 300 mls/minute or higher was 83% in 2012.
Only 3.3% (274 patients) had blood flow rates < 250 mls/minute. Blood flow rates were not reported in 447 patients.
Blood flow rates of 350 mls/minute and higher were less frequent in patients dialysing using central venous catheters than in those using AVFs or AVGs (Figure 5.11).
NEW ZEALAND In December 2012, 70% of patients were prescribed 300 mls/minute or higher.
There were 8.6% using < 250 mls/minute; many of these were receiving long hour HD.
5-7
ANZDATA Registry 2013 Report HAEMODIALYSIS _____________________________________________________________________________________
Figure 5.14
Duration and Number of Sessions Per Week December 2011
Sessions Per
week
Hours of Each Treatment Total
<4 4 4.5 5 5.5 >5.5 Not Reported
Australia
3.1-4.9 321 (4.0) 3177 (39.3) 1868 (23.1) 2358 (29.2) 127 (1.6) 226 (2.8) 6 (0.1) 8083
<=3 41 (7.3) 95 (16.9) 54 (9.6) 117 (20.9) 16 (2.9) 238 (42.4) 0 (0.0) 561
>=5 64 (40.8) 44 (28.0) 0 (0.0) 7 (4.5) 2 (1.3) 39 (24.8) 1 (0.6) 157
Not reported 1 (0.2) 0 (0.0) 2 (0.5) 1 (0.2) 0 (0.0) 1 (0.2) 413 (98.8) 418
Total 427 (4.6) 3316 (36.0) 1924 (20.9) 2483 (26.9) 145 (1.6) 504 (5.5) 420 (4.6) 9219
New Zealand
3.1-4.9 32 (2.2) 452 (31.3) 380 (26.3) 465 (32.2) 41 (2.8) 61 (4.2) 12 (0.8) 1443
<=3 5 (2.4) 39 (18.9) 25 (12.1) 61 (29.6) 10 (4.9) 60 (29.1) 6 (2.9) 206
>=5 6 (28.6) 5 (23.8) 1 (4.8) 4 (19.0) 0 (0.0) 3 (14.3) 2 (9.5) 21
Not reported 0 (0.0) 0 (0.0) 0 (0.0) 3 (11.1) 0 (0.0) 3 (11.1) 21 (77.8) 27
Total 43 (2.5) 496 (29.2) 406 (23.9) 533 (31.4) 51 (3.0) 127 (7.5) 41 (2.4) 1697
* Intermediate durations are rounded up, e.g. 4.25 is included in 4.5
Figure 5.15
92
62
92
62
92
62
89
92
88
112
86
121
0
20
40
60
80
100
Per
cent
Australia New Zealand
2010 2011 2012 2010 2011 2012
Haemodialysis Frequency per WeekDecember 2010-2012
5+
3.1-4.9<=3
Frequency/Week
FREQUENT AND LONG HAEMODIALYSIS (Figures 5.14 - 5.23)
The proportions of those dialysing > 3 times per week in Australia has plateaued, with no change from 2009. In New Zealand the proportion dialysing more than three times per week continues to increase. The proportions dialysing ≥ 4.5 hours per session has slowly increased. The proportion dialysing more than the “standard” 12 hours per week has been steadily increasing.
In 2012, 59% and 70% of HD patients were dialysing ≥ 13.5 hours per week in Australia and New Zealand respectively. Figures 5.16-5.20 show these from several perspectives.
Figure 5.16
5
40
20
28
26
5
38
21
28
25
5
38
22
28
26
3
36
18
33
37
2
31
23
33
37
3
30
25
32
38
0
20
40
60
80
100
Per
cent
Australia New Zealand
2010 2011 2012 2010 2011 2012
Haemodialysis Session Length (Hours)December 2010-2012
>5.55.554.5
4<4
Length (Hours)
Figure 5.17
5
38
19
31
5
5
37
20
32
5
5
36
21
32
6
2
34
19
38
7
2
28
23
39
7
3
27
24
38
8
0
20
40
60
80
100
Per
cent
Australia New Zealand
2010 2011 2012 2010 2011 2012
Haemodialysis Duration (Hours per Week)December 2010-2012
>=2015-19.913.5-14.9
12-13.4<12
Hours/Week
5-8
HAEMODIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
Figure 5.18
0
.5
1
1.5
2
2.5
3
3.5
20042005
20062007
20082009
20102011
201220042005
20062007
20082009
20102011
2012
Australia New ZealandP
erce
nt
Survey Period
Percentage of PatientsDialysing Five or More Days per Week
Figure 5.19
45
50
55
60
65
70
20042005
20062007
20082009
20102011
201220042005
20062007
20082009
20102011
2012
Australia New Zealand
Per
cent
Survey Period
Percentage of Patients Dialysing 3 Days per WeekDialysing 4.5 Hours or Longer per Session
Figure 5.20
45
50
55
60
65
70
20042005
20062007
20082009
20102011
201220042005
20062007
20082009
20102011
2012
Australia New Zealand
Per
cent
Survey Period
Percentage of PatientsDialysing >12 Hours per Week
5-9
ANZDATA Registry 2013 Report HAEMODIALYSIS _____________________________________________________________________________________
Figure 5.21
Haemodialysis Percentage ≥ 5 Sessions per Week By Australian State and Country
Australia New
Zealand Qld NSW/ACT Vic Tas SA NT WA
2012 58 (3.6%) 25 (0.9%) 46 (2.0%) 3 (1.7%) 11 (1.9%) 3 (0.6%) 11 (1.4%) 21 (1.3%)
2011 61 (3.7%) 24 (0.8%) 50 (2.2%) 2 (1.3%) 7 (1.2%) 3 (0.7%) 18 (2.1%) 24 (1.5%)
2009 41 (2.6%) 28 (1.0%) 40 (1.9%) 2 (1.4%) 7 (1.3%) 0 (0.0%) 10 (1.3%) 28 (1.9%)
2010 52 (3.2%) 25 (0.9%) 48 (2.2%) 3 (2.1%) 8 (1.4%) 5 (1.2%) 15 (1.9%) 28 (1.8%)
Figure 5.22
Haemodialysis Percentage ≥ 4.5 Hours Per Session Three Sessions per Week
By Australian State and Country
Australia New
Zealand Qld NSW/ACT Vic Tas SA NT WA
2012 802 (59.6%) 1886 (73.8%) 956 (45.7%) 107 (67.7%) 132 (24.4%) 351 (77.0%) 217 (28.7%) 940 (66.7%)
2011 843 (58.7%) 1927 (74.3%) 890 (42.5%) 100 (69.4%) 133 (24.1%) 319 (74.9%) 227 (28.5%) 921 (66.2%)
2009 788 (58.6%) 1748 (72.6%) 663 (34.9%) 81 (60.4%) 132 (25.9%) 305 (80.9%) 192 (26.7%) 754 (57.6%)
2010 829 (59.5%) 1859 (72.8%) 757 (37.8%) 79 (61.2%) 138 (26.2%) 301 (77.2%) 201 (27.1%) 828 (60.6%)
Figure 5.23
Haemodialysis Percentage >12 Hours per Week By Australian State and Country
Australia New
Zealand Qld NSW/ACT Vic Tas SA NT WA
2012 983 (61.7%) 2134 (75.1%) 1167 (50.4%) 126 (70.0%) 161 (27.5%) 358 (77.2%) 277 (34.1%) 1157 (70.1%)
2011 1009 (61.4%) 2185 (75.1%) 1087 (47.1%) 112 (70.9%) 160 (26.8%) 328 (75.4%) 287 (33.3%) 1111 (69.7%)
2010 996 (61.4%) 2083 (73.8%) 959 (43.0%) 92 (63.0%) 167 (29.5%) 311 (77.4%) 257 (32.1%) 997 (64.2%)
2009 964 (61.5%) 1990 (73.4%) 873 (41.1%) 92 (62.2%) 161 (29.8%) 308 (80.4%) 238 (30.7%) 905 (61.1%)
Dialysis frequency and session length vary among the Australian jurisdictions. Patients in Queensland and Victoria are more likely to dialyse more frequently, while patients in New South Wales/ACT and the Northern Territory tend to dialyse longer per session on average (Figures 5.21 - 5.23).
5-10
HAEMODIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
Figure 5.24
Patient Survival - 90 days after HD start Censored for Transplant 2001 - 2012
% [95% Confidence Interval]
No. of Patients
Survival
6 months 1 year 3 years 5 years
Australia
2001‐2003 3467 96 [95, 97] 90 [88, 91] 68 [66, 70] 50 [48, 52]
2004‐2006 4222 96 [95, 97] 89 [88, 90] 68 [67, 70] 50 [48, 51]
2007‐2009 4697 96 [95, 96] 90 [89, 91] 70 [69, 72] 53 [51, 55]
2010‐2012 4450 96 [96, 97] 91 [90, 92] ‐ ‐
New Zealand
2001‐2003 653 97 [95, 98] 92 [90, 94] 72 [68, 76] 54 [50, 59]
2004‐2006 704 97 [95, 98] 91 [89, 93] 71 [67, 75] 51 [47, 55]
2007‐2009 793 96 [94, 97] 91 [89, 93] 71 [68, 75] 53 [47, 58]
2010‐2012 735 98 [96, 99] 94 [91, 95] ‐ ‐
OUTCOMES AMONG HAEMODIALYSIS PATIENTS
In Australia, there has been little change in haemodialysis patient survival over time, after adjusting for age, diabetes status, sex, race and comorbidities.
In New Zealand, recent cohorts have slightly better survival. Unadjusted survivals are shown in Figures 5.24-5.26.
In both countries, diabetes status and age have marked effects on haemodialysis patient survival. (Figures 5.24 - 5.34).
Note: For all tables and graphs the times indicated are from the 90th day and not the first treatment.
Figure 5.25
0.00
0.25
0.50
0.75
1.00
Pat
ient
Sur
viva
l
0 1 2 3 4 5
Years
2001-2003 (3467)2004-2006 (4222)2007-2009 (4697)
2010-2012 (4450)
Patient Survival - Haemodialysis at 90 Days2001 - 2012
Censored for Transplant - Australia
Figure 5.26
0.00
0.25
0.50
0.75
1.00
Pat
ient
Sur
viva
l
0 1 2 3 4 5
Years
2001-2003 (653)2004-2006 (704)2007-2009 (793)
2010-2012 (735)
Patient Survival - Haemodialysis at 90 Days2001 - 2012
Censored for Transplant - New Zealand
5-11
ANZDATA Registry 2013 Report HAEMODIALYSIS _____________________________________________________________________________________
Figures 5.27- 5.28
These figures show survival curves for patients treated with haemodialysis at day 90, adjusted to a median age of 63.1 years for Australia and 57.2 years for New Zealand; non-diabetic primary renal disease; caucasoid race; female gender and no comorbid conditions (lung disease, coronary artery disease, peripheral vascular disease or cerebrovascular disease).
Note: x axis scale refers to time after day 90. PRD = Primary renal disease.
Figure 5.32-5.34 show survival stratified by age at the start of treatment.
Figure 5.27
0.00
0.25
0.50
0.75
1.00
Pat
ient
Sur
viva
l
0 1 2 3 4 5
Years
2001-2003 (3467)2004-2006 (4222)2007-2009 (4697)
2010-2012 (4450)
Adjusted for Age, Race, Diabetic PRD, Comorbidity and Gender
Patient Survival - Haemodialysis at 90 Days2001 - 2012
Censored for Transplant - Australia
Figure 5.28
0.00
0.25
0.50
0.75
1.00
Pat
ient
Sur
viva
l
0 1 2 3 4 5
Years
2001-2003 (653)2004-2006 (704)2007-2009 (793)
2010-2012 (735)
Adjusted for Age, Race, Diabetic PRD, Comorbidity and Gender
Patient Survival - Haemodialysis at 90 Days2001 - 2012
Censored for Transplant - New Zealand
5-12
HAEMODIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
Figure 5.29
Haemodialysis at 90 Days Patient Survival - Diabetic / Non Diabetic
Censored for Transplant 2001 - 2012 % [95% Confidence Interval]
Survival
6 months 1 year 3 years 5 years
Australia
Non Diabetic 96 [96, 96] 90 [89, 91] 70 [69, 71] 53 [51, 54]
Diabetic 96 [96, 97] 90 [89, 91] 68 [67, 70] 49 [47, 50]
New Zealand
Non Diabetic 97 [95, 97] 92 [91, 94] 76 [73, 78] 58 [54, 62]
Diabetic 97 [96, 98] 92 [90, 93] 69 [66, 72] 49 [45, 52]
No. of Patients
11228
5616
1501
1387
Figure 5.30
0.00
0.25
0.50
0.75
1.00
Pat
ient
Sur
viva
l
0 1 2 3 4 5
Years
Non diabetic (11228)
Diabetic (5616)
Patient Survival - Haemodialysis at 90 Days2008 - 2012
Censored for Transplant - Australia
Figure 5.31
0.00
0.25
0.50
0.75
1.00
Pat
ient
Sur
viva
l
0 1 2 3 4 5
Years
Non diabetic (1501)
Diabetic (1387)
Patient Survival - Haemodialysis at 90 Days2008 - 2012
Censored for Transplant - New Zealand
5-13
ANZDATA Registry 2013 Report HAEMODIALYSIS _____________________________________________________________________________________
Figure 5.32
Haemodialysis at 90 Days Patient Survival - By Age Group
Censored for Transplant 2001 - 2012 % [95% Confidence Interval]
Age Groups Survival
6 months 1 year 3 years 5 years
Australia
<40 years 1720 99 [98, 99] 97 [96, 98] 88 [86, 90] 80 [77, 83]
40‐59 years 5362 98 [97, 98] 94 [94, 95] 81 [80, 82] 68 [66, 69]
60‐74 years 6047 95 [95, 96] 89 [88, 89] 67 [66, 68] 48 [47, 50]
>=75 years 3715 93 [93, 94] 84 [83, 85] 53 [51, 55] 29 [27, 31]
New Zealand
<40 years 396 100 [98, 100] 97 [95, 99] 83 [77, 87] 75 [68, 81]
40‐59 years 1248 97 [96, 98] 95 [93, 96] 80 [77, 82] 63 [59, 67]
60‐74 years 1000 96 [94, 97] 90 [87, 92] 66 [62, 69] 43 [38, 47]
>=75 years 244 95 [91, 97] 82 [76, 87] 48 [41, 56] 22 [14, 30]
No. of Patients
Figure 5.33
0.00
0.25
0.50
0.75
1.00
Pat
ient
Sur
viva
l
0 1 2 3 4 5
Years
<40 (1720)40-59 (5362)60-74 (6047)
>=75 (3715)
Age (years)
Patient Survival - Haemodialysis at 90 Days2008 - 2012
Censored for Transplant - Australia
Figure 5.34
0.00
0.25
0.50
0.75
1.00
Pat
ient
Sur
viva
l
0 1 2 3 4 5
Years
<40 (396)40-59 (1248)60-74 (1000)
>=75 (244)
Age (years)
Patient Survival - Haemodialysis at 90 Days2008 - 2012
Censored for Transplant - New Zealand
5-14
HAEMODIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
MEMBRANE TYPE AND SURFACE AREAS
AUSTRALIA Figures 5.35 - 5.37.
Usage of low flux polysulfone dialysers was 0.44% in 2012, 0.77% in December 2011, 2.5% in 2010 and 5% in 2008). The use of high flux polysulphone continues to decrease (0.07% in 2012, <1% in 2011, 2010 and 2009, 1.5% in 2008, 7% in both 2007 and 2006, 9% in 2005 and 39% in 2004.
High flux Polysulphone-Helixone decreased to 61% in December 2012 from 63% in 2011, 57% in 2010, 53% in 2009 and 49% in 2008. Similarly high flux Polyamix increased to 22% in 2012 from 33% in the previous years.
99% of patients were receiving dialysis with high flux dialysers in 2012 (99% in 2011, 96% in 2010, 88% in 2009 and 81% in 2008).
NEW ZEALAND Figures 5.35, 5.36 and 5.39.
Low flux polysulphone decreased to 11.2% in December 2012, from 11% and 13% in December 2011 and 2010 respectively.
81% (1349 patients) were reported as receiving dialysis with high flux dialysers in December 2012, an increase from 77% (1223 patients) in 2011 and 62% (924 patients) in 2010.
Figure 5.35
Haemodialyser Membrane Types by Surface Area 31-Dec-2012
Dialyser Membrane Type Flux
Square Metres Total
<1.0 1.0-1.4 1.5-1.7 1.8-1.9 >1.9
Australia Cellulose Triacetate High . . 1 5 21 27
Polyamix High 3 26 358 . 1604 1991
Polyamix Low . 2 16 . 24 42
Polyethersulfone High . . 4 2 97 103
Polynephron High . . . . 105 105
Polysulphone High 1 2 . 2 1 6
Polysulphone Low . . . 10 31 41
Polysulphone‐Helixone High 2 500 . 3194 1911 5607
Purima Mid . . 13 . . 13
Revaclear High . 180 . . . 180
Revaclear Max High . . . 455 . 455
Synphan Low . 3 . . . 3
Total 6 713 392 3668 3794 9219
New Zealand Polyamix High . 1 9 . 68 78
Polysulphone‐Helixone High . 299 . 363 344 1006
Revaclear High . 10 . . . 10
Unreported Unreported . . . . . 30
Total . 314 53 702 598 1697
Polysulphone Low . 3 . 84 103 190
Polyamix Low . 1 44 . 83 128
.
.
.
.
.
.
.
.
.
.
.
.
646
.
.
.
.
.
30
30
Unreported Unreported . . . . . 646 646
Revaclear Max High . . . 255 . . 255
Figure 5.37
0.1
0.1
0.2
0.0
7.2 8.
3
0.2
7.9
4.4
37.6
42.7
0.2
0.1
26.6
20.2
19.0
22.3
0.5
0.4
0.9
1.4
0
10
20
30
40
Per
cent
<1.3 1.3 1.4 1.6 1.7 1.8 1.9 2.1 2.2 2.4 2.5
Haemodialysis Surface AreaAustralia
Dec 2011 (8908)Dec 2012 (8573)
Figure 5.38
0.1 0.2
0.2
0.1
23
.3
18
.6
6.6
3.2
21
.6
42
.1
35
.8
9.1
6.1
20
.6
6.3
6.2
0
10
20
30
40
Per
cent
<1.3 1.3 1.4 1.7 1.8 2.1 2.2 2.4
Haemodialysis Surface AreaNew Zealand
Dec 2011 (1594)Dec 2012 (1667)
Figure 5.36
Number of Patients at end of 2012 by HD Modality
NT NSW/ACT VIC QLD SA WA TAS NZ Total
HAEMODIALYSIS‐PLATE DIALYSERS 0 1 1 2 0 0 0 0 4
HAEMOFILTRATION 0 10 0 2 1 2 0 1 16
HAEMODIAFILTRATION 5 400 53 286 173 172 27 322 1438
Total 468 2869 2316 1613 590 842 180 1674 10552
HAEMODIALYSIS‐HOLLOW FIBRE DIALYSERS
463 2458 2262 1323 416 668 153 1351 9094
5-15
ANZDATA Registry 2013 Report HAEMODIALYSIS _____________________________________________________________________________________
ANAEMIA
In Australia, mean haemoglobin and erythropoietic agent use has gradually reduced. Haemodialysis patients had a higher erythropoietic agent usage despite a similar mean haemoglobin compared with peritoneal dialysis patients (Figures 5.39 - 5.40).
In New Zealand, mean haemoglobin has stabilised. The increase in erythropoietic agent usage seen over 2005-2012 has reached a plateau and begun to fall.
Figure 5.39
110
115
120
Dec 05Dec 06
Dec 07Dec 08
Dec 09Dec 10
Dec 11Dec 12
Dec 05Dec 06
Dec 07Dec 08
Dec 09Dec 10
Dec 11Dec 12
Australia New Zealand
PD HD
Mea
n H
b(g/
L)
Survey Period
Mean Haemoglobin Among Dialysis PatientsBy Survey Period
Figure 5.40
60
70
80
90
100
Dec 05Dec 06
Dec 07Dec 08
Dec 09Dec 10
Dec 11Dec 12
Dec 05Dec 06
Dec 07Dec 08
Dec 09Dec 10
Dec 11Dec 12
Australia New Zealand
PD HD
Per
cent
Survey Period
Use of Erythropoietic AgentsBy Survey Period
5-16
HAEMODIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
In Australia, among patients dialysing at 31 December 2012, haemoglobin was <110 g/L in 41% and >140g/L in 3% of haemodialysis patients, which is the same as the previous two years.
In New Zealand, the corresponding percentages were 44% and 4% respectively. Figure 5.42 shows the proportion of patients with proven or likely cardiovascular disease reported as a comorbidity to the Registry, achieving the clinical target of haemoglobin ≤ 120 g/L.
HAEMOGLOBIN
Figure 5.41
39
30
21
83
41
30
19
83
41
30
19
73
41
26
21
84
44
25
18
94
44
27
17
84
Pe
rce
nt
Australia New Zealand
Dec 10 Dec 11 Dec 12 Dec 10 Dec 11 Dec 12
Haemoglobin - HaemodialysisDecember 2008-2012
<110 110-119 120-129 130-139 140Hb(g/L)
39
32
29
41
32
27
41
32
27
38
33
29
40
34
26
40
32
27
Per
cent
No CAD CAD
Dec 10 Dec 11 Dec 12 Dec 10 Dec 11 Dec 12
Haemoglobin - HaemodialysisBy Coronary Artery Disease StatusAustralia - December 2008-2012
<110 110-120 120Hb(g/L)
Figure 5.42
43
28
29
46
28
26
45
28
27
39
29
32
42
28
31
44
30
27
Per
cent
No CAD CAD
Dec 10 Dec 11 Dec 12 Dec 10 Dec 11 Dec 12
Haemoglobin - HaemodialysisBy Coronary Artery Disease Status
New Zealand - December 2008-2012
<110 110-120 120Hb(g/L)
5-17
ANZDATA Registry 2013 Report HAEMODIALYSIS _____________________________________________________________________________________
Figures 5.43- 5.46
The first 2 figures show the median haemoglobin (with inter-quartile range) for individual centres, arranged from lowest to highest. Also shown are the proportion of patients in each centre with a haemoglobin of 110-129 g/L.
In Australia, median haemoglobin for each centre ranged from 105.5 to 122 g/L for haemodialysis patients and in New Zealand 105-116 g/L.
The proportion of patients in Australia with a haemoglobin of 110-129 g/L in each centre ranged from 32% to 78% for haemodialysis patients and for New Zealand 34% to 51%. For Figures 5.45 and 5.46 the error bars show the 95% confidence intervals.
HAEMOGLOBIN BY TREATING CENTRE
Figure 5.43
Excludes hospitals with <10 patients90
100
110
120
130
140
Med
ian
Hb
(g/L
)
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70
Caring Hospital
Australia 31 December 2012
Haemoglobin in Haemodialysis Patients
Figure 5.44
Excludes hospitals with <10 patients90
100
110
120
130
140
Med
ian
Hb
(g/L
)
0 1 2 3 4 5 6 7 8 9 10
Caring Hospital
New Zealand 31 December 2012
Haemoglobin in Haemodialysis Patients
Figure 5.45
Excludes hospitals with <10 patients0
10
20
30
40
50
60
70
80
90
100
Pe
rce
nt
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70
Caring Hospital
Australia 31 December 2012
% Haemodialysis Patients with Hb 110-129 g/L
Figure 5.46
Excludes hospitals with <10 patients0
10
20
30
40
50
60
70
80
90
100
Per
cent
0 1 2 3 4 5 6 7 8 9 10
Caring Hospital
New Zealand 31 December 2012
% Haemodialysis Patients with Hb 110-129 g/L
5-18
HAEMODIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
FERRITIN AND TRANSFERRIN SATURATION
Figures 5.47 - 5.48
In Australia and New Zealand the proportions of haemodialysis patients with ferritin <200 mcg/L and those with ferritin ≥ 500 mcg/L have been relatively stable.
In Australia distributions of transferrin saturation have been unchanged for the past three years, while in New Zealand the proportion with a transferrin saturation <20 has decreased from 38% in December 2011 to 34% in 2012.
Figure 5.47
1012
37
23
19
1111
39
22
17
1111
39
22
16
14
14
34
23
15
18
13
35
19
15
17
15
35
21
12
Per
cent
Australia New Zealand
Dec 10 Dec 11 Dec 12 Dec 10 Dec 11 Dec 12
Ferritin - HaemodialysisDecember 2008-2012
<100 100-199 200-499 500-799 800g/L
Figure 5.48
31
37
19
13
31
37
19
13
31
37
19
12
31
39
18
12
38
38
17
8
34
37
19
10
Per
cent
Australia New Zealand
Dec 10 Dec 11 Dec 12 Dec 10 Dec 11 Dec 12
Transferrin Saturation - HaemodialysisDecember 2008-2012
<20 20-29 30-39 40T/Sat(%)
5-19
ANZDATA Registry 2013 Report HAEMODIALYSIS _____________________________________________________________________________________
FERRITIN BY TREATING CENTRE
Figures 5.49 - 5.52
These figures show the proportions of patients in each centre with ferritin of 200-500 mcg/L and transferrin saturation of >20% respectively, as recommended by the CARI guidelines.
In Australia, the proportions of patients with ferritin within this range in each centre varied widely between 3-72% for haemodialysis patients. Similarly large variations between centres were seen for transferrin saturation, between 30-86%. This large variation probably reflects differences in practices, protocols and patient case-mix among centres.
In New Zealand, the corresponding figures for ferritin were between 23-49% for haemodialysis patients and the corresponding figures for transferrin saturation were between 48-71%. In both countries, significant proportions of patients did not have ferritin and transferrin saturation within the recommended ranges, even in the “best performing” centres.
Figure 5.51
Excludes hospitals with <10 patients0
10
20
30
40
50
60
70
80
90
100
Per
cent
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70
Caring Hospital
Australia 31 December 2012
% Haemodialysis Patients with TSat >20%
Figure 5.52
Excludes hospitals with <10 patients0
10
20
30
40
50
60
70
80
90
100
Per
cent
0 1 2 3 4 5 6 7 8 9 10
Caring Hospital
New Zealand 31 December 2012
% Haemodialysis Patients with TSat >20%
Figure 5.49
Excludes hospitals with <10 patients010
20
30
4050
60
70
8090
100
Per
cent
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70
Caring Hospital
Australia 31 December 2012
% Haemodialysis Patientswith Ferritin 200-500 g/L
Figure 5.50
Excludes hospitals with <10 patients010
20
30
4050
60
70
8090
100
Per
cent
0 1 2 3 4 5 6 7 8 9 10
Caring Hospital
New Zealand 31 December 2012
% Haemodialysis Patientswith Ferritin 200-500 g/L
5-20
HAEMODIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
SERUM CALCIUM
Figure 5.53
In Australia the proportions of patients with serum calcium ≥ 2.4 mmol/L is stable. In New Zealand it has decreased from 40% in December 2011 to 40% in December 2012. The proportion with calcium < 2.2 mmol/L has increased from 35% in December 2010 to 37% and 36% respectively in 2011 and 2012 in Australia.
Figures 5.54 and 5.55 show the proportions of patients at each centre with serum calcium 2.1-2.4 mmol/L, as recommended by the CARI guidelines. NB the values in the guidelines are for corrected total calcium, while those in this report are for uncorrected total calcium.
In Australia, the proportions ranged widely between 39-81% for haemodialysis patients, while in New Zealand the corresponding proportions were 47-72%.
SERUM CALCIUM BY TREATING CENTRE
Figure 5.53
8
27
42
184
9
28
41
184
8
28
42
184
618
37
28
11
617
36
30
12
618
37
27
13
Per
cent
Australia New Zealand
Dec 10 Dec 11 Dec 12 Dec 10 Dec 11 Dec 12
Serum Calcium - HaemodialysisDecember 2008-2012
<2.0 2.0-2.1 2.2-2.3 2.4-2.5 2.6Calcium(mmol/L)
Figure 5.55
Excludes hospitals with <10 patients010
20
30
4050
60
70
8090
100
Per
cent
0 1 2 3 4 5 6 7 8 9 10
Caring Hospital
New Zealand 31 December 2012
% Haemodialysis Patients withCalcium 2.1-2.4 mmol/L
Figure 5.54
Excludes hospitals with <10 patients010
20
30
4050
60
70
8090
100
Per
cent
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70
Caring Hospital
Australia 31 December 2012
% Haemodialysis Patientswith Calcium 2.1-2.4 mmol/L
5-21
ANZDATA Registry 2013 Report HAEMODIALYSIS _____________________________________________________________________________________
SERUM PHOSPHATE
Figure 5.56
In Australia, the control of serum phosphate has stabilised after a period of steady improvements. In New Zealand as well, the proportion with serum phosphate > 1.8 mmol/L has largely remained stable.
SERUM PHOSPHATE BY TREATING CENTRE
Figures 5.57 - 5.58 show the proportions of patients at each centre with serum phosphate 0.8-1.6 mmol/L, as recommended by the CARI guidelines.
In Australia, the proportions ranged widely between 27-75% for haemodialysis patients and in
New Zealand, the corresponding proportions were 29-54%.
Figure 5.56
38
16
14
32
36
17
13
33
37
17
14
32
23
15
15
47
25
15
13
47
24
13
14
48
Per
cent
Australia New Zealand
Dec 10 Dec 11 Dec 12 Dec 10 Dec 11 Dec 12
Serum Phosphate - HaemodialysisDecember 2008-2012
<1.4 1.4-1.5 1.6-1.7 1.8Phosphate (mmol/L)
Figure 5.57
Excludes hospitals with <10 patients010
20
30
4050
60
70
8090
100
Per
cent
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70
Caring Hospital
Australia 31 December 2012
% Haemodialysis Patients withPhosphate 0.8-1.6 mmol/L
Figure 5.58
Excludes hospitals with <10 patients010
20
30
4050
60
70
8090
100
Per
cent
0 1 2 3 4 5 6 7 8 9 10
Caring Hospital
New Zealand 31 December 2012
% Haemodialysis Patients withPhosphate 0.8-1.6 mmol/L
5-22
HAEMODIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
CALCIUM-PHOSPHATE PRODUCT
Figure 5.59
In both Australia and New Zealand, improvements in the calcium-phosphate product seen over the last few years have plateaued.
Overall, the proportion of people with high calcium-phosphate product was substantially higher in New Zealand than Australia.
Figures 5.60 - 5.61 show the proportions of patients at each centre with calcium-phosphate product <4.0 mmol2/L2, as recommended by the CARI guidelines.
In Australia, the proportions ranged widely between 32-87% for haemodialysis patients while in New Zealand, the corresponding proportions were 36-64%.
Figure 5.60
Excludes hospitals with <10 patients010
20
30
4050
60
70
8090
100
Per
cent
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70
Caring Hospital
Australia 31 December 2012
% Haemodialysis Patients withCa X PO4 < 4.0 mmol
2/L
2
Figure 5.59
51
16
128
13
51
15
119
14
51
16
128
13
32
17
15
12
24
33
15
13
12
27
33
14
15
12
26
Pe
rce
nt
Australia New Zealand
Dec 10 Dec 11 Dec 12 Dec 10 Dec 11 Dec 12
Calcium Phosphate Product - HaemodialysisDecember 2008-2012
<3.5 3.5-3.9 4.0-4.4 4.5-4.9 5.0Ca X PO 4 (mmol2/L
2)
Figure 5.61
Excludes hospitals with <10 patients010
20
30
4050
60
70
8090
100
Per
cent
0 1 2 3 4 5 6 7 8 9 10
Caring Hospital
New Zealand 31 December 2012
% Haemodialysis Patients withCa X PO4 < 4.0 mmol
2/L
2
5-23
ANZDATA Registry 2013 Report HAEMODIALYSIS _____________________________________________________________________________________
UREA REDUCTION RATIO
Figures 5.62-5.64
Distributions of URR values have shown an increase in those in higher URR groups the past three years. About 10% and 27% of patients on haemodialysis three times a week have URR <65% in Australia and New Zealand respectively.
URR is highest in patients dialysing with an AV graft and lowest in those using catheters (Figure 5.63). Of those with URR < 65%, 14% in Australia and 23% in New Zealand had CVC access.
Figure 5.64
Urea Reduction Ratio - Prevalent Patients Three Sessions per Week - December 2012
Hours per Session Urea Reduction Ratio %
< 65 >=65 Total
Australia
<4 hours 37 (13.6%) 236 (86.4%) 273
4 hours 275 (9.6%) 2603 (90.4%) 2878
>4-5 hours 326 (8.6%) 3486 (91.4%) 3812
>5 hours 18 (6.6%) 255 (93.4%) 273
Total 656 (9.1%) 6580 (90.9%) 7236
New Zealand
<4 hours 10 (41.7%) 14 (58.3%) 24
4 hours 111 (28.9%) 273 (71.1%) 384
>4-5 hours 199 (26.7%) 547 (73.3%) 746
>5 hours 15 (19.7%) 61 (80.3%) 76
Total 335 (27.2%) 895 (72.8%) 1230
Figure 5.63
3510
23
28
31
245
18
30
42
912
15
21
20
22
1015
18
19
16
23
612
24
24
18
14
17
21
16
19
12
15P
erc
en
t
Australia New Zealand
AVF AVG CVC AVF AVG CVC
HD Three Sessions per Week - December
Urea Reduction RatioRelated to Type of Access
<60 60-64 65-69 70-74 75-79 80-100URR (%)
Figure 5.62
3511
24
28
28
3511
24
27
30
4611
23
27
30
15
15
19
22
15
14
12
13
19
22
15
19
11
16
18
19
16
20
Per
cent
Australia New Zealand
Dec 10 Dec 11 Dec 12 Dec 10 Dec 11 Dec 12
HD Three Sessions per Week
Urea Reduction Ratio
<60 60-64 65-69 70-74 75-79 80-100URR (%)
5-24
HAEMODIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
UREA REDUCTION RATIO BY TREATING CENTRE
Figures 5.65 and 5.66 show the median URR in each hospital and Figures 5.67 and 5.68 show the proportions of haemodial-ysis patients dialysing three times per week in each hospital with URR > 70%, the target recommended by the CARI guide-lines.
Median URR values in the respective countries did not vary greatly: 70-88% in Australia and 66-84% in New Zealand. How-ever, the proportions with URR >70% in each unit varied widely, from 44-100% in Australia and 34-90% in New Zealand.
Figure 5.65
Excludes hospitals with <10 patients50
60
70
80
90
100
Me
dia
n U
RR
(%)
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70
Caring Hospital
Australia 31 December 2012
Median URR in Haemodialysis Patients(Three Sessions per Week)
Figure 5.67
Excludes hospitals with <10 patients010
20
30
4050
60
70
8090
100
Per
cent
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70
Caring Hospital
Australia 31 December 2012
% Haemodialysis Patients with URR>70%(Three Sessions per Week)
Figure 5.66
Excludes hospitals with <10 patients50
60
70
80
90
100M
edia
n U
RR
(%)
0 1 2 3 4 5 6 7 8
Caring Hospital
New Zealand 31 December 2012
Median URR in Haemodialysis Patients(Three Sessions per Week)
Figure 5.68
Excludes hospitals with <10 patients010
20
30
4050
60
70
8090
100
Per
cent
0 1 2 3 4 5 6 7 8
Caring Hospital
New Zealand 31 December 2012
% Haemodialysis Patients with URR>70%(Three Sessions per Week)
5-25
ANZDATA Registry 2013 Report HAEMODIALYSIS _____________________________________________________________________________________
VASCULAR ACCESS AT FIRST TREATMENT
Figures 5.69 to 5.78
The proportion of patients starting haemodialysis with an AVF has continued to rise in both Australia and New Zealand although the majority of patients still commence with a catheter.
In Australia, tunnelled catheters were more common than non-tunnelled, but the reverse was true in New Zealand. Overall, in New Zealand the use of non-tunnelled catheter has decreased to 35% in 2012 from 45% in 2010.
Female, young (age <25years) patients and those patients who were first seen by nephrologists < 3 months before starting haemodialysis (“late referrals”) were less likely to start with an AVF or AVG.
In both Australian and New Zealand indigenous peoples had similar or decreased rates of AVF or AVG at the commencement of dialysis.
ANZDATA does not collect information about indication for HD catheter usage, hence the reason less than half of non-late referred patients commence with a central venous catheter is not known.
Figure 5.69
37
2
39
22
41
2
38
18
38
2
42
17
43
2
43
12
42
2
39
18
22
1
33
44
29
2
29
41
23
2
30
45
29
1
29
41
33
1
31
35
Pe
rcen
t
Australia New Zealand
2008 2009 2010 2011 2012 2008 2009 2010 2011 2012
Vascular Access - Initial RRTHaemodialysis at Initial Modality
AVF AVG Tunnel Catheter Non-Tunnel Catheter
Figure 5.70
162
60
22
39
2
41
18
47
1
36
16
37
2
40
21
29
0
24
47
29
1
33
37
37
1
29
33
28
3
34
34
Pe
rcen
t
Australia New Zealand
<25 25-54 55-74 >=75 <25 25-54 55-74 >=75
Vascular Access - Initial RRTBy Age Group 2012
AVF AVG Tunnel Catheter Non-Tunnel Catheter
Figure 5.71
38
2
39
21
43
2
37
18
38
3
43
16
44
2
43
12
42
2
40
17
36
3
39
23
40
3
39
18
38
2
42
18
43
2
43
12
42
1
38
19
Per
cent
Non Diabetic Diabetic
2008 2009 2010 2011 2012 2008 2009 2010 2011 2012
Vascular Access - Initial RRTBy Diabetic Status - Australia
AVF AVG Tunnel Catheter Non-Tunnel Catheter
Figure 5.72
162
38
44
30
3
27
39
26
1
28
45
29
1
28
43
35
3
29
33
26
0
29
45
28
1
30
41
21
3
31
45
30
1
30
40
32
0
31
37
Per
cent
Non Diabetic Diabetic
2008 2009 2010 2011 2012 2008 2009 2010 2011 2012
Vascular Access - Initial RRTBy Diabetic Status - New Zealand
AVF AVG Tunnel Catheter Non-Tunnel Catheter
5-26
HAEMODIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
VASCULAR ACCESS AT FIRST TREATMENT
Figure 5.73
33
4
42
21
38
3
41
18
35
3
44
19
40
2
47
11
39
1
41
18
39
1
37
22
43
2
36
19
40
2
42
17
46
1
40
13
43
2
37
18
Per
cent
Female Male
2008 2009 2010 2011 2012 2008 2009 2010 2011 2012
Vascular Access - Initial RRTBy Gender - Australia
AVF AVG Tunnel Catheter Non-Tunnel Catheter
Figure 5.74
211
33
45
26
5
34
35
193
31
47
26
1
27
47
28
1
34
38
23
1
33
44
31
0
25
44
26
1
30
43
31
0
30
38
36
1
29
34
Per
cent
Female Male
2008 2009 2010 2011 2012 2008 2009 2010 2011 2012
Vascular Access - Initial RRTBy Gender - New Zealand
AVF AVG Tunnel Catheter Non-Tunnel Catheter
Figure 5.75
47
3
35
15
51
3
32
14
49
3
37
11
53
2
36
9
53
2
33
12
100
50
40
120
55
32
81
58
33
141
64
21
122
54
33
Per
cent
Early Late
2008 2009 2010 2011 2012 2008 2009 2010 2011 2012
Vascular Access - Initial RRTBy Referral Time - Australia
AVF AVG Tunnel Catheter Non-Tunnel Catheter
Figure 5.76
30
1
34
35
36
3
29
32
30
3
30
37
39
1
26
34
42
2
30
26
31
29
67
40
29
67
00
30
70
30
37
60
30
31
66
Per
cent
Early Late
2008 2009 2010 2011 2012 2008 2009 2010 2011 2012
Vascular Access - Initial RRTBy Referral Time - New Zealand
AVF AVG Tunnel Catheter Non-Tunnel Catheter
Figure 5.77
44
2
38
16
39
2
38
21
36
2
41
22
38
3
35
25
32
1
30
37
32
0
28
40
Per
cent
Australia New Zealand
Caucasian ATSI Asian Caucasian Maori Pacific People
Vascular Access - Initial RRTBy Racial Origin - 2012
AVF AVG Tunnel Catheter Non-Tunnel Catheter
Figure 5.78
25
4
55
16
36
2
41
20
43
2
39
16
45
2
36
18
50
0
34
16
33
0
67
0
173
34
45
34
1
30
35
31
027
42
43
1
30
26
Per
cent
Australia New Zealand
Under
weight
Norm
al
Overw
eight
Obese
Mor
bidly
Obese
Under
weight
Norm
al
Overw
eight
Obese
Mor
bidly
Obe
se
Vascular Access - Initial RRTBy BMI - 2012
AVF AVG Tunnel Catheter Non-Tunnel Catheter
5-27
ANZDATA Registry 2013 Report HAEMODIALYSIS _____________________________________________________________________________________
VASCULAR ACCESS AT FIRST TREATMENT
Figure 5.79
Vascular Access at First Treatment Haemodialysis as Initial Modality 1-Jan-2009 to 31-Dec-2012
2009 2010 2011 2012
AVF or AVG CVC AVF or AVG CVC AVF or AVG CVC AVF or AVG CVC
Australia
QLD 152 (41%) 219 (59%) 138 (40%) 208 (60%) 132 (39%) 203 (61%) 141 (45%) 169 (55%)
NSW/ACT 187 (37%) 317 (63%) 201 (37%) 339 (63%) 229 (39%) 358 (61%) 225 (39%) 353 (61%)
Vic 214 (50%) 217 (50%) 201 (45%) 246 (55%) 231 (51%) 225 (49%) 206 (49%) 216 (51%)
Tas 16 (43%) 21 (57%) 19 (61%) 12 (39%) 19 (61%) 12 (39%) 22 (63%) 13 (37%)
SA 89 (61%) 58 (39%) 56 (41%) 82 (59%) 92 (69%) 42 (31%) 70 (49%) 72 (51%)
NT 27 (46%) 32 (54%) 25 (45%) 30 (55%) 38 (49%) 40 (51%) 26 (30%) 60 (70%)
WA 66 (38%) 108 (62%) 55 (32%) 115 (68%) 85 (39%) 131 (61%) 68 (38%) 110 (62%)
New Zealand
111 (31%) 249 (69%) 84 (25%) 251 (75%) 95 (30%) 224 (70%) 113 (34%) 216 (66%)
Figures 5.80 and 5.81 show the proportion of patients in each hospital starting haemodialysis with an AVF/AVG, arranged from the lowest to the highest. In Australia, this ranged widely from 18-77%. The corresponding range in New Zealand was 19-68%. This wide variation reflects differences in practices, protocols, resources and patient case-mix among centres.
Figure 5.81
Excludes hospitals with <10 patients0
10
20
30
40
50
60
70
80
90
100
Per
cent
0 1 2 3 4 5 6 7 8
Caring Hospital
% New HD Patients Starting with AVF/AVGNew Zealand 1 Jan 2012 - 31 Dec 2012
Figure 5.80
Excludes hospitals with <10 patients0
10
20
30
40
50
60
70
80
90
100
Per
cent
0 5 10 15 20 25 30 35 40 45
Caring Hospital
% New HD Patients Starting with AVF/AVGAustralia 1 Jan 2012 - 31 Dec 2012
5-28
HAEMODIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
PREVALENT HAEMODIALYSIS ACCESS
Figures 5.82 - 5.90
These show dialysis access among prevalent (rather than incident) patients (those receiving haemodialysis at 31 December 2012).
In both Australia and New Zealand, the proportions of patients dialysing with an AV graft at 31 December 2012 are declining, while those dialysing with an AV fistulas are stable. The proportions dialysing with catheters have increased in New Zealand more than in Australia in 2012.
Female patients in both countries, young (age < 25 years) in Australia or old (age ≥75 years) patients in New Zealand were less likely to be dialysing with an AVF or AVG.
Figure 5.82
78
9
130
79
8
130
78
7
131
73
5
21
1
73
5
21
1
73
4
20
3
Per
cent
Australia New Zealand
Dec 10 Dec 11 Dec 12 Dec 10 Dec 11 Dec 12
Prevalent Haemodialysis Access
AVF AVG Tunnel Catheter Non-Tunnel Catheter
Figure 5.83
73
2
23
3
79
6132
79
8131
78
8131
76
217
4
73
3
20
4
75
5
182
64
5
29
3
Pe
rce
nt
Australia New Zealand
<25 25-54 55-74 >=75 <25 25-54 55-74 >=75
Prevalent Haemodialysis AccessBy Age Group - December 2012
AVF AVG Tunnel Catheter Non-Tunnel Catheter
5-29
ANZDATA Registry 2013 Report HAEMODIALYSIS _____________________________________________________________________________________
PREVALENT HAEMODIALYSIS ACCESS
Figure 5.84
79
9120
80
8120
79
8121
76
8
160
78
7140
78
7141
Per
cent
Non Diabetic Diabetic
Dec 10 Dec 11 Dec 12 Dec 10 Dec 11 Dec 12
Prevalent Haemodialysis AccessBy Diabetic Status - Australia
AVF AVG Tunnel Catheter Non-Tunnel Catheter
Figure 5.85
75
5
200
75
5
191
74
5
184
71
5
23
2
71
5
22
1
73
4
21
2
Per
cent
Non Diabetic Diabetic
Dec 10 Dec 11 Dec 12 Dec 10 Dec 11 Dec 12
Prevalent Haemodialysis AccessBy Diabetic Status - New Zealand
AVF AVG Tunnel Catheter Non-Tunnel Catheter
Figure 5.86
71
13
160
72
11
160
73
10
151
82
6120
83
6110
82
5111
Per
cent
Female Male
Dec 10 Dec 11 Dec 12 Dec 10 Dec 11 Dec 12
Prevalent Haemodialysis AccessBy Gender - Australia
AVF AVG Tunnel Catheter Non-Tunnel Catheter
Figure 5.87
64
8
27
1
67
7
25
1
66
6
25
3
79
3171
77
4
181
78
3162
Per
cent
Female Male
Dec 10 Dec 11 Dec 12 Dec 10 Dec 11 Dec 12
Prevalent Haemodialysis AccessBy Gender - New Zealand
AVF AVG Tunnel Catheter Non-Tunnel Catheter
Figure 5.88
69
10
192
78
7141
80
7121
81
7111
82
7101
59
4
30
7
62
5
29
4
75
3202
78
4143
80
4132
Per
cent
Australia New Zealand
Under
weight
Norm
al
Overw
eight
Obese
Mor
bidly
Obese
Under
weight
Norm
al
Overw
eight
Obese
Mor
bidly
Obese
Prevalent Haemodialysis AccessBy BMI - 2012
AVF AVG Tunnel Catheter Non-Tunnel Catheter
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HAEMODIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
PREVALENT HAEMODIALYSIS ACCESS
In Australia indigenous people were more likely to be dialysing with an AVF. In New Zealand, Maori and Pacific people were more likely to dialyse with an AVF.
Patients on home haemodialysis have the highest rate of AVF use in both Australia and New Zealand.
Figure 5.89
78
8131
82
3131
76
8
151
72
6
19
3
73
5
19
2
77
2192
Per
cent
Australia New Zealand
Caucasian ATSI Asian Caucasian Maori Pacific People
Prevalent Haemodialysis AccessBy Racial Origin - December 2012
AVF AVG Tunnel Catheter Non-Tunnel Catheter
Figure 5.90
69
6
23
2
80
8111
92
520
61
4
31
4
82
3142
89
641
Per
cent
Australia New Zealand
Hosp HD Sat HD Home HD Hosp HD Sat HD Home HD
Prevalent Haemodialysis AccessBy Location - December 2012
AVF AVG Tunnel Catheter Non-Tunnel Catheter
5-31
ANZDATA Registry 2013 Report HAEMODIALYSIS _____________________________________________________________________________________
Figure 5.91
Prevalent Vascular Access at 31-Dec-2012
Dec 2010 Dec 2011 Dec 2012
AVF or AVG CVC AVF or AVG CVC AVF or AVG CVC
Australia
QLD 1426 (88%) 196 (12%) 1430 (87%) 212 (13%) 1383 (87%) 208 (13%)
NSW/ACT 2391 (85%) 432 (15%) 2492 (86%) 414 (14%) 2418 (85%) 442 (15%)
Vic 1972 (88%) 257 (12%) 2049 (89%) 256 (11%) 2022 (88%) 278 (12%)
Tas 128 (88%) 18 (12%) 134 (85%) 24 (15%) 152 (84%) 29 (16%)
SA 505 (89%) 61 (11%) 555 (93%) 41 (7%) 541 (92%) 46 (8%)
NT 368 (92%) 34 (8%) 393 (90%) 42 (10%) 394 (86%) 65 (14%)
WA 621 (77%) 183 (23%) 674 (78%) 190 (22%) 600 (76%) 187 (24%)
New Zealand
1209 (78%) 346 (22%) 1246 (78%) 347 (22%) 1298 (77%) 378 (23%)
Figures 5.91 - 5.93 show the proportion of haemodialysis patients at each state or hospital dialysing with an AVF/AVG on 31st December, 2012, arranged from the lowest to the highest.
In Australia, the hospital proportions varied widely from 71-100%. The corresponding range in New Zealand was 68-89%. The error bars displayed show the 95% confidence intervals.
PREVALENT HAEMODIALYSIS ACCESS
Figure 5.92
Excludes hospitals with <10 patients0
10
20
30
40
50
60
70
80
90
100
Pe
rce
nt
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70
Caring Hospital
% Prevalent HD Patients Dialysing with AVF/AVGAustralia 31 December 2012
Figure 5.93
Excludes hospitals with <10 patients0
10
20
30
40
50
60
70
80
90
100
Per
cent
0 1 2 3 4 5 6 7 8 9 10
Caring Hospital
% Prevalent HD Patients Dialysing with AVF/AVGNew Zealand 31 December 2012
5-32
HAEMODIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
Figure 5.96
38 39
28
39
3134
31
36 37
54
0
20
40
60
Per
cent
age
Obe
se
QLD NSW ACT VIC TAS SA NT WA AUS NZ
Obesity in Incident Haemodialysis PatientsBy State and Country - 2012
OBESITY AMONG INCIDENT HAEMODIALYSIS PATIENTS
Figures 5.94 - 5.99 show the proportions of incident haemodialysis patients with obesity and morbid obesity. In both Australia and New Zealand obesity rates have been increasing over the last ten years. The proportion of morbidly obese patients starting haemodialysis has doubled from 2003 to 2012 in Australia and increased by approximately 63% in New Zealand.
As might be expected, patients with diabetes are more likely to be obese or morbidly obese compared with those without diabetes (Figures 5.99 - 5.100).
Obesity for these analysis is defined as a BMI>30kg/m². Morbid obesity is defined as ≥35kg/m²
Figure 5.94
2326
29 30 32 34 3235 37 37 39
4447 47 46 45
49 50 5154
0
20
40
60
Per
cent
age
Obe
se
Australia New Zealand
03 04 05 06 07 08 09 10 11 12 03 04 05 06 07 08 09 10 11 12
Obesity in Incident Haemodialysis PatientsBy Year
Figure 5.95
911 12 12
15 16 15 16 1719 19
2123
26 25 24
28
32
28
31
0
10
20
30
Pe
rcen
tage
Mor
bid
ly O
bese
Australia New Zealand
03 04 05 06 07 08 09 10 11 12 03 04 05 06 07 08 09 10 11 12
Morbid Obesity in Incident Haemodialysis PatientsBy Year
5-33
ANZDATA Registry 2013 Report HAEMODIALYSIS _____________________________________________________________________________________
Figure 5.97
19 19
12
21
26
16
13
22
19
31
0
10
20
30
Per
cent
age
Mor
bidl
y O
bese
QLD NSW ACT VIC TAS SA NT WA AUS NZ
Morbid Obesity in Incident Haemodialysis PatientsBy State and Country - 2012
10
17
26
1823
39
0
10
20
30
40
Per
cent
age
Mor
bidl
y O
bese
Australia New Zealand
Non-D
iabet
ic
Diabet
es C
o-m
orbid
Diabet
ic Nep
hrop
athy
Non-D
iabet
ic
Diabet
es C
o-m
orbid
Diabet
ic Nep
hrop
athy
Morbid Obesity in Incident Haemodialysis PatientsBy Diabetes - 2012
Figure 5.99
Figure 5.98
26
40
50
39 42
64
0
20
40
60
Pe
rce
nta
ge
Ob
ese
Australia New Zealand
Non-D
iabet
ic
Diabet
es C
o-m
orbid
Diabet
ic Nep
hrop
athy
Non-D
iabet
ic
Diabet
es C
o-m
orbid
Diabet
ic Nep
hrop
athy
Obesity in Incident Haemodialysis PatientsBy Diabetes - 2012
5-34
HAEMODIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
Figure 5.101
78 8
9 910
1112 12
13
19 1920 20
21 2122
2324
25
0
5
10
15
20
25
Per
cent
age
Mor
bidl
y O
bese
Australia New Zealand
03 04 05 06 07 08 09 10 11 12 03 04 05 06 07 08 09 10 11 12
Morbid Obesity in Prevalent Haemodialysis PatientsBy Year
Figures 5.100 - 5.105 show the proportion of prevalent haemodialysis patients with obesity and morbid obesity. In both Australia and New Zealand prevalent obesity rates have been increasing over the last ten years. In Australia the proportion of morbidly obese patients treated with haemodialysis has nearly doubled from 2003 to 2012.
Patients with diabetes are more likely to be obese or morbidly obese compared to those without diabetes (Figures 5.104 and 5.105).
OBESITY AMONG PREVALENT HAEMODIALYSIS PATIENTS
Figure 5.100
19 20 2123 24
26 2628 29 30
39 40 3941 42 42
44 45 4547
0
10
20
30
40
50
Per
cent
age
Obe
se
Australia New Zealand
03 04 05 06 07 08 09 10 11 12 03 04 05 06 07 08 09 10 11 12
Obesity in Prevalent Haemodialysis PatientsBy Year
5-35
ANZDATA Registry 2013 Report HAEMODIALYSIS _____________________________________________________________________________________
Figure 5.105
3.98.2
118.9
17
26
0
5
10
15
20
25
Pe
rcen
tage
Mo
rbid
ly O
bese
Australia New Zealand
Non-D
iabet
ic
Diabet
es C
o-m
orbid
Diabet
ic Nep
hrop
athy
Non-D
iabet
ic
Diabet
es C
o-m
orbid
Diabet
ic Nep
hrop
athy
Morbid Obesity in Prevalent Haemodialysis PatientsBy Diabetes - 2012
Figure 5.102
30 31
23
29
3432
23
3230
47
0
10
20
30
40
50
Per
cent
age
Obe
se
QLD NSW ACT VIC TAS SA NT WA AUS NZ
Obesity in Prevalent Haemodialysis PatientsBy State and Country - 2012
Figure 5.104
17
3037
30
42
58
0
20
40
60
Per
cent
age
Obe
se
Australia New Zealand
Non-D
iabet
ic
Diabet
es C
o-m
orbid
Diabet
ic Nep
hrop
athy
Non-D
iabet
ic
Diabet
es C
o-m
orbid
Diabet
ic Nep
hrop
athy
Obesity in Prevalent Haemodialysis PatientsBy Diabetes - 2012
1314
9
1213
14
8
1413
25
0
5
10
15
20
25
Per
cent
age
Mor
bidl
y O
bese
QLD NSW ACT VIC TAS SA NT WA AUS NZ
Morbid Obesity in Prevalent Haemodialysis PatientsBy State and Country - 2012
Figure 5.103
5-36
HAEMODIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
Home Haemodialysis
The proportion of all prevalent dialysis patients who were using home HD in each State was 12% for New South Wales / ACT, 11.5% Queensland, 7.4% Victoria, 6.6% the Northern Territory, 7% Tasmania, 4.8% Western Australia and 3% for South Australia.
The distribution of patients receiving home haemodialysis by state is shown in Figure 5.106. As can be appreciated, numbers are greatest in New South Wales and in New Zealand, with substantial numbers also in Victoria and Queensland.
These proportions were lower among older people (Figure 5.108).
Considerable further discussion is contained in chapter 4 .
Figure 5.106
240
477
206
15 22 3355
469
0
100
200
300
400
500
Num
ber
QLD NSW/ACT VIC TAS SA NT WA NZ
at 31-Dec-2012
Home HD Numbers by State
5-37
ANZDATA Registry 2013 Report HAEMODIALYSIS _____________________________________________________________________________________
The distribution of prevalent home dialysis patients by age group is shown in Figure 5.107.
1
21
53
18
7
2
23
51
19
6
2
20
52
23
3
60
20
20
5
45
41
9
9
85
6
15
62
20
4
3
24
55
14
4
0
20
40
60
80
100
Per
cent
QLD NSW/ACT VIC TAS SA NT WA NZ
at 31-Dec-2012
Home HD by Age Group
<2525-4445-64
65-74>=75
Figure 5.107
Figure 5.108
Proportion (%) of Prevalent Patients aged ≥ 65 years Treated with Home Haemodialysis 2008 - 2012
State 2008 2009 2010 2011 2012
Australia 243 (4.4%) 254 (4.3%) 276 (4.5%) 298 (4.7%) 349 (5.3%)
Queensland 37 (4.1%) 37 (4.0%) 41 (4.2%) 47 (4.9%) 60 (6.1%)
New South Wales/ACT 97 (5.4%) 100 (5.3%) 102 (5.2%) 109 (5.4%) 117 (5.5%)
Victoria 44 (3.5%) 43 (3.3%) 47 (3.4%) 47 (3.2%) 54 (3.5%)
Tasmania 2 (2.7%) 2 (2.4%) 4 (4.3%) 4 (4.0%) 6 (5.4%)
South Australia 0 (0.0%) 0 (0.0%) 3 (0.8%) 4 (1.0%) 11 (2.7%)
Northern Territory 1 (2.0%) 1 (2.3%) 1 (1.9%) 1 (1.7%) 2 (2.9%)
Western Australia 4 (0.9%) 5 (1.1%) 8 (1.7%) 9 (1.8%) 13 (2.5%)
New Zealand 58 (8.2%) 66 (8.6%) 70 (8.5%) 77 (9.3%) 86 (10.1%)
5-38
HAEMODIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
The trend in numbers treated with home HD for different age groups are illustrated for Australia and New Zealand in the Figure 5.109 and 5.110. The Y axes for individual graphs vary – the absolute numbers in the age groups 25 to 64 years are substantially greater than among older patients. However, there has been strong growth in the older age groups in the last few years.
1520253035
200
220
240
260
300
400
500
600
80100120140160
0
20
40
60
1990 1995 2000 2005 2010
1990 1995 2000 2005 2010 1990 1995 2000 2005 2010
<25 25-44 45-64
65-74 >=75Num
ber
Year
Australia
Home HD Numbers by Age at 31-Dec
Figure 5.109
Figure 5.110
5
10
15
60
80
100
120
50100150
200250
20
40
60
0
5
10
15
1990 1995 2000 2005 2010
1990 1995 2000 2005 2010 1990 1995 2000 2005 2010
<25 25-44 45-64
65-74 >=75Num
ber
Year
New Zealand
Home HD Numbers by Age at 31-Dec
5-39
ANZDATA Registry 2013 Report HAEMODIALYSIS _____________________________________________________________________________________
Technique failure The following three figures explore the concept of technique failure as applied to home haemodialysis. Each treatment episode can end in a variety of ways. Changes to another dialysis modality (either institutional haemodialysis or peritoneal dialysis) are considered a “failure”, as is death. Follow-up is censored at transplantation, or 31 Dec 2012.
Figure 5.112
0.00
0.25
0.50
0.75
1.00
0 2 4 6 8 10
Years
<2525-4445-6465-74
>=75
Age at RRT start
Censored at transplantationAustralia and New Zealand combined
Home Haemodialysis 2002 - 2012
Technique Failure
Figure 5.111
0.00
0.25
0.50
0.75
1.00
0 2 4 6 8 10
Years
AustraliaNew Zealand
Censored at transplantation
Home Haemodialysis 2002 - 2012
Technique Failure
5-40
HAEMODIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
When death of patient is counted as a censoring event (rather than “failure”), the differences between the age groups become less apparent (Figure 5.113). It can be seen that (among those alive and not transplanted) over 75% of home haemodialysis patients continue in this therapy after 2 years. However, as time passes there is a progressive difference which emerges with higher technique failure rates among the older patients.
Figure 5.113
0.00
0.25
0.50
0.75
1.00
0 2 4 6 8 10
Years
<2525-4445-64
65-74>=75
Age at RRT start
Censored at transplantation and death
Home Haemodialysis 2002 - 2012Australia
Death-censored Technique Failure
0.00
0.25
0.50
0.75
1.00
0 2 4 6 8 10
Years
<2525-4445-64
65-74>=75
Age at RRT start
Censored at transplantation and death
Home Haemodialysis 2002 - 2012New Zealand
Death-censored Technique Failure
Figure 5.114
5-41
ANZDATA Registry 2013 Report HAEMODIALYSIS _____________________________________________________________________________________
Definitions in use CARI guidelines Caring for Australasians with Renal Impairment guidelines
Quotidian HD > 3 sessions/week and/or > 5.5 hours/session
Long Hour HD ≥ 6.5 hours per HD session
High Flux Dialyser Ultrafiltration coefficient (kuf) >20 ml/hr/mmHg as specified by the manufacturer)
AVF Native vein arteriovenous fistula
AVG Synthetic arteriovenous bridge graft
CVC Central venous HD catheter (Includes both tunnelled and non-tunnelled unless otherwise stated)
Obese BMI ≥ 30
Morbid Obesity BMI ≥ 35
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HAEMODIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
This page is intentionally blank
Neil Boudville
Hannah Dent
Stephen McDonald
Kylie Hurst
Philip Clayton
CHAPTER 6
PERITONEAL DIALYSIS
2013 Annual Report - 36th Edition
6-2
PERITONEAL DIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
STOCK AND FLOW
AUSTRALIA
Peritoneal dialysis was used to treat 19% of all dialysis patients in 2012 (APD-1374, CAPD-853, total 11446). PD accounted for 44% of all home dialysis, a figure which has remained stable for several years (Figure 6.1). Of the 2,227 patients on peritoneal dialysis at December 2012, 185 (8%)had experienced at least five years of continuous peritoneal dialysis (Figure 6.2).
The proportion of all home dialysis patients on peritoneal dialysis in each State ranged from 12% (Tasmania) to 72% (Western Australia) (Figure 6.1).
The annual stock and flow of patients during the period 2008-2012 is shown in Figures 6.3 and 6.4.
There were 977 new peritoneal dialysis patients in the calendar year 2012; of these 658 patients (67%) started renal replacement therapy with peritoneal dialysis and 319 (33%) had previously been treated with haemodialysis or a transplant (Figure 6.3).
Numbers of new patients over the age of 65 years increased 24%, from 330 to 410 in 2012, following a increase of 8% in 2011 (Figure 6.8). Most age groups increased with the
exception of the 0-14, 15-24 and 45-54 year age groups which decreased slightly.
The proportion of people with diabetic nephropathy has been stable over the last 5 years.
The proportion of patients in each age group treated with peritoneal dialysis ranged from 0% (≥ 85 years) to 28% (55-64 years).
There were 244 deaths in 2012 compared with 278 in 2011.
For more detail see Appendix II at our website (www.anzdata.org.au/v1/report_2013.html).
The prevalence of automated peritoneal dialysis is stable (61%) (Figure 6.10)
There were 210 peritoneal dialysis patients who received a transplant in 2012 compared with 211 in 2011; this was 9% of all patients treated (Figure 6.3).
Permanent transfers to haemodialysis fell in 2012 (to 450 patients (20%) from 477 patients (23%) in 2011. (Figure 6.3).
Figure 6.1
Proportion (%) Peritoneal Dialysis of all
Home Dialysis Patients 2008 - 2012
State 2008 2009 2010 2012 2011
Queensland 52% 50% 48% 41% 44%
New South Wales 44% 42% 40% 42% 40%
Australian Capital Territory 41% 35% 30% 37% 27%
Victoria 47% 44% 42% 42% 40%
Tasmania 36% 35% 32% 12% 24%
South Australia 80% 69% 44% 35% 46%
Northern Territory 37% 33% 44% 38% 38%
Western Australia 82% 78% 73% 72% 73%
Australia 50% 47% 45% 44% 44%
New Zealand 59% 55% 53% 46% 50%
0
100
200
300
Nu
mb
er
of
Patie
nts
0 1 2 3 4 5 6 7 8 9 10
Years on PD
Prevalent PD patients Australia 31 Dec 2012
Time on Peritoneal Dialysis
0
20
40
60
80
Nu
mb
er
of
Patie
nts
0 1 2 3 4 5 6 7 8 9 10
Years on PD
Prevalent PD patients New Zealand 31 Dec 2012
Time on Peritoneal DialysisFigure 6.2a Figure 6.2b
6-3
ANZDATA Registry 2013 Report PERITONEAL DIALYSIS _____________________________________________________________________________________
Figure 6.3
Stock and Flow of Peritoneal Dialysis Patients
2008 - 2012
State 2008 2009 2010 2011 2012
Australia
Patients new to PD 997 894 758 830 977
First Dialysis Treatment 657 589 501 549 658
Previous Dialysis (HD) 329 290 250 273 304
Previous Transplant 11 15 7 8 15
Transplanted 177 160 189 211 210
Deaths 321 334 290 278 244
Never Transplanted 305 322 286 271 237
Previously Transplant 16 12 4 7 7
Transfer to Haemodialysis 526 561 506 477 450
Patients Dialysing (PD) at 31 December 2,242 2,202 2,091 2,074 2,227
New Zealand
Patients new to PD 274 284 275 242 263
First Dialysis Treatment 153 200 163 151 164
Previous Dialysis (HD) 120 82 112 91 95
Previous Transplant 1 2 0 0 4
Transplanted 28 38 45 39 43
Deaths 128 130 117 146 132
Never Transplanted 121 127 111 140 129
Previously Transplant 7 3 6 6 3
Transfer to Haemodialysis 140 134 129 137 138
Patients Dialysing (PD) at 31 December 763 800 832 792 772
These figures are calculated differently to previous years. For example, previous transplant is transplant before PD, and previous HD is HD immediately before PD. Death not include death while on PD and within 30 days of transferring to HD. Transfer to HD is defined
as use of HD > 30 days.
Figure 6.4
2227 Patients
0
500
1000
1500
2000
2500
2008 2009 2010 2011 2012
New Patients
Transplants
Transfer to HD
Deaths
No. dialysing
Stock and Flow of Peritoneal Dialysis PatientsAustralia 2008-2012
Figure 6.5
0
200
400
600
800
1000
2008 2009 2010 2011 2012
New Patients
Transplants
Transfer to HD
Deaths
No. dialysing
Stock and Flow of Peritoneal Dialysis PatientsNew Zealand 2008-2012
6-4
PERITONEAL DIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
Figure 6.8 Australia
Stock and Flow of Peritoneal Dialysis by Age Groups 2008 - 2012
Age Groups 2008 2009 2010 2011 2012
New Patients *
00-14 years 14 (1%) 25 (3%) 20 (3%) 22 (3%) 20 (2%)
15-24 years 30 (3%) 23 (3%) 16 (2%) 26 (3%) 25 (3%)
25-34 years 53 (5%) 55 (6%) 42 (6%) 42 (5%) 58 (6%)
35-44 years 93 (9%) 76 (9%) 79 (10%) 86 (10%) 115 (12%)
45-54 years 170 (17%) 121 (14%) 130 (17%) 150 (18%) 137 (14%)
55-64 years 217 (22%) 195 (22%) 165 (22%) 174 (21%) 211 (22%)
65-74 years 225 (23%) 225 (25%) 182 (24%) 178 (21%) 237 (24%)
75-84 years 181 (18%) 151 (17%) 113 (15%) 136 (16%) 154 (16%)
>=85 years 14 (1%) 23 (3%) 11 (1%) 16 (2%) 19 (2%)
Total 997 894 758 830 976
Patients Dialysing
00-14 years 28 (1%) 32 (1%) 27 (1%) 25 (1%) 29 (1%)
15-24 years 44 (2%) 52 (2%) 40 (2%) 44 (2%) 35 (2%)
25-34 years 84 (4%) 93 (4%) 91 (4%) 91 (4%) 95 (4%)
35-44 years 177 (8%) 171 (8%) 174 (8%) 178 (9%) 202 (9%)
45-54 years 359 (16%) 327 (15%) 292 (14%) 307 (15%) 325 (15%)
55-64 years 492 (22%) 467 (21%) 456 (22%) 439 (21%) 477 (21%)
65-74 years 556 (25%) 571 (26%) 536 (26%) 511 (25%) 545 (24%)
75-84 years 437 (19%) 420 (19%) 409 (20%) 416 (20%) 453 (20%)
>=85 years 65 (3%) 69 (3%) 66 (3%) 63 (3%) 66 (3%)
Total 2,242 2,202 2,091 2,074 2,227
Primary Renal Disease *
Glomerulonephritis 260 (26%) 252 (28%) 200 (26%) 223 (27%) 244 (25%)
Analgesic Nephropathy 28 (3%) 13 (1%) 13 (2%) 9 (1%) 10 (1%)
Hypertension 118 (12%) 148 (17%) 97 (13%) 112 (13%) 105 (11%)
Polycystic Disease 67 (7%) 55 (6%) 53 (7%) 45 (5%) 51 (5%)
Reflux Nephropathy 40 (4%) 39 (4%) 22 (3%) 23 (3%) 35 (4%)
Diabetic Nephropathy 328 (33%) 266 (30%) 251 (33%) 272 (33%) 309 (32%)
Miscellaneous 80 (8%) 81 (9%) 84 (11%) 95 (11%) 152 (16%)
Uncertain 76 (8%) 40 (4%) 38 (5%) 51 (6%) 70 (7%)
Total 997 894 758 830 976
* New patients receiving first peritoneal dialysis treatment
Figure 6.6
2.0 2.6
5.9
11.8
14.0
21.6
24.3
15.8
1.9
Number of Patients=976
0
5
10
15
20
25
Pe
rce
nt
0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Australia 2012
Age (%) of New Peritoneal Dialysis Patients
Figure 6.7
1.3 1.6
4.3
9.1
14.6
21.4
24.5
20.3
3.0
Number of Patients=2227
0
5
10
15
20
25
Pe
rce
nt
0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Australia 2012
Age (%) of Current Peritoneal Dialysis Patients
6-5
ANZDATA Registry 2013 Report PERITONEAL DIALYSIS _____________________________________________________________________________________
Figure 6.9
73
25 2522 20 19 20 18
11
Number of PD Patients=2227
0
10
20
30
40
50
60
70
80
Pe
rce
nt
0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Australia 2012
PD Patients (%) of All Prevalent Dialysis
Figure 6.10 Australia
Number (per Million) of Prevalent PD Patients, Australia 2008-2012
2008 2009 2010 2011 2012
APD/CAPD
APD 1,271 ( 59.44) 1,313 ( 60.30) 1,279 ( 57.97) 1,283 (57.48) 1,374 (60.82)
CAPD 971 ( 45.41) 889 ( 40.82) 812 ( 36.80) 791 (35.44) 853 (37.76)
Location
Home 2,206 (103.17) 2,178 (100.02) 2,075 ( 94.05) 2,050 (91.84) 2,184 (96.68)
Satellite 0 0 0 1 ( 0.04) 1 ( 0.04)
Hospital 36 ( 1.68) 24 ( 1.10) 16 ( 0.73) 23 ( 1.03) 42 ( 1.86)
Total 2,242 (104.86) 2,202 (101.12) 2,091 (94.78) 2,074 (92.92) 2,227 (98.58)
6-6
PERITONEAL DIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
NEW ZEALAND
Peritoneal dialysis accounted for 31% of all dialysis patients and 98% of all patients dialysing at home.
A substantially lower proportion of patients used automated PD than in Australia. Forty seven percent of all peritoneal dialysis in 2012 was APD compared with 44% in 2011 and 43% in 2009.
The annual stock and flow of patients during the period 2008 to 2012 is shown in Figures 6.3 and 6.5. Of the 772 patients on peritoneal dialysis at December 2012, 82 (10%) had more than five years continuous treatment (Figure 6.2b).
Primary renal disease of new peritoneal dialysis patients is shown in Figure 6.12, and the age distribution of prevalent peritoneal dialysis patients is shown in Figures 6.14 and 6.15.
The most common primary renal disease of new patients to peritoneal dialysis was diabetic nephropathy (45%), a increase of 1% from 2011, followed by glomerulonephritis (22%) and hypertension (8%).
The proportion of patients in each age group treated with peritoneal dialysis ranged from 67% (0-14 years) and 24% (≥85 years) (Figure 6.11).
There were 132 deaths amongst prevalent peritoneal dialysis patients in 2012 compared with 146 in 2011. (Figure 6.3).
For more detail see Appendix III at our website (www.anzdata.org.au/v1/report_2013.html).
There were 43 patients transplanted in 2012 (39 in 2011).
Figure 6.11
67
2926 26 27
31
3833
24
Number of PD Patients=772
0
10
20
30
40
50
60
70
80
Pe
rce
nt
0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
New Zealand 2012
PD Patients (%) of All Prevalent Dialysis
Figure 6.12
Number (per Million) of Prevalent PD Patients
New Zealand 2008-2012
2008 2009 2010 2011 2012
APD / CAPD
APD 288 (67.47) 337 (78.09) 359 (82.19) 350 (79.45) 366 (82.56)
CAPD 475 (111.27) 463 (107.28) 473 (108.29) 442 (100.34) 406 (91.58)
Location
Home 758 (177.56) 796 (184.44) 828 (189.57) 788 (178.88) 758 (170.99)
Hospital 5 (1.17) 4 (0.93) 4 (0.92) 4 (0.91) 14 (3.16)
Total 763 (178.74) 800 (185.37) 832 (190.48) 792 (179.79) 772 (174.14)
6-7
ANZDATA Registry 2013 Report PERITONEAL DIALYSIS _____________________________________________________________________________________
Figure 6.15 New Zealand
Stock and Flow of Peritoneal Dialysis by Age Groups 2008 - 2012
Age Groups 2008 2009 2010 2011 2012
New Patients *
00-14 years 10 (4%) 3 (1%) 3 (1%) 5 (2%) 6 (2%)
15-24 years 13 (5%) 4 (1%) 8 (3%) 4 (2%) 11 (4%)
25-34 years 11 (4%) 9 (3%) 9 (3%) 12 (5%) 10 (4%)
35-44 years 18 (7%) 28 (10%) 21 (8%) 21 (9%) 25 (10%)
45-54 years 58 (21%) 60 (21%) 41 (15%) 38 (16%) 60 (23%)
55-64 years 77 (28%) 63 (22%) 88 (32%) 72 (30%) 73 (28%)
65-74 years 65 (24%) 83 (29%) 70 (25%) 66 (27%) 63 (24%)
75-84 years 22 (8%) 33 (12%) 35 (13%) 23 (10%) 14 (5%)
>=85 years 0 (0%) 1 (0%) 0 (0%) 1 (0%) 1 (0%)
Total 274 284 275 242 263
Patients Dialysing
00-14 years 13 (2%) 10 (1%) 7 (1%) 9 (1%) 4 (1%)
15-24 years 27 (4%) 26 (3%) 22 (3%) 22 (3%) 17 (2%)
25-34 years 30 (4%) 32 (4%) 29 (3%) 27 (3%) 33 (4%)
35-44 years 58 (8%) 62 (8%) 61 (7%) 58 (7%) 60 (8%)
45-54 years 140 (18%) 149 (19%) 132 (16%) 113 (14%) 122 (16%)
55-64 years 210 (28%) 205 (26%) 240 (29%) 231 (29%) 216 (28%)
65-74 years 183 (24%) 222 (28%) 226 (27%) 223 (28%) 226 (29%)
75-84 years 85 (11%) 83 (10%) 109 (13%) 103 (13%) 88 (11%)
>=85 years 17 (2%) 11 (1%) 6 (1%) 6 (1%) 6 (1%)
Total 763 800 832 792 772
Primary Renal Disease *
Glomerulonephritis 65 (24%) 57 (20%) 65 (24%) 55 (23%) 59 (22%)
Analgesic Nephropathy 2 (1%) 0 (0%) 3 (1%) 3 (1%) 3 (1%)
Hypertension 35 (13%) 33 (12%) 36 (13%) 29 (12%) 22 (8%)
Polycystic Disease 12 (4%) 18 (6%) 7 (3%) 11 (5%) 13 (5%)
Reflux Nephropathy 4 (1%) 5 (2%) 3 (1%) 4 (2%) 7 (3%)
Diabetic Nephropathy 115 (42%) 128 (45%) 134 (49%) 106 (44%) 118 (45%)
Miscellaneous 27 (10%) 31 (11%) 20 (7%) 23 (10%) 32 (12%)
Uncertain 14 (5%) 12 (4%) 7 (3%) 11 (5%) 9 (3%)
Total 274 284 275 242 263
* New patients receiving first peritoneal dialysis treatment
Figure 6.13
2.34.2 3.8
9.5
22.8
27.8
24.0
5.3
0.4
Number of Patients=263
0
5
10
15
20
25
30
Pe
rce
nt
0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
New Zealand 2012
Age (%) of New Peritoneal Dialysis Patients
Figure 6.14
0.52.2
4.3
7.8
15.8
28.029.3
11.4
0.8
Number of Patients=772
0
5
10
15
20
25
30
Pe
rce
nt
0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
New Zealand 2012
Age (%) of Current Peritoneal Dialysis Patients
6-8
PERITONEAL DIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
PERITONEAL DIALYSIS FLUIDS
At the end of 2012, 34.23% of CAPD and 42.36% of APD patients were receiving Icodextrin in Australia (Figures 6.16 and 6.17). These proportions were lower for CAPD (29.31%) and higher for APD (68.58%) in New Zealand (Figure 6.18). There was also considerable variation between States in Icodextrin usage rates, with the highest rates seen in the South Australia for CAPD and Tasmania for APD (Figure 6.18, 6.19). Low GDP fluids (whether lactate or bicarbonate based fluids) were used infrequently in 2012, consistent with previous years (Figure 6.20 - 6.25). For figures 6.17 to 6.25, percentages are not graphed if fewer than 10 patents.
Figure 6.16
Icodextrin Usage by Modality Type - December 2012
Modality
Type
Australia New Zealand
No Yes NR* Total No Yes NR* Total
546 292 15 853 286 119 1 406 CAPD
n
64.01% 34.23% 1.76% 70.44% 29.31% 0.25% %
APD 768 582 24 1374 113 251 2 366 n
55.90% 42.36% 1.75% 30.87% 68.58% 0.55% %
Total 1314 874 39 2227 399 370 3 772 n
59.00% 39.25% 1.75% 51.68% 47.93% 0.39% %
NR* - Not Reported
Figure 6.17
70
30
66
34
65
35
55
45
55
45
57
43
0
20
40
60
80
100
Pe
rce
nt
CAPD APD
Dec 10 Dec 11 Dec 12 Dec 10 Dec 11 Dec 12
Prevalent Patients December 2010 - 2012Australia
Icodextrin Use by Modality
Yes
No
Icodextrin
Figure 6.18
76
24
73
27
71
29
34
66
31
69
31
69
0
20
40
60
80
100
Pe
rce
nt
CAPD APD
Dec 10 Dec 11 Dec 12 Dec 10 Dec 11 Dec 12
Prevalent Patients December 2010 - 2012New Zealand
Icodextrin Use by Modality
Yes
No
Icodextrin
Figure 6.19
15
85
69
31
70
30
59
41
8
92
72
28
71
29
63
37
68
32
34
66
57
43
56
44
19
81
31
69
0
20
40
60
80
100
Pe
rce
nt
CAPD APD
NT
NS
W/A
CT
VIC
QL
D
SA
WA
TA
S
NZ
NT
NS
W/A
CT
VIC
QL
D
SA
WA
TA
S
NZ
Proportions not presented if <10 patients
Prevalent Patients December 2012
Icodextrin Use by State and New Zealand
Yes
No
Icodextrin
* Percentages are not graphed if fewer than 10 patients. * Percentages are not graphed if fewer than 10 patients.
* Percentages are not graphed if fewer than 10 patients.
6-9
ANZDATA Registry 2013 Report PERITONEAL DIALYSIS _____________________________________________________________________________________
PERITONEAL DIALYSIS FLUIDS
Figure 6.20
Low GDP - Lactate Usage by Modality Type - December 2012
Modality Type
Australia New Zealand
No Yes NR* Total No Yes NR* Total
CAPD 775 63 15 853 405 . 1 406 n
90.86% 7.39% 1.76% 99.75% .% 0.25% %
APD 1303 47 24 1374 355 9 2 366 n
94.83% 3.42% 1.75% 96.99% 2.46% 0.55% %
2078 110 39 2227 760 9 3 772 Total
n
93.31% 4.94% 1.75% 98.45% 1.17% 0.39% %
NR* - Not Reported
96
4
98
2
92
8
97
3
97
3
97
3
0
20
40
60
80
100
Pe
rce
nt
CAPD APD
Dec 10 Dec 11 Dec 12 Dec 10 Dec 11 Dec 12
Prevalent Patients December 2010 - 2012Australia
Low GDP - Lactate Use by Modality
Yes
No
Lactate
100
0
100
0
100
0
97
3
97
3
98
2
0
20
40
60
80
100
Pe
rce
nt
CAPD APD
Dec 10 Dec 11 Dec 12 Dec 10 Dec 11 Dec 12
Prevalent Patients December 2010 - 2012New Zealand
Low GDP - Lactate Use by Modality
Yes
No
Lactate
* Percentages are not graphed if fewer than 10 patients.
* Percentages are not graphed if fewer than 10 patients.
Figure 6.21
Figure 6.22
6-10
PERITONEAL DIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
99
1
95
5
98
2
98
2
97
3
98
2
0
20
40
60
80
100
Pe
rce
nt
CAPD APD
Dec 10 Dec 11 Dec 12 Dec 10 Dec 11 Dec 12
Prevalent Patients December 2010 - 2012Australia
Low GDP - Bicarb Use by Modality
Yes
No
Bicarb
Figure 6.24
98
2
99
1
100
0
98
2
99
1
99
1
0
20
40
60
80
100
Pe
rce
nt
CAPD APD
Dec 10 Dec 11 Dec 12 Dec 10 Dec 11 Dec 12
Prevalent Patients December 2010 - 2012New Zealand
Low GDP - Bicarb Use by Modality
Yes
No
Bicarb
Figure 6.25
Figure 6.23
Low GDP - Bicarb Usage by Modality Type - December 2012
Modality Type
Australia New Zealand
No Yes NR* Total No Yes NR* Total
CAPD 822 15 16 853 404 1 1 406 n
96.37% 1.76% 1.88% 99.51% 0.25% 0.25% %
1328 22 24 1374 362 2 2 366 APD
n
96.65% 1.60% 1.75% 98.91% 0.55% 0.55% %
Total 2150 37 40 2227 766 3 3 772 n
96.54% 1.66% 1.80% 99.22% 0.39% 0.39% %
NR* - Not Reported
PERITONEAL DIALYSIS FLUIDS
* Percentages are not graphed if fewer than 10 patients.
* Percentages are not graphed if fewer than 10 patients.
6-11
ANZDATA Registry 2013 Report PERITONEAL DIALYSIS _____________________________________________________________________________________
Figure 6.26
Peritoneal Dialysis at 90 Days Patient Survival
2001-2012, Censored for Transplant
% [95% Confidence Interval]
Year of Starting
No. of Patients
Survival
6 months 1 year 3 years 5 years
Australia
2001-2003 1923 96 [95, 97] 89 [87, 90] 64 [61, 66] 42 [40, 45]
2004-2006 1968 96 [95, 97] 91 [90, 92] 67 [65, 70] 49 [46, 51]
2005-2009 2094 97 [97, 98] 92 [91, 93] 71 [69, 73] 52 [49, 55]
2010-2012 1950 97 [97, 98] 94 [93, 95] - -
New Zealand
2001-2003 661 96 [95, 98] 87 [84, 89] 58 [54, 62] 37 [33, 41]
2004-2006 635 97 [96, 98] 91 [88, 93] 67 [63, 70] 44 [40, 48]
2005-2009 622 97 [95, 98] 92 [89, 94] 69 [65, 73] 47 [42, 52]
2010-2012 614 97 [96, 98] 92 [90, 94] - -
OUTCOMES AMONG PERITONEAL DIALYSIS PATIENTS
Patient Survival
On univariate analyses, there has been some slight improvement in PD patient survival in Australia at six months and one, three and five years from 2000.
In New Zealand PD patient survival has improved slightly for each cohort.
(Figures 6.26 - 6.28).
Diabetic PD patients had lower patient survival at later time points in both Australia and New Zealand (Figures 6.29 - 6.31).
As expected PD patient survival is closely related to age (Figures 6.32 -6.34).
Figure 6.27
0.00
0.25
0.50
0.75
1.00
0 1 2 3 4 5
Years
2001-2003 (1923)
2004-2006 (1968)
2007-2009 (2094)
2010-2012 (1950)
Patient Survival - PD at 90th Day of RRT2001 - 2012
Censored for Transplant - Australia
Figure 6.28
0.00
0.25
0.50
0.75
1.00
0 1 2 3 4 5
Years
2001-2003 (661)
2004-2006 (635)
2007-2009 (622)
2010-2012 (614)
Patient Survival - PD at 90th Day of RRT2001 - 2012
Censored for Transplant - New Zealand
6-12
PERITONEAL DIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
Figure 6.29
Peritoneal Dialysis at 90 Days
Patient Survival - Diabetic / Non Diabetic
Censored for Transplant Commenced 2001 - 2012
% [95% Confidence Interval]
No. of
Patients
Survival
6 months 1 year 3 years 5 years
Australia
Non Diabetic 4730 97 [97, 98] 93 [92, 94] 74 [72, 75] 55 [53, 57]
Diabetic 3203 96 [95, 96] 89 [88, 90] 61 [59, 63] 39 [37, 41]
New Zealand
Non Diabetic 1301 97 [96, 98] 92 [90, 93] 70 [67, 73] 52 [48, 55]
Diabetic 1231 97 [96, 98] 89 [87, 91] 59 [56, 62] 34 [31, 38]
Diabetic patients are those with diabetes as a comorbidity. Previous reports categorised diabetics as those with diabetic nephropathy
Figure 6.30
0.00
0.25
0.50
0.75
1.00
0 1 2 3 4 5
Years
Non-Diabetic (4730)
Diabetic (3203)
Patient Survival - PD at 90th Day of RRT2001 - 2012
Censored for Transplant - Australia
Figure 6.31
0.00
0.25
0.50
0.75
1.00
0 1 2 3 4 5
Years
Non-Diabetic (1301)
Diabetic (1231)
Patient Survival - PD at 90th Day of RRT2001 - 2012
Censored for Transplant - New Zealand
6-13
ANZDATA Registry 2013 Report PERITONEAL DIALYSIS _____________________________________________________________________________________
Figure 6.32
Peritoneal Dialysis at 90 Days
Patient Survival - By Age Group
Censored for Transplant 2001 - 2012
% [95% Confidence Interval]
Age Groups
Survival No. of
Patients 6 months 1 year 3 years 5 years
Australia
0-14 183 99 [96, 100] 98 [93, 99] 91 [79, 97] 91 [79, 97]
15-34 605 99 [98, 100] 98 [97, 99] 93 [89, 95] 86 [80, 90]
35-54 2041 98 [97, 99] 96 [95, 97] 83 [81, 85] 68 [65, 71]
55-64 1694 98 [97, 98] 93 [92, 95] 72 [69, 74] 54 [51, 57]
65-74 2021 96 [95, 96] 88 [86, 89] 62 [60, 64] 38 [36, 41]
>= 75 1391 94 [92, 95] 84 [82, 86] 49 [46, 52] 27 [24, 29]
New Zealand
0-14 58 96 [87, 99] 96 [87, 99] 89 [71, 96] 89 [71, 96]
15-34 163 99 [96, 100] 97 [93, 99] 91 [83, 95] 82 [72, 89]
35-54 671 97 [96, 98] 94 [92, 96] 72 [68, 76] 52 [47, 57]
55-64 708 98 [96, 99] 92 [90, 94] 66 [62, 70] 45 [41, 50]
65-74 674 97 [95, 98] 86 [83, 89] 57 [53, 61] 31 [27, 35]
>= 75 258 93 [89, 95] 83 [77, 87] 46 [40, 52] 24 [18, 30]
Figure 6.34
0.00
0.25
0.50
0.75
1.00
0 1 2 3 4 5
Years
0-14 (58)
15-34 (163)
35-54 (671)
55-64 (708)
65-74 (674)
75 (258)
Patient Survival - PD at 90th Day of RRT2001 - 2012
Censored for Transplant - New Zealand
Figure 6.33
0.00
0.25
0.50
0.75
1.00
0 1 2 3 4 5
Years
0-14 (183)
15-34 (605)
35-54 (2041)
55-64 (1694)
65-74 (2021)
75 (1391)
Patient Survival - PD at 90th Day of RRT2001 - 2012
Censored for Transplant - Australia
6-14
PERITONEAL DIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
PERITONEAL DIALYSIS TECHNIQUE SURVIVAL
Figure 6.35
Peritoneal Dialysis at 90 Days
Technique Survival - Diabetic / Non Diabetic
Censored for Transplant Commenced 2000- 2011
% [95% Confidence Interval]
Survival No. of
Patients 6 months 1 year 3 years 5 years
Australia
Non Diabetic 85 [84, 86] 73 [72, 74] 39 [37, 40] 19 [18, 21] 5130
Diabetic 82 [81, 83] 70 [68, 71] 30 [28, 31] 11 [10, 13] 3501
New Zealand
Non Diabetic 89 [87, 91] 79 [77, 81] 45 [41, 48] 23 [20, 26] 1378
Diabetic 89 [87, 90] 76 [74, 79] 36 [33, 39] 14 [12, 16] 1311
Figure 6.36
0.00
0.25
0.50
0.75
1.00
0 1 2 3 4 5
Years
Non-Diabetic (N=5130)
Diabetic (N=3501)
Technique Survival - PD at 90th Day of RRT2001 - 2012
Censored for Transplant - Australia
Figure 6.37
0.00
0.25
0.50
0.75
1.00
0 1 2 3 4 5
Years
Non-Diabetic (N=1378)
Diabetic (N=1311)
Technique Survival - PD at 90th Day of RRT2001 - 2012
Censored for Transplant - New Zealand
Methods
Survivals are calculated using the Kaplan-Meier technique. Patients are followed from the 90th day after first treatment for those on peritoneal dialysis at that time point and not transplanted during those first 90 days.
For patient survival patients are censored at first transplant and at most recent follow up regardless of dialysis modality changes.
For technique survival, failure is defined as a change from peritoneal dialysis to haemodialysis or death.
Figures 6.35-6.41 show Technical survival for patients receiving peritoneal dialysis. In those analysed, patients are censored at the time of transplantation.
6-15
ANZDATA Registry 2013 Report PERITONEAL DIALYSIS _____________________________________________________________________________________
Figure 6.38
Peritoneal Dialysis at 90 Days
Technique Survival - By Age Group
Censored for Transplant 2001 - 2012
% [95% Confidence Interval]
Age Groups Survival
No. of Patients 6 months 1 year 3 years 5 years
Australia
2001-2003 2076 83 [81, 85] 70 [68, 72] 32 [30, 34] 13 [12, 15]
2004-2006 2138 84 [82, 85] 71 [69, 73] 33 [31, 35] 15 [13, 17]
2007-2009 2296 84 [82, 85] 72 [70, 74] 36 [34, 38] 18 [16, 20]
2010-2012 2123 85 [84, 87] 75 [73, 77] - -
New Zealand
2001-2003 690 89 [87, 92] 77 [73, 80] 37 [33, 40] 15 [12, 18]
2004-2006 685 88 [85, 90] 76 [73, 79] 41 [37, 45] 19 [16, 22]
2007-2009 665 89 [86, 91] 79 [75, 82] 42 [38, 46] 21 [17, 25]
2010-2012 649 89 [86, 91] 80 [76, 83] - -
Figure 6.39
0.00
0.25
0.50
0.75
1.00
0 1 2 3 4 5
Years
0-14 (N=200)
15-34 (N=656)
35-54 (N=2186)
55-64 (N=1815)
65-74 (N=2213)
75
Age
Technique Survival - PD at 90th Day of RRT2001 - 2012
Censored for Transplant - Australia
Figure 6.40
0.00
0.25
0.50
0.75
1.00
0 1 2 3 4 5
Years
0-14 (N=64)
15-34 (N=180)
35-54 (N=708)
55-64 (N=730)
65-74 (N=725)
75 (N=282)
Age
Technique Survival - PD at 90th Day of RRT2001 - 2012
Censored for Transplant - New Zealand
6-16
PERITONEAL DIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
TECHNIQUE FAILURE
(EXCLUDING DEATH OR TRANSPLANTATION)
Technique failure is analysed here as a change from peritoneal dialysis to haemodialysis and was still treated by haemodialysis at 30 days after the transfer date. In Australia, the most common primary cause of technique failure was due to infective causes (generally acute Peritonitis), rather than a technical cause or patient preference.
This accounted for 30% of transfers during 2012 (Figure 6.41).
Technical failures (primarily dialysate leak) were the second most common cause, followed by dialysis failure (generally inadequate solute clearance).
In New Zealand, the most common primary cause of technique failure was also due to infective causes, which accounted for 34% of transfers during 2011/2012 and technical failure of 22% (Figure 6.45). It is recognised that these are broad categories, and there are likely to be multiple contributors (medical and social) in many individual cases.
Figure 6.41
Causes of Technique Failure 1-Jan-2012 to 31-Dec-2012
Excluding Death, Transplantation, Recovery of Renal Function
Causes of Technique Failure Australia New Zealand
Abdominal Abscess 4 2
Acute Peritonitis 81 26
Diverticulitis 2
Recurrent/Persistent Peritonitis 52 18
Tunnel/Exit Site Infection 10 6
Unspecified Peritoneal Infection 6
Total Infective Causes 155 (30%) 52 (34%)
Catheter Migrated 4
Evacuation Of Hematoma 1
Inadequate Fluid Ultrafiltration 26 16
Inadequate Solute Clearance 48 16
Total Dialysis Failure 79 (15%) 32 (21%)
Abdominal Pain 4 1
Cardiovascular Instability 2 1
Catheter Block 17 2
Catheter Fell Out 1 1
Dialysate Leak 34 5
Hernia 25 5
Hydrothorax 3
Multiple Adhesions 2
Pleural Effusion 4
Sclerosing Peritonitis 1 3
Scrotal Oedema 6 1
Surgery 24 12
Total Technical Failure 121 (23%) 33 (22%)
Geography-Poor Access Dialysis Service 1
Patient Preference 25 6
Unable To Manage Self-Care 36 7
Total Patient Preference 63 (12%) 13 (9%)
Acute Pancreatitis 1
Bronchiectesis 1
Calciphylaxis 2
Failure To Thrive 2
Planned Transfer After Acute PD Start 2 1
Poor Nutrition 2
Total Other 10 (2%) 1 (1%)
Total Not Reported 90 (17%) 20 (13%)
NB Figures relate to 2012 only. Previous data reflected a 2 year period.
6-17
ANZDATA Registry 2013 Report PERITONEAL DIALYSIS _____________________________________________________________________________________
PERITONITIS
Australian median time to first peritonitis was 24 months, with 37% of patients completely free of peritonitis at three years. In New Zealand the time was 21 months (32% of patients free of peritonitis at three years), (Figure 6.42). As noted in previous reports there is a strong association between ethnicity and peritonitis free survival (Figure 6.45).
The median peritonitis-free survival for home automated peritoneal dialysis patients was 32 months in Australia, and 33.7 months in New Zealand. Peritonitis rates in patients treated with APD and CAPD are very similar. This was explored in detail in a recent ANZDATA publication: Lan PG, Johnson DW, McDonald SP, Boudville N, Borlace M, Badve SV, et al. The Association between Peritoneal Dialysis Modality and Peritonitis. Clin J Am Soc Nephrol. 2014 Mar 13.
Figure 6.42
First PD Treatment to First Episode of Peritonitis
By Age at First PD 01-Jan-2008 to 31-Dec-2012
Survival Age Groups
All
00-14 15-34 35-54 55-64 65-74 >=75
Australia (n=101) (n=376) (n=1187) (n=987) (n=1049) (n=756) (n=4456)
3 months 79 [69,85] 88 [84,91] 87 [85,89] 88 [85,90] 90 [88,92] 88 [85,90] 88 [87,89]
6 months 68 [57,76] 80 [76,84] 80 [77,82] 81 [78,83] 84 [81,86] 82 [79,85] 81 [80,82]
9 months 60 [48,70] 73 [68,78] 74 [71,77] 73 [70,76] 77 [74,80] 76 [72,79] 74 [73,76]
1 year 54 [41,65] 68 [62,73] 67 [64,70] 68 [64,71] 72 [69,75] 68 [64,72] 69 [67,70]
2 years 36 [20,52] 50 [42,57] 50 [46,54] 47 [43,51] 54 [50,58] 50 [45,55] 50 [48,52]
3 years 24 [6,47] 35 [26,44] 37 [32,42] 35 [30,40] 38 [33,43] 38 [33,44] 37 [34,39]
New Zealand (n=27) (n=93) (n=379) (n=378) (n=350) (n=111) (n=1338)
3 months 80 [58,91] 92 [84,96] 89 [86,92] 87 [83,90] 85 [81,89] 86 [77,91] 87 [85,89]
6 months 52 [29,70] 83 [73,89] 78 [74,82] 78 [74,82] 77 [72,81] 80 [71,87] 78 [75,80]
9 months 52 [29,70] 72 [60,81] 71 [66,76] 72 [66,76] 70 [65,75] 74 [64,82] 71 [68,73]
1 year 45 [23,65] 68 [56,78] 62 [56,67] 64 [58,69] 63 [57,68] 67 [56,76] 63 [60,66]
2 years 45 [23,65] 40 [24,55] 44 [38,50] 48 [42,55] 44 [37,50] 51 [38,62] 45 [42,49]
3 years - 25 [9,45] 29 [22,37] 38 [30,45] 28 [21,36] 41 [28,55] 32 [28,36]
% Survival [95% Confidence Interval]
Figure 6.43
0.00
0.25
0.50
0.75
1.00
0m 3m 6m 9m 12m/1yr 15m 18m 21m 2yr
Analysis Time
00-14 (101)
15-34 (376)
35-54 (1187)
55-64 (987)
65-74 (1049)
75 (756)
First PD Treatment to First PeritonitisRelated to Age at First PD
2008- 2012 Australia
Figure 6.44
0.00
0.25
0.50
0.75
1.00
0m 3m 6m 9m 12m/1yr 15m 18m 21m 2yr
Analysis Time
00-14 (27)
15-34 (93)
35-54 (379)
55-64 (378)
65-74 (350)
75 (111)
First PD Treatment to First PeritonitisRelated to Age at First PD2008 - 2012 New Zealand
6-18
PERITONEAL DIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
0.00
0.25
0.50
0.75
1.00
0m 3m 6m 9m 12m/1yr 15m 18m 21m 2yr
Analysis Time
Asian 35-54 (165)
Caucasian 35-54 (776)
Indigenous 35-54 (222)
Asian 55-64 (138)
Caucasian 55-64 (685)
Indigenous 55-64 (142)
First PD Treatment to First PeritonitisRelated to Race and Age at First PD
2008 - 2012 Australia
Figure 6.45
0.00
0.25
0.50
0.75
1.00
0m 3m 6m 9m 12m/1yr 15m 18m 21m 2yr
Analysis Time
Asian 35-54 (145)
Caucasian 35-54 (748)
Indigenous 35-54 (210)
Asian 55-64 (90)
Caucasian 55-64 (689)
Indigenous 55-64 (133)
First PD Treatment to First PeritonitisRelated to Race and Age at First PD
2003 - 2007 Australia
Figure 6.46
0.00
0.25
0.50
0.75
1.00
0m 3m 6m 9m 12m/1yr 15m 18m 21m 2yr
Analysis Time
Asian 35-54 (33)
Caucasian 35-54 (140)
Indigenous 35-54 (205)
Asian 55-64 (45)
Caucasian 55-64 (142)
Indigenous 55-64 (186)
First PD Treatment to First PeritonitisRelated to Race and Age at First PD
2008 - 2012 New Zealand
0.00
0.25
0.50
0.75
1.00
0m 3m 6m 9m 12m/1yr 15m 18m 21m 2yr
Analysis Time
Asian 35-54 (28)
Caucasian 35-54 (139)
Indigenous 35-54 (182)
Asian 55-64 (21)
Caucasian 55-64 (122)
Indigenous 55-64 (203)
First PD Treatment to First PeritonitisRelated to Race and Age at First PD
2003 - 2007 New Zealand
6-19
ANZDATA Registry 2013 Report PERITONEAL DIALYSIS _____________________________________________________________________________________
Figure 6.47
First Home APD Treatment to First Episode of Peritonitis
By Age at Entry 01-Jan-2008 to 31-Dec-2012
Survival Age Groups
All 00-14 15-34 35-54 55-64 65-74 >=75
Australia (n=97) (n=297) (n=860) (n=651) (n=689) (n=474) (n=3068)
3 months 83 [73, 89] 90 [86, 93] 90 [88, 92] 91 [88, 93] 93 [90, 94] 92 [89, 94] 91 [90, 92]
6 months 74 [63, 82] 84 [79, 88] 84 [82, 87] 85 [82, 88] 87 [84, 89] 88 [84, 90] 85 [84, 86]
9 months 69 [57, 78] 78 [72, 83] 79 [76, 82] 80 [76, 83] 81 [78, 84] 78 [74, 82] 79 [77, 81]
1 year 64 [51, 75] 72 [65, 78] 73 [69, 76] 75 [71, 79] 78 [74, 81] 75 [70, 79] 74 [72, 76]
2 years 44 [25, 62] 53 [43, 62] 59 [54, 64] 57 [52, 63] 61 [55, 66] 58 [51, 64] 58 [55, 60]
3 years 44 [25, 62] 37 [26, 48] 43 [37, 50] 53 [47, 59] 48 [41, 54] 46 [38, 55] 47 [43, 50]
New Zealand (n=26) (n=71) (n=259) (n=203) (n=173) (n=48) (n=780)
3 months 88 [67, 96] 88 [77, 94] 89 [84, 92] 95 [91, 97] 92 [86, 95] 98 [85, 100] 92 [89, 93]
6 months 59 [36, 76] 84 [73, 91] 83 [78, 87] 89 [83, 93] 79 [71, 85] 95 [82, 99] 84 [81, 86]
9 months 52 [29, 71] 68 [54, 79] 78 [72, 83] 83 [76, 88] 73 [64, 80] 81 [64, 90] 77 [73, 80]
1 year 52 [29, 71] 66 [51, 77] 72 [65, 78] 75 [67, 81] 68 [59, 75] 71 [53, 84] 71 [67, 74]
2 years 52 [29, 71] 41 [24, 57] 61 [52, 68] 63 [54, 71] 56 [45, 65] 37 [15, 59] 57 [52, 62]
3 years 52 [29, 71] 34 [17, 52] 49 [37, 61] 56 [45, 66] 47 [34, 58] - 48 [42, 54]
% Survival [95% Confidence Interval]
0.00
0.25
0.50
0.75
1.00
0m 3m 6m 9m 12m/1yr 15m 18m 21m 2yr
Analysis Time
00-14 (97)
15-34 (297)
35-54 (860)
55-64 (651)
65-74 (689)
75 (474)
First Home APD Treatment to First PeritonitisRelated to Age at First Home APD
2008 - 2012 Australia
0.00
0.25
0.50
0.75
1.00
0m 3m 6m 9m 12m/1yr 15m 18m 21m 2yr
Analysis Time
00-14 (26)
15-34 (71)
35-54 (259)
55-64 (203)
65-74 (173)
75 (48)
First Home APD Treatment to First PeritonitisRelated to Age at First Home APD
2008 - 2012 New Zealand
Figure 6.48
6-20
PERITONEAL DIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
AUSTRALIAN PERITONITIS REGISTRY
1-OCT-2003 TO 31-DEC-2012
This section contains details of the organism and treatment for episodes of peritonitis within Australia collected by ANZDATA. A more detailed collection of data about peritonitis was started in late 2003. Similar information for patients in New Zealand is collected separately by the New Zealand Peritonitis Registry (reported separately).
During 2012, the number of episodes of peritonitis has followed a continuing trend downwards, similar to previous years (shown in Figure 6.49). This is reflected in the overall rates per person-year (figure 6.50). Figure 6.51 shows the rates for each state of Australia. Although the absolute rates vary between states, the overall trend towards lower rates can be seen in most states.
Figure 6.51
Figure 6.50
0.63
0.580.57
0.60
0.62
0.58
0.53
0.43
0.38
24
20
18
Patient-
month
s p
er
epis
ode
0.50
0.60
0.70
Epis
odes p
er
patient-
year
2003/4 2005 2006 2007 2008 2009 2010 2011 2012
Number of Episodes per Patient Year andPatient Months per Episode 2004 – 2012
24
60
12
24
60
12
0.20
0.50
1.00
0.20
0.50
1.00
20
03
/420
05
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/420
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/420
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/420
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11
20
12
NT NSW/ACT Vic Qld
SA WA Tas
Epis
od
es p
er
patie
nt-
ye
ar
Graphs by Current state
Number of Episodes per Patient Year andPatient Months per Episode 2004 – 2012
Figure 6.49
Number of Peritonitis Episodes
Year Number
2003 (from Oct 250
2004 1,196
2005 1,072
2006 1,116
2007 1,254
2008 1,369
2009 1,345
2010 1,138
2011 927
2012 893
Total 9,647
6-21
ANZDATA Registry 2013 Report PERITONEAL DIALYSIS _____________________________________________________________________________________
There remains quite widespread variation in the major organisms reported between the different states in Australia (Figure 6.53). We do not collect data about variation in prophylaxis, patient selection processes, PD training or other factors that might account for part or all of this variation.
There has been a gradual trend over this time towards a lower proportion of episodes attributable to gram negative organisms and non-MRSA S. aureus, with a decrease in 2012 of culture negative episodes (Figure 6.52). The Registry does not collect data on use of prior antibiotics or laboratory techniques that might influence the rate of culture negative peritonitis.
Figure 6.53
0
20
40
60
80
100
Pe
rce
nt
NT
NS
W/A
CT
Vic
Qld
SA
WA
Tas
Episodes during 2012
Peritonitis in Australia
Culture negative
Coag neg Staph
MRSA
Staph aureus, non MRSA
Other Gram Pos
Gram negative org
Anaerobes
Fungi
Mycobacteria
Other
No culture taken
0
.2
.4
.6
.8
1
Pro
po
rtio
n
2003
/04
2005
2006
2007
2008
2009
2010
2011
2012
Distribution of Organisms Causing Peritonitis
Culture Negative
Coag neg Staph
MRSA
Staph aureus, nonMRSA
other Gram Pos
Gram negative org
Anaerobes
Fungi
Mycobacteria
Other
Figure 6.52
6-22
PERITONEAL DIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
ANTIBIOTIC TREATMENT
The proportion of episodes which were treated with an aminoglycoside-containing initial regimen has increased slightly over the period 2006-2009 but declined in 2010-2012. Similarly, the proportion treated with a regimen containing vancomycin is slowly increasing, but declined in 2010 and 2012 (Figure 6.54).
Among episodes of peritonitis treated during 2012, the proportion of those who received vancomycin in the initial or second antibiotic regimen is shown in Figure 6.55.
Figure 6.55
17%
32%
11%
40%
No No No Yes
Yes No Yes Yes
Vanc / gent
First regimen
40%
18%
37%
6%
No No No Yes
Yes No Yes Yes
Vanc / gent
Second regimen
49%
16%
30%
4%
No No No Yes
Yes No Yes Yes
Vanc / gent
Third regimen
0
.2
.4
.6
.8
Pro
po
rtio
n o
f in
itia
l a
ntib
iotic r
eg
ime
ns
2003/42005 2006 2007 2008 2009 2010 2011 2012
Vancomycin
Aminoglycoside
Initial antibiotic regimen
Figure 6.54
6-23
ANZDATA Registry 2013 Report PERITONEAL DIALYSIS _____________________________________________________________________________________
OUTCOMES
There is a strong relationship between the type of organism and the proportion of transfer to permanent haemodialysis. After fungal, mycobacterial or gram negative peritonitis, there is a considerably higher proportion of permanent transfers to HD than with other, more common, causes of peritonitis.
RATES OF PERITONITIS ACROSS INDIVIDUAL UNITS
Figure 6.57 shows the peritonitis rates for all units in Australia over the period 1st October, 2003 to 31st December 2012. Only units who averaged at least ten patient-years of peritonitis treatment per year over that period are included. There is substantial variation in the rates between units; this has been a pattern seen for a number of years.
Figure 6.56
Figure 6.57
24
12
6
4
Pa
tie
nt-
mo
nth
s p
er
ep
iso
de
.5
1
1.5
2
2.5
3
Ep
iso
de
s p
er
pa
tie
nt-
ye
ar
Confidence intervals not shown where upper limit >3Units with <10 person-years PD over 2003-12 not shown
All peritonitis episodes 2003-12
Peritonitis rates by treating unit
158
173
16
97
134
161
1
20
2
30
2
Culture negative
Coag neg Staph
MRSA
Staph aureus, non MRSA
Other Gram Pos
Gram negative org
Anaerobes
Fungi
Mycobacteria
Other
No culture taken
0 .2 .4 .6 .8 1
Proportion
Primary organism
14
309
139
217
36
94
18
NT
NSW/ACT
Vic
Qld
SA
WA
Tas
0 .1 .2 .3 .4 .5
Proportion
Treating state
Values are total number of peritonitis episodes reported in 2012
Proportion of Episodes Resulting inPermanent Haemodialysis Transfer
6-24
PERITONEAL DIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
Figure 6.58
24
12
6
4
Patient-
month
s p
er
epis
ode
.5
1
1.5
2
2.5
3
Epis
odes p
er
patient-
year
Confidence intervals not shown where upper limit >3Units with <5 person-years PD over 2012 not shown
2012 only
Peritonitis rates by treating unit
As demonstrated in Figure 6.62 there remains over a threefold variation in peritonitis rates between units. There are a number of individual characteristics which predict the occurrence of peritonitis, including older age, diabetes, cigarette smoking (but not centre size) and Aboriginal racial origin. These are covered in greater detail in a manuscript in Peritoneal Dialysis International (Ghali et al Perit Dial Inter 2011: 31(6):651-62). Similarly, there remains considerable variation between units (Figure 6.62), and between States (Figure 6.63).
Figure 6.59
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0.57
1.02
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36
24
12
8
Patient-
month
s p
er
epis
ode
0.33
0.50
1.00
1.50
Epis
odes p
er
patient-
year
NT NSW/ACT Vic Qld SA WA Tas
All episodes of peritonitis 1/10/03 to 31/12/12
Rates of peritonitis by state
6-25
ANZDATA Registry 2013 Report PERITONEAL DIALYSIS _____________________________________________________________________________________
HAEMOGLOBIN
In Australia, at the end of 2012, haemoglobin was <110 g/L in 43% between 110-119 g/L in 28% of PD patients, the same as in 2012, and >140 g/L in 4%, which is similar to previous years.
In New Zealand, the corresponding percentages were very similar - 44%, 29% and 4% respectively.
Figure 6.61 shows the Haemoglobin levels in PD patients with proven or likely coronary artery disease .
Figure 6.60
38
29
19
95
43
27
18
74
43
28
17
84
39
29
20
94
44
27
19
83
44
29
17
64
Perc
ent
Australia New Zealand
2010 2011 2012 2010 2011 2012
Haemoglobin - Peritoneal DialysisDecember 2010-2012
<110 110-119 120-129 130-139 140Hb(g/L)
Figure 6.61
40
27
19
95
44
27
18
75
41
27
18
95
36
31
18
105
42
28
17
84
46
28
1664
Perc
ent
No CAD CAD
2010 2011 2012 2010 2011 2012
Australia, December 2010-2012
Haemoglobin - Peritoneal DialysisBy Coronary Artery Disease Status
<110 110-119 120-129 130-139 140Hb(g/L)
37
32
20
83
43
27
20
82
45
29
1664
42
25
19
94
44
26
17
85
42
29
18
65
Perc
ent
No CAD CAD
2010 2011 2012 2010 2011 2012
New Zealand, December 2010-2012
Haemoglobin - Peritoneal DialysisBy Coronary Artery Disease Status
<110 110-119 120-129 130-139 140Hb(g/L)
6-26
PERITONEAL DIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
Figures 6.62 - 6.65:
These figures show the median haemoglobin (with inter-quartile range) for individual centres, arranged from lowest to high-est (Figures 6.66 and 6.67). Also shown are the proportion of patients in each centre with a haemoglobin of 110-129 g/L (Figures 6.68 and 6.69).
In Australia, median haemoglobin for each centre ranged from 104 to 124 g/L for peritoneal dialysis patients and in New Zealand 104 -118 g/L.
The proportion of patients in Australia with a haemoglobin of 110-129 g/L in each centre ranged from 21% to 76% for peri-toneal dialysis patients and for New Zealand 29% to 63%. This large variation is likely to reflect differences in practices, protocols and patient case-mix among centres.
HAEMOGLOBIN IN PERITONEAL DIALYSIS PATIENTS
BY TREATING CENTRE
Figure 6.62
Excludes hospitals with <10 patients70
80
90
100
110
120
130
140
Me
dia
n H
b (
g/L
)
1 5 10 15 20 25 30 35 40 45
Caring Hospital
Australia 31 December 2012
Haemoglobin in Peritoneal Dialysis Patients
Figure 6.63
Excludes hospitals with <10 patients70
80
90
100
110
120
130
140
Me
dia
n H
b (
g/L
)
1 2 3 4 5 6 7 8 9 10 11
Caring Hospital
New Zealand 31 December 2012
Haemoglobin in Peritoneal Dialysis Patients
Figure 6.64
Excludes hospitals with <10 patients0
10
20
30
40
50
60
70
80
90
100
Pe
rce
nt
1 5 10 15 20 25 30 35 40 45
Caring Hospital
Australia 31 December 2012
% Peritoneal Dialysis Patientswith Hb 110-129 g/L
Figure 6.65
Excludes hospitals with <10 patients0
10
20
30
40
50
60
70
80
90
100
Pe
rce
nt
1 2 3 4 5 6 7 8 9 10 11
Caring Hospital
New Zealand 31 December 2012
% Peritoneal Dialysis Patientswith Hb 110-129 g/L
6-27
ANZDATA Registry 2013 Report PERITONEAL DIALYSIS _____________________________________________________________________________________
FERRITIN AND TRANSFERRIN SATURATION
Overall there are no remarkable trends in this area.
In both Australia and New Zealand, distributions of ferritin, transferrin saturation have remained stable for the past three years.
Figure 6.66
18
20
36
15
11
18
19
38
15
10
19
21
37
14
9
13
18
42
15
12
12
22
39
16
10
16
21
39
14
9
Perc
ent
Australia New Zealand
2010 2011 2012 2010 2011 2012
Ferritin - Peritoneal DialysisDecember 2010-2012
<100 100-199 200-499 500-799 800g/L
Figure 6.67
33
39
19
9
30
43
17
10
32
42
17
9
28
42
19
11
30
41
19
10
29
46
17
8
Perc
ent
Australia New Zealand
2010 2011 2012 2010 2011 2012
Transferrin Saturation - Peritoneal DialysisDecember 2010-2012
<20 20-29 30-39 40T/Sat(%)
6-28
PERITONEAL DIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
FERRITIN BY TREATING CENTRE
The proportions of patients in each centre with ferritin between 200-500 mcg/L and transferrin saturation of >20% respective-ly, as recommended by the CARI guidelines, are shown in Figures 6.68-6.71.
In Australia, the proportions of patients with ferritin within this range in each centre varied widely between 8-61% for peritoneal dialysis patients. Similarly large variations between centres were seen for transferrin saturation, between 31-85%. Again, this large variation may reflect differences in practices, protocols and patient case-mix among centres.
In New Zealand, the corresponding figures for ferritin were between 24-48% for peritoneal dialysis patients and for transferrin saturation between 40-84%. In both countries, significant proportions of patients did not have ferritin and transferrin saturation within the recommended ranges.
Figure 6.69
Excludes hospitals with <10 patients0
10
20
30
40
50
60
70
80
90
100
Pe
rce
nt
1 2 3 4 5 6 7 8 9 10 11
Caring Hospital
New Zealand 31 December 2012
% Peritoneal Dialysis Patientswith Ferritin 200-500 g/L
Figure 6.70
Excludes hospitals with <10 patients0
10
20
30
40
50
60
70
80
90
100
Pe
rce
nt
1 5 10 15 20 25 30 35 40
Caring Hospital
Australia 31 December 2012
% Peritoneal Dialysis Patients with TSat>20%
Figure 6.71
Excludes hospitals with <10 patients0
10
20
30
40
50
60
70
80
90
100
Pe
rce
nt
1 2 3 4 5 6 7 8 9 10 11
Caring Hospital
New Zealand 31 December 2012
% Peritoneal Dialysis Patients with TSat>20%
Figure 6.68
Excludes hospitals with <10 patients0
10
20
30
40
50
60
70
80
90
100
Pe
rce
nt
1 5 10 15 20 25 30 35 40
Caring Hospital
Australia 31 December
% Peritoneal Dialysis Patientswith Ferritin 200-500 g/L
6-29
ANZDATA Registry 2013 Report PERITONEAL DIALYSIS _____________________________________________________________________________________
SERUM CALCIUM
In both Australia and New Zealand the proportions of patients with proportions with serum calcium ≥2.4 mmol/L and < 2.2 mmol/L have remained fairly stable (Figure 6.72)
Figures 6.73 and 6.74 show the proportions of patients at each centre with serum calcium 2.1-2.4 mmol/L, as rec-ommended by the CARI guidelines. Note however that the values in the guidelines were for corrected total calci-um, while those in this report are for uncorrected total calcium.
In Australia, the proportions ranged widely between 34-75% for peritoneal dialysis patients, while in New Zealand the corresponding proportions were 52-72%.
SERUM CALCIUM BY TREATING CENTRE
Figure 6.72
11
28
40
17
4
11
31
38
16
5
11
30
39
164
6
22
38
25
9
5
21
43
24
7
6
20
40
26
8
Perc
ent
Australia New Zealand
2010 2011 2012 2010 2011 2012
Serum Calcium - Peritoneal DialysisDecember 2010-2012
<2.0 2.0-2.1 2.2-2.3 2.4-2.5 2.6Calcium(mmol/L)
Figure 6.73
Excludes hospitals with <10 patients0
10
20
30
40
50
60
70
80
90
100
Pe
rce
nt
1 5 10 15 20 25 30 35 40 45
Caring Hospital
Australia 31 December 2012
% Peritoneal Dialysis Patientswith Calcium 2.1-2.4 mmol/L
Figure 6.74
Excludes hospitals with <10 patients0
10
20
30
40
50
60
70
80
90
100
Pe
rce
nt
1 2 3 4 5 6 7 8 9 10 11
Caring Hospital
New Zealand 31 December 2012
% Peritoneal Dialysis Patientswith Calcium 2.1-2.4 mmol/L
6-30
PERITONEAL DIALYSIS ANZDATA Registry 2013 Report _____________________________________________________________________________________
SERUM PHOSPHATE
In Australia, serum phosphate has stabilized over the last three years (reflected in the size of the ≥ 1.8 mmol/L group) (Figure 6.75)
In New Zealand, the proportions with serum phosphate ≥ 1.8 mmol/L have remained stable.
SERUM PHOSPHATE BY TREATING CENTRE
Figures 6.76 - 6.77 show the proportions of patients at each centre with serum phosphate 0.8-1.6 mmol/L, as recommended by the CARI guidelines.
In Australia, the proportions ranged widely between 8-80% for peritoneal dialysis patients and in New Zea-land, the corresponding proportions were 32-55%.
Figure 6.76
Excludes hospitals with <10 patients0
10
20
30
40
50
60
70
80
90
100
Pe
rce
nt
1 5 10 15 20 25 30 35 40 45
Caring Hospital
Australia 31 December 2012
% Peritoneal Dialysis Patients withPhosphate 0.8-1.6 mmol/L
Figure 6.77
Excludes hospitals with <10 patients0
10
20
30
40
50
60
70
80
90
100
Pe
rce
nt
1 2 3 4 5 6 7 8 9 10 11
Caring Hospital
New Zealand 31 December 2012
% Peritoneal Dialysis Patients withPhosphate 0.8-1.6 mmol/L
Figure 6.75
28
17
16
38
28
17
18
37
26
19
17
38
26
15
15
43
24
16
18
42
24
19
17
41
Perc
ent
Australia New Zealand
2010 2011 2012 2010 2011 2012
Serum Phosphate - Peritoneal DialysisDecember 2010-2012
<1.4 1.4-1.5 1.6-1.7 1.8Phosphate (mmol/L)
6-31
ANZDATA Registry 2013 Report PERITONEAL DIALYSIS _____________________________________________________________________________________
CALCIUM-PHOSPHATE PRODUCT
In both Australia and New Zealand, calcium-phosphate product has remained steady, with smaller proportions of patients with a product ≥ 3.5 mmol2/L2. (Figure 6.82).
Overall, the proportion of people with high calcium-phosphate product was higher in New Zealand than Australia.
CALCIUM-PHOSPHATE PRODUCT BY TREATING CENTRE
Figures 6.79 - 6.80 show the proportions of patients at each centre with calcium-phosphate product <4.0 mmol2/L2, as recommended by the CARI guidelines.
In Australia, the proportions ranged widely between 39-93% for peritoneal dialysis patients while in New Zealand, the corresponding proportions were 42-68%.
Figure 6.78
43
18
15
10
15
44
19
139
15
43
19
14
9
15
39
16
16
10
20
37
18
17
9
18
37
18
15
11
18
Perc
ent
Australia New Zealand
2010 2011 2012 2010 2011 2012
December 2010-2012
Calcium Phosphate ProductPeritoneal Dialysis
<3.5 3.5-3.9 4.0-4.4 4.5-4.9 5.0Ca X PO4 (mmol2/L
2)
Figure 6.80
Excludes hospitals with <10 patients0
10
20
30
40
50
60
70
80
90
100
Pe
rce
nt
1 2 3 4 5 6 7 8 9 10 11
Caring Hospital
New Zealand 31 December 2012
% Peritoneal Dialysis Patients withCa X PO4 < 4.0 mmol
2/L
2
Figure 6.79
Excludes hospitals with <10 patients0
10
20
30
40
50
60
70
80
90
100
Pe
rce
nt
1 5 10 15 20 25 30 35 40 45
Caring Hospital
Australia 31 December 2012
% Peritoneal Dialysis Patients withCa X PO4 < 4.0 mmol
2/L
2
Philip Clayton
Blair Grace
Jeremy Chapman
Jenni Wright
Stephen McDonald
CHAPTER 7
TRANSPLANT WAITING LIST
2013 Annual Report - 36th Edition
Data from ANZDATA and the Na onal Organ Matching System
of Australia (NOMS)
7-2
TRANSPLANT WAITING LIST ANZDATA Registry 2013 Report _____________________________________________________________________________________
The waiting list data reported here are derived from the Australian National Organ Matching System (NOMS) and ANZDATA. We are working with the New Zealand Blood Service to undertake similar analyses for NZ patients. Waiting list data refers to waiting for deceased donor (DD) kidney-only transplants. Patients wait-listed for multi-organ transplants are excluded. Recipients of living donor (LD) transplants may or may not be on the waiting list prior to transplantation. To understand the relative contributions of deceased and living donor transplants to patients on / not on the kidney-only waiting list, DD and LD transplants to recipients not on the kidney-only waiting list are also included. The numbers of people moving on and off the active waiting list for any reason are shown. Patients are categorised as either active or off the list - an “interim” or “temporarily off list” status is considered to be off list, since these patients will not be allocated kidneys. A number of de-listed patients may return to the list in subsequent years. If a patient was listed and de-listed more than once in a calendar year, only the net change is counted. In the tables below, the rows describe: Number on the active list at the beginning of the year Number added to the active list during the year Number removed from the active list during the year Number of deceased donor (DD) transplants to people on the waiting list Number of living donor (LD) transplants to people on the waiting list Number of transplants performed outside Australia / New Zealand to people on the waiting list Number who died while on the active waiting list Number on the waiting list at the end of the year Number of DD transplants to recipients not on the waiting list* Number of LD transplants to recipients not on the waiting list * includes patients listed for a multi-organ transplant who received a kidney transplant +/- another organ, and rarely, manual allocation of a DD kidney to a patient not on the waiting list Figure 7.1 shows the basic stock and flow tables for Australia for each year. The number of patients waiting for a kidney transplant has been steadily falling over time despite increasing numbers of patients being listed each year. Figure 7.2 shows these data for non-indigenous and indigenous patients respectively.
Figure 7.1
Australian Deceased Donor Kidney Waiting List Stock and Flow Totals
Event 2007 2008 2009 2010 2011 2012
Active start of year 1339 1333 1251 1264 1183 1087
Made active 592 653 670 630 707 736
Taken off list 167 182 178 149 197 153
Deceased donor transplant 315 417 401 499 533 554
Living donor transplant 95 122 64 58 62 45
Overseas transplant 8 2 4 1 2 0
Died on list 13 12 10 4 9 6
Active end of year 1333 1251 1264 1183 1087 1065
Deceased donor transplant off list 29 42 45 51 37 53
Living donor transplant off list 176 232 263 238 193 193
7-3
ANZDATA Registry 2013 Report TRANSPLANT WAITING LIST _____________________________________________________________________________________
Figure 7.2
Australian Deceased Donor Kidney Waiting List
Stock and Flow for each Year by Indigenous Status
Race Event 2007 2008 2009 2010 2011 2012
Non-indigenous
Active start of year 1285 1281 1205 1219 1134 1054
Made active 573 621 642 592 678 706
Taken off list 162 174 167 141 178 145
Deceased donor transplant 301 393 384 474 508 534
Living donor transplant 93 118 63 58 61 45
Overseas transplant 8 2 4 1 2 0
Died on list 13 10 10 3 9 5
Active end of year 1281 1205 1219 1134 1054 1031
Deceased donor transplant off list
29 42 42 48 36 53
Living donor transplant off list 174 229 260 238 192 193
Active start of year 54 52 46 45 49 33
Made active 19 32 28 38 29 30
Taken off list 5 8 11 8 19 8
Deceased donor transplant 14 24 17 25 25 20
Living donor transplant 2 4 1 0 1 0
Overseas transplant 0 0 0 0 0 0
Died 0 2 0 1 0 1
Active end of year 52 46 45 49 33 34
Deceased donor transplant off list
0 0 3 3 1 0
Living donor transplant off list 2 3 3 0 1 0
Indigenous
The numbers of both dialysis patients and transplants vary with age; in Figure 7.3 the stock and flow for the years 2008-12 is shown by broad age groups. As expected, older patients are less likely to be listed than younger patients, and the proportion removed from the list is higher.
7-4
TRANSPLANT WAITING LIST ANZDATA Registry 2013 Report _____________________________________________________________________________________
Figure 7.3
Australian Deceased Donor Kidney Waiting List
Stock and Flow for each Year by Age
Age Event 2007 2008 2009 2010 2011 2012
< 45
Active start of year 359 382 334 380 386 407
Made active 186 186 227 212 268 274
Taken off list 31 53 38 42 43 39
Deceased donor transplant 94 126 113 137 170 205
Living donor transplant 35 53 25 27 31 28
Overseas transplant 1 1 3 0 1 0
Died 2 1 2 0 2 3
Active end of year 382 334 380 386 407 406
Deceased donor transplant off list 18 32 28 31 22 33
Living donor transplant off list 89 100 123 127 97 110
45 - 54
Active start of year 375 386 364 373 345 301
Made active 170 175 180 175 192 217
Taken off list 42 45 37 43 61 41
Deceased donor transplant 84 119 110 150 160 166
Living donor transplant 27 29 20 8 11 7
Overseas transplant 4 0 1 1 0 0
Died 2 4 3 1 4 1
Active end of year 386 364 373 345 301 303
Deceased donor transplant off list 10 7 14 13 13 16
Living donor transplant off list 42 56 52 51 38 37
55 - 64
Active start of year 427 394 393 366 346 309
Made active 160 203 194 181 202 196
Taken off list 58 44 68 36 64 57
Deceased donor transplant 103 123 131 148 154 152
Living donor transplant 22 30 18 15 17 9
Overseas transplant 2 1 0 0 1 0
Died 8 6 4 2 3 2
Active end of year 394 393 366 346 309 285
Deceased donor transplant off list 1 3 3 5 2 4
Living donor transplant off list 33 48 68 52 44 35
Active start of year 178 171 160 145 106 70
Made active 76 89 69 62 45 49
Taken off list 36 40 35 28 29 16
Deceased donor transplant 34 49 47 64 49 31
Living donor transplant 11 10 1 8 3 1
Overseas transplant 1 0 0 0 0 0
Died 1 1 1 1 0 0
Active end of year 171 160 145 106 70 71
Deceased donor transplant off list 0 0 0 2 0 0
Living donor transplant off list 12 28 20 8 14 11
65 +
7-5
ANZDATA Registry 2013 Report TRANSPLANT WAITING LIST _____________________________________________________________________________________
Figure 7.4
Australian Deceased Donor Kidney Waiting List
Stock and Flow for each Year by State
State Event 2007 2008 2009 2010 2011 2012
NSW/ACT
Active start of year 700 700 667 614 549 518
Made active 240 248 217 200 250 261
Taken off list 90 105 107 71 108 80
Deceased donor transplant 84 110 118 163 132 143
Living donor transplant 53 59 34 28 32 28
Overseas transplant 4 1 2 1 2 0
Died on list 9 6 9 2 7 2
Active end of year 700 667 614 549 518 526
Deceased donor transplant off list 13 18 17 17 16 24
Living donor transplant off list 41 58 74 56 57 47
VIC/TAS
Active start of year 351 348 326 352 353 322
Made active 144 169 203 212 212 244
Taken off list 36 43 38 38 44 43
Deceased donor transplant 81 114 119 155 180 172
Living donor transplant 26 33 18 17 19 12
Overseas transplant 2 0 2 0 0 0
Died on list 2 1 0 1 0 3
Active end of year 348 326 352 353 322 336
Deceased donor transplant off list 12 18 14 23 15 13
Living donor transplant off list 61 84 79 87 64 73
Active start of year 129 128 139 163 141 127
Made active 97 123 123 101 116 112
Taken off list 19 10 18 22 15 12
Deceased donor transplant 66 87 75 94 109 120
Living donor transplant 12 12 6 7 5 1
Overseas transplant 1 1 0 0 0 0
Died on list 0 2 0 0 1 0
Active end of year 128 139 163 141 127 106
Deceased donor transplant off list 0 2 2 2 2 6
Living donor transplant off list 31 29 49 36 31 31
QLD
7-6
TRANSPLANT WAITING LIST ANZDATA Registry 2013 Report _____________________________________________________________________________________
Figure 7.4 (contd…)
Australian Deceased Donor Kidney Waiting List
Stock and Flow for each Year by State
State Event 2007 2008 2009 2010 2011 2012
SA/NT
Active start of year 52 67 58 51 52 57
Made active 74 74 62 61 72 76
Taken off list 7 3 7 5 8 10
Deceased donor transplant 52 67 57 50 56 64
Living donor transplant 0 12 4 5 3 3
Overseas transplant 0 0 0 0 0 0
Died 0 1 1 0 0 1
Active end of year 67 58 51 52 57 55
Deceased donor transplant off list 1 1 5 6 4 7
Living donor transplant off list 26 29 19 23 13 20
Active start of year 107 90 61 84 88 63
Made active 37 39 65 56 57 43
Taken off list 15 21 8 13 22 8
Deceased donor transplant 32 39 32 37 56 55
Living donor transplant 4 6 2 1 3 1
Overseas transplant 1 0 0 0 0 0
Died 2 2 0 1 1 0
Active end of year 90 61 84 88 63 42
Deceased donor transplant off list 3 3 7 3 0 3
Living donor transplant off list 17 32 42 36 28 22
WA
Differences between states (combined into transplanting regions) are shown in figure 7.4. Approximately half of all patients on the waiting list are in NSW. Waiting list numbers in each state are reflective of both listing practices and donation rates, both current and historical. The fall in the number of wait-listed patients has predominantly occurred in NSW, and to a lesser extent WA.
7-7
ANZDATA Registry 2013 Report TRANSPLANT WAITING LIST _____________________________________________________________________________________
Figure 7.5
Australian Deceased Donor Kidney Waiting List
Stock and Flow for each Year by Blood Group
Blood Event 2007 2008 2009 2010 2011 2012
A
Active start of year 417 446 400 415 357 295
Made active 219 222 258 233 242 286
Taken off list 50 63 56 57 58 44
Deceased donor transplant 109 162 158 209 217 219
Living donor transplant 27 41 26 21 25 11
Overseas transplant 2 0 1 0 0 0
Died on list 2 2 2 4 4 3
Active end of year 446 400 415 357 295 304
Deceased donor transplant off list 11 9 11 12 10 23
Living donor transplant off list 80 85 87 100 72 75
AB
Active start of year 20 19 9 17 11 22
Made active 16 18 21 25 35 29
Taken off list 2 2 0 2 2 1
Deceased donor transplant 15 23 13 29 22 28
Living donor transplant 0 3 0 0 0 3
Overseas transplant 0 0 0 0 0 0
Died on list 0 0 0 0 0 0
Active end of year 19 9 17 11 22 19
Deceased donor transplant off list 2 1 4 4 2 1 Living donor transplant off list 2 12 9 10 3 12
B
Active start of year 183 165 149 164 169 160
Made active 75 71 89 80 92 111
Taken off list 22 26 24 17 27 26
Deceased donor transplant 57 50 38 50 65 63
Living donor transplant 12 9 10 7 7 4
Overseas transplant 0 0 0 1 2 0
Died on list 2 2 2 0 0 0
Active end of year 165 149 164 169 160 178
Deceased donor transplant off list 0 4 6 5 1 3 Living donor transplant off list 13 27 30 23 29 21
Active start of year 716 701 692 668 646 610
Made active 281 342 302 292 338 310
Taken off list 92 91 98 73 110 82
Deceased donor transplant 134 181 191 211 229 244
Living donor transplant 55 69 28 30 30 27
Overseas transplant 6 2 3 0 0 0
Died on list 9 8 6 0 5 3
Active end of year 701 692 668 646 610 564
Deceased donor transplant off list 14 21 17 19 17 18
Living donor transplant off list 71 91 108 97 83 80
O
Figure 7.5 shows the same data by blood group. Turnover is highest for blood group AB patients and generally lowest for blood group O. The totals are slightly lower than Figure 7.1 due to a small number of patients with missing blood group data (13 in 2012).
7-8
TRANSPLANT WAITING LIST ANZDATA Registry 2013 Report _____________________________________________________________________________________
Figure 7.6 shows the survival of patients who commenced dialysis in Australia over 2007-2012 and were subsequently wait-listed for a deceased donor kidney-only transplant. Survival is shown from the time of listing and is censored at transplantation (but not at removal from the list). The mortality rate of this highly selected patient group was low at 1.6 deaths per 100 patient-years (95% CI 1.3-2.1).
0.00
0.25
0.50
0.75
1.00
2471 1215 641 342 159 Number at risk
0 1 2 3 4
Years since wait-listing
Survival from first listing for kidney-only transplantExcludes patients who receieved a living donor or overseas transplant prior to wait-listing
Australian incident dialysis patients 2007-2012Censored at transplantation
Survival after wait-listing
Figure 7.6
Philip Clayton
Wai Lim
Kylie Hurst
CHAPTER 8
TRANSPLANTATION
2013 Annual Report - 36th Edition
TRANSPLANTATION ANZDATA Registry 2013 Report _____________________________________________________________________________________
8-2
TRANSPLANTS PERFORMED IN 2012
AUSTRALIA The 845 transplant operations performed in 2012 represent a slight increase over 2011. This was driven by an increase in the number of deceased donor kidney transplants, offset-ting a continuing fall in living donor numbers.
The 2012 numbers represent a transplant rate of 37 per million population per year, un-changed from 2011. The progressive increase in the number of kidney transplants from non-heart beating donors appears to have stabi-lised (Figure 8.4).
For more up to date figures on the deceased organ donor rate, see www.anzdata.org.au/anzod/updates/anzodupdate.htm
Living donor transplants accounted for 28% (238 grafts) in 2012, down from 31% in 2011 and 35% in 2010.
Primary recipients (those receiving a first transplant) received 88% of all kidneys trans-planted in 2012, similar to recent years.
NEW ZEALAND The number of transplant operations (108) performed in 2012 represents a transplant rate of 24 per million population per year com-pared with 27 in 2011 (Figure 8.1).
The percentage of living donors remained steady at 50% of all operations in 2012 (Figure 8.3). There were no transplants from non-heart beating donors in 2012.
Of the grafts performed in 2012, 92% were to primary recipients.
Figure 8.1
Number of Kidney Transplant Operations Total (Living Donors)
Year Australia New Zealand
1st 2nd 3rd 4th 5th Total 1st 2nd 3rd 4th Total
1963 5 1 0 0 0 6 (0) 0 0 0 0 0
1964 2 0 0 0 0 2 (0) 0 0 0 0 0
1965 12 1 1 0 0 14 (3) 1 0 0 0 1 (1)
1966 18 2 0 0 0 20 (5) 10 3 0 0 13 (0)
1967 69 2 0 0 0 71 (2) 18 4 1 0 23 (1)
1968 97 10 0 0 0 107 (0) 17 4 0 0 21 (2)
1969 149 12 0 0 0 161 (0) 39 5 0 0 44 (0)
1970 168 12 2 0 0 182 (1) 21 3 1 0 25 (0)
1971 207 22 1 0 0 230 (1) 26 6 0 0 32 (1)
1972 183 16 0 0 0 199 (2) 43 8 0 0 51 (1)
1973 213 30 1 0 0 244 (7) 50 10 2 0 62 (0)
1974 224 35 4 0 0 263 (6) 35 5 1 0 41 (3)
1975 271 29 3 1 0 304 (7) 61 13 0 0 74 (2)
1976 223 41 4 0 0 268 (10) 38 13 1 0 52 (1)
1977 265 57 4 0 0 326 (16) 46 10 2 0 58 (4)
1978 269 43 2 0 0 314 (17) 43 11 3 0 57 (11)
1979 293 35 5 0 0 333 (34) 61 13 3 2 79 (16)
1980 287 63 9 0 0 359 (36) 57 13 4 0 74 (18)
1981 306 58 9 1 0 374 (35) 51 8 1 0 60 (10)
1982 321 72 6 0 0 399 (53) 48 17 0 0 65 (8)
1983 272 63 10 2 0 347 (48) 69 25 4 0 98 (11)
1984 362 72 10 1 0 445 (48) 63 11 0 0 74 (16)
1985 318 79 17 1 0 415 (36) 60 25 3 0 88 (6)
1986 366 63 7 2 0 438 (32) 79 19 6 1 105 (13)
1987 310 58 21 3 0 392 (40) 57 17 4 1 79 (20)
1988 391 62 10 2 1 466 (46) 61 11 6 0 78 (8)
1989 433 46 10 2 0 491 (48) 71 11 1 0 83 (12)
1990 387 45 9 2 0 443 (59) 86 14 2 0 102 (23)
1991 386 70 11 3 0 470 (78) 62 10 4 1 77 (13)
1992 404 57 13 3 0 477 (70) 105 5 5 0 115 (17)
1993 385 63 6 4 1 459 (66) 68 13 2 0 83 (20)
1994 384 41 12 2 1 440 (103) 70 11 1 1 83 (20)
1995 371 60 11 0 0 442 (94) 84 7 3 0 94 (24)
1996 416 50 9 0 0 475 (115) 88 7 1 0 96 (26)
1997 447 51 6 1 0 505 (147) 101 10 1 0 112 (31)
1998 443 62 11 2 0 518 (161) 95 10 1 0 106 (31)
1999 403 43 9 0 0 455 (169) 97 11 4 0 112 (42)
2000 476 47 7 1 0 531 (181) 91 13 2 0 106 (31)
2001 488 45 6 2 0 541 (213) 101 9 0 0 110 (43)
2002 537 60 5 2 0 604 (230) 103 12 2 0 117 (48)
2003 472 60 10 1 0 543 (218) 94 13 4 0 111 (44)
2004 583 53 11 3 0 650 (244) 98 7 0 0 105 (48)
2005 539 67 15 2 0 623 (246) 87 5 0 1 93 (46)
2006 549 70 17 5 0 641 (273) 80 8 2 0 90 (49)
2007 527 75 11 0 2 615 (271) 112 9 2 0 123 (58)
2008 708 84 16 5 0 813 (354) 111 10 1 0 122 (69)
2009 674 88 11 0 0 773 (327) 109 12 0 0 121 (67)
2010 744 83 18 1 0 846 (296) 104 5 1 0 110 (60)
2011 744 68 10 3 0 825 (255) 110 7 1 0 118 (57)
2012 747 80 15 1 2 845 (238) 99 9 0 0 108 (54)
8-3
ANZDATA Registry 2013 Report TRANSPLANTATION _____________________________________________________________________________________
Figure 8.2
354
459
327
446
296
550
255
570
238
607
0
200
400
600N
umbe
r of
tran
spla
nts
2008 2009 2010 2011 2012
Australia 2008-2012
Deceased and Living Donor Transplants
Living donor
Deceased donor
Figure 8.3
69
53
67
5460
5057
6154 54
0
20
40
60
80
Num
ber
of tr
ansp
lant
s
2008 2009 2010 2011 2012
New Zealand 2008-2012
Deceased and Living Donor Transplants
Living donor
Deceased donor
Figure 8.4
43
75
117
151
129
0
50
100
150
Nu
mb
er
of t
ran
spla
nts
2008 2009 2010 2011 2012
Australia 2008-2012
Transplants from Non-Heart Beating Donors
416
371
433 419
478
0
100
200
300
400
500
Num
ber
of t
rans
plan
ts
2008 2009 2010 2011 2012
Australia 2008-2012
Transplants from Heart Beating Donors
TRANSPLANTATION ANZDATA Registry 2013 Report _____________________________________________________________________________________
8-4
TRANSPLANT RATE OF PATIENTS DIALYSED
In Australia transplantation was performed in 6% of patients who received dialysis in 2012.
Of all patients in the 15-64 year age group who received dialysis treatment during 2012, 10% were transplanted in 2012, the same as in 2011 (Figure 8.6).
The ratio of transplantation to numbers dialysing in Australia was the highest in the age groups 5-14 years (41%) and 0-4 and 15-24 years of age (24%) and declined with increasing age (Figure 8.7).
In New Zealand transplantation was performed for 4% of patients, the same percentage as 2011 (Figure 8.5).
As in Australia, the rate of transplantation for New Zealand patients was highest among those less than 14 years old (Figure 8.8).
* Pre-emptive transplant patients included
Figure 8.5
6
5
6
7
6
8
3
6 6
4
0
2
4
6
8
% t
rans
plan
ted
QLD NSW ACT Vic Tas SA NT WA Aust NZ
Related to patients dialysed
Ratio of Transplantation 2012
Figure 8.6
10
8
12
14
11
16
3
10 10
5
0
5
10
15
20
% t
rans
plan
ted
QLDNSWACT Vic Tas SA NT WA Aust NZ
Related to patients dialysed, ages 15-64
Ratio of Transplantation 2012
Living
Deceased
Figure 8.7
24
41
24
18
1211
7
20 0
0
10
20
30
40
% t
ran
spla
nte
d
0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Age
Related to patients dialysed
Ratio of Transplantation 2012 - Australia
Figure 8.8
0
63
410
5 4 4 2 0 00
20
40
60
% t
rans
plan
ted
0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Age
Related to patients dialysed
Ratio of Transplantation 2012 - New Zealand
8-5
ANZDATA Registry 2013 Report TRANSPLANTATION _____________________________________________________________________________________
AGE OF RECIPIENTS TRANSPLANTED IN 2012
AUSTRALIA
The median age of transplant recipients in 2012 was 49 years. The age range was 1 to 80 years (Figures 8.9 and 8.10).
The transplantation rate per million for each age group and as a percentage of dialysed patients for each age group are shown in Figures 8.7 and 8.10.
NEW ZEALAND
The median age of transplant recipients in 2012 was 50.5 years. The age range was 8 to 73 years (Figures 8.8 and 8.11).
Recipients aged between 35 and 54 years comprised 26% of the total. Sixty-two percent of recipients were over 54 years of age in 2012.
Figure 8.9
Graft Number and Age of Patients Transplanted 2012
Donor Source
Graft No.
Age Groups Total
00-04 05-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84
Australia
Deceased
1 2 6 16 66 85 143 155 58 2 533
2 0 0 4 4 12 25 14 2 0 61
3 0 0 2 0 3 5 1 0 0 11
Living Donor
4 0 0 0 0 1 1 0 0 0 2
1 5 13 29 23 41 40 43 18 2 214
2 0 0 2 6 6 2 1 2 0 19
3 0 0 0 0 1 3 0 0 0 4
4 0 0 0 0 0 1 0 0 0 1
Total 7 19 53 99 149 220 214 80 4 845
New Zealand
Deceased 1 0 0 3 0 10 5 9 16 7 50
2 0 0 0 0 0 0 3 1 0 4
Living Donor 1 0 0 7 2 3 8 8 17 4 49
2 0 0 0 1 1 1 2 0 0 5
Total 0 0 10 3 14 14 22 34 11 108
Figure 8.10
5 7
17
30
47
72
81
46
4
0
20
40
60
80
Tra
nspl
ants
per
mill
ion
popu
latio
n
0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84
Age
Australia
Transplant Operations (per million) 2012
Figure 8.11
17
5
24 24
36
68
32
0
20
40
60
80
Tra
nspl
ants
per
mill
ion
popu
latio
n
5-14 15-24 25-34 35-44 45-54 55-64 65-74
Age
New Zealand
Transplant Operations (per million) 2012
TRANSPLANTATION ANZDATA Registry 2013 Report _____________________________________________________________________________________
8-6
ETHNICITY OF TRANSPLANT RECIPIENTS
AUSTRALIA
Figure 8.12.
For the 15-64 year age group in 2012, 13.0% of dialysed Caucasian patients were transplanted. For Australian Aboriginals and Torres Strait Islanders (ATSI), the numbers receiving transplants remains low.
In contrast, the number of ATSI patients dialysed continues to increase each year.
NEW ZEALAND Figure 8.13.
Amongst the 15-64 year age group, the proportion of Maori and Pacific People who received a renal transplant in 2011 was substantially lower than other groups.
Figure 8.12 Australia
Transplantation Rate - Age Group 15-64 years 2003 - 2012
Year Caucasian Aboriginal and
Torres St. Islanders All Patients
Tx Dialysed Rate Tx Dialysed Rate Tx Dialysed Rate
2003 414 3790 10.9% 12 783 1.5% 478 5251 9.1%
2004 491 3875 12.7% 25 856 2.9% 581 5438 10.7%
2005 460 4040 11.4% 20 930 2.2% 548 5716 9.6%
2006 481 4241 11.3% 27 989 2.7% 579 6039 9.6%
2007 471 4380 10.8% 17 1065 1.6% 557 6331 8.8%
2008 602 4488 13.4% 29 1176 2.5% 724 6632 10.9%
2009 574 4497 12.8% 23 1199 1.9% 687 6719 10.2%
2010 607 4438 13.7% 27 1215 2.2% 734 6727 10.9%
2011 550 4474 12.3% 25 1274 2.0% 695 6879 10.1%
2012 585 4512 13.0% 19 1337 1.4% 734 7082 10.4%
Figure 8.13 New Zealand
Transplantation Rate - Age Group 15-64 years 2003 - 2012
Year Caucasian Maori Pacific People All Patients
Tx Dialysed Rate Tx Dialysed Rate Tx Dialysed Rate Tx Dialysed Rate
2003 64 545 11.7% 16 531 3.0% 13 271 4.8% 101 1442 7.0%
2004 65 542 12.0% 10 558 1.8% 12 285 4.2% 96 1483 6.5%
2005 73 568 12.9% 3 563 0.5% 3 303 1.0% 82 1523 5.4%
2006 59 567 10.4% 9 606 1.5% 5 322 1.6% 80 1599 5.0%
2007 82 576 14.2% 15 616 2.4% 6 344 1.7% 111 1648 6.7%
2008 84 586 14.3% 12 620 1.9% 9 376 2.4% 112 1699 6.6%
2009 77 599 12.9% 13 637 2.0% 6 405 1.5% 101 1783 5.7%
2010 62 593 10.5% 17 662 2.6% 8 445 1.8% 95 1860 5.1%
2011 67 606 11.1% 18 652 2.8% 7 467 1.5% 104 1887 5.5%
2012 60 601 10.0% 12 672 1.8% 7 488 1.4% 88 1942 4.5%
Figure 8.14
New Transplanted Patients 2008 - 2012 Related to Ethnicity
Race 2008 2009 2010 2011 2012
Australia 813 (100.0%) 773 (100.0%) 846 (100.0%) 825 (100.0%) 845 (100.0%)
Caucasian 675 (83.0%) 651 (84.2%) 706 (83.5%) 657 (79.6%) 669 (79.2%)
Aboriginal/Torres St. Islanders 31 (3.8%) 24 (3.1%) 28 (3.3%) 28 (3.4%) 20 (2.4%)
Asian 83 (10.2%) 75 (9.7%) 83 (9.8%) 97 (11.8%) 88 (10.4%)
Other 24 (3.0%) 23 (3.0%) 29 (3.4%) 43 (5.2%) 68 (8.0%)
New Zealand 122 (100.0%) 121 (100.0%) 110 (100.0%) 118 (100.0%) 108 (100.0%)
Caucasian 93 (76.2%) 91 (75.2%) 71 (64.5%) 77 (65.3%) 74 (68.5%)
Asian 7 (5.7%) 5 (4.1%) 8 (7.3%) 11 (9.3%) 11 (10.2%)
Maori 12 (9.8%) 19 (15.7%) 20 (18.2%) 20 (16.9%) 15 (13.9%)
Pacific 10 (8.2%) 6 (5.0%) 9 (8.2%) 9 (7.6%) 7 (6.5%)
Other - - 2 (1.8%) 1 (0.8%) 1 (0.9%)
AUSTRALIA AND NEW ZEALAND Figure 8.14 shows these data in another format.
In Australia in 2012, 2.4% of transplant recipients were of Aboriginal/TSI ethnicity.
In New Zealand, 13.9% of transplant recipients were Maoris and 6.5% were Pacific People.
8-7
ANZDATA Registry 2013 Report TRANSPLANTATION _____________________________________________________________________________________
AUSTRALIAN REGIONAL TRANSPLANTATION ACTIVITY
The rate of transplantation for each transplant region is shown in Figures 8.15 and 8.16.
Transplants performed for people resident in Tasmania and the Northern Territory patients are included in figures for Victoria and South Australia regions respectively. These regions share common waiting lists and allocation protocols.
The transplant rates for residents of each State and New Zealand are shown in Figure 8.17.
The highest rate (65 per million) occurred in the Northern Territory, followed by South Australia (48 per million) and Victoria (44 per million). The lowest rate (29 per million) was in Tasmania.
Figure 8.15
Transplants in each Region 2008 - 2012 Number of Operations
(per Million Population per year)
State 2007 2008 2009 2011
Queensland 136 (32) 140 (32) 137 (31) 159 (35)
New South Wales / ACT * 243 (33) 238 (32) 265 (35) 247 (32)
Victoria / Tasmania * 246 (42) 233 (39) 285 (48) 268 (44)
South Australia / NT * 110 (60) 83 (45) 82 (44) 88 (47)
Western Australia 78 (36) 79 (35) 77 (34) 83 (34)
Australia 813 (38) 773 (35) 846 (38) 845 (37)
* For calculation of population related totals, the populations of these States were summed
2010
155 (35)
232 (31)
278 (46)
74 (40)
86 (37)
825 (37)
NSW population excludes residents of the Southern Area Health Service ACT population includes residents of the Southern Area Health Service
Medical services in the ACT service the Southern Area Region
Figure 8.17
3631
34
44
29
48
65
3537
25
0
20
40
60
Rat
e o
f tra
nspl
anta
tion
QLDNSWACT Vic Tas SA NT WA Aust NZ
Related to population (per million)
Rate of Transplantation 2012
Deceased
Living
0
20
40
60
80
Tra
nspl
ants
per
mill
ion
popu
latio
n
0
20
40
60
80
Tra
nspl
ants
per
mill
ion
popu
latio
n
2008 2009 2010 2011 2012
Year
QLDNSW/ACTVic/TasSA/NT
WA
Australian transplant regions
Transplant Operations 2008-2012
Figure 8.16
TRANSPLANTATION ANZDATA Registry 2013 Report _____________________________________________________________________________________
8-8
FUNCTIONING TRANSPLANTS AT 31ST DECEMBER 2012
Figure 8.18
Summary of Kidney Transplantation
Australia 1963 - 2012 Graft No. Performed Functioning*
Deceased Donor
First 13386 5132
Second 1997 615
Third 326 105
Fourth 48 14
Fifth 6 2
Total 15763 5868
Living Donor
First 4462 3121
Second 409 262
Third 59 44
Fourth 10 8
Fifth 1 0
Total 4941 3435
First 0 15
Second 0 2
Total 20704 9320
* Lost to follow up not included
Unknown
Figure 8.19
Summary of Kidney Transplantation
New Zealand 1965 - 2012
Performed Functioning*
Deceased Donor
First 2282 748
Second 400 78
Third 76 18
Fourth 7 0
Total 2765 844
Living Donor
First 998 626
Second 82 48
Third 6 4
Total 1086 678
Total 3851 1524
* Lost to follow up not included
Unknown First 0 2
AUSTRALIA There have been 20,704 transplant operations performed on 17,884 patients since 1963. Fourteen percent of transplanted kidneys and 14% of functioning grafts were regrafts. Living donor transplants accounted for 24% of operations.
There were 9320 patients with functioning grafts at the end of 2012. Of these, 63% were from deceased donors. The number of functioning grafts at the end of 2012 represents a 5% increase over the previous year. The annual rate of increase has remained steady (Figures 8.20 and 8.21).
The prevalence of functioning grafts in each State is shown in Figures 8.20 and 8.21. South Australia/Northern Territory had the highest prevalence of functioning renal transplants (547 per million). The lowest prevalence was in Western Australia (372 per million) and NSW/ACT (374 per million).
The age distribution of functioning transplants as a proportion of patients on renal replacement therapy is shown in Figure 8.23. The proportion depending on living donor grafts is greater in the younger age groups (Figures 8.23 and 8.24).
The details of age are shown Figure 8.25, and details of age, gender and ethnicity are shown in figure 8.28.
The majority of recipients with functioning grafts were male (61%). The ethnic origin of recipients was Caucasian 85%, Asian 9.5%, Aboriginal and Torres Strait Islanders 2% and Others 3% (Figure 8.28).
Thirty-five percent of grafts were functioning ten or more years and 9% for 20 or more years. There were 205 recipients with grafts functioning 30 years or longer (Figure 8.29). The longest functioning graft had functioned for 44 years at 31st December, 2012.
NEW ZEALAND There have been 3,851 operations performed on 3,287 patients since 1965 (Figure 8.19). Fifteen percent of operations were regrafts. Kidneys from living donors accounted for 28% of operations.
There were 1,524 patients with functioning grafts at the end of 2011. Of these, 10% were regrafts.
The age relationship and donor source are shown in Figure 8.25. The majority were male (59%) and the racial distribution was Caucasian 75%, Maori 10%, Pacific People 6% and Asian 8% (Figure 8.28).
The majority (68%) of patients with functioning grafts were in the 35-64 year age group and the mean and median ages were 51 and 53 years respectively. The modal age group was 55-64 years (Figure 8.25).
The longest surviving graft had functioned for 42 years at 31st December 2012. There were 168 grafts functioning for 20 or more years and 30 for 30 or more years (Figure 8.30).
8-9
ANZDATA Registry 2013 Report TRANSPLANTATION _____________________________________________________________________________________
Figure 8.20
Functioning Transplants 2003 - 2012 Transplanting Region, Australia and New Zealand
(Number Per Million Population) Year QLD NSW/ACT * VIC/Tas * SA/NT * WA Australia NZ
2003 1243 (326) 1976 (282) 1593 (295) 726 (419) 551 (282) 6089 (306) 1164 (289)
2004 1289 (330) 2077 (295) 1671 (306) 773 (444) 585 (295) 6395 (318) 1218 (298)
2005 1329 (333) 2148 (303) 1756 (317) 783 (445) 640 (317) 6656 (326) 1243 (301)
2006 1376 (336) 2232 (312) 1870 (333) 825 (464) 684 (332) 6987 (338) 1256 (300)
2007 1425 (341) 2286 (316) 1961 (344) 870 (484) 709 (335) 7251 (345) 1300 (307)
2008 1505 (352) 2394 (327) 2095 (362) 912 (502) 748 (343) 7654 (358) 1350 (316)
2009 1576 (361) 2497 (336) 2252 (382) 935 (508) 787 (350) 8047 (370) 1404 (325)
2010 1649 (373) 2648 (353) 2416 (404) 975 (524) 818 (356) 8506 (386) 1440 (330)
2011 1717 (384) 2740 (362) 2573 (426) 988 (528) 860 (366) 8878 (398) 1483 (337)
2012 1810 (400) 2866 (374) 2718 (444) 1029 (547) 897 (372) 9320 (413) 1524 (344)
* For calculation of population related totals, the population of these States were combined Patients lost to follow up are not included
Figure 8.21
100
200
300
400
500
600
700
100
200
300
400
500
600
700
Per
mill
ion
popu
latio
n
2002 2004 2006 2008 2010 2012
Year
QLDNSW/ACTVic/TasSA/NT
WA
Australia 2003-2012
Functioning Transplants by Region
Figure 8.22
400374 382
445 437
578
331372
413
344
0
200
400
600
Tra
nspl
ants
per
mill
ion
popu
latio
n
QLD NSW ACT Vic Tas SA NT WA Aust NZ
Per million population
Prevalence of Functioning Transplants 31 Dec 2012
Figure 8.23
111
3550
57636466
8543
0 20 40 60 80 100
Percentage of patients
85+
75-84
65-74
55-64
45-54
35-44
25-34
15-24
5-14
0-4
Age
As mode of RRT, Australia 2012
Prevalence of Functioning Transplants
Living donor
Deceased donor
Figure 8.24
1416
2937
45484848
8767
0 20 40 60 80 100
Percentage of patients
85+
75-84
65-74
55-64
45-54
35-44
25-34
15-24
5-14
0-4
Age
As mode of RRT, New Zealand 2012
Prevalence of Functioning Transplants
Living donor
Deceased donor
TRANSPLANTATION ANZDATA Registry 2013 Report _____________________________________________________________________________________
8-10
Figure 8.25
Age of All Functioning Transplant Patients Resident Country at Transplant 31-Dec-2012
Donor Source
Graft No.
Age Groups Total
00-04 05-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85-94
12 136 292 708 1559 2258 2508 1527 314 6 9320
Deceased Donor
1 6 40 89 249 715 1240 1538 1022 228 5 5132
2 - 4 8 40 103 198 163 82 16 1 615
3 - - 2 8 25 41 18 11 - - 105 4 - - - - 5 6 3 - - - 14
5 - - - - - 1 1 - - - 2
Total 6 44 99 297 848 1486 1723 1115 244 6 5868
Living Donor
1 6 89 180 376 627 687 720 386 65 - 3136
2 - 3 12 32 71 64 56 21 5 - 264
3 - - 1 1 11 19 8 4 - - 44
4 - - - 2 2 2 1 1 - - 8
Total 6 92 193 411 711 772 785 412 70 - 3452
New Zealand 4 26 59 120 221 386 423 236 46 3 1524
Deceased Donor
1 2 5 12 51 82 178 224 151 41 2 748
2 - - 1 2 14 32 22 7 - - 78
3 - - - - 6 5 5 2 - - 18
Total 2 5 13 53 102 215 251 160 41 2 844
Living Donor
1 2 21 44 62 104 151 162 76 5 1 628
2 - - 2 5 14 17 10 - - - 48
3 - - - - 1 3 - - - - 4
Total 2 21 46 67 119 171 172 76 5 1 680
Australia
Figure 8.26
12136
292
708
1559
22582508
1527
314
6
0
500
1,000
1,500
2,000
2,500
Nu
mb
er
of t
ran
spla
nts
0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Age
Australia 2012 (n=9320)
Age Distribution of Functioning Transplants
8 4995
218
492
737
954879
310
14
0
200
400
600
800
1,000
Tra
nspl
ants
per
mill
ion
popu
latio
n
0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Age
Per million population, Australia 2012
Age Distribution of Functioning Transplants
Figure 8.27
426
59
120
221
386423
236
463
0
100
200
300
400
Num
ber
of tr
ansp
lant
s
0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Age
New Zealand 2012 (n=1524)
Age Distribution of Functioning Transplants
13 4592
209
373
624
844
687
240
40
0
200
400
600
800
Tra
nspl
ants
per
mill
ion
popu
latio
n
0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Age
Per million population, New Zealand 2012
Age Distribution of Functioning Transplants
8-11
ANZDATA Registry 2013 Report TRANSPLANTATION _____________________________________________________________________________________
Figure 8.28
Functioning Transplant Patients - Resident Country at Transplant Related to Ethnicity and Age Group 31-Dec-2012
Gender Racial Origin Prevalent Age Groups
Total 00-04 05-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85-94
Australia 12 136 292 708 1559 2258 2508 1527 314 6 9320
Female
Caucasian 2 34 100 235 492 690 778 524 132 2 2989
Aboriginal/TSI - 2 2 7 21 25 21 5 - - 83
Asian 1 4 8 30 78 101 133 47 7 - 409 Other 1 8 8 23 26 29 25 9 2 - 131
Total 4 48 118 295 617 845 957 585 141 2 3612
Male
Caucasian 6 68 147 355 808 1219 1335 852 158 4 4952
Aboriginal/TSI - 3 5 7 21 29 34 10 1 - 110
Asian - 7 13 32 83 126 139 63 11 - 474
Other 2 10 9 19 30 39 43 17 3 - 172
Total 8 88 174 413 942 1413 1551 942 173 4 5708
New Zealand 4 26 59 120 221 386 423 236 46 3 1524
Female
Caucasian - 8 25 28 75 115 129 76 20 1 477 Asian - 1 4 6 3 17 14 6 1 - 52
Maori - 4 4 6 14 12 9 6 3 - 58
Pacific - 1 - 7 6 14 6 3 1 - 38
Total - 14 33 47 98 158 158 91 25 1 625
Male
Caucasian 4 10 22 45 102 177 193 102 16 2 673
Asian - - - 11 8 12 27 13 3 - 74
Maori - 1 4 11 6 26 22 19 2 - 91
Pacific - 1 - 5 6 11 19 9 - - 51
Other - - - 1 1 2 4 2 - - 10
Total 4 12 26 73 123 228 265 145 21 2 899
Other - - - - - - - - - - -
Figure 8.29
0
200
400
600
800
Nu
mb
er
of f
un
ctio
nin
g g
rafts
<1 1 2 3 4 5 6 7 8 9 10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Duration (years)
Australia 2012 (n=9320)
Number and Duration of Functioning Grafts
DeceasedLiving
Figure 8.30
0
50
100
Num
ber
of f
unct
ioni
ng g
raft
s
<1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32
Duration (years)
New Zealand 2012 (n=1524)
Number and Duration of Functioning Grafts
DeceasedLiving
TRANSPLANTATION ANZDATA Registry 2013 Report _____________________________________________________________________________________
8-12
RATES OF GRAFT LOSS
Figure 8.31
Graft Loss Rate 2003 - 2012
2006 2007 2008 2009 2010 2012
Australia 7297 7602 8064 8427 8893 9723
Death with Function 2.0% 2.1% 2.1% 1.7% 2.0% 1.6% Loss of Graft Function 2.4% 2.5% 2.9% 2.7% 2.3% 2.4%
All Losses 4.4% 4.6% 5.0% 4.4% 4.3% 4.1%
New Zealand 1333 1379 1422 1471 1514 1591
Death with Function 2.6% 3.2% 1.8% 2.3% 2.2% 1.7% Loss of Graft Function 3.5% 2.9% 2.0% 2.4% 2.1% 2.4%
All Losses 6.0% 6.1% 3.9% 4.7% 4.4% 4.1%
2011
9331
2.3%
2.3%
4.7%
1558
2.7%
2.0%
4.7%
2005
7018
2.3%
2.7%
5.0%
1311
2.3%
3.4%
5.6%
2004
6739
2.1%
3.1%
5.2%
1269
2.2%
1.8%
4.0%
2003
6401
2.2%
2.6%
4.9%
1224
2.2%
2.5%
4.7%
Figure 8.32
Year of Graft Loss Due to Death or Failure 2003 - 2012
Loss Cause of Failure 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Total
Australia
Failed
Death with Function 146 146 165 146 165 175 148 177 221 164 1653
Rejection - Acute 3 5 3 7 11 10 17 8 10 10 84
Chronic Allograft (CAN) 112 145 136 108 133 174 153 149 151 178 1439
Rejection - Hyperacute - - - 1 - 2 - - - 1 4 Vascular 15 18 13 14 8 14 17 11 6 10 126 Technical Problems 3 2 4 5 2 4 3 3 5 2 33 Glomerulonephritis 12 13 16 23 15 10 15 15 15 16 150
Non Compliance 10 9 6 3 8 6 12 6 6 9 75 Other 13 20 15 19 17 16 15 18 26 25 184
Total 314 358 358 326 359 411 380 387 440 415 3748
New Zealand
Death with Function 27 27 31 34 44 26 34 33 41 27 324
Rejection - Acute 1 - 2 2 1 1 1 - 3 1 12
Chronic Allograft (CAN) 18 14 23 31 20 20 28 17 15 26 212
Rejection - Hyperacute - 1 - - - - - - - - 1 Vascular 1 - 4 - 3 1 2 3 2 1 17 Technical Problems 2 - 2 3 1 - - - - - 8
Glomerulonephritis 4 2 3 6 5 5 - 4 4 5 38
Non Compliance 3 - 1 1 6 1 1 5 3 - 21 Other 4 4 8 4 5 1 2 2 4 5 39
Total 60 48 74 81 85 55 68 64 72 65 672
Failed
The rates of loss of graft function and death with a functioning graft in Australia in 2012 were 2.4% and 1.6% per patient year respectively; in total 4.1% of grafts at risk were lost (Figure 8.31).
In 2012, the rate of loss of graft function in New Zealand was 2.4% and death with functioning graft was 1.7%; in total 4.1% of grafts at risk were lost (Figure 8.31).
The causes of graft failure from 2003 to 2012 are shown in Figure 8.32.
Chronic allograft nephropathy and death with function remain the key impediments to long term graft survival.
The importance of death with function, chronic allograft nephropathy and other causes of graft loss after one year is evident in Figure 8.33. Among the causes of death with functioning graft, cardiovascular disease and malignancy were predominant.
8-13
ANZDATA Registry 2013 Report TRANSPLANTATION _____________________________________________________________________________________
Figure 8.33
Graft Losses 2008 - 2012
Australia New Zealand
Graft Function Graft Function
<1 year >= 1 year Any Time <1 year >= 1 year Any Time
Death with functioning Graft
Cardiac 19 (27%) 178 (22%) 197 (22%) 5 (50%) 44 (29%) 49 (30%)
Vascular 7 (10%) 69 (8%) 76 (9%) 1 (10%) 8 (5%) 9 (6%)
Infection 29 (41%) 133 (16%) 162 (18%) - 23 (15%) 23 (14%)
Social 2 (3%) 66 (8%) 68 (8%) 1 (10%) 8 (5%) 9 (6%)
Malignancy 5 (7%) 276 (34%) 281 (32%) 2 (20%) 53 (35%) 55 (34%)
Miscellaneous 8 (11%) 93 (11%) 101 (11%) 1 (10%) 15 (10%) 16 (10%)
Total 70 (100%) 815 (100%) 885 (100%) 10 (100%) 151 (100%) 161 (100%)
Graft Failure
Rejection - Acute 30 (21%) 25 (2%) 55 (5%) - 6 (4%) 6 (4%)
Rejection - Chronic Allograft (CAN) 10 (7%) 795 (79%) 805 (70%) 1 (7%) 105 (71%) 106 (65%)
Rejection - Hyperacute 3 (2%) - 3 (<1%) - - -
Vascular 44 (31%) 14 (1%) 58 (5%) 5 (33%) 4 (3%) 9 (6%)
Technical Problems 12 (9%) 5 (<1%) 17 (1%) - - -
Glomerulonephritis 8 (6%) 63 (6%) 71 (6%) - - -
Non Compliance 1 (1%) 38 (4%) 39 (3%) 1 (7%) 9 (6%) 10 (6%)
Other 33 (23%) 67 (7%) 100 (9%) 5 (33%) 9 (6%) 14 (9%)
Cause of Loss
Total 141 (100%) 1007 (100%) 1148 (100%) 15 (100%) 148 (100%) 163 (100%)
TRANSPLANTATION ANZDATA Registry 2013 Report _____________________________________________________________________________________
8-14
IMMUNOSUPPRESSION
AUSTRALIA
Immunosuppression data for 2012 was reported poorly in both Australia and New Zealand. At the time of data lock for analysis, over half of patients transplanted in 2012 were transplanted in hospitals where the proportion of patients reported to be receiving no baseline immunosuppression was unrealistically low. For this reason we are not reporting immunosuppression data at this stage.
ANZDATA is following up with contributing units and hopes to release an online-only supplement to this year’s Report once data capture is considered complete. We are also planning to revise our data collection form to improve completeness of reporting.
Aza = Azathioprine CyA = Cyclosporine Tacrol = Tacrolimus MMF = Mycophenolate Mofetil MPA = Mycophenolic Acid (Enteric Coated) Sirol = Sirolimus Pred = Prednisolone
Figure 8.34 Australia
Immunosuppressive Therapy - Primary Deceased Donor Graft 2005 - 2012
Year Aza CyA Tacrol MMF Sirol Everolimus Pred Number of Deceased
Donor Grafts
Initial treatment
2005 9 (3%) 131 (41%) 172 (54%) 299 (94%) 17 (5%) - 308 (97%) 319
2006 - 155 (51%) 139 (45%) 260 (85%) 3 (1%) 19 (6%) 296 (97%) 306
2007 2 (1%) 138 (48%) 140 (49%) 244 (85%) - 5 (2%) 285 (99%) 287
2008 2 (1%) 137 (35%) 240 (61%) 364 (93%) - - 389 (99%) 391
2009 4 (1%) 62 (16%) 310 (82%) 356 (95%) - 3 (1%) 375 (100%) 376
2010 - 66 (14%) 409 (86%) 426 (89%) 1 (<1%) 3 (1%) 477 (100%) 478
2011 1 (<1%) 54 (11%) 446 (87%) 300 (59%) - - 505 (99%) 511
2012
Treatment at
12 months
2005 23 (8%) 83 (29%) 172 (59%) 229 (79%) 29 (10%) 3 (1%) 262 (90%) 291
2006 12 (4%) 94 (34%) 145 (52%) 216 (78%) 21 (8%) 20 (7%) 259 (93%) 278
2007 13 (5%) 86 (32%) 149 (56%) 189 (71%) 12 (5%) 14 (5%) 252 (95%) 265
2008 17 (5%) 84 (23%) 251 (70%) 288 (80%) 12 (3%) 9 (2%) 345 (96%) 361
2009 18 (5%) 40 (11%) 283 (80%) 282 (80%) 18 (5%) 9 (3%) 341 (96%) 354
2010 24 (5%) 52 (11%) 370 (81%) 323 (71%) 16 (4%) 11 (2%) 440 (97%) 454
2011
Treatment at
24 months
2005 23 (8%) 76 (27%) 156 (55%) 220 (78%) 45 (16%) 5 (2%) 238 (84%) 282
2006 15 (6%) 81 (30%) 144 (53%) 207 (76%) 23 (8%) 25 (9%) 248 (92%) 271
2007 12 (5%) 79 (31%) 152 (59%) 181 (70%) 14 (5%) 13 (5%) 243 (94%) 259
2008 20 (6%) 80 (23%) 238 (68%) 275 (79%) 12 (3%) 9 (3%) 324 (93%) 350
2009 23 (7%) 39 (11%) 273 (79%) 254 (74%) 20 (6%) 11 (3%) 328 (95%) 344
2010
MPA
4 (1%)
24 (8%)
36 (13%)
22 (6%)
13 (3%)
37 (8%)
204 (40%)
21 (7%)
27 (10%)
51 (19%)
37 (10%)
39 (11%)
82 (18%)
23 (8%)
31 (11%)
54 (21%)
39 (11%)
53 (15%)
8-15
ANZDATA Registry 2013 Report TRANSPLANTATION _____________________________________________________________________________________
IMMUNOSUPPRESSION
NEW ZEALAND
See note on page 8-14
Aza = Azathioprine CyA = Cyclosporine Tacrol = Tacrolimus MMF = Mycophenolate Mofetil MPA = Mycophenolic Acid (Enteric Coated) Sirol = Sirolimus Pred = Prednisolone
Figure 8.35 New Zealand
Immunosuppressive Therapy - Primary Deceased Donor Graft 2005 - 2012
Year Aza CyA Tacrol MMF Sirol Everolimus Pred Number of Deceased
Donor Grafts
Initial treatment
2005 - 32 (76%) 8 (19%) 41 (98%) - - 41 (98%) 42
2006 - 26 (68%) 11 (30%) 34 (92%) - 3 (8%) 37 (100%) 37
2007 - 43 (74%) 15 (26%) 57 (98%) - 1 (2%) 58 (100%) 58
2008 - 30 (67%) 15 (33%) 42 (93%) - - 45 (100%) 45
2009 - 39 (78%) 10 (20%) 49 (98%) - - 49 (98%) 50
2010 - 32 (71%) 13 (29%) 45 (100%) - - 45 (100%) 45
2011 - 41 (71%) 17 (29%) 58 (100%) - - 58 (100%) 58
2012
Treatment at
12 months
2005 2 (5%) 21 (55%) 16 (42%) 33 (87%) 2 (5%) 1 (3%) 35 (92%) 38
2006 - 18 (53%) 15 (45%) 29 (88%) - 3 (9%) 32 (97%) 33
2007 3 (6%) 31 (60%) 20 (38%) 43 (83%) 2 (4%) 1 (2%) 48 (92%) 52
2008 2 (5%) 21 (48%) 23 (52%) 39 (89%) - - 41 (93%) 44
2009 - 24 (50%) 23 (48%) 48 (100%) 1 (2%) - 45 (94%) 48
2010 2 (5%) 16 (37%) 27 (63%) 41 (95%) - - 42 (98%) 43
2011
Treatment at
24 months
2005 2 (6%) 18 (50%) 17 (47%) 30 (83%) 2 (6%) 1 (3%) 29 (81%) 36
2006 - 16 (50%) 16 (50%) 28 (88%) - 2 (6%) 30 (94%) 32
2007 3 (6%) 29 (58%) 20 (40%) 41 (82%) 2 (4%) 1 (2%) 45 (90%) 50
2008 2 (5%) 20 (48%) 22 (52%) 37 (88%) 1 (2%) - 40 (95%) 42
2009 - 21 (46%) 24 (52%) 45 (98%) 1 (2%) - 42 (91%) 46
2010
MPA
-
-
-
3 (7%)
-
-
-
1 (3%)
-
-
1 (2%)
-
-
1 (3%)
-
-
-
-
TRANSPLANTATION ANZDATA Registry 2013 Report _____________________________________________________________________________________
8-16
Figure 8.36
Antibody Use for Induction Immunosuppression Australia and New Zealand 2008 - 2012
Number of Kidney Transplant Recipients Receiving Each Agent by Year
(% Total New Transplants)
2008 2009 2010 2011 2012
Australia
Muromonab-CD3 - 1 (0.1%) - -
Intravenous immunoglobulin 25 (3.1%) 28 (3.6%) 39 (4.6%) 42 (5.1%)
Anti-CD25 740 (91.0%) 715 (92.5%) 800 (94.6%) 765 (92.7%)
Rituximab 21 (2.6%) 17 (2.2%) 9 (1.1%) 10 (1.2%)
T cell depleting polyclonal Ab 22 (2.7%) 40 (5.2%) 52 (6.1%) 33 (4.0%)
Total new transplants 813 773 846 825 845
New Zealand
Intravenous immunoglobulin - - - -
Anti-CD25 74 (60.7%) 63 (52.1%) 65 (59.1%) 114 (96.6%)
Rituximab 1 (0.8%) 2 (1.7%) 1 (0.9%) 3 (2.5%)
T cell depleting polyclonal Ab - - 1 (0.9%) 1 (0.8%)
Total new transplants 122 121 110 118 108
USE OF ANTIBODY THERAPY FOR INDUCTION IMMUNOSUPPRESSION
AUSTRALIA AND NEW ZEALAND
As with the immunosuppression data, the induction antibody data reported to ANZDATA for the 2012 survey were incomplete (see note on page 8-14). For this reason we are not reporting 2012 induction antibody use at this time. Once again, we hope to release a supplemental report online once data capture is considered complete.
8-17
ANZDATA Registry 2013 Report TRANSPLANTATION _____________________________________________________________________________________
USE OF ANTIBODY THERAPY FOR TREATMENT OF REJECTION
AUSTRALIA AND NEW ZEALAND
Figure 8.37 shows the number of people who received antibody agents for treating acute rejection by calendar year. The number is also reported as a proportion of new transplant recipients in each calendar year, but readers should be aware that although the large majority of people experiencing acute rejection do so within the first six months of transplantation, some experience rejection after this time (when they would not necessarily be counted as a new transplant). For this reason the total number of transplant recipients treated during the year is also reported.
Muromonab-CD3 has been withdrawn from sale and was unavailable from 2011. The use of T cell depleting polyclonal Ab and Intravenous Immunoglobulin has decreased in 2012.
Figure 8.37
Antibody Use as Treatment for Acute Rejection Australia and New Zealand 2008 - 2012
Number of Kidney Transplant Recipients Receiving Each Agent by Year
(% Total New Transplants)
2008 2009 2010 2011 2012
Australia
Muromonab-CD3 10 (1.2%) 12 (1.6%) 2 (0.2%) - -
Intravenous immunoglobulin 89 (10.9%) 105 (13.6%) 92 (10.9%) 105 (12.7%) 41 (4.9%)
Anti-CD25 1 (0.1%) 1 (0.1%) - - -
Rituximab 24 (3.0%) 26 (3.4%) 15 (1.8%) 11 (1.3%) 6 (0.7%)
T cell depleting polyclonal Ab 19 (2.3%) 27 (3.5%) 41 (4.8%) 42 (5.1%) 20 (2.4%)
Total new transplants 813 773 846 825 845
New Zealand
Muromonab-CD3 10 (8.2%) 8 (6.6%) 4 (3.6%) - -
Intravenous immunoglobulin 2 (1.6%) 7 (5.8%) 4 (3.6%) 3 (2.5%) 3 (2.8%)
Anti-CD25 1 (0.8%) - - 1 (0.8%) -
Rituximab - 3 (2.5%) - - 1 (0.9%)
T cell depleting polyclonal Ab 3 (2.5%) 2 (1.7%) 12 (10.9%) 11 (9.3%) 4 (3.7%)
Total new transplants 122 121 110 118 108
Total transplants at risk 8064 8427 8893 9331 9723
Total transplants at risk 1422 1471 1514 1558 1591
TRANSPLANTATION ANZDATA Registry 2013 Report _____________________________________________________________________________________
8-18
REJECTION RATES
AUSTRALIA AND NEW ZEALAND
Figure 8.38 shows the proportion of patients experiencing rejection in the first six months after transplant. For both living and deceased donor primary grafts, the six month incidence of rejection has fallen over the last decade.
Rejection rates in subsequent grafts are more variable due to the lower number of recipients, but have not clearly fallen in either living or deceased donors.
Figure 8.38
Australia and New Zealand Rejection Rates at Six Months Post Transplant
Donor Source 2003 2004 2005 2006 2007 2008 2009 2010 2012
Living Donor
First graft 27.7% 21.6% 19.6% 19.6% 21.1% 17.0% 16.8% 17.8% 11.0%
Second and subsequent 33.3% 34.8% 18.5% 33.3% 34.3% 30.0% 24.3% 12.9% 10.3%
Deceased Donor
First graft 26.8% 22.8% 18.6% 16.3% 17.7% 22.0% 21.1% 18.7% 13.7%
Second and subsequent 25.0% 27.5% 31.7% 36.4% 32.8% 32.9% 36.5% 27.3% 19.2%
2011
17.5%
18.5%
20.0%
17.7%
8-19
ANZDATA Registry 2013 Report TRANSPLANTATION _____________________________________________________________________________________
SHORT TERM SURVIVAL - PRIMARY DECEASED DONOR GRAFTS
AUSTRALIA
Graft and patient survival for primary deceased donor grafts performed in Australia, calculated by the Kaplan-Meier method, is shown in Figure 8.39. The figures include graft losses or deaths on the day of transplant, and graft survival is not censored for death. Unadjusted one year patient and graft survival for primary deceased donor grafts in Australia have stabilised in the past ten years. Kaplan-Meier graphs illustrating this are shown in Figure 8.40.
Figure 8.39
Primary Deceased Donor - Australia Recipient and Graft Survival 1993 - 2012
% [95% Confidence Interval]
Year of Transplant
Survival
1 month 6 months 1 year 5 years
Recipient Survival
1993-1994 (n=609) 99 (97, 99) 96 (94, 97) 95 (93, 97) 85 (82, 88)
1995-1996 (n=601) 99 (98, 100) 96 (94, 97) 95 (93, 97) 88 (85, 90)
1997-1998 (n=606) 99 (97, 99) 97 (95, 98) 96 (94, 97) 87 (84, 89)
1999-2000 (n=559) 99 (98, 100) 97 (96, 98) 96 (94, 97) 87 (84, 90)
2001-2002 (n=615) 99 (98, 100) 97 (96, 98) 96 (94, 97) 90 (88, 92)
2003-2004 (n=636) 99 (98, 100) 97 (95, 98) 96 (94, 97) 88 (85, 90)
2005-2006 (n=625) 99 (98, 100) 97 (96, 98) 96 (94, 97) 89 (86, 91)
2007-2008 (n=678) 99 (98, 100) 98 (97, 99) 97 (96, 98) 91 (89, 93)
2009-2010 (n=854) 99 (98, 100) 98 (97, 99) 98 (96, 98) -
2011-2012 (n=1044) 100 (99, 100) 98 (97, 99) 97 (96, 98) -
Graft Survival
1993-1994 (n=609) 93 (91, 95) 89 (86, 91) 88 (85, 90) 73 (69, 76)
1995-1996 (n=601) 95 (92, 96) 90 (88, 92) 89 (86, 91) 78 (74, 81)
1997-1998 (n=606) 95 (93, 97) 92 (90, 94) 90 (88, 92) 77 (74, 80)
1999-2000 (n=559) 96 (95, 98) 93 (91, 95) 92 (89, 94) 80 (76, 83)
2001-2002 (n=615) 96 (94, 97) 94 (92, 96) 92 (90, 94) 82 (79, 85)
2003-2004 (n=636) 94 (92, 96) 92 (90, 94) 91 (88, 93) 80 (76, 83)
2005-2006 (n=625) 95 (93, 97) 93 (91, 95) 91 (89, 93) 79 (76, 82)
2007-2008 (n=678) 96 (94, 97) 94 (92, 95) 92 (90, 94) 81 (78, 84)
2009-2010 (n=854) 98 (97, 99) 96 (95, 97) 95 (93, 96) -
2011-2012 (n=1044) 98 (97, 99) 96 (94, 97) 95 (93, 96) -
0.65
0.70
0.75
0.80
0.85
0.90
0.95
1.00
Rec
ipie
nt s
urvi
val
0 1 2 3 4 5
Years
2005-2006 (625)2007-2008 (678)2009-2010 (854)
2011-2012 (1044)
Recipient survival - Australia
Primary Deceased Donor Grafts
Figure 8.40
0.65
0.70
0.75
0.80
0.85
0.90
0.95
1.00
Gra
ft s
urvi
val
0 1 2 3 4 5
Years
2005-2006 (625)2007-2008 (678)
2009-2010 (854)
2011-2012 (1044)
Graft survival - Australia
Primary Deceased Donor Grafts
TRANSPLANTATION ANZDATA Registry 2013 Report _____________________________________________________________________________________
8-20
SHORT TERM SURVIVAL - PRIMARY DECEASED DONOR GRAFTS
NEW ZEALAND
Graft and patient survival for primary deceased donor grafts performed in New Zealand, calculated by the Kaplan-Meier method, is shown in Figure 8.41. Like Australia, the improvement in unadjusted one year patient and graft survival have stabilised in the past ten years, although there is greater random variation due to smaller overall numbers. Figure 8.42 presents these data as Kaplan-Meier curves.
Figure 8.41
Primary Deceased Donor - New Zealand Recipient and Graft Survival 1993 - 2012
% [95% Confidence Interval]
Year of Transplant
Survival
1 month 6 months 1 year 5 years
Recipient Survival
1993-1994 (n=103) 96 (90, 99) 88 (80, 93) 85 (77, 91) 78 (68, 85)
1995-1996 (n=126) 98 (94, 100) 94 (89, 97) 93 (87, 96) 86 (78, 91)
1997-1998 (n=139) 99 (94, 100) 94 (88, 97) 94 (88, 97) 84 (77, 89)
1999-2000 (n=122) 97 (92, 99) 95 (89, 98) 93 (87, 97) 82 (74, 88)
2001-2002 (n=121) 99 (94, 100) 95 (89, 98) 95 (89, 98) 86 (78, 91)
2003-2004 (n=104) 99 (93, 100) 95 (89, 98) 95 (89, 98) 91 (84, 95)
2005-2006 (n=79) 99 (91, 100) 96 (89, 99) 96 (89, 99) 87 (78, 93)
2007-2008 (n=103) 99 (93, 100) 97 (91, 99) 96 (90, 99) 87 (79, 92)
2009-2010 (n=95) 100 99 (93, 100) 98 (92, 99) -
2011-2012 (n=108) 99 (94, 100) 99 (94, 100) 99 (94, 100) -
Graft Survival
1993-1994 (n=103) 83 (74, 89) 78 (68, 85) 74 (64, 81) 59 (49, 68)
1995-1996 (n=126) 91 (85, 95) 88 (81, 93) 84 (76, 89) 72 (64, 79)
1997-1998 (n=139) 93 (87, 96) 87 (80, 92) 86 (79, 90) 73 (65, 80)
1999-2000 (n=122) 89 (82, 94) 87 (79, 92) 84 (76, 89) 72 (63, 79)
2001-2002 (n=121) 95 (89, 98) 92 (85, 95) 92 (85, 95) 79 (71, 86)
2003-2004 (n=104) 93 (86, 97) 88 (81, 93) 88 (81, 93) 79 (70, 86)
2005-2006 (n=79) 92 (84, 97) 90 (81, 95) 90 (81, 95) 80 (69, 87)
2007-2008 (n=103) 97 (91, 99) 95 (89, 98) 93 (86, 97) 81 (72, 88)
2009-2010 (n=95) 99 (93, 100) 97 (91, 99) 96 (89, 98) -
2011-2012 (n=108) 95 (89, 98) 95 (89, 98) 95 (89, 98) -
Figure 8.42
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Recipient Survival - New Zealand
Primary Deceased Donor Grafts
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Graft Survival - New Zealand
Primary Deceased Donor Grafts
8-21
ANZDATA Registry 2013 Report TRANSPLANTATION _____________________________________________________________________________________
Figure 8.43
Recipient and Graft Survival of Primary Grafts Deceased Donors - Australia and New Zealand
Recipient Survival Graft Survival
Time Period 1 year 5 yrs 10 yrs 15 yrs 20 yrs 1 year 5 yrs 10 yrs 15 yrs 20 yrs
1970-1974 (n=1149) 77.0% 57.4% 44.4% 34.2% 25.1% 58.2% 41.9% 30.3% 22.8% 14.6%
1975-1979 (n=1463) 81.0% 63.6% 49.4% 35.5% 26.2% 51.7% 36.0% 25.6% 17.7% 12.6%
1980-1984 (n=1595) 91.4% 75.1% 59.4% 45.9% 34.7% 63.3% 45.4% 32.1% 23.0% 16.2%
1985-1989 (n=1916) 92.1% 80.3% 64.5% 51.2% 39.6% 80.8% 65.8% 47.2% 32.9% 21.4%
1990-1994 (n=1906) 93.4% 83.9% 67.7% 53.2% 40.9% 85.0% 70.9% 50.7% 34.7% 23.7%
1995-1999 (n=1779) 94.7% 86.1% 72.4% 57.1% - 88.6% 76.2% 58.6% 41.7% -
2000-2004 (n=1850) 96.0% 89.1% 77.0% - - 91.6% 80.8% 64.0% - -
2005-2009 (n=1911) 96.7% 89.5% - - - 92.3% 80.5% - - -
2010-2014 (n=1675) 97.5% - - - - 94.9% - - - -
LONG TERM SURVIVAL - PRIMARY DECEASED DONOR GRAFTS AUSTRALIA AND NEW ZEALAND
The aim of this section is to summarise the longer term outcomes of kidney transplants in a survival metric rather than as rates - that is, to describe the proportion of grafts surviving at particular time points.
As can be seen from the tables and figures, the graft survival advantage of living over deceased donor recipients and first over subsequent grafts is consistent over time. The considerable jump in survival from the 1980-84 cohort to 1985-89 coincides with the introduction of Cyclosporin into routine clinical practice in Australia. Since that time there have been lesser but consistent improvements in graft survival.
Figure 8.44
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Primary Deceased Donor Grafts
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8-22
Patient and graft survival for second or subsequent deceased donor grafts in Australia, calculated by the Kaplan-Meier method, is shown in Figures 8.45 and 8.46.
Figure 8.45
Second and Subsequent Deceased Donor - Australia Recipient and Graft Survival 1993 - 2012
% [95% Confidence Interval]
Year of Transplant
Survival
1 month 6 months 1 year 5 years
Recipient Survival
1993-1994 (n=121) 98 (94, 100) 98 (93, 99) 94 (88, 97) 86 (78, 91)
1995-1996 (n=107) 99 (94, 100) 97 (92, 99) 97 (92, 99) 86 (78, 91)
1997-1998 (n=109) 100 97 (92, 99) 95 (89, 98) 86 (78, 91)
1999-2000 (n=77) 99 (91, 100) 96 (88, 99) 95 (87, 98) 86 (76, 92)
2001-2002 (n=87) 99 (92, 100) 94 (87, 98) 92 (84, 96) 87 (78, 93)
2003-2004 (n=95) 99 (93, 100) 98 (92, 99) 95 (88, 98) 85 (76, 91)
2005-2006 (n=120) 100 99 (94, 100) 97 (91, 99) 88 (81, 93)
2007-2008 (n=125) 99 (94, 100) 98 (93, 99) 96 (91, 98) 85 (76, 90)
2009-2010 (n=142) 99 (95, 100) 97 (93, 99) 95 (90, 98) -
2011-2012 (n=133) 100 99 (94, 100) 99 (94, 100) -
Graft Survival
1993-1994 (n=121) 87 (79, 92) 85 (77, 90) 83 (76, 89) 70 (61, 78)
1995-1996 (n=107) 83 (75, 89) 78 (68, 84) 77 (67, 84) 61 (51, 69)
1997-1998 (n=109) 93 (86, 96) 89 (81, 94) 84 (76, 90) 73 (64, 81)
1999-2000 (n=77) 92 (83, 96) 88 (79, 94) 87 (77, 93) 68 (56, 77)
2001-2002 (n=87) 92 (84, 96) 85 (76, 91) 82 (72, 88) 67 (56, 75)
2003-2004 (n=95) 94 (86, 97) 94 (86, 97) 89 (81, 94) 72 (61, 80)
2005-2006 (n=120) 97 (91, 99) 93 (87, 97) 89 (82, 94) 71 (62, 78)
2007-2008 (n=125) 96 (91, 98) 93 (87, 96) 90 (84, 94) 70 (61, 78)
2009-2010 (n=142) 94 (89, 97) 93 (87, 96) 91 (85, 95) -
2011-2012 (n=133) 98 (94, 100) 98 (93, 99) 95 (89, 98) -
SHORT TERM SURVIVAL - SECOND AND SUBSEQUENT DECEASED DONOR GRAFTS
AUSTRALIA AND NEW ZEALAND
Figure 8.46
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2011-2012 (133)
Recipient survival - Australia
Second and Subsequent Deceased Donor Grafts
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2011-2012 (133)
Graft survival - Australia
Second and Subsequent Deceased Donor Grafts
8-23
ANZDATA Registry 2013 Report TRANSPLANTATION _____________________________________________________________________________________
Figure 8.47
Recipient and Graft Survival of Second and Subsequent Grafts Deceased Donors
Australia and New Zealand
Graft Survival
Time Period 1 year 5 yrs 10 yrs 15 yrs 20 yrs 1 year 5 yrs 10 yrs 15 yrs 20 yrs
1970-1974 (n=158) 79.1% 55.7% 42.4% 33.5% 26.6% 58.9% 37.3% 27.2% 21.5% 14.6%
1975-1979 (n=284) 78.2% 57.4% 44.7% 31.3% 20.0% 44.0% 28.2% 20.4% 15.0% 8.1%
1980-1984 (n=417) 90.6% 74.8% 59.0% 46.8% 37.1% 48.9% 36.0% 25.6% 20.3% 14.2%
1985-1989 (n=458) 93.7% 79.2% 62.8% 47.3% 35.1% 70.1% 51.7% 34.4% 23.2% 13.9%
1990-1994 (n=374) 93.0% 82.6% 67.9% 54.0% 40.8% 78.3% 64.2% 44.1% 31.2% 21.0%
1995-1999 (n=296) 95.9% 86.1% 73.3% 60.0% - 81.8% 66.6% 44.3% 31.1% -
2000-2004 (n=268) 93.7% 86.2% 74.8% - - 86.6% 70.1% 51.5% - -
2005-2009 (n=343) 96.2% 87.9% - - - 89.5% 73.1% - - -
2010-2014 (n=217) 96.3% - - - - 93.4% - - - -
Recipient Survival
LONG TERM SURVIVAL - SECOND AND SUBSEQUENT DECEASED DONOR GRAFTS
AUSTRALIA AND NEW ZEALAND
The long-term graft and patient survival of second and subsequent grafts is shown in Figures 8.47 and 8.48. There has been a steady improvement in both graft and patient survival, such that survival of subsequent grafts is now similar to primary grafts (Figures 8.43 and 8.44).
Figure 8.48
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Second and Subsequent Deceased Donor Grafts
TRANSPLANTATION ANZDATA Registry 2013 Report _____________________________________________________________________________________
8-24
Figure 8.50 New Zealand
Year of Transplant
1 month 6 months 1 year 5 years
Recipient Survival
1993-1994 (n=160) 100 99 (95, 100) 98 (94, 99) 94 (89, 97)
1995-1996 (n=186) 100 98 (95, 99) 97 (94, 99) 95 (90, 97)
1997-1998 (n=284) 100 99 (96, 99) 98 (96, 99) 96 (93, 98)
1999-2000 (n=320) 99 (98, 100) 98 (96, 99) 98 (96, 99) 94 (91, 96)
2001-2002 (n=410) 100 (98, 100) 99 (97, 100) 99 (97, 99) 95 (92, 97)
2003-2004 (n=419) 100 (98, 100) 99 (97, 100) 99 (97, 100) 94 (92, 96)
2005-2006 (n=463) 100 (98, 100) 100 (98, 100) 99 (98, 100) 97 (95, 98)
2007-2008 (n=557) 100 (99, 100) 99 (97, 99) 99 (97, 99) 94 (92, 96)
2009-2010 (n=564) 100 (99, 100) 99 (98, 100) 98 (97, 99) - 2011-2012 (n=447) 100 100 (98, 100) 100 (98, 100) -
Graft Survival
1993-1994 (n=35) 91 (76, 97) 89 (72, 96) 89 (72, 96) 74 (56, 86)
1995-1996 (n=46) 98 (86, 100) 98 (86, 100) 98 (86, 100) 76 (61, 86)
1997-1998 (n=57) 96 (87, 99) 96 (87, 99) 95 (85, 98) 72 (58, 82)
1999-2000 (n=66) 95 (87, 99) 94 (85, 98) 94 (85, 98) 82 (70, 89)
2001-2002 (n=83) 100 99 (92, 100) 99 (92, 100) 88 (79, 93)
2003-2004 (n=88) 97 (90, 99) 95 (88, 98) 95 (88, 98) 86 (77, 92)
2005-2006 (n=88) 99 (92, 100) 97 (90, 99) 95 (88, 98) 91 (83, 95)
2007-2008 (n=120) 98 (94, 100) 98 (92, 99) 97 (91, 99) 84 (76, 90)
2009-2010 (n=118) 99 (94, 100) 97 (92, 99) 97 (91, 99) -
2011-2012 (n=101) 97 (91, 99) 97 (91, 99) 95 (87, 98) -
Primary Living Donor Grafts 1993 - 2012 Recipient and Graft Survival
% [95% Confidence Interval]
Figure 8.49 Australia
Year of Transplant
Primary Living Donor Grafts 1993 - 2012 Recipient and Graft Survival
% [95% Confidence Interval]
1 month 6 months 1 year 5 years
Recipient Survival
1993-1994 (n=160) 100 99 (95, 100) 98 (94, 99) 94 (89, 97)
1995-1996 (n=186) 100 98 (95, 99) 97 (94, 99) 95 (90, 97)
1997-1998 (n=284) 100 99 (96, 99) 98 (96, 99) 96 (93, 98)
1999-2000 (n=320) 99 (98, 100) 98 (96, 99) 98 (96, 99) 94 (91, 96)
2001-2002 (n=410) 100 (98, 100) 99 (97, 100) 99 (97, 99) 95 (92, 97)
2003-2004 (n=419) 100 (98, 100) 99 (97, 100) 99 (97, 100) 94 (92, 96)
2005-2006 (n=463) 100 (98, 100) 100 (98, 100) 99 (98, 100) 97 (95, 98)
2007-2008 (n=557) 100 (99, 100) 99 (97, 99) 99 (97, 99) 94 (92, 96)
2009-2010 (n=564) 100 (99, 100) 99 (98, 100) 98 (97, 99) -
2011-2012 (n=447) 100 100 (98, 100) 100 (98, 100) -
Graft Survival
1993-1994 (n=160) 97 (93, 99) 96 (91, 98) 95 (90, 97) 85 (78, 90)
1995-1996 (n=186) 93 (88, 96) 91 (86, 94) 90 (84, 93) 84 (78, 89)
1997-1998 (n=284) 98 (96, 99) 97 (94, 98) 96 (94, 98) 87 (82, 90)
1999-2000 (n=320) 97 (94, 98) 95 (92, 97) 94 (91, 96) 86 (82, 90)
2001-2002 (n=410) 98 (96, 99) 96 (94, 98) 96 (93, 97) 88 (85, 91)
2003-2004 (n=419) 99 (97, 100) 98 (96, 99) 97 (95, 98) 88 (84, 91)
2005-2006 (n=463) 98 (97, 99) 98 (96, 99) 97 (95, 98) 90 (87, 93)
2007-2008 (n=557) 98 (96, 99) 97 (95, 98) 97 (95, 98) 88 (85, 91)
2009-2010 (n=564) 99 (98, 100) 98 (97, 99) 97 (95, 98) -
2011-2012 (n=447) 99 (97, 99) 98 (96, 99) 98 (96, 99) -
For primary living donor graft recipients, excellent patient and graft survival rates have been maintained despite the increased rates of living donor transplantation and corresponding increase in performing less ideal living donor transplants, particularly from older donors and unrelated donor transplants. Current patient and graft survival for primary living donor recipients in Australia and New Zealand are similar.
SHORT TERM SURVIVAL - PRIMARY LIVING DONOR GRAFTS AUSTRALIA AND NEW ZEALAND
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ANZDATA Registry 2013 Report TRANSPLANTATION _____________________________________________________________________________________
Figure 8.51
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2005-2006 (463)2007-2008 (557)2009-2010 (564)
2011-2012 (447)
Recipient Survival - Australia
Primary Living Donor Grafts
Figure 8.52
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Graft Survival - Australia
Primary Living Donor Grafts
Figure 8.53
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2011-2012 (101)
Recipient survival - New Zealand
Primary Living Donor Grafts
Figure 8.54
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Primary Living Donor Grafts
TRANSPLANTATION ANZDATA Registry 2013 Report _____________________________________________________________________________________
8-26
Figure 8.55
Recipient and Graft Survival of Primary Grafts Living Donors - Australia and New Zealand
Recipient Survival Graft Survival
Time Period 1 year 5 yrs 10 yrs 15 yrs 20 yrs 1 year 5 yrs 10 yrs 15 yrs 20 yrs
1970‐1974 (n=21) 90.5% 81.0% 61.9% 52.4% 42.9% 85.7% 76.2% 61.5% 46.2% 20.5%
1975‐1979 (n=107) 90.7% 78.5% 71.0% 61.7% 52.2% 81.2% 63.3% 49.9% 41.2% 31.1%
1980‐1984 (n=241) 96.3% 85.4% 74.9% 64.8% 55.4% 82.8% 71.2% 59.3% 46.5% 35.9%
1985‐1989 (n=230) 95.2% 87.8% 79.9% 71.1% 62.9% 90.8% 74.8% 60.5% 45.1% 35.0%
1990‐1994 (n=431) 97.2% 89.2% 84.0% 74.5% 68.5% 91.8% 79.6% 65.3% 48.8% 32.0%
1995‐1999 (n=766) 98.6% 94.7% 86.6% 76.8% ‐ 94.5% 84.0% 68.8% 52.1% ‐
2000‐2004 (n=1193) 98.5% 94.3% 86.6% ‐ ‐ 95.9% 87.7% 72.4% ‐ ‐
2005‐2009 (n=1585) 98.5% 95.2% ‐ ‐ ‐ 96.7% 89.1% ‐ ‐ ‐
2010‐2014 (n=873) 99.0% ‐ ‐ ‐ ‐ 97.2% ‐ ‐ ‐ ‐
Figure 8.56
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Graft survival - Australia and New Zealand
Primary Living Donor Grafts
LONG TERM SURVIVAL - PRIMARY LIVING DONOR GRAFTS AUSTRALIA AND NEW ZEALAND
8-27
ANZDATA Registry 2013 Report TRANSPLANTATION _____________________________________________________________________________________
Figure 8.57
Recipient and Graft Survival of Second and Subsequent Grafts Living Donors - Australia and New Zealand
Recipient Survival Graft Survival
Time Period 1 year 5 yrs 10 yrs 15 yrs 20 yrs 1 year 5 yrs 10 yrs 15 yrs 20 yrs
1970-1974 (n=1) 100.0% 100.0% - - - 100.0% 100.0% - - -
1975-1979 (n=11) 100.0% 100.0% 81.8% 72.7% 63.6% 72.7% 45.5% 36.4% 36.4% 27.3%
1980-1984 (n=42) 97.6% 81.0% 78.6% 71.4% 51.9% 78.6% 64.3% 59.5% 50.0% 40.5%
1985-1989 (n=31) 96.8% 83.9% 71.0% 64.5% 47.5% 87.1% 74.2% 58.1% 45.2% 29.0%
1990-1994 (n=38) 100.0% 94.7% 73.3% 67.9% 51.3% 100.0% 86.8% 41.2% 35.7% 24.7%
1995-1999 (n=74) 98.6% 98.6% 89.2% 81.1% - 93.2% 82.4% 68.9% 57.9% -
2000-2004 (n=107) 98.1% 95.3% 85.7% - - 93.5% 85.0% 67.2% - -
2005-2009 (n=175) 98.3% 93.2% - - - 95.4% 82.1% - - -
2010-2014 (n=87) 98.7% - - - - 95.2% - - - -
0.00
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1985-1989
Graft survival - Australia and New Zealand
Second and Subsequent Living Donor Grafts
Figure 8.58
LONG TERM SURVIVAL - SECOND AND SUBSEQUENT LIVING DONOR GRAFTS
AUSTRALIA AND NEW ZEALAND
TRANSPLANTATION ANZDATA Registry 2013 Report _____________________________________________________________________________________
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Philip Clayton
CHAPTER 9
KIDNEY DONATION
2013 Annual Report - 36th Edition
KIDNEY DONATION ANZDATA Registry 2013 Report _____________________________________________________________________________________
9-2
DECEASED KIDNEY DONORS
The data for this section come from the Australia and New Zealand Organ Donor (ANZOD) Registry. Much more information about deceased organ donors in Australia and New Zealand can be found on the ANZOD website, http://www.anzdata.org.au/anzod/v1/indexanzod.html. Figures 9.1 and 9.2 show the different types of deceased kidney donors in each country over 2003-2012. In Australia there has been a large increase in the number of donors since 2008, driven primarily by an increase in expanded criteria (ECD) and in particular cardiac death (DCD) donors. In New Zealand the donor numbers are steady and the proportion of ECD and DCD donors are much lower than in Australia.
The causes of death of deceased donors are shown in Figures 9.3 and 9.4. Stroke remains the most common cause of kidney donor death in both Australia and New Zealand. In Australia there has been a slight reduction in the proportion of deaths due to road trauma, with a corresponding increase in the proportion due to hypoxia/anoxia.
0
100
200
300
Num
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onor
s
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012DCD, donor after cardiac deathDBD ECD, expanded critera donor after brain deathDCD SCD, standard criteria donor after brain death
Australia 2003-2012
Deceased Kidney Donor Type
DCDDBD ECDDBD SCD
Figure 9.1
0
10
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30
40
Num
ber
of d
onor
s
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012DCD, donor after cardiac deathDBD ECD, expanded critera donor after brain deathDCD SCD, standard criteria donor after brain death
New Zealand 2003-2012
Deceased Kidney Donor Type
DCDDBD ECDDBD SCD
Figure 9.2
0
20
40
60
%
2002 2004 2006 2008 2010 2012
StrokeHypoxia/anoxiaRoad trauma
Other traumaOtherCerebral tumour
Australia 2003-2012
Cause of donor death
Figure 9.3
0
20
40
60
%
2002 2004 2006 2008 2010 2012
StrokeHypoxia/anoxiaRoad trauma
Other traumaOtherCerebral tumour
New Zealand 2003-2012
Cause of donor death
Figure 9.4
ANZDATA Registry 2013 Report KIDNEY DONATION _____________________________________________________________________________________
9-3
Figures 9.7 and 9.8 show the discard rate of retrieved kidneys – the proportion of kidneys that were retrieved for the purpose of transplantation, but not ultimately transplanted into a recipient. The error bars represent 95% confidence intervals. Despite the increasing age and complexity of donors in Australia the discard rate has remained steady at around 3% over the last 10 years. In New Zealand discard rates have historically been slightly higher than in Australia (note the different y-axis scales), although over 2011-2012 the discard rate was <2%.
0
10
20
30
40
50
Don
or a
ge (
year
s),
mea
n an
d 95
% C
I
1995 2000 2005 2010 2015
Year
Australia 1993-2012
Deceased kidney donor age
Figure 9.5
0
10
20
30
40
50
Don
or a
ge (
year
s),
mea
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d 95
% C
I
1995 2000 2005 2010 2015
Year
New Zealand 1993-2012
Deceased kidney donor age
Figure 9.6
0
2
4
6
8
10
% k
idne
ys r
etrie
ved
but
not
tran
spla
nted
2002 2004 2006 2008 2010 2012
Australia 2003-2012
Discard rate of retrieved kidneys
Figure 9.7
0
10
20
30
40
% k
idn
eys
re
trie
ved
bu
t no
t tra
nsp
lan
ted
2002 2004 2006 2008 2010 2012
New Zealand 2003-2012
Discard rate of retrieved kidneys
Figure 9.8
Figures 9.5 and 9.6 show the mean age of deceased kidney donors in Australia and New Zealand over the last 20 years. In Australia the mean age has increased steadily from 36 years in 1993 to 46 years in 2012. In New Zealand the trend is less clear, and donors are generally younger than in Australia; the mean donor age in 2012 was 44 years.
KIDNEY DONATION ANZDATA Registry 2013 Report _____________________________________________________________________________________
9-4
LIVING KIDNEY DONORS
AUSTRALIA There were 238 living donor kidney transplants performed in 2012 in Australia, representing 28% of all transplant operations (Figure 9.9). Living donor transplants have been falling as a proportion of all transplants since 2008 (Figure 9.10).
Figure 9.12 shows the number of living donors for the years 2003-2012 by donor age. Since 2008 the number of living donors decreased in the most common age groups of 35-44, 45-54 and 55-64.
The proportion of living donor transplants for each State and New Zealand for recipients aged 25-44 years is shown for the years 2005-2008 and 2009-2012 in Figure 9.11. Overall there has been a decrease in this age group for both countries from 2005-2008 to 2009-2012, more pronounced in Australia.
The proportion of genetically unrelated donors was 40% (96 donors) in 2012 compared with 50% (127 donors) in 2011, shown in Figures 9.13 and 9.16. Fifty-four percent of living unrelated donors were spouses or partners. The age distribution of living donors is shown in Figure 9.12.
There were five non-directed donors in 2012. ABO incompatible transplants in 2012 fell to 28 from a peak of 40 in 2010 (Figure 9.15).
NEW ZEALAND The number of living donor transplants decreased by 5% (54 donors) in New Zealand in 2012, as shown in Figure 9.14.
There were 32 genetically unrelated kidney donors in 2012, compared with 33 in 2011.
Fifty percent of grafts were from a living donor.
Unrelated donors represented 57% of all living donors in 2012, shown in Figures 9.14 and 9.16. More friends donated than spouses or partners.
There were four non-directed donors in 2012, similar to previous years.
Figure 9.9
Living Donor Operations as a Proportion(%) of Annual Transplantation
Australia 2007 - 2012
Recipient Age Groups
Year of Transplantation
2007 2008 2009 2010 20101
00-04 years 89% 75% 55% 60% 50%
05-14 years 56% 59% 71% 60% 46%
15-24 years 65% 67% 73% 76% 58%
25-34 years 57% 53% 54% 44% 40%
35-44 years 38% 36% 41% 41% 35%
45-54 years 43% 41% 39% 26% 22%
55-64 years 35% 39% 37% 31% 28%
65-74 years 45% 44% 33% 18% 23%
75-84 years 0% 0% 0% 67% 50%
All Recipients 44% 44% 42% 35% 31%
2012
71%
68%
58%
29%
32%
21%
21%
25%
50%
28%
Figure 9.11
3328
4239
51
42 4440
4346 4339
5756
0
20
40
60
%
QLD
NSW/A
CT
Vic/Tas
SA/NT
WA
Aust
NZ
Age 25-44, 2005-2008 vs 2009-2012
Percentage Living Donor Grafts
2005-2008
2009-2012
Figure 9.10
7571
59
68 67
5853
2936
32
41
21
39
21
44
25
0
20
40
60
80
%
0-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74
Age
Stratified by age, 2008 vs 2012
Percentage Living Donor Grafts - Australia
2008 (44%)2012 (28%)
ANZDATA Registry 2013 Report KIDNEY DONATION _____________________________________________________________________________________
9-5
218244 246
273 271
354327
296
255238
0
100
200
300
400
Num
ber
of tr
ansp
lant
s
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Australia 2003-2012
Source of Living Kidney Donor
Unrelated
Related
Figure 9.13
4448 46
49
58
69 6760
5754
0
20
40
60
80
Nu
mb
er
of
tra
nsp
lan
ts
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
New Zealand 2003-2012
Source of Living Kidney Donor
Unrelated
Related
Figure 9.14
Figure 9.15
0
50
100
150
0
50
100
150
Num
ber
of tr
ansp
lant
s
2002 2004 2006 2008 2010 2012
Year of transplant
18-2425-34
35-4445-5455-6465-74
75+
Age of Living Donors in Australia 2003-2012
Figure 9.12
36
30
40
35
28
0
10
20
30
40
Nu
mb
er
of A
BO
i tra
nsp
lan
ts
2008 2009 2010 2011 2012
Australia 2008-2012
ABO Incompatible Living Donor Transplants
KIDNEY DONATION ANZDATA Registry 2013 Report _____________________________________________________________________________________
9-6
Figure 9.17 Gender of Living Kidney Donors 2008 - 2012
Source and State/Country of Transplant
2008 2009 2010 2011 2012 Male Female Total Male Female Total Male Female Total Male Female Total Male Female Total
Related NSW/ACT 57% 43% 63 48% 52% 66 37% 63% 46 41% 59% 46 37% 57% 46 VIC/TAS 39% 61% 56 26% 74% 58 42% 58% 66 50% 50% 44 40% 60% 50
QLD 35% 65% 17 31% 69% 26 57% 43% 21 45% 55% 20 38% 62% 21 SA/NT 45% 55% 22 44% 56% 16 40% 60% 20 30% 70% 10 57% 43% 14 WA 41% 59% 17 55% 45% 20 42% 58% 24 50% 50% 8 55% 45% 11
Australia 46% 54% 175 39% 61% 186 42% 58% 177 45% 55% 128 42% 56% 142
New Zealand 47% 53% 38 49% 51% 41 57% 43% 37 50% 50% 24 48% 52% 23
Unrelated
NSW/ACT 31% 69% 51 37% 63% 41 41% 59% 37 43% 57% 42 41% 59% 27 VIC/TAS 52% 48% 60 35% 65% 40 41% 59% 39 43% 58% 40 47% 53% 36
QLD 33% 67% 27 41% 59% 29 36% 64% 22 25% 75% 16 30% 70% 10
SA/NT 37% 63% 19 86% 14% 7 38% 63% 8 50% 50% 6 33% 67% 9 WA 32% 68% 22 38% 63% 24 23% 77% 13 43% 57% 23 36% 64% 14
Australia 39% 61% 179 40% 60% 141 38% 62% 119 41% 59% 127 41% 59% 96
New Zealand 39% 61% 31 42% 58% 26 43% 57% 23 42% 58% 33 26% 74% 31
Figure 9.16
Source of Living Donor Kidneys 2008 - 2012 (x = identical twin) (+ = non identical twin)
Source Australia New Zealand 2008 2009 2010 2011 2012 2008 2009 2010 2011 2012
Total Living Donors 354 327 296 255 238 69 67 60 57 54
Related (175) (186) (177) (128) (142) (38) (41) (37) (24) (23)
Mother 46 53 48 38 40 6 5 3 0 4
Father 41 27 37 33 35 9 6 5 3 6
Sister 30 41 35 22 26 9 8 6 9 3
Brother 33 32 26 18 20 5 11 10 5 1
Identical twin sister 0 0 1 0 0 0 0 0 0 0
Identical twin brother 0 0 0 1 0 0 0 0 1 0
Non-identical twin sister 1 2 0 1 0 0 0 0 0 0
Non-identical twin brother 0 0 2 0 0 0 0 0 0 0
Daughter 6 4 4 5 3 1 4 2 2 4
Son 3 4 7 1 3 2 3 3 2 4
Grandmother 2 5 3 0 3 0 0 0 0 0
Grandfather 0 0 1 1 0 0 0 0 0 0
Cousin 5 5 4 2 4 2 0 3 1 0
Niece 0 1 1 1 0 1 2 1 0 1
Nephew 0 3 0 0 0 0 0 0 0 0
Aunt 7 6 7 3 4 1 2 2 0 0
Uncle 1 3 1 2 4 2 0 2 1 0
Unrelated (179) (141) (119) (127) (96) (31) (26) (23) (33) (31)
Wife 64 63 47 47 32 5 2 5 10 8
Husband 35 33 21 20 15 5 1 2 4 1
Mother-in-law 0 1 1 0 1 0 0 0 0 0
Father-in-law 1 0 1 0 1 0 0 0 0 0
Stepmother 1 0 0 0 0 0 0 0 0 0
Stepfather 2 0 0 0 1 1 0 1 0 0
Stepsister 1 0 0 0 0 0 1 0 0 0
Sister-in-law 4 4 0 2 1 1 0 0 0 0
Brother-in-law 1 3 1 0 2 1 0 1 1 0
Daughter-in-law 0 0 1 0 0 0 0 0 0 0
Son-in-law 1 1 0 0 0 0 1 0 1 0
Stepdaughter 1 0 0 0 0 0 0 0 0 0
Stepson 0 0 1 1 0 0 0 0 0 0
Partner 10 6 6 6 5 0 1 2 4 1
Friend 27 18 16 12 7 10 13 7 5 14
Non-directed 6 4 1 5 5 8 6 4 3 4
Pathological 13 6 11 9 12 0 0 0 0 0
Paired kidney exchange 5 2 8 25 11 0 0 0 2 2
Other 7 0 4 0 3 0 1 1 3 1
ANZDATA Registry 2013 Report KIDNEY DONATION _____________________________________________________________________________________
9-7
Figure 9.18
Timing of Living Donor Transplantation for Primary Grafts in Relation to Date of Dialysis Start
by Year of Transplant 2008 - 2012
2008 2009 2010 2011 2012
Aust
Pre-emptive 94 (30%) 108 (36%) 92 (35%) 87 (37%) 76 (36%)
<1 month post dialysis 5 (2%) 10 (3%) 6 (2%) 7 (3%) 6 (3%)
1 month to <1 year post dialysis 77 (24%) 81 (27%) 62 (23%) 66 (28%) 70 (33%)
>=1 year post dialysis 141 (44%) 99 (33%) 106 (40%) 73 (31%) 62 (29%)
NZ
Pre-emptive 20 (30%) 18 (31%) 15 (25%) 12 (23%) 15 (31%)
<1 month post dialysis 2 (3%) 1 (2%) 1 (2%) 1 (2%) 1 (2%)
1 month to <1 year post dialysis 14 (21%) 8 (14%) 10 (17%) 11 (21%) 12 (24%)
>=1 year post dialysis 30 (45%) 32 (54%) 33 (56%) 28 (54%) 21 (43%)
The timing of primary living donor transplants relative to the start of dialysis is shown in Figure 9.18.
The proportion of all primary living donor transplants performed “pre-emptively” in Australia was 36%, compared with 37% in 2012. There has been a gradual reduction in the number of pre-emptive transplants over the last few years (Figure 9.19). Twenty-nine percent of recipients had received dialysis treatment for twelve months or longer prior to a first living donor graft.
The proportion of pre-emptive primary living donor transplants in New Zealand was 31% in 2012 compared with 23% in 2011 (Figure 9.18). Forty-three percent received dialysis for twelve months or longer prior to being transplanted.
TIMING OF LIVING DONOR TRANSPLANTS
50 52
7265 62
94
108
9287
76
0
20
40
60
80
100
Num
ber
of tr
ansp
lant
s
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
2003-2012
Pre-emptive Transplants - Australia
Figure 9.19
KIDNEY DONATION ANZDATA Registry 2013 Report _____________________________________________________________________________________
9-8
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Germaine Wong
Blair Grace
Philip Clayton
Jonathon C. Craig
CHAPTER 10
CANCER
2013 Annual Report - 36th Edition
10-2
CANCER REPORT ANZDATA Registry 2012 Report _____________________________________________________________________________________
There is now consistent evidence showing an increased risk of cancer by at least 1.5 and 2-fold for people on dialysis and with kidney transplants, respectively. Cancer is also second to cardiovascular disease as the major cause of mortality and morbidity in these patients. Cancer can occur de novo or recur after transplantation. Patients with a prior cancer are also at risk of developing a new cancer type after transplantation. In this report, we provide the overall and site-specific cancer risks for those on dialysis and with a functioning kidney allograft between 1965 – 2012. We will also present the incidence of disease recurrence and new cancer development among those with a prior cancer. Finally, several new and novel risk factors for cancer after transplantation have been established using data from the ANZDATA Registry. Understanding the potential modifiable risk factors of cancer may enable clinicians, health professionals and decision makers to develop strategies that may prevent and/or halt disease occurrence and progression in the future.
Figure 10.1 Cumulative incidence of all cancers (excluding non-melanocytic skin cancers) in Australia and New Zealand The cumulative incidence of cancers is similar between Australia and New Zealand. Over 9% of patients on renal replacement therapy (RRT) develop a cancer (excluding non-melanocytic) within 10 years of commencing RRT.
INTRODUCTION
0
5
10
15
Cum
ulat
ive
inci
denc
e (%
)
5778 1695 348New Zealand25716 7976 1697Australia
Number at risk
0 5 10
Years on RRT
AustraliaNZ
All Cancers, all patients
Figure 10.1
Figure 10.2
Cumulative (%) Incidence of all Cancers in Australia and New Zealand (excluding non-melanocytic skin cancers)
Country 6 months 1 years 2 years 5 years 10 years
Australia 1.3 (1.2, 1.5) 2.1 (2.0, 2.3) 3.5 (3.3, 3.7) 6.4 (6.1, 6.8) 9.4 (8.9, 9.9)
New Zealand 1.2 (1.0, 1.6) 1.9 (1.6, 2.3) 3.2 (2.8, 3.7) 6.0 (5.4, 6.7) 9.4 (8.4, 10.4)
CUMULATIVE INCIDENCE OF ALL CANCERS
10-3
ANZDATA Registry 2012 Report CANCER REPORT _____________________________________________________________________________________
Figures 10.3a and 10.3b Cumulative incidence of all cancers (excluding non-melanocytic skin cancer) among those with a functioning kidney transplant, stratified by age at transplant.
CUMULATIVE INCIDENCE OF ALL CANCERS AMONG THOSE WITH FUNCTIONING KIDNEY TRANSPLANTS
0
5
10
15
% D
evel
opin
g C
ance
r
0 5 10
Years with Graft
45+ years
0-44 years
All CancersFunctioning grafts - Australia
0
5
10
% D
eve
lopi
ng
Can
cer
0 5 10
Years on Dialysis
45+ years
0-44 years
All CancersDialysis patients - Australia
0
5
10
15
% D
eve
lopi
ng
Can
cer
0 5 10
Years with Graft
45+ years
0-44 years
All CancersFunctioning grafts - New Zealand
0
5
10
% D
eve
lopi
ng
Can
cer
0 5 10
Years on Dialysis
45+ years
0-44 years
All CancersDialysis patients - New Zealand
Figure 10.3a
Figure 10.3b
Figure 10.4a and 10.4b Cumulative incidence of all cancers (excluding non-melanocytic skin cancer) among those with a functioning kidney transplant, stratified by age at transplant.
Figure 10.4a Figure 10.4b
10-4
CANCER REPORT ANZDATA Registry 2012 Report _____________________________________________________________________________________
Figures 10.5 - 10.7 Cumulative incidence of the three most common cancer types among those on RRT in Australia and New Zealand. Cancer of the lung is the most common cancer type, followed by colorectal and urinary tract cancers.
CUMULATIVE INCIDENCE OF THE THREE MOST PREVALENT CANCER TYPES AMONG THOSE ON RRT IN AUSTRALIA AND NEW ZEALAND
0
0.5
1
1.5
% D
eve
lopi
ng
Can
cer
0 5 10
Years on RRT
Australia
New Zealand
Colorectal CancersAll patients
0
0.5
1
% D
eve
lopi
ng
Can
cer
0 5 10
Years on RRT
Australia
New Zealand
Kidney CancersAll patients
0
0.5
1
1.5
2
% D
eve
lopi
ng
Can
cer
0 5 10
Years on RRT
Australia
New Zealand
Lung CancersAll patients
Figure 10.5
Figure 10.6
Figure 10.7
10-5
ANZDATA Registry 2012 Report CANCER REPORT _____________________________________________________________________________________
FREQUENCY OF SITE-SPECIFIC CANCERS
Figure 10.8
Frequency of Site-Specific Cancers
Recipients who developed incident
cancer following first transplant
Recipients with prior cancer and developed a new cancer following
first transplant
Recipients with prior cancer and developed
cancer recurrence following first
transplant
All cancers (n, %) 2760 (100) 57 (100) 23 (100)
Colorectal 509 (18.4) 11 (19.3) 1 (4.4)
Urinary tract 370 (13.4) 8 (14.0) 7 (30.4)
Female genitourinary 288 (10.8) 1 (1.8) 3 (13.0)
Melanoma 295 (10.7) 8 (14.0) 3 (13.0)
Lung 218 (7.9) 8 (14.0) -
Haematological 217 (7.9) 4 (7.0) 2 (8.7)
Prostate 167 (6.1) 5 (8.8) -
Breast 150 (5.8) 6 (10.5) 6 (26.1)
Oral 126 (4.6) 3 (5.3) 1 (4.4)
Central nervous system (CNS)
93 (3.4) 2 (3.5) -
Thyroid/endocrine 67 (2.4) - -
Connective tissue 30 (1.1) 1 (1.8)
Others 54 (2.0) - -
Cancers with unknown site 165 (6.0) - -
Figure 10.8 Of the 21,415 transplanted patients, 651 (3.0%) had cancer prior to transplantation. A total of 23 patients experienced cancer recurrence during the follow-up. Fifty seven (out of 651, 8.7%) developed a new second cancer after transplantation. Among those with disease recurrence, cancers of the urinary tract system were most prevalent, followed by breast, lung cancers and melanomas.
10-6
CANCER REPORT ANZDATA Registry 2012 Report _____________________________________________________________________________________
Novel Risk Factors for Cancer Development After Kidney Transplantation
Figure 10.9
Novel Risk Factors for Cancer Development After Kidney Transplantation
Acute rejection and cancer risk Lim WH et al Transplantation 2014
Recipients who experienced acute rejection and treated with T-cell-depleting antibody were 40% more likely to develop incident cancer compared with those who did not experience acute rejection, particularly genitourinary tract cancers
Time on dialysis and cancer risk Wong G et al Transplantation 2013
There is a linear relationship between duration of dialysis and the risk of cancer after transplantation, with over 2.5-fold increase in the risk of lung and urinary tract cancers among recipients who had been on dialysis for the longest duration before transplantation
Immunosuppression pre-transplant and cancer risk Hibberd A et al Transplantation 2013
Use of pre-transplantation immunosuppression in the treatment of primary kidney disease is associated with 1.8-3.7-fold greater risk of anogenital cancers, non-Hodgkin's lymphomas, breast cancers and urinary tract cancers
Donor type and cancer risk Lim WH et al TSANZ abstract 2013
Compared to recipients of live-donor kidneys, recipients of expanded criteria deceased donor kidneys were at a 1.5-fold greater risk of developing incident cancers, particularly genitourinary cancers and post-transplant lymphoproliferative disease
Donor cancer transmission in kidney transplantation Systematic review of donor cancer transmission Xiao D et al Am J Transplant 2013
A total of 69 studies with 104 donor-transmitted cancer cases were identified, with the three most common transmitted cancer types being renal cell cancers (n = 20, 19%), melanoma (n = 18, 17%), lymphoma (n = 15, 14%) and lung cancers (n = 9, 9%). Recipients with donor-transmitted melanoma and lung cancers incurred the poorest overall survival and therefore donors with a history of melanoma or lung cancer should not be considered.
10-7
ANZDATA Registry 2012 Report CANCER REPORT _____________________________________________________________________________________
This page is intentionally blank
Sean Kennedy
Nancy Briggs
Hannah Dent
Stephen McDonald
Kylie Hurst
Philip Clayton
CHAPTER 11
PAEDIATRIC
2013 Annual Report - 36th Edition
11-2
PAEDIATRIC REPORT ANZDATA Registry 2013 Report _____________________________________________________________________________________
INCIDENCE AND PREVALENCE OF ESKD IN CHILDREN AND ADOLESCENTS 1991 - 2012
This year, as well as providing a summary of current trends in the frequency and causes of ESKD, the paediatric report will focus on dialysis delivery and adequacy, technique survival and biochemical out-comes, as well as an overview of the frequency, causes and treatment of children and adolescents with ESKD.
GENERAL OVERVIEW As shown in Figure 11.1, there is no clear long term trend in the incidence of children and adoles-cents developing ESKD and being treated with renal replacement therapy, although there are fluctu-ations from year to year. Prevalent numbers of treated ESKD have gradually increased across all age groups reflecting improved survival through increased duration of ESKD (Figure 11.2).
Figure 11.1
0
5
10
15
20
RR
T in
cide
nce
(per
mill
ion)
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0-45-910-14
15-17
Age (years)
Incidence of RRT - Age 0-17 YearsAustralia
0
10
20
30
40
RR
T in
cide
nce
(per
mill
ion)
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0-45-910-14
15-17
Age (years)
Incidence of RRT - Age 0-17 YearsNew Zealand
Figure 11.2
0
50
100
150
RR
T p
reva
len
ce (
pe
r m
illio
n)
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0-45-910-14
15-17
Age (years)
Prevalence of RRT - Age 0-17 YearsAustralia
0
50
100
150
RR
T p
reva
lenc
e (p
er m
illio
n)
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0-45-910-14
15-17
Age (years)
Prevalence of RRT - Age 0-17 YearsNew Zealand
11-3
ANZDATA Registry 2013 Report PAEDIATRIC REPORT _____________________________________________________________________________________
CAUSES OF ESKD IN CHILDREN AND ADOLESCENTS 2007 - 2012 Overall, glomerulonephritis remains the most common cause of ESKD in children and adolescents
(29%) but causes vary significantly with age. In young children renal hypoplasia/dysplasia is the most
common cause while reflux nephropathy is a common cause of ESKD in adolescents.
Figure 11.3
Causes of End Stage Kidney Disease In Children and Adolescents 2007 - 2012 Australia and New Zealand
Primary Renal Disease Age Groups (Years)
Total 0-4 5-9 10-14 15-17
GN 10 (12%) 20 (31%) 27 (33%) 40 (40%) 97 (29%)
Familial GN - - 2 (2%) 3 (3%) 5 (2%)
Reflux Nephropathy 4 (5%) 2 (3%) 5 (6%) 10 (10%) 21 (6%)
Polycystic Kidney Disease 8 (10%) 5 (8%) 1 (1%) 2 (2%) 16 (5%)
Medullary Cystic Disease - 1 (2%) 4 (5%) 2 (2%) 7 (2%)
Posterior Urethral Valve 7 (9%) - 11 (13%) 2 (2%) 20 (6%)
Haemolytic Uraemic Syndrome 7 (9%) 1 (2%) 2 (2%) 2 (2%) 12 (4%)
Hypoplasia/Dysplasia 24 (29%) 14 (22%) 10 (12%) 14 (14%) 62 (19%)
Cortical Necrosis 2 (2%) 2 (3%) 2 (2%) 3 (3%) 9 (3%)
Interstitial Nephritis - 1 (2%) 1 (1%) 1 (1%) 3 (1%)
Cystinosis - 1 (2%) 1 (1%) - 2 (1%)
Uncertain 1 (1%) 2 (3%) - 5 (5%) 8 (2%)
Misc/Other 19 (23%) 16 (25%) 16 (19%) 16 (16%) 67 (20%)
Total 82 65 83 100 330
Diabetes - - 1 (1%) - 1 (0%)
11-4
PAEDIATRIC REPORT ANZDATA Registry 2013 Report _____________________________________________________________________________________
Figure 11.4
Modality of Initial Renal Replacement Therapy By Year of First Treatment - Australia and New Zealand
< 18 Years of Age at First Treatment
Current
Treatment
Year
2007 2008 2009 2010 2011 2012 Total
0-9 Years 20 23 27 22 29 26 147
HD 4 (3%) 6 (4%) 4 (3%) 5 (3%) 10 (7%) 8 (5%) 37 (25%)
PD 14 (10%) 15 (10%) 17 (12%) 14 (10%) 14 (10%) 12 (8%) 86 (59%)
Transplant 2 (1%) 2 (1%) 6 (4%) 3 (2%) 5 (3%) 6 (4%) 24 (16%)
10-17 Years 31 38 27 25 24 38 183
HD 12 (7%) 22 (12%) 12 (7%) 13 (7%) 8 (4%) 16 (9%) 83 (45%)
PD 12 (7%) 8 (4%) 12 (7%) 5 (3%) 10 (5%) 15 (8%) 62 (34%)
Transplant 7 (4%) 8 (4%) 3 (2%) 7 (4%) 6 (3%) 7 (4%) 38 (21%)
Total 51 61 54 47 53 64 330
MODALITY OF TREATMENT 2007 - 2012 The modality of the first renal replacement treatment is shown in Figure 11.4. Although numbers are
small and therefore fluctuate from year to year, around 20% of children and adolescents receive pre-
emptive kidney transplants. Of the remainder, similar numbers commence renal replacement therapy
with haemodialysis or peritoneal dialysis.
For prevalent patients (Figure 11.5), a very different pattern is seen, with the great majority of children and adolescents treated with a functioning transplant. This reflects the relatively high rate of transplan-tation among children.
Figure 11.5
Modality of Treatment for all Patients in Australia and New Zealand < 18 Years of Age at 31st December
Current
Treatment
Year
2007 2008 2009 2010 2011 2012 Total
Haemodialysis 24 (8%) 35 (11%) 29 (9%) 30 (9%) 29 (9%) 30 (8%) 177 (9%)
Peritoneal Dialysis 55 (18%) 54 (17%) 57 (18%) 50 (15%) 52 (16%) 49 (14%) 317 (16%)
Transplant 229 (74%) 225 (72%) 229 (73%) 245 (75%) 251 (76%) 275 (78%) 1454 (75%)
Total 308 314 315 325 332 354 1948
11-5
ANZDATA Registry 2013 Report PAEDIATRIC REPORT _____________________________________________________________________________________
DIALYSIS DELIVERY AND ADEQUACY
Figure 11.6
2.5
3
3.5
4
Mea
n S
essi
ons/
Wee
k
2008 2009 2010 2011 2012
Australia
2.5
3
3.5
4
Mea
n S
essi
ons/
Wee
k
2008 2009 2010 2011 2012
New Zealand
Mean Sessions per Week (95% CI)Among Haemodialysis Patients
December 2008-2012
Figure 11.7
3.5
4
4.5
5
Mea
n H
ours
/Ses
sion
2008 2009 2010 2011 2012
Australia
3.5
4
4.5
5
Mea
n H
ours
/Ses
sion
2008 2009 2010 2011 2012
New Zealand
Mean Hours per Session (95% CI)Among Haemodialysis Patients
December 2008-2012
Figure 11.6 and 11.7 summarise the recent trends in HD practice among Paediatric patients.
DIALYSIS HOURS
11-6
PAEDIATRIC REPORT ANZDATA Registry 2013 Report _____________________________________________________________________________________
HAEMOGLOBIN
Various dialysis process indicators are summarized in Figures 11.8 - 11.16. For all of these graphs, the box indicates the 25th, 50th, and 75th centiles. The “Whiskers” indicate the 95th centiles for each category.
50
75
100
125
150
175
200
Hb
(g
/L)
2008 2009 2010 2011 2012
Haemodialysis
50
75
100
125
150
175
200
Hb
(g
/L)
2008 2009 2010 2011 2012
Peritoneal Dialysis
Haemoglobin, December 2008-2012Australia
50
75
100
125
150
175
200
Hb
(g
/L)
2008 2009 2010 2011 2012
Haemodialysis
50
75
100
125
150
175
200
Hb
(g
/L)
2008 2009 2010 2011 2012
Peritoneal Dialysis
Haemoglobin, December 2008-2012New Zealand
Figure 11.8
40
60
80
100
2008 2009 2010 2011 2012 2008 2009 2010 2011 2012
Australia New Zealand
HD PD
Per
cent
Use of Erythropoietic AgentsDecember 2008-2012
ERYTHROPOIETIC AGENT USAGE
FERRITIN
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
Fe
rriti
n (g
/L)
2008 2009 2010 2011 2012
Haemodialysis
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
Fe
rriti
n (g
/L)
2008 2009 2010 2011 2012
Peritoneal Dialysis
Ferritin, December 2008-2012Australia
0
500
1,000
1,500
2,000
Fe
rriti
n (g
/L)
2008 2009 2010 2011 2012
Haemodialysis
0
500
1,000
1,500
2,000
Fe
rriti
n (g
/L)
2008 2009 2010 2011 2012
Peritoneal Dialysis
Ferritin, December 2008-2012New Zealand
Figure 11.10
Figure 11.9
11-7
ANZDATA Registry 2013 Report PAEDIATRIC REPORT _____________________________________________________________________________________
UREA REDUCTION RATIO (HD PATIENTS) KT/V (PD PATIENTS)
0
10
20
30
40
50
60
70
80
90
100
UR
R (
%)
2008 2009 2010 2011 2012
Australia
0
10
20
30
40
50
60
70
80
90
100
UR
R (
%)
2008 2009 2010 2011 2012
New Zealand
URR 90% excluded as non-physiological.
Urea Reduction Ratio (HD Patients)December 2008-2012
0
1
2
3
4
5
Kt/V
2008 2009 2010 2011 2012
Australia
0
1
2
3
4
5
Kt/V
2008 2009 2010 2011 2012
New Zealand
Kt/V > 4 excluded as non-physiological.
Kt/V (PD Patients)December 2008-2012
Figure 11.12 Figure 11.13
Figure 11.14
Proportion of Prevalent Patients for whom URR or Kt/V was reported < 18 Years of Age at 31st December in Australia and New Zealand
2008 - 2012
Current Treatment
Year
Modality 2008 2009 2010 2011 2012
Australia Haemodialysis 56% 96% 96% 63% 61%
Australia Peritoneal Dialysis 13% 7% 10% 5% 10%
New Zealand Haemodialysis 80% 100% 100% 80% 86%
New Zealand Peritoneal Dialysis 94% 93% 90% 100% 80%
TRANSFERRITIN SATURATION
0
20
40
60
80
100
Tra
nsf
err
in S
atu
ratio
n (
%)
2008 2009 2010 2011 2012
Haemodialysis
0
20
40
60
80
100
Tra
nsf
err
in S
atu
ratio
n (
%)
2008 2009 2010 2011 2012
Peritoneal Dialysis
Transferrin Saturation, December 2008-2012Australia
0
20
40
60
80
100
Tra
nsf
err
in S
atu
ratio
n (
%)
2008 2009 2010 2011 2012
Haemodialysis
0
20
40
60
80
100
Tra
nsf
err
in S
atu
ratio
n (
%)
2008 2009 2010 2011 2012
Peritoneal Dialysis
Transferrin Saturation, December 2008-2012New Zealand
Figure 11.11
Dialysis adequacy is reported for the majority of NZ patients. However the reporting rates of adequacy for Australian patients are low, particularly for those on PD. The NZ data suggest that the majority of patients meet accepted targets for adequacy.
11-8
PAEDIATRIC REPORT ANZDATA Registry 2013 Report _____________________________________________________________________________________
BIOCHEMICAL OUTCOMES
SERUM CALCIUM
SERUM PHOSPHATE
For HD patients, Serum Phosphate is reported from a pre-dialysis specimen of a mid–week session.
1
1.5
2
2.5
3
Ca
lciu
m (
mm
ol/L
)
2008 2009 2010 2011 2012
Haemodialysis
1
1.5
2
2.5
3
Ca
lciu
m (
mm
ol/L
)
2008 2009 2010 2011 2012
Peritoneal Dialysis
Serum Calcium, December 2008-2012Australia
1
1.5
2
2.5
3
Ca
lciu
m (
mm
ol/L
)
2008 2009 2010 2011 2012
Haemodialysis
1
1.5
2
2.5
3
Ca
lciu
m (
mm
ol/L
)
2008 2009 2010 2011 2012
Peritoneal Dialysis
Serum Calcium, December 2008-2012New Zealand
Figure 11.15
0
1
2
3
4
5
Ph
osp
ha
te (
mm
ol/L
)
2008 2009 2010 2011 2012
Haemodialysis
0
1
2
3
4
5
Ph
osp
ha
te (
mm
ol/L
)
2008 2009 2010 2011 2012
Peritoneal Dialysis
Serum Phosphate, December 2008-2012Australia
0
1
2
3
4
5
Ph
osp
ha
te (
mm
ol/L
)
2008 2009 2010 2011 2012
Haemodialysis
0
1
2
3
4
5
Ph
osp
ha
te (
mm
ol/L
)
2008 2009 2010 2011 2012
Peritoneal Dialysis
Serum Phosphate, December 2008-2012New Zealand
Figure 11.16
11-9
ANZDATA Registry 2013 Report PAEDIATRIC REPORT _____________________________________________________________________________________
AT FIRST TREATMENT HAEMODIALYSIS ACCESS
VASCULAR ACCESS
PREVALENT HAEMODIALYSIS ACCESS
Figure 11.17
0 0 0 017
100 100 100 10083
n=5 n=4 n=5 n=9 n=6
1330
18 13 9
8870
82 88 91
n=16 n=10 n=11 n=8 n=11
0
20
40
60
80
100
2008 2009 2010 2011 2012 2008 2009 2010 2011 2012
0-9 years 10-17 years
AVF/AVG CVC
Per
cent
Vascular Access at First TreatmentAustralia 2008-2012
0 0
100 100
n=1 n=1
0 0 020
100 100 10080
n=6 n=2 n=2 n=5
0
20
40
60
80
100
2008 2009 2010 2011 2012 2008 2009 2010 2011 2012
0-9 years 10-17 years
AVF/AVG CVC
Per
cent
Vascular Access at First TreatmentNew Zealand 2008-2012
Figure 11.18
0
25
014
33
0
0
0
0
0
100
75
10086
33
0 0 0 0
33
n=5 n=4 n=2 n=7 n=6
40
70 6753
41
5
0 14
0
0
55
3019
4753
0 0 0 0 6
n=20 n=20 n=21 n=17 n=17
0
20
40
60
80
100
2008 2009 2010 2011 2012 2008 2009 2010 2011 2012
0-9 years 10-17 years
AVF AVG CVC Not reported
Per
cent
Prevalent Haemodialysis AccessAustralia 2008-2012
0 00 0
100 100
0 0
n=2 n=1
50
2033
80
57
13
0
0
0
0
38
8067
20
43
0 0 0 0 0
n=8 n=5 n=6 n=5 n=7
0
20
40
60
80
100
2008 2009 2010 2011 2012 2008 2009 2010 2011 2012
0-9 years 10-17 years
AVF AVG CVC Not reported
Per
cent
Prevalent Haemodialysis AccessNew Zealand 2008-2012
Vascular access for haemodialysis is summarised in Figures 11.17 -11.18.
11-10
PAEDIATRIC REPORT ANZDATA Registry 2013 Report _____________________________________________________________________________________
HAEMODIALYSIS SURVIVAL BY AGE CATEGORY
0.00
0.25
0.50
0.75
1.00
75 23 11 10 4 3 110-17 years38 4 0 0 0 0 00-9 years
N at Risk
0 1 2 3 4 5 6
Years
0-9 years
10-17 years
Australia 2006-2012
HD Technique Survival by Age Category
Figure 11.19
0.00
0.25
0.50
0.75
1.00
22 9 7 3 3 2 110-17 years2 0 0 0 0 0 00-9 years
N at Risk
0 1 2 3 4 5 6
Years
0-9 years
10-17 years
New Zealand 2006-2012
HD Technique Survival by Age Category
Figure 11.20
Haemodialysis technique survival, censored for transplantation, loss to follow-up and recovery of renal function is presented above
Of the total 137 patients, 54 changed from HD to PD. Of those 54 patients, 30% changed within 30 days, 35% changed between 1 to 2 months and 31% changed between 2 and 6 months. 31% of patients received a transplant within 1 year and 34% received a transplant within 2 years.
11-11
ANZDATA Registry 2013 Report PAEDIATRIC REPORT _____________________________________________________________________________________
PD technique survival, censored for transplantation, loss to follow-up and recovery of renal function is presented below. The numbers available for analysis after the first year drop significantly in each age group in both countries, due to transplantation. Of the 170 patients, 41 (24%) received a transplant within one year of commencement of RRT. By two years a total of 73 (43%) of patients had received transplants.
Use of PD solutions is shown in Figure 11.23.
PD TECHNIQUE SURVIVAL BY AGE CATEGORY
Figure 11.23
Use of PD Solutions 2009 - 2012
Solutions
Australia
2009 2010 2011 2012 2009 2010 2011 2012
(n = 43) (n = 40) (n = 40) (n = 39) (n = 14) (n = 10) (n = 12) (n = 10)
Glucose 42 (98%) 30 (75%) 28 (70%) 35 (90%) 14 (100%) 10 (100%) 12 (100%) 10 (100%)
Icodextrin 2 (5%) 2 (5%) 6 (15%) 9 (23%) 1 (7%) 0 (0%) 2 (17%) 3 (30%)
Low GDP Lactate 11 (26%) 17 (43%) 11 (28%) 5 (13%) 12 (86%) 8 (80%) 10 (83%) 5 (50%)
Low GDP Bicarbonate 1 (2%) 8 (20%) 6 (15%) 4 (10%) 0 (0%) 0 (0%) 0 (0%) 0 (0%)
New Zealand
Figure 11.21
0.00
0.25
0.50
0.75
1.00
51 20 8 3 1 1 110-17 years74 38 11 2 1 0 00-9 years
N at Risk
0 1 2 3 4 5 6
Years
0-9 years
10-17 years
Australia 2006-2012
PD Technique Survival by Age Category
Figure 11.22
0.00
0.25
0.50
0.75
1.00
16 3 0 0 0 0 010-17 years23 15 2 1 0 0 00-9 years
N at Risk
0 1 2 3 4 5 6
Years
0-9 years
10-17 years
New Zealand 2006-2012
PD Technique Survival by Age Category
11-12
PAEDIATRIC REPORT ANZDATA Registry 2013 Report _____________________________________________________________________________________
0.00
0.25
0.50
0.75
1.00
0 3 6 9 12 15 18 21 24 27 30 33 36
Months
0-6 (9)6-11 (9)
12-17 (12)
First PD Treatment to First Peritonitisby Age at First PD
Australia and New Zealand2008-2012
TIME TO FIRST PERITONITIS FOR PATIENTS < 18 YEARS OLD
Figure 11.24
0.84 0.85
1.07
0.61
0.99
0.76
1.01
1.23
0.50
60
30
18
15
12
10
8
Pat
ient
-Mon
ths
per
Epi
sode
.2
.4
.6
.8
1
1.2
1.4
1.6
Epi
sode
s pe
r P
atie
nt-Y
ear
2004 2005 2006 2007 2008 2009 2010 2011 2012
2004 - 2012
Episodes of Peritonitis per Patient-Yearand Patient-Months per Episode
Australia
Figure 11.25
Prior to 2012, there has not been an appreciable change in peritonitis rates in Australia, which have been around 1 episode of peritonitis per patient year. Time from commencement of PD to first peritonitis tends to be shorter in younger patients.
PERITONITIS RATES FOR PATIENTS < 18 YEARS OLD
ANZDATA Registry 2013 Report INDIGENOUS _____________________________________________________________________________________
12-1
Stephen McDonald
Matthew Jose
Kylie Hurst
CHAPTER 12 END-STAGE KIDNEY
DISEASE AMONG INDIGENOUS PEOPLES
OF AUSTRALIA AND NEW ZEALAND
2013 Annual Report - 36th Edition
INDIGENOUS ANZDATA Registry 2013 Report _____________________________________________________________________________________
12-2
Figure 12.1
New Patients 2007 - 2012 Australia New Zealand
Mode of Treatment
Non- Indigenous
ATSI Total Non-
Indige-nous
Maori Pacific People
Total
2007
PD 532 56 588 83 35 13 131
HD 1,546 183 1,729 139 108 64 311
Graft 65 0 65 23 3 0 26
2008
PD 606 51 657 96 35 22 153
HD 1,593 199 1,792 136 119 65 320
Graft 100 0 100 21 3 0 24
2009
PD 552 35 587 124 53 22 199
HD 1,558 159 1,717 158 121 81 360
Graft 115 2 117 22 2 0 24
2010
PD 460 36 496 88 47 28 163
HD 1,554 168 1,722 147 106 80 333
Graft 101 0 101 14 2 0 16
2011
PD 513 30 543 90 37 22 149
HD 1,591 220 1,811 152 89 72 313
Graft 99 0 99 15 0 0 15
2012
HD 1577 211 1788 138 120 73 331
Graft 89 0 89 16 1 1 18
Total 15,535 1,623 17,158 1,819 1,100 642 3,561
PD 614 43 657 100 46 18 164
INTRODUCTION
In this chapter, rates of end-stage kidney disease among Indigenous Peoples of Australia and New Zealand are presented. For Australia, these are Aboriginal and Torres Strait Islanders; for New Zealand, analyses include Maori and Pacific Peoples. In all cases, indigenous origin is reported by the renal unit on the basis of self-description. Maori and Pacific Peoples resident in Australia and Aboriginal and Torres Strait islanders resident in New Zealand are not considered “indigenous” unless otherwise specified. For some tables, we have also included data on Maori and Pacific Peoples living in Australia. While not indigenous to Australia, these have been included as useful comparators with the NZ experience of this group.
NEW PATIENTS
Australia
A total of 254 Aboriginal and Torres Strait Islander People commenced dialysis in Australia during 2012. The majority (88%) were treated with haemodialysis as their initial RRT modality. No pre-emptive transplants were performed among Aboriginal Australians in 2012.
New Zealand
The number of Maori and Pacific People starting dialysis increased in 2012 (166 patients) and decreased (91 patients) respectively.
46 (28% of total) Maori patients commenced on PD in 2012 while the number of Pacific Peoples starting with PD was 20%.
Figures 12.1 -
Figure 12.2
0
20
40
60
80
100
2008 2009 2010 2011 2012
Percentage of New Patients - AustraliaCommencing on Haemodialysis
ATSI Non Indigenous
Figure 12.3
0
20
40
60
80
100
2008 2009 2010 2011 2012
Percentage of New Patients - New ZealandCommencing on Haemodialysis
Maori Pacific People Non Indigenous
12.7
ANZDATA Registry 2013 Report INDIGENOUS _____________________________________________________________________________________
12-3
Overall, the incidence rates (per million population) of indigenous peoples in Australia and NZ are considerably higher than that for non-indigenous people. Direct comparisons are confounded by the different age distributions - the indigenous population for both countries is considerably younger than the non-indigenous population. Although rates fluctuate from year to year, in both countries the indigenous incidence rates have stabilised in recent years. The relative rate differs with age and also (for Aboriginal Australians) with gender - this is illustrated in Figure 12.5.
INCIDENCE RATES
Among Aboriginal Australians, there is a marked excess relative rate among those aged 35-64 years. The relative rate is higher among females than males.
Among Maori and Pacific People the excess rate is concentrated among older groups, and there is no gender difference.
Figure 12.5
0
5
10
15
20
Rel
ativ
e ra
te
0-14 15-24 25-34 35-44 45-54 55-64 65-74 75+Age (years)
Female Male
Australia, 2008-2012Relative incidence rate Aboriginal vs non Aboriginal
Figure 12.4
0
100
200
300
400
500
Pe
r m
illio
n p
er
yea
r
1985 1990 1995 2000 2005 2010Year
Aboriginal and TSI
Aboriginal & TSI, Australia
0
100
200
300
400
Pe
r m
illio
n p
er
yea
r
1985 1990 1995 2000 2005 2010Year
Maori Pacific Peoples
Maori and Pacific Peoples, treated in New Zealand
ANZDATANote X and Y scales differ
Unadjusted incident RRT rate
Figure 12.6
1
5
10
15
20
Re
lativ
e ra
te
0-14 15-24 25-34 35-44 45-54 55-64 65-74 75+Age (years)
Mäori Pacific Peoples
The relative rates for male and female are similar at all ages for Mäori and Pacific Peoples
New Zealand, 2008-2012
Relative incidence rateMäori & Pacific Peoples vs non-Mäori
INDIGENOUS ANZDATA Registry 2013 Report _____________________________________________________________________________________
12-4
The overall stabilisation of rates among Aboriginal Australians is seen consistently across each age group. In some age groups (such as 25-34 & 65-74 years) there is a suggestion of a downwards trend. There are a number of factors which contribute to incident numbers of RRT (among both indigenous and non-indigenous people). It is not clear whether this stabilisation reflects the underlying rates of diabetes, rates of disease progression, referral patterns or other diseases.
Figure 12.8
0
50
050
100150200
0
500
0500
10001500
5001000150020002500
01000200030004000
01000200030004000
0100020003000
19901995200020052010
19901995200020052010 19901995200020052010
0-14 15-24 25-34
35-44 45-54 55-64
65-74 75+
Rate 95% CI
Per
mill
ion
per
year
Year
note: Y axis scales differ
Aboriginal & TSI, AustraliaAge-specific incident RRT rate
There is also considerable variation between Australian jurisdictions in the Aboriginal/TSI RRT incident rates. The incidence rates for each State/Territory can be seen in Figure 12.7.
While rates for the very young (<15 years) and older (>65 years) groups are similar in each State/Territory, the rates for people 25-65 years of age show a clear trend of progressively higher rates from NSW/Victoria to Queensland then South Australia, Western Australia and the Northern Territory. Data is shown for a three year period given the small numbers in some locations.
020406080
100
pe
r m
illio
n p
er
yea
r
NS
W
Vic
Qld
SA
WA
NT
0-24 years
0
500
1000
1500
pe
r m
illio
n p
er
yea
r
NS
W
Vic
Qld
SA
WA
NT
25-44 years
010002000300040005000
pe
r m
illio
n p
er
yea
r
NS
W
Vic
Qld
SA
WA
NT
45-54 years
100020003000400050006000
pe
r m
illio
n p
er
yea
r
NS
W
Vic
Qld
SA
WA
NT
55-64 years
010002000300040005000
pe
r m
illio
n p
er
yea
r
NS
W
Vic
Qld
SA
WA
NT
65-74 years
0
2000
4000
6000
8000
pe
r m
illio
n p
er
yea
r
NS
W
Vic
Qld
SA
WA
NT
75+ years
ANZDATA and ABS data, 2010-12
among Aboriginal & TSI people, by state and age at RRT startAge-specific incidence rates of treated RRT
Rate 95% CI
Figure 12.7
ANZDATA Registry 2013 Report INDIGENOUS _____________________________________________________________________________________
12-5
Age specific trends for Maori and Pacific Peoples are shown in Figures 12.9 and 12.10. Note that the Y axis scale varies.
Figure 12.9
0
50
050
100150
0100200300
0100200300400
0500
10001500
5001000150020002500
0100020003000
0100020003000
19901995200020052010
19901995200020052010 19901995200020052010
0-14 15-24 25-34
35-44 45-54 55-64
65-74 75+
Rate 95% CI
Per
mill
ion
per
year
Year
note: Y axis scales differ
Maori, New ZealandAge-specific incident RRT rate
020406080
0100200300
0100200300400
0200400600
0500
10001500
01000200030004000
01000200030004000
01000200030004000
19901995200020052010
19901995200020052010 19901995200020052010
0-14 15-24 25-34
35-44 45-54 55-64
65-74 75+
Rate 95% CI
Per
mill
ion
per
year
Year
note: Y axis scales differ
Pacific Peoples, New ZealandAge-specific incident RRT rate
Figure 12.10
INDIGENOUS ANZDATA Registry 2013 Report _____________________________________________________________________________________
12-6
Figure 12.11
New Transplants 2001 - 2012
Australia New Zealand
Year Donor Source
Non- Indigenous ATSI Maori Pacific
People Non-
Indigenous ATSI Maori Pacific People
2002 LD 226 0 1 3 43 3 2
DD 353 17 1 3 46 10 13
Total 579 17 2 6 89 13 15
2003 LD 214 3 0 1 33 8 3
DD 314 10 1 48 8 11
Total 528 13 1 1 81 16 14
2004 LD 239 4 0 1 39 5 4
DD 377 22 1 6 42 7 8
Total 616 26 1 7 81 12 12
2005 LD 239 3 0 4 44 2
DD 357 19 0 1 42 3 2
Total 596 22 0 5 86 3 4
2006 LD 265 3 0 5 42 4 3
DD 337 24 5 2 31 6 4
Total 602 27 5 7 73 10 7
2007 LD 261 4 1 5 45 9 4
DD 327 14 1 2 55 8 2
Total 588 18 2 7 100 17 6
2008 LD 341 7 2 4 58 7 4
DD 430 24 0 5 42 5 6
Total 771 31 2 9 100 12 10
2009 LD 320 4 2 1 58 8 1
DD 418 20 3 5 38 11 5
Total 738 24 5 6 96 19 6
2010 LD 292 0 1 3 49 7 4
DD 512 28 1 9 32 13 5
Total 804 28 2 12 81 20 9
2011 LD 249 2 1 3 49 6 2
DD 521 26 10 13 40 14 7
Total 770 28 11 16 89 20 9
2012 LD 235 0 3 0 49 4 1
DD 566 20 8 13 37 11 6
Total 801 20 11 13 86 15 7
In both Australia and New Zealand numbers of transplants to indigenous recipients were low.
Australia
Over the period 2002-2012 there was an increase in the number of transplants from deceased donors, which now have stabilised. Numbers from living donors remain extremely low. The table also contains transplants to Maori and Pacific people resident in Australia; the number of these increased over 2002-2010, and has now stabilised.
New Zealand
The number of transplants to Maori and Pacific Peoples recipients remains stable. In contrast to the situation in Australia, there is a higher proportion of transplants from living donors.
NEW TRANSPLANTS
Figure 12.12 Indigenous Transplant
Numbers. Australian figures include ATSI only.
0
10
20
30
0
10
20
30
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Australia New Zealand
Deceased Live related Live unrelated
Nu
mb
er
Indigenous transplants numbersATSI in Australia, Maori and PP in New Zealand
ANZDATA Registry 2013 Report INDIGENOUS _____________________________________________________________________________________
12-7
Cumulative incidence curves (utilising competing risk techniques to account for the effects of both components of graft failure) are shown for indigenous transplant outcomes in Figure 12.13. It can be seen that for Aboriginal and TSI, there are higher rates of loss of graft function, and substantially higher rates of death with graft function compared with non-indigenous. Both of these differences are progressive over time. Lesser differences are seen for Maori / PP. In particular, the excess death rate among Maori/PP stabilises after the initial months.
Information on donor source is shown in Figure 12.14. There are substantially lower rates of living donation among indigenous groups in Australia, with a lesser difference in New Zealand. Australian figures include ATSI only.
Figure 12.14
0
.1
.2
0 1 2 3 4 5 0 1 2 3 4 5
Loss graft function Death with graft function
ATSI Aust non-indigNZ non-indig Maori/PP
Cu
mu
lativ
e in
cid
ence
Years
ANZDATA, all grafts 1 Jan 2001 to 31 Dec 2012DD1, cumulative incidence competing risks
Transplant outcomes
Figure 12.13
61%23%
16%
88%
5%7%
48%
31%
21%
65%
23%
12%
Australia Non-indigenous Australia Aboriginal/TSI
New Zealand Non-indigenous New Zealand Maori /Islander
Deceased Live related Live unrelated
ANZDATA, Donor source, grafts 1 Jan 2001 to 31 Dec 2012
Donor source, by indigenous status
INDIGENOUS ANZDATA Registry 2013 Report _____________________________________________________________________________________
12-8
Australia
The number of prevalent Aboriginal and Torres Strait Islander People with treated end-stage kidney disease increased to 1618, continuing a gradual increase. The percentage of ATSI on home haemodialysis was 7% in 2012 (this includes patients who perform independent self-care dialysis in community settings).
The percentage of ATSI treated with peritoneal dialysis was steady in 2012.
New Zealand
The number of prevalent Maori with treated end-stage kidney disease increased in 2012, whilst Pacific People remained the same. The percentage of Maori (24%) treated with home haemodialysis remains similar to past years, whilst in Pacific People this percentage (17%) has increased since 2008.
TREATMENT OF PREVALENT PATIENTS
Figure 12.15
Prevalent Patients 2008 - 2012 (% Haemodialysis Patients on Home HD)
Australia New Zealand
Year Mode of Treatment
Non-Indigenous
Aboriginal/TSI Maori Pacific
People Non-
Indigenous Maori Pacific People
2008
PD 2015 166 21 40 434 224 108
HD 6711 (13%) 997 (5%) 58 (14%) 169 (14%) 550 (32%) 463 (24%) 329 (13%)
Func TX* 7430 159 29 62 1154 110 81
2009
PD 1997 142 18 46 453 238 109
HD 6981 (12%) 1042 (7%) 69 (16%) 177 (16%) 605 (33%) 492 (26%) 380 (13%)
Func TX* 7809 160 34 65 1196 117 84
2010
PD 1882 142 25 44 455 255 121
HD 7270 (12%) 1072 (7%) 78 (17%) 194 (15%) 628 (36%) 507 (26%) 421 (17%)
Func TX* 8232 177 33 73 1223 128 86
2011
PD 1868 134 22 48 428 247 120
HD 7498 (12%) 1173 (6%) 79 (18%) 211 (18%) 649 (36%) 500 (26%) 449 (16%)
Func TX* 8569 190 42 83 1252 141 88
2012
PD 1995 145 29 58 422 240 110
HD 7624 (12%) 1280 (7%) 83 (13%) 232 (16%) 674 (38%) 533 (24%) 490 (17%)
Func TX* 8978 193 49 90 1286 148 89
* By Resident Country at 31st December
ANZDATA Registry 2013 Report INDIGENOUS _____________________________________________________________________________________
12-9
The distribution of dialysis modality is shown graphically in Figures 12.16 below. Among indigenous Australians, the principal differences are a substantially lower rate of home HD and APD. This figure also includes the experience for Maori and Pacific Peoples treated in Australia at the end of 2012; their experience is similar to non-indigenous groups. Similar data is shown for New Zealand in Figure 12.17. Again, rates of home treatments (home HD in particular) are lower among the indigenous groups.
DIALYSIS MODALITY
Figure 12.16
13%8%
23%47%
9%5%
6%
19%
64%
6%
13%
13%
20%45%
10% 12%8%
21%46%
13%
Non-indigenous Aboriginal/TSI
Maori Pacific islander
APD CAPDHospital HD Satellite HD
Home HD
Patients at end 2012 dialysing and resident in Australia
Australia, by indigenous originDialysis modality end 2012
17%
21%
29%
9%
23% 18%
13%
34%
19%
17%
6%12%
43%
25%
14%
Non-indigenous Maori
Pacific islander
APD CAPDHospital HD Satellite HD
Home HD
Patients at end 2012 dialysing and resident in New Zealand
NZ, by indigenous originDialysis modality end 2012
Figure 12.17
INDIGENOUS ANZDATA Registry 2013 Report _____________________________________________________________________________________
12-10
In both Australia and New Zealand, there has been a gradual trend towards lower eGFR at the time of dialysis start, over 2011/12 among all groups. However, there is also a consistent difference (in both countries ) between indigenous and non-indigenous, with higher eGFR values among the non-indigenous groups.
ESTIMATED GLOMERULAR FILTRATION RATE AT TREATMENT START
02468
10
02468
10
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Non - Indigenous Aboriginal/TSI
Maori Pacific People
Med
ian
eGF
R (
mL/
min
/1.7
3m2
Excluding pre-emptive transplants
Australia
eGFR at Dialysis Start
Figure 12.18
02468
10
02468
10
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Non - Indigenous Maori
Pacific People
Med
ian
eGF
R (
mL/
min
/1.7
3m2
Excluding pre-emptive transplants
New Zealand
eGFR at Dialysis Start
Figure 12.19
ANZDATA Registry 2013 Report INDIGENOUS _____________________________________________________________________________________
12-11
INCIDENCE AND PREVALENCE BY STATE/TERRITORY
The next four pages show a variety of figures which summarise various key rates (incidence, prevalence, transplant rates) among indigenous people in Australia and New Zealand. In large part they show information from previous pages, in a series of differing formats.
State Incidence
The Northern Territory has the highest national incidence among indigenous people of treated end-stage kidney disease in Australia at 743pmp, the next highest is in South Australia (527 pmp).
Dialysis by Resident State
Treatment patterns for Aboriginal and Torres Strait Islander People vary by State. The highest rates are in the Northern Territory, Western Australia and South Australia.
Transplant by Referring State
Rates of prevalent transplants vary substantially between States with highest rates in South and Western Australia. These rates are per population, not per dialysis patient, and they reflect both background rates of kidney disease and transplant rates.
0
200
400
600
800
1,000
1,200
Per
mill
ion
AT
SI p
opul
atio
n
QLD NSW/ACT VIC/TAS SA NT WA Australia
Incidence of New ATSI Patients
Year
20082009
2010
2011
2012
Figure 12.23
0
50
100
150
200
Per
mill
ion
AT
SI p
opul
atio
n
QLD NSW/ACT VIC/TAS SA NT WA Australia
Incidence of New Transplants ATSI PatientsBy referring State
Year
2008
2009
20102011
2012
Figure 12.24
INDIGENOUS ANZDATA Registry 2013 Report _____________________________________________________________________________________
12-12
0
1,000
2,000
3,000
4,000
5,000
6,000
Per
mill
ion
AT
SI p
opul
atio
n
QLD NSW/ACTVIC/TAS SA NT WA Australia
Prevalence of HaemodialysisATSI Patients
Year
2008
2009
20102011
2012
Figure 12.25
0
100
200
300
400
500
600
700
Per
mill
ion
AT
SI p
opul
atio
nQLD NSW/ACTVIC/TAS SA NT WA Australia
Prevalence of Peritoneal DialysisATSI Patients
Year
2008
2009
20102011
2012
Figure 12.26
0
200
400
600
800
1,000
1,200
Per
mill
ion
AT
SI p
opul
atio
n
QLD NSW/ACTVIC/TAS SA NT WA Australia
Functioning TransplantsATSI Patients
Year
2008
2009
20102011
2012
Figure 12.27
0
100
200
300
400
500
600
700
800
900
1,000
Per
mill
ion
AT
SI p
opul
atio
n
QLD NSW/ACTVIC/TAS SA NT WA Australia
Deaths ATSI Patients
Year
2008
2009
2010
2011
2012
Figure 12.28
ANZDATA Registry 2013 Report INDIGENOUS _____________________________________________________________________________________
12-13
0
100
200
300
400
Per
Mill
ion
Pop
ulat
ion
2008 2009 2010 2011 2012
Incidence of New Patients - New ZealandMaori and Pacific People
Maori Pacific People
Figure 12.29
0
10
20
30
40
Per
Mill
ion
Pop
ulat
ion
2008 2009 2010 2011 2012
Incidence of New Transplants - New ZealandMaori and Pacific People
Maori Pacific People
Figure 12.30
0
250
500
750
1,000
1,250
1,500
Per
Mill
ion
Pop
ulat
ion
2008 2009 2010 2011 2012
Prevalence of Haemodialysis- New ZealandMaori and Pacific People
Maori Pacific People
Figure 12.31
INDIGENOUS ANZDATA Registry 2013 Report _____________________________________________________________________________________
12-14
0
100
200
300
400
500
600
Per
Mill
ion
Pop
ulat
ion
2008 2009 2010 2011 2012
Prevalence of Peritoneal Dialysis- New ZealandMaori and Pacific People
Maori Pacific People
Figure 12.32
0
100
200
300
400
Per
Mill
ion
Pop
ulat
ion
2008 2009 2010 2011 2012
Functioning Transplant - New ZealandMaori and Pacific People
Maori Pacific People
Figure 12.33
0
100
200
300
Per
Mill
ion
Pop
ulat
ion
2008 2009 2010 2011 2012
Deaths - New ZealandMaori and Pacific People
Maori Pacific People
Figure 12.34
ANZDATA Registry 2013 Report INDIGENOUS _____________________________________________________________________________________
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GEOGRAPHICAL DISTRIBUTION
Figure 12.35 shows the number of incident ATSI (patients by postcode) The distribution of prevalent dialysis patients are summarized in Figure 12.36 (by state) and 12.37 by statistical subdivision (obtained by mapping postcodes to SSD). Note that some postcodes were distributed over more than one SSD
Incident numbers, by postcode, 2008-2013(50,100](20,50](10,20](5,10](2,5](1,2][0,1]
ANZDATA, indigenous patients only, based on postcode at first RRT
by postcodeIncident indigenous patients 2008-2012
Percent indigenous RRT patients, Dec 31 2012(75,100](50,75](20,50](10,20](5,10][0,5]No data
by state/territory
Prevalent indigenous patients, 31 Dec 2012
INDIGENOUS ANZDATA Registry 2013 Report _____________________________________________________________________________________
12-16
Figure 12.37
NSW Vic
Qld SA
WA NT
ANZDATA, based on postcode of residence reported at at end 2012mapped to SSD using ABS concordance files
31 Dec 2012Prevalent indigenous dialysis patients
Number of dialysis patients100 - 20050 - 10020 - 5010 - 205 - 102 - 51 - 20 - 1
ANZDATA Registry 2013 Report INDIGENOUS _____________________________________________________________________________________
12-17
Figure 12.39
Vascular Access Use at First ESKD Treatment Where this is Haemodialysis 2008 - 2012
Australia New Zealand
Year Vascular Access
ATSI Maori Pacific People
Non-Indigenous
Maori Pacific People
Non-Indigenous
2008 CVC 138 (58%) 9 (60%) 23 (64%) 1078 (58%) 100 (70%) 60 (85%) 128 (71%)
AVF/AVG 87 6 11 685 29 10 37
2009 CVC 110 (56%) 13 (52%) 25 (76%) 983 (54%) 99 (71%) 56 (64%) 138 (68%)
AVF/AVG 76 11 8 738 34 30 51
2010 CVC 113 (59%) 10 (56%) 23 (64%) 1003 (56%) 90 (74%) 65 (69%) 123 (66%)
AVF/AVG 69 7 10 692 24 20 44
CVC 135 (55%) 10 (45%) 26 (63%) 976 (52%) 68 (61%) 65 (74%) 135 (64%)
AVF/AVG 104 9 13 769 31 17 52
2012 CVC 125 (51%) 15 (79%) 33 (69%) 928 (51%) 88 (60%) 55 (61%) 99 (57%)
AVF/AVG 92 2 12 700 41 24 53
2011
VASCULAR ACCESS
For all indigenous groups in Australia and New Zealand the vascular access rates (at first HD) are stable over recent years. For both indigenous and non-indigenous groups these rates are higher in NZ than Australia.
Figure 12.38
Late Referral 2008 - 2012 % Late Referral of (Total Number of Patients)
Australia New Zealand
Year ATSI Maori Pacific People
Non-Indigenous
Maori Pacific People
Non-Indigenous
2008 24% (251) 24% (21) 32% (41) 21% (2238) 31% (157) 22% (87) 17% (253)
2009 22% (196) 32% (22) 37% (38) 20% (2175) 22% (177) 13% (103) 15% (304)
2010 25% (206) 19% (26) 26% (42) 22% (2056) 19% (155) 16% (109) 15% (251)
2011 30% (256) 19% (21) 17% (46) 22% (2173) 18% (129) 26% (95) 22% (261)
2012 25% (254) 34% (29) 26% (57) 21% (2194) 17% (167) 16% (92) 14% (254)
Australia
The percentage of Aboriginal and Torres Strait Islander People referred late for treatment has been stable for the last 3 years, and is very similar to the non-indigenous rate. In 2012 51% commenced haemodialysis using a catheter rather than permanent access (Figure 12.39); again this is a similar situation to the non-indigenous patients.
New Zealand
The proportion of Maori people referred late in 2012 decreased to 17% from 18% in 2011. For Pacific People referred late, the proportion decreased to 16% . Most Maori (60%) and Pacific People (61%) commenced haemodialysis with a catheter (Figure 12.39).
LATE REFERRAL
INDIGENOUS ANZDATA Registry 2013 Report _____________________________________________________________________________________
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Figure 12.40
Incidence and Prevalence - Aboriginal And Torres Strait Islanders 2008- 2012 by Resident State (Number per million ATSI population in each state)
Australia
Year Mode of
Treatment QLD NSW/ACT VIC/TAS SA NT WA Australia
2008
New Patients 56 (367) 33 (202) 4 (75) 19 (651) 76 (1146) 63 (857) 251 (466) Prevalent HD 243 (1593) 108 (662) 31 (578) 62 (2124) 335 (5054) 218 (2965) 997 (1852) Prevalent PD 49 (321) 33 (202) 6 (112) 8 (274) 26 (392) 44 (598) 166 (308) Functioning 30 (197) 21 (129) 7 (130) 29 (994) 35 (528) 37 (503) 159 (295) Transplant 5 (33) 4 (25) 1 (19) 5 (171) 1 (15) 15 (204) 31 (58) Deaths 45 (295) 18 (110) 3 (56) 6 (206) 55 (830) 37 (503) 164 (305)
2009
New Patients 49 (313) 21 (126) 10 (182) 16 (537) 59 (875) 41 (548) 196 (356) Prevalent HD 248 (1585) 119 (715) 33 (601) 62 (2082) 361 (5353) 219 (2925) 1042 (1895) Prevalent PD 50 (320) 22 (132) 5 (91) 7 (235) 22 (326) 36 (481) 142 (258) Functioning 26 (166) 21 (126) 8 (146) 29 (974) 31 (460) 45 (601) 160 (291) Transplant 1 (6) 5 (30) 1 (18) 5 (168) 2 (30) 10 (134) 24 (44) Deaths 50 (320) 22 (132) 9 (164) 14 (470) 42 (623) 40 (534) 177 (322)
2010
New Patients 62 (386) 30 (177) 13 (232) 17 (560) 52 (758) 32 (420) 206 (367) Prevalent HD 253 (1576) 120 (707) 42 (748) 67 (2205) 368 (5365) 222 (2913) 1072 (1909) Prevalent PD 49 (305) 29 (171) 5 (89) 2 (66) 29 (423) 28 (367) 142 (253) Functioning 30 (187) 26 (153) 10 (178) 33 (1086) 32 (466) 46 (604) 177 (315) Transplant 4 (25) 6 (35) 2 (36) 5 (165) 2 (29) 9 (118) 28 (50)
Deaths 55 (343) 18 (106) 1 (18) 9 (296) 42 (612) 38 (499) 163 (290)
2011
New Patients 63 (383) 36 (208) 13 (226) 16 (516) 67 (960) 61 (786) 256 (446) Prevalent HD 268 (1627) 141 (814) 50 (870) 77 (2483) 395 (5663) 242 (3118) 1173 (2044) Prevalent PD 56 (340) 21 (121) 3 (52) 2 (65) 20 (287) 32 (412) 134 (234) Functioning 32 (194) 29 (167) 12 (209) 34 (1097) 33 (473) 50 (644) 190 (331) Transplant 3 (18) 5 (29) 2 (35) 4 (129) 5 (72) 9 (116) 28 (49) Deaths 39 (237) 20 (115) 5 (87) 5 (161) 47 (674) 33 (425) 149 (260)
New Patients 54 (320) 48 (271) 14 (238) 12 (379) 84 (1185) 42 (532) 254 (433) Prevalent HD 290 (1716) 162 (916) 53 (902) 77 (2433) 436 (6149) 262 (3316) 1280 (2183) Prevalent PD 53 (314) 34 (192) 6 (102) 5 (158) 19 (268) 28 (354) 145 (247) Functioning 37 (219) 28 (158) 13 (221) 31 (980) 33 (465) 51 (645) 193 (329) Transplant 5 (30) 2 (11) 2 (34) 1 (32) 5 (71) 5 (63) 20 (34) Deaths 30 (178) 13 (73) 8 (136) 12 (379) 46 (649) 24 (304) 133 (227)
2012
ANZDATA Registry 2013 Report INDIGENOUS _____________________________________________________________________________________
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Figure 12.41
Cause of Death 2012
Australia New Zealand
Year Modality Cause Aboriginal/TSI Maori Pacific
People Non-
Indigenous Maori Pacific People
Non-Indigenous
2012
Dialysis Cardiac 53 (43%) 4 (44%) 13 379 (29%) 66 (53%) 33 (55%) 59 (34%)
Dialysis Vascular 7 (6%) 1 (11%) 1 (6%) 96 (7%) 9 (7%) 4 (7%) 10 (6%)
Dialysis Infec on 15 (12%) 1 (11%) 1 (6%) 102 (8%) 11 (9%) 6 (10%) 12 (7%)
Dialysis Social 35 (28%) 1 (11%) 1 (6%) 499 (39%) 17 (14%) 8 (13%) 54 (31%)
Dialysis Malignancy 2 (2%) ‐ ‐ 74 (6%) 6 (5%) ‐ 7 (4%)
Dialysis Miscellaneous 11 (9%) 2 (22%) 2 (11%) 142 (11%) 15 (12%) 9 (15%) 31 (18%)
Dialysis Total 123 9 18 1292 124 60 173
Transplant Cardiac 2 (33%) ‐ ‐ 33 (21%) 2 (50%) 1 (50%) 6 (29%)
Transplant Vascular ‐ ‐ ‐ 16 (10%) ‐ 1 (50%) 2 (10%)
Transplant Infec on 2 (33%) ‐ ‐ 22 (14%) 1 (25%) ‐ 2 (10%)
Transplant Social ‐ ‐ ‐ 16 (10%) ‐ ‐ 1 (5%)
Transplant Malignancy 2 (33%) 1 (100%) ‐ 45 (29%) 1 (25%) ‐ 8 (38%)
Transplant Miscellaneous ‐ ‐ 1 24 (15%) ‐ ‐ 2 (10%)
Transplant Total 6 1 1 156 4 2 21
INDIGENOUS ANZDATA Registry 2013 Report _____________________________________________________________________________________
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