CHAPTER 6 PERITONEAL DIALYSIS John Collins

334 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
334
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
8
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

CHAPTER 6 PERITONEAL DIALYSIS John Collins

  1. 1. CHAPTER 6 PERITONEAL DIALYSIS John Collins
  2. 2. PERITONEAL DIALYSIS ANZDATA Registry 2001 Report STOCK AND FLOW Avtˆ…rÃ% AUSTRALIA Q…‚ƒ‚…‡v‚ÃÈÃQr…v‡‚rhyÃ9vhy’†v†Ã‚sÃhyy C‚€rÃQh‡vr‡†ÃÃÃÃÃà ((%ÃÃ! Of the 14,744 patients treated since 1978, 1723 (12%) were still alive on T‡h‡r ((% (( ((' ((( ! peritoneal dialysis (PD) at 31 Rˆrr†yhq (È (È (#È '%È '#È December, 2000. CAPD treated 21% IrÃT‚ˆ‡uÃXhyr† %È %È $(È $'È $'È (24% 1999) of all dialysis patients 6ˆ†‡8hƒv‡hyÃUr……v‡‚…’ #È !È È $È $È and Automated Peritoneal Dialysis Wvp‡‚…vh %È %'È %È È !È (APD) 6% (4% in 1999), together Uh†€hvh ('È È (#È ''È ''È T‚ˆ‡uÃ6ˆ†‡…hyvh È (È 'È (È 'È accounting for 70% of all home I‚…‡ur…ÃUr……v‡‚…’ È È È È È dialysis. Of the 14,744 patients, 484 Xr†‡r…Ã6ˆ†‡…hyvh '%È '%È 'È 'È (È patients (3%) had had at least five 6ˆ†‡…hyvh È È È È È years of continuous peritoneal dialysis (fig 6.5). IrÃarhyhq #È $È %È (È 'È APD had increased 45% from 267 patients in 1999 to 386 patients in 2000. In relation to age, the proportion of all dialysis patients (65-74 years and 75-84 years) using peritoneal Avtˆ…rÃ%! dialysis was 30% and 27% (31% and 30% respectively in 1999); range T‡‚pxÃhqÃAy‚Ã‚sÃQr…v‡‚rhyÃ9vhy’†v†ÃQh‡vr‡† 21% (35-44 years) to 78% (0-14 ((%ÃÃ! years). ((% (( ((' ((( ! The annual stock and flow of patients during the period 1996-2000 is 6ˆ†‡…hyvh shown in Figures 6.2 and 6.3. Qh‡vr‡†ÃrÃ‡‚ÃQ9 %(' %'$ !! $% ( The State prevalence of peritoneal ÃÃÃÃÃAv…†‡Ã9vhy’†v†ÃU…rh‡€r‡ ($ ( # # $ # % dialysis ranged from 13% (Northern ÃÃÃÃÃQ…r‰v‚ˆ†Ã9vhy’†v†ÃC9 !'' !' # Territory), 19% (Tasmania), 20% ÃÃÃÃÃAhvyrqÃU…h†ƒyh‡ $ # ! (South Australia), 23% (Victoria), U…h†ƒyh‡rq ! $ !! (! !! 30% (New South Wales), 31% 9rh‡u† !%' !(% ( !'( ÃÃÃÃÃIr‰r…ÃU…h†ƒyh‡rq !'' !$' !'% !( !' (Queensland and Western Australia) ÃÃÃÃÃQ…r‰v‚ˆ†ÃU…h†ƒyh‡ ! % ( and 36% (ACT). Qr…€hr‡ÃU…h†sr…†ÃPˆ‡Ã3 !À‚‡u† !% !(! ! ! $$ The proportion of peritoneal dialysis Ur€ƒ‚…h…’ÃU…h†sr…†Ã1 !À‚‡u† %# ' #' $! ( of all home dialysis patients in each Qh‡vr‡†Ã9vhy’†vtÃh‡Ã Ã9rpr€ir… $'( %!# % ( %'# ! State ranged from 58% (New South Qh‡vr‡†Ã9vhy’†vtÃh‡ÃC‚€rà Ã9rpr€ir… $ $ $ %!% %( Wales), 72% (Victoria), 75% (ACT), ÈÂsÃhyyÃC‚€rÃ9vhy’†v†ÃQh‡vr‡† È È È È È 83% (South Australia), 84% (Queensland), 88% (Tasmania), 90% IrÃarhyhq (Western Australia) and 100% Qh‡vr‡†ÃrÃ‡‚ÃQ9 !! !!! !$ !%% !% ÃÃÃÃÃAv…†‡Ã9vhy’†v†ÃU…rh‡€r‡ % !( $ ( (Northern Territory) (fig 6.1). ÃÃÃÃÃQ…r‰v‚ˆ†Ã9vhy’†v†ÃC9 ' '( ( ' # There were 779 new peritoneal ÃÃÃÃÃAhvyrqÃU…h†ƒyh‡ % # % dialysis patients in the calendar year U…h†ƒyh‡rq $! #! # # 2000, a rise of 3% compared to the 9rh‡u† (% $ (' # previous year; of whom 416 (53%) ÃÃÃÃÃIr‰r…ÃU…h†ƒyh‡rq (! ( ( started dialysis with peritoneal ÃÃÃÃÃQ…r‰v‚ˆ†ÃU…h†ƒyh‡ % # $ $ dialysis and 363 (47%) previously Qr…€hr‡ÃU…h†sr…†ÃPˆ‡Ã3 !À‚‡u† $% ' %% '# '( Ur€ƒ‚…h…’ÃU…h†sr…†Ã1 !À‚‡u† !( #% # $$ % had haemodialysis or a failed Qh‡vr‡†Ã9vhy’†vtÃh‡Ã Ã9rpr€ir… $% $( %# %! % transplant (fig 6.2). Qh‡vr‡†Ã9vhy’†vtÃh‡ÃC‚€rà Ã9rpr€ir… $$$ $! %! %%% % ÈÂsÃhyyÃC‚€rÃ9vhy’†v†ÃQh‡vr‡† #È $È %È (È 'È 44
  3. 3. ANZDATA Registry 2001 Report PERITONEAL DIALYSIS Figure 6.3 T‡‚pxÃhqÃAy‚Ã‚sÃQr…v‡‚rhyÃ9vhy’†v†ÃQh‡vr‡† New patients over the age of 65 6ˆ†‡…hyvhÃÃà ((#ÃÃ! decreased 11%, from 350 in 1999 to Number of Patients 316 in 2000. However, there was a 56% 30 00 New Patients increase (61 patients) in 2000 in the Transplants age group 25-34 years compared to 39 25 00 Perm. Transfer Deaths patients in 1999 and a 30% increase 20 00 No. Dialysing 1723 Patients (174 patients) in the age group 55-64 years compared to 134 patients last 15 00 year. 10 00 There were 289 deaths (309 in 1999), 5 00 (17.3 deaths per 100 patient years; 0 11.4% of patients at risk); 9% 25-44 94 95 96 97 98 99 00 years, 19% 45-64 years, 34% 65-84 years) (fig 3.5). For more detail see Appendix II at Website (www.anzdata.org.au). There were 122 patients receiving a Figure 6.4 transplant in 2000 compared to 92 in 1999; 7% of all patients treated, 12% T‡‚pxÃhqÃAy‚Ã‚sÃQr…v‡‚rhyÃ9vhy’†v†ÃQh‡vr‡† of patients 65 years treated during the IrÃarhyhqÃÃà ((#ÃÃ! year (fig 6.2). Number of Patients Permanent transfer (12 months) to 12 00 haemodialysis rose from 321 patients New Patients Transplants (19% of patients dialysed) to 355 10 00 Perm. Transfer patients (21%) in 2000. Most transfers 8 00 Deaths 677 No. Dialysing Patients to haemodialysis were permanent (355/ 474) (fig 6.2). 6 00 The primary renal disease of new 4 00 patients to peritoneal dialysis was 29% 2 00 for glomerulonephritis and 25% for 0 diabetic nephropathy (fig 6.8). 94 95 96 97 98 99 00 Avtˆ…rÃ%$ 8‚‡vˆ‚ˆ†ÃQr…v‚qÂsÃQr…v‡‚rhyÃ9vhy’†v†Ãh‡Ã ÃHh…puÃ! 0RQWKV % ! ' (!# !$ % #! ##' #(% % ! '# '$(% ( ' 3 ( 6ˆ†‡…hyvh †‡ÃU…rh‡€r‡Ã '('ÃQ‡† $' !# %!# %( (%( $( #( % # $ ! ( (% $ ! ! 6yyÃU…rh‡€r‡†Ã ###ÃQ‡† #%## !( ( ## $!! # #' !%! % %! !$ !( IrÃarhyhq †‡ÃU…rh‡€r‡Ãà (ÃQ‡† %' $ # ## !( !' !% ! ' $ ! ! 6yyÃU…rh‡€r‡†Ã!ÃQ‡† '%' %$ $!! # ! !$ !! ( '' # ! # ! 45
  4. 4. PERITONEAL DIALYSIS ANZDATA Registry 2001 Report Figure 6.6 Figure 6.7 6trÂsÃIrÃQ9ÃQh‡vr‡† 6trÂsÃ9vhy’†vtÃQ9ÃQh‡vr‡† Australia (n=779) Australia (n=1723) 27% 29% 22% 20% 16% 13% 16% 14% 8% 8% 7% 9% 2% 3% 1% 1% 3% 0.6% 0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 =85 0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 =85 No. No. Pats. 15 26 61 66 121 174 206 104 6 Pats. 25 51 114 152 280 350 505 234 12 Avtˆ…rÃ%' 6VTUS6GD6 T‡‚pxÃhqÃAy‚Ã‚sÃQr…v‡‚rhyÃ9vhy’†v†ÃÃÃÃà ((%ÃÃ! 6trÃB…‚ˆƒ† ((% (( ((' ((( ! IrÃQh‡vr‡†Ã★ #Òrh…† ! È ( È ' !È % !È $ !È $!#Òrh…† ' È ( È ! È ' !È !% È !$#Òrh…† #$ %È # È # %È ( $È % 'È $##Òrh…† ' È È È % È %% 'È #$$#Òrh…† (( #È $È ( $È ! %È ! %È $$%#Òrh…† % !È $ !!È $ ! È # 'È # !!È %$#Òrh…† ! È ! È !!! È !#% È !% !È $'#Òrh…† $' 'È ! È '' !È ! È # È 3Ã'$Òrh…† # È È ! 1 È ! 1 È % È U‚‡hy %(' È %'$ È !! È $% È ( È Qh‡vr‡†Ã9vhy’†vt #Òrh…† !! È !! È !( !È ! È !$ È $!#Òrh…† #$ È ## È ( !È ## !È $ È !$#Òrh…† '' %È %È ( %È (% %È # È $##Òrh…† % È È %( È % È $! (È #$$#Òrh…† !$' %È !%$ %È !$% %È !' È !' %È $$%#Òrh…† !È $ ! È $ ! È # !È $ !È %$#Òrh…† #'$ È #(' È $ È $ È $$ !(È $'#Òrh…† # (È ' È (% !È !!( #È !# #È 3Ã'$Òrh…† $ 1 È ! 1 È $ 1 È 1 È ! 1 È U‚‡hy $'( È %!# È % ( È %'# È ! È Q…v€h…’ÃSrhyÃ9v†rh†rÃ★ By‚€r…ˆy‚rƒu…v‡v† ! ' È !! !È !! È !! !(È !!! !(È 6hytr†vpÃIrƒu…‚ƒh‡u’ $( 'È #' È $! È % 'È $! È C’ƒr…‡r†v‚ ($ #È '$ È '' !È È ' #È Q‚y’p’†‡vpÃ9v†rh†r ! $È ' %È # %È $ $È #! $È Srsyˆ‘ÃIrƒu…‚ƒh‡u’ #È $È ! #È !$ È ' $È 9vhir‡vpÃIrƒu…‚ƒh‡u’ % !È %% !#È # !#È !! !(È ( !$È Hv†pryyhr‚ˆ† % (È ## %È %! (È %' (È %$ 'È Vpr…‡hv # %È # È $ È $ È $$ È U‚‡hy %(' È %'$ È !! È $% È ( È ★ IrÃƒh‡vr‡†Ã…rprv‰vtÃsv…†‡Ãƒr…v‡‚rhyÃqvhy’†v†Ã‡…rh‡€r‡ 46
  5. 5. ANZDATA Registry 2001 Report PERITONEAL DIALYSIS Figure 6.9 Q9ÃQh‡vr‡†ÃÈÂsÃhyyÃ9vhy’†v† Australia (n=1723) 78% 35% 30% 25% 26% 27% 27% 29% 21% 0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 =85 Figure 6.10 Iˆ€ir…ÃQr…ÃHvyyv‚ÃQ9ÃQh‡vr‡† Australia 1996 - 2000 Non Diabetic Diabetic 86.9 87.6 86.3 88.7 89.9 1996 1997 1998 1999 2000 Figure 6.11 6Q9ÃQh‡vr‡†ÃÈÂsÃhyyÃ9vhy’†v† Australia (n=386) 63% 18% 8% 5% 7% 5% 5% 5% 7% 0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 =85 Figure 6.12 Iˆ€ir…ÃQr…ÃHvyyv‚Ã6Q9ÃQh‡vr‡† Australia 1996 - 2000 Non Diabetic Diabetic 20.1 11.5 14.0 7.0 9.5 1996 1997 1998 1999 2000 47
  6. 6. PERITONEAL DIALYSIS ANZDATA Registry 2001 Report Figure 6.13 Q9ÃQh‡vr‡†ÃÈÂsÃhyyÃ9vhy’†v† New Zealand (n=677) N EW ZEALAND 100% The annual stock and flow of patients 75% during the period 1996 to 2000 is 62% 60% 48% 53% shown in Figures 6.2 and 6.4. Of the 41% 31% 38% 3,772 treated since 1978, 677 (18%) were alive at 31 December 2000, 197 (5%) had had more than five 0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 =85 years continuous treatment (fig 6.5). Peritoneal dialysis accounted for 51% of all dialysis patients and 78% Figure 6.14 of all patients dialysing at home. Iˆ€ir…ÃQr…ÃHvOyv‚ÃQ9ÃQh‡vr‡† Modal age group was 55-64 years (30%), 9% 35 years (10% 1999), New Zealand 1996 - 2000 31% 65 years (32% 1999) (fig 6.18 Non Diabetic and 6.19). Diabetic There were 260 new peritoneal 150.7 153.9 167.1 176.3 176.7 dialysis patients in the calendar year 2000 (266 in 1999), 53% as initial dialysis treatment; 31% were 55-64 years, 8% 35 years, 33% 65 years (fig 6.17 and 6.19). For more detail 1996 1997 1998 1999 2000 see Appendix III at Website (www.anzdata.org.au). There were 140 deaths in 2000 (98 in Figure 6.15 1999). 21.0 deaths per 100 patient 6Q9ÃQh‡vr‡†ÃÈÂsÃhyyÃ9vhy’†v† years, (14.7% of patients at risk; 13% 25-44 years, 21% 45-64 years, 49% 65-84 years) (fig 3.5). For New Zealand (n=80) more detail see Appendix III at 75% Website (www.anzdata.org.au). Forty one patients were transplanted in 2000 (41 in 1999), 6% of patients 20% dialysed, 8% of patients 65 years 2% 10% 5% 4% 5% 3% old (fig 6.2). 0% 0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 =85 The primary renal disease of new patients to peritoneal dialysis was 40% diabetic nephropathy and 23% Figure 6.16 glomerulonephritis. The proportion of patients in each Iˆ€ir…ÃQr…ÃHvyyv‚Ã6Q9ÃQh‡vr‡† group using peritoneal dialysis range from 31% (15-24 years), 38% (25- New Zealand 1996 - 2000 34 years) to 75% (0-14 years) and Non Diabetic 100% (85-94 years) (fig 6.13). Diabetic 20.9 13.4 7.5 8.7 9.2 1996 1997 1998 1999 2000 48
  7. 7. ANZDATA Registry 2001 Report PERITONEAL DIALYSIS Figure 6.17 Figure 6.18 6trÂsÃIrÃQ9ÃQh‡vr‡† 6trÂsÃ9vhy’†vtÃQ9ÃQh‡vr‡† New Zealand (n=260) New Zealand (n=677) 31% 30% 20% 23% 19% 21% 11% 10% 8% 9% 6% 1% 2% 5% 0.8% 2% 0.5% 0.3% 0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 =85 0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 =85 No. No. Pats. 5 4 13 24 49 80 55 29 1 Pats. 6 17 38 67 135 201 153 56 4 Avtˆ…rÃ% ( I@XÃa@6G6I9 T‡‚pxÃhqÃAy‚Ã‚sÃQr…v‡‚rhyÃ9vhy’†v†ÃÃÃÃà ((%ÃÃ! 6trÃB…‚ˆƒ† ((% (( ((' ((( ! IrÃQh‡vr‡†Ã★ #Òrh…† % È # !È $ !È $ !È $ !È $!#Òrh…† ! $È È ' È $ !È # !È !$#Òrh…† ! $È $È ( 'È ! $È $È $##Òrh…† ! !È ! (È ! 'È ! (È !# (È #$$#Òrh…† $ !#È #% ! È ## È $% ! È #( (È $$%#Òrh…† % !(È % !È '! !È ' !(È ' È %$#Òrh…† ## !È %# !(È % !#È % !È $$ ! È $'#Òrh…† !È ( #È $È !# (È !( È 3Ã'$Òrh…† È 1 È 1 È ! 1 È 1 È U‚‡hy !! È !!! È !$ È !%% È !% È Qh‡vr‡†Ã9vhy’†vt #Òrh…† !È ! !È ( !È ' È % 1 È $!#Òrh…† ! #È ! #È ! #È ' È !È !$#Òrh…† # È # È # %È ( %È ' %È $##Òrh…† È %$ È È È % È #$$#Òrh…† !#È !!È !( !È % !È $ !È $$%#Òrh…† % !(È % !'È ( !'È '' !'È ! È %$#Òrh…† 'È ! ! È #$ !È %# !#È $ !È $'#Òrh…† $ È !$ #È # $È ## È $% 'È 3Ã'$Òrh…† È 1 È 1 È # 1 È # 1 È U‚‡hy $% È $( È %# È %! È % È Q…v€h…’ÃSrhyÃ9v†rh†rÃ★ By‚€r…ˆy‚rƒu…v‡v† #( !!È # ! È ## È $ !È % !È 6hytr†vpÃIrƒu…‚ƒh‡u’ È È 1 È 1 È È C’ƒr…‡r†v‚ !# È $ %È $È # È ( $È Q‚y’p’†‡vpÃ9v†rh†r % È ' #È #È $ %È $ !È Srsyˆ‘ÃIrƒu…‚ƒh‡u’ $ È È ( #È ' È #È 9vhir‡vpÃIrƒu…‚ƒh‡u’ ' #È ( ##È ! #(È # #È #È Hv†pryyhr‚ˆ† !! È ( (È $ %È ! 'È !( È Vpr…‡hv È ( #È # $È ! È ! $È U‚‡hy !! È !!! È !$ È !%% È !% È ★ IrÃƒh‡vr‡†Ã…rprv‰vtÃsv…†‡Ãƒr…v‡‚rhyÃqvhy’†v†Ã‡…rh‡€r‡ 49
  8. 8. PERITONEAL DIALYSIS ANZDATA Registry 2001 Report ADEQUACY OF DIALYSIS BMI ON CAPD There has been debate in the literature regarding the use of peritoneal dialysis in large patients. In Australia over the period 1990 to 2000, 49.4% of all dialysis patients with a BMI of 20 kg/m2 are on PD, versus 41.2% of all patients with a BMI of 35 kg/m2. After two years of dialysis in all BMI groups there was a lower percentage on PD ranging from 43.3% in the 20 kg/m2 group through to 34.4% in the 35 kg/m2 group. In New Zealand where two thirds of all patients are on PD this trend at two years was not evident. However, as in Australia a lower percentage (57.3%) of all dialysis patients in the 35kg/m2 BMI group were managed with PD. Avtˆ…rÃ%! IrÃQh‡vr‡†ÃÃÃÃÃà Eh ((Ãǂà 9rp! ÈÃQ9ÂsÃ6yyÃ9vhy’†v†ÃU…rh‡€r‡Ãh‡Ã(Ãqh’†ÃhqÃ!Òrh…†Ãi’Ã7HD 7HD Ryq ITX 68U Wvp Uh† T6 IU X6 $867 1= (Ãqh’† $!%È $%%È $#È #'!È # È !(È !È $!!È #(#È %'!È 1Ã! !Òrh…† #'(È ##È $%È (!È #'È #(È ! È $#È ##È %%È (Ãqh’† #!È #$%È #%È %È $È !%!È #$È $#È # (È % È !!#( !Òrh…† #$%È '#È #$!È È #'(È !$È #È #(È È !!È (Ãqh’† #'!È ##È $ È # È $!(È !$%È 'È #È # È %!È !$!(( !Òrh…† 'È %%È #$$È !%È $!È !$#È %È # (È #È %%%È (Ãqh’† $#È #$ È $È !È #'#È !% È %È #(È #! È %# È #( !Òrh…† #$È %È # !È !È È !È !È # !È #$È %! È (Ãqh’† #(È # %È # 'È ''È È !$'È $#È $!(È # !È $È 3Ã$ !Òrh…† %$È #È #$È # È $'$È !#È È #(È ##È $($È PD LITRES PER WEEK The trend noted in earlier reports showing an increase in percentage of patients on larger weekly volumes of peritoneal dialysis has continued in most BMI groups in both Australia and New Zealand. This may reflect the widely promulgated view up to 2001 that more dialysis promotes a better long term outcome. Avtˆ…rÃ%! W‚yˆ€rÂsÃ9vhy’†h‡rÃr…ÃXrrx Hh…puà ((' Hh…puÃ! 6tr Gv‡…r†Ãƒr…ÃXrrx Gv‡…r†Ãƒr…ÃXrrx B…‚ˆƒ† I‚ÃQ‡† #! $% '# I‚ÃQ‡† #! $% '# $XVW 1= 50
  9. 9. ANZDATA Registry 2001 Report PERITONEAL DIALYSIS Figure 6.22 RELATIONSHIP OF BMI TO WEEKLY DIALYSATE VOLUME 6ˆ†‡…hyvhÃÃÃÃà ((ÃÃ! IrÃarhyhqÃÃÃà ((ÃÃ! BMI 20 7HDÃÃ1! 100% 100% 100% 100% 80% 80% 80% 80% 60% 60% 60% ≤ 56 L / Week 60% ≤ 56 L / Week ≥ 70 L / Week 40% ≥ 70 L / Week 40% 40% 40% 20% 20% 20% 20% 0% 0% 0% 0% Sep-97 Mar-98 Sep-98 Mar-99 Sep-99 Mar-00 Sep-00 Mar-01 Sep-97 Mar-98 Sep-98 Mar-99 Sep-99 Mar-00 Sep-00 Mar-01 6ˆ†‡…hyvhÃÃÃÃà ((ÃÃ! IrÃarhyhqÃÃÃÃà ((ÃÃ! 7HDÃÃÃÃ!ÃÃ!#( 7HDÃÃÃÃ!ÃÃ!#( 100% 100% 100% 100% ≤ 56 L / Week ≤ 56 L / Week 80% ≥ 70 L / Week 80% 80% ≥ 70 L / Week 80% 60% 60% 60% 60% 40% 40% 40% 40% 20% 20% 20% 20% 0% 0% 0% 0% Sep-97 Mar-98 Sep-98 Mar-99 Sep-99 Mar-00 Sep-00 Mar-01 Sep-97 Mar-98 Sep-98 Mar-99 Sep-99 Mar-00 Sep-00 Mar-01 6ˆ†‡…hyvhÃÃÃÃà ((ÃÃ! IrÃarhyhqÃÃÃÃà ((ÃÃ! 7HDÃÃÃÃ!$ÃÃ!(( 7HDÃÃÃÃ!$ÃÃ!(( 100% 100% 100% 100% ≤ 56 L / Week ≤ 56 L / Week 80% ≥ 70 L / Week 80% 80% ≥ 70 L / Week 80% 60% 60% 60% 60% 40% 40% 40% 40% 20% 20% 20% 20% 0% 0% 0% 0% Sep-97 Mar-98 Sep-98 Mar-99 Sep-99 Mar-00 Sep-00 Mar-01 Sep-97 Mar-98 Sep-98 Mar-99 Sep-99 Mar-00 Sep-00 Mar-01 6ˆ†‡…hyvhÃÃÃÃà ((ÃÃ! IrÃarhyhqÃÃÃÃà ((ÃÃ! 7HDÃÃ≥Ãà 7HDÃÃ≥à 100% 100% 100% 100% ≤ 56 L / Week ≤ 56 L / Week 80% ≥ 70 L / Week 80% 80% ≥ 70 L / Week 80% 60% 60% 60% 60% 40% 40% 40% 40% 20% 20% 20% 20% 0% 0% 0% 0% Sep-97 Mar-98 Sep-98 Mar-99 Sep-99 Mar-00 Sep-00 Mar-01 Sep-97 Mar-98 Sep-98 Mar-99 Sep-99 Mar-00 Sep-00 Mar-01 51
  10. 10. PERITONEAL DIALYSIS ANZDATA Registry 2001 Report PERITONITIS Australian median survival peritonitis free has in- While the numbers are still small, peritonitis free creased at 18.5 months overall, with a growing survival in this group does appear to be worse than for number (31%) of patients completely free of perito- those patients who are on CAPD. This somewhat nitis in three years and in New Zealand it was 11.64 surprising result may reflect a tendency based on months (21% of patients) (fig 6.23). As noted in funding constraints to utilise APD primarily in patients previous reports there is a strong association between who are dependent on others for some or much of ethnicity and peritonitis free survival (fig 6.25). In their dialysis care with the attendant risks seen in this this Report, for the first time, we comment on group of patients. peritonitis free survival in patients on APD (fig 6.25). Avtˆ…rÃ%! Av…†‡ÃQ9ÃU…rh‡€r‡Ã‡‚ÃAv…†‡Ã@ƒv†‚qrÂsÃQr…v‡‚v‡v† Sryh‡rqǂÃ6trÃh‡Ã@‡…’ÃÃÃÃà ((ǂà 9rp! 6trÃB…‚ˆƒ† Tˆ…‰v‰hy 6yy # $# $$# $$%# %$# 3Ã$ 6ˆ†‡…hyvh 2%( 2!' 2 2% 2''! 2 2!(#' À‚‡u† ! + $$ #% ' ! ! '$ $' '% $ #% '# %%( ' ! !$ '$ !!' %À‚‡u† $ %! ! $ ! %! $ #! $ ( $( # % $% # !# !( # ( (À‚‡u† #( %$ ! %$ % ( % ! ! %$ ' ( %% ! #( %% !% Òrh… # % $( # ' %! ! !% % !! !! $( ( $( ! % !Òrh…† # # !' # !# ' # !% '! # !! % ( $ ( #! ! # Òrh…† #% !' !# ! ! ! ! # ! $ IÃarhyhq 2 2$ 2!'! 2! 2!( 2' 2(($ À‚‡u† '! #$ $( '$ !! ! ' !! !#! '% ! '( ' # % '# ! (! %À‚‡u† $ !# # %' $% # %( !( %! % !' ! ! ( $# #! %( $ $$( (À‚‡u† $ !# $% %! !( $( ( $! %# # %# % $' #! Òrh… $ !# #' %% ! $ '( #! ! $ $ % '( $$ % !! #( ' !(( !Òrh…† !% % $ !' ! !% # ( $ !( ( ( ( Òrh…† ! ! ! ( ! % !# #$ ! ! !$ ÈÃTˆ…‰v‰hyÃÃT@ÃÃhqÃÃIˆ€ir…†Ãh‡Ã…v†x Figure 6.24 Av…†‡ÃQ9ÃU…rh‡€r‡Ã‡‚ÃAv…†‡ÃQr…v‡‚v‡v†Ã Av…†‡ÃQ9ÃU…rh‡€r‡Ã‡‚ÃAv…†‡ÃQr…v‡‚v‡v†Ã Sryh‡rqǂÃ6trÃh‡Ã@‡…’ÃÃà ((ÃÃ! Sryh‡rqǂÃ6trÃh‡Ã@‡…’ÃÃà ((ÃÃ! % Survival Australia % Survival New Zealand 100% 100% 100% 100% Age Group Age Group 80% 80% 0-14 (69) 80% 80% 0-14 (17) 15-34 (280) 15-34 (75) 60% 60% 60% 60% 35-44 (733) 35-44 (282) 40% 40% 55-64 (607) 40% 40% 55-64 (302) 65-74 (882) 65-74 (239) 20% 20% 20% 20% ≥ 75 (80) ≥ 75 (377) 0% 0% 0% 0% 3 6 9 12 24 3 6 9 12 24 Months Months 52
  11. 11. ANZDATA Registry 2001 Report PERITONEAL DIALYSIS Figure 6.25 Qr…v‡‚v‡v†ÃA…rrÃTˆ…‰v‰hyÃÃà Qr…v‡‚v‡v†ÃA…rrÃTˆ…‰v‰hyÃà Sryh‡rqǂÃShprÃÃà Sryh‡rqǂÃShprÃÃà 6ˆ†‡…hyvhÃà ((! (($ 6ˆ†‡…hyvhÃà ((! 100% 100% 80% 80% 60% 60% Caucasoid Caucasoid 35-54 yrs 40% 35-54 yrs 40% 35-54 yrs 35-54 yrs 55-64 yrs Aboriginal 55-64 yrs 55-64 yrs Aboriginal 55-64 yrs 20% Maori/Pac Isl 20% Maori/Pac Isl 0% 0% 3 6 9 12 24 3 6 9 12 24 Months Months Qr…v‡‚v‡v†ÃA…rrÃTˆ…‰v‰hyÃÃà Qr…v‡‚v‡v†ÃA…rrÃTˆ…‰v‰hyÃà Sryh‡rqǂÃShprÃÃà Sryh‡rqǂÃShprÃÃà IrÃarhyhqÃà ((! (($ IrÃarhyhqÃà ((! 100% 100% 80% 80% 60% 60% Caucasoid Caucasoid 55-64 yrs 40% 55-64 yrs 40% 35-54 yrs 35-54 yrs Maori/Pac Isl 20% Maori/Pac Isl 20% 35-54 yrs 35-54 yrs 55-64 yrs 0% 55-64 yrs 0% 3 6 9 12 24 3 6 9 12 24 Months Months Avtˆ…rÃ%!% Av…†‡ÃC‚€rÃ6Q9ÃU…rh‡€r‡Ã‡‚ÃAv…†‡Ã@ƒv†‚qrÂsÃQr…v‡‚v‡v† Sryh‡rqǂÃ6trÃh‡Ã@‡…’ÃÃÃÃà ((ǂà 9rp! 6trÃB…‚ˆƒ† Tˆ…‰v‰hy 6yy # $# $$# $$%# %$# 3Ã$ 6ˆ†‡…hyvh 2#' 2( 2 $# 2(! 2 ! 2#( 2$$# À‚‡u + % ( '! # '% '$ !( #' '$ ' '$ '! % ' ' $$ # ' % $( ÃÀ‚‡u† % ! ! #' # ( #( %' ## '( ' $$ % ! ( # # %À‚‡u† $$ $ !# % $ $' %% # (# % $ $ % #$ %% ' $$ # % ! !( (À‚‡u† $ ! $( $$ # %! #! ' % $' ## %# # $ ( %! !' %! !! ! Òrh… '$ % # !% $ $ $( % ' !$ #( %! # $% ' ! # !' '( IÃarhyhq 2 % 2! 2! 2 $ 2 2% 2(# À‚‡u %! ! # '# '# ( '# !$ ( %% ' ' ' ' ' #! '# À‚‡u† !$ $ ( # ' ( ! ! ! ' ' % ' ' % $! %% %À‚‡u† !$ $ %# ! (# ! ! %$ %$ % $ !#' % $$ #( (À‚‡u† $$ # ' (# $ ! ! %$ %$ $ $# $' # Òrh… #! #( $ $ # ' %$ %$ # # $ ! ÈÃTˆ…‰v‰hyÃÃT@ÃÃhqÃÃIˆ€ir…†Ãh‡Ã…v†x 53
  12. 12. PERITONEAL DIALYSIS ANZDATA Registry 2001 Report TECHNIQUE FAILURE (CENSORED FOR DEATH OR TRANSPLANTATION) Avtˆ…rÃ%! Figures 6.27-29, show the causes of technique failure. In comparison to 8hˆ†r†Ã‚sÃUrpuv„ˆrÃAhvyˆ…rÃÃÃÃ6ƒ…vyà (($ǂÃHh…puà ((' the epoch 1995 to 1998 infective @‘pyˆqvtÃ9rh‡uÃU…h†ƒyh‡h‡v‚ complications as an overall cause of Srp‚‰r…’ÂsÃSrhyÃAˆp‡v‚ technique failure has reduced in 6ˆ†‡…hyvh IrÃarhyhq Australia from 42% to 32% and in 8hˆ†r†Ã‚sÃUrpuv„ˆrÃAhvyˆ…r New Zealand from 43% to 40%. In Q…v€h…’ Trp‚qh…’ Q…v€h…’ Trp‚qh…’ Australia there has been an increase in Srpˆ……r‡ƒr…†v†‡r‡Ãƒr…v‡‚v‡v† !# ( the number of patients failing because 6pˆ‡rÃr…v‡‚v‡v† ( $ # of inadequate solute clearance or Uˆryr‘v‡Ã†v‡rÃvsrp‡v‚ !' # inadequate fluid ultrafiltration rising U‚‡hyÃDsrp‡v‰rÃ8‚€ƒyvph‡v‚† %#Ã#!È 'Ã!(È $#Ã#È Ã #È from 15% to 21% of total failures and Dhqr„ˆh‡rƂyˆ‡rÃpyrh…hpr ! # !' a rise in failure for social reasons Dhqr„ˆh‡rÃsyˆvqÈy‡…hsvy‡…h‡v‚ $ $ !! from 26% to 31%. U‚‡hyÃ9vhy’†v†ÃAhvyˆ…r !!'à $È (à $È $à #È 9vhy’†h‡rÃyrhx ! $ ' A similar change was noted in New 8h‡ur‡r…Ãiy‚px % ! ' Zealand in relationship to dialysis 8h‡ur‡r…Ãsryyˆ‡ failure and there was also a climb in Cr…vh #' # technique failure secondary to social 6iq‚€vhyÃhv # 6iq‚€vhyƈ…tr…’ $ ! ( reasons. These trends may reflect a Hˆy‡vƒyrÃhqur†v‚† ! tendency over the last three years to C’q…‚‡u‚…h‘ transfer more patients from PD to Chr€‚ƒr…v‡‚rˆ€ haemodialysis because of concerns Tp…‚‡hyÂrqr€h about inadequate dialysis. U‚‡hyÃUrpuvphyÃAhvyˆ…r !$$Ã È !$Ã#È #'Ã È !Ã!(È VhiyrǂÀhhtrÆrysÃph…r ' ( Interestingly, in Australia, patient Qh‡vr‡Ãƒ…rsr…rpr !$ ( ' preference as a cause for transfer has U‚‡hyÃT‚pvhyÃSrh†‚† ''Ã!%È Ã %È %ÃÈ #Ã$È risen dramatically from 250 (16.5%) in the era 1995 to 1998, to 470 (23.2%) in the era 1998-2001. The Avtˆ…rÃ%!' opposite trend occurred in New Zealand over the same period with 87 8hˆ†r†Ã‚sÃUrpuv„ˆrÃAhvyˆ…rÃÃÃÃ6ƒ…vyà (('ǂÃHh…puÃ! (24%) and 89 (16.8%) being recorded @‘pyˆqvtÃ9rh‡uÃU…h†ƒyh‡h‡v‚ in the 2 epochs. These differences Srp‚‰r…’ÂsÃSrhyÃAˆp‡v‚ may reflect the constraints placed on 6ˆ†‡…hyvh IrÃarhyhq availability of hospital and satellite 8hˆ†r†Ã‚sÃUrpuv„ˆrÃAhvyˆ…r Q…v€h…’ Trp‚qh…’ Q…v€h…’ Trp‚qh…’ haemodialysis in New Zealand in contrast to Australia. Srpˆ……r‡ƒr…†v†‡r‡Ãƒr…v‡‚v‡v† !'# ' ' ! 6pˆ‡rÃr…v‡‚v‡v† !# $ $ Ethnicity also importantly influences Uˆryr‘v‡Ã†v‡rÃvsrp‡v‚ '% the cause of technique failure. In U‚‡hyÃDsrp‡v‰rÃ8‚€ƒyvph‡v‚† %##Ã!È 'à %È ! Ã#È 'Ã!%È Australia, 55% of Aborigines fail for Dhqr„ˆh‡rƂyˆ‡rÃpyrh…hpr !#$ '$ $ infective reasons as opposed to 34% Dhqr„ˆh‡rÃsyˆvqÈy‡…hsvy‡…h‡v‚ # of Caucasians and 32% of Asians. U‚‡hyÃ9vhy’†v†ÃAhvyˆ…r # (Ã! È !#Ã!!È 'Ã!È 'Ã!%È Similarly in New Zealand, 48% of 9vhy’†h‡rÃyrhx ' !! ## Maori and 49% of Pacific Islanders 8h‡ur‡r…Ãiy‚px ! $ 8h‡ur‡r…Ãsryyˆ‡ ' fail PD for infective reasons as Cr…vh # ' opposed to 33% of Caucasians and 6iq‚€vhyÃhv ! 41% of Asians. In contrast social 6iq‚€vhyƈ…tr…’ $' # % reasons account for only 19% of Hˆy‡vƒyrÃhqur†v‚† ! $ failures in Australian Aborigines and C’q…‚‡u‚…h‘ Chr€‚ƒr…v‡‚rˆ€ New Zealand Maori and Pacific Tp…‚‡hyÂrqr€h Islanders. These failure rates related U‚‡hyÃUrpuvphyÃAhvyˆ…r !!à %È !ÃÈ ' à $È Ã!!È to infection correlate with the ten- VhiyrǂÀhhtrÆrysÃph…r ! !' dency towards early peritonitis in the Qh‡vr‡Ãƒ…rsr…rpr # ! '( indigenous populations (fig 6.29). U‚‡hyÃT‚pvhyÃSrh†‚† %#!Ã È #Ã È Ã!!È 'Ã!%È 54
  13. 13. ANZDATA Registry 2001 Report PERITONEAL DIALYSIS Avtˆ…rÃ%!( 8hˆ†r†Ã‚sÃUrpuv„ˆrÃAhvyˆ…rÃÃÃÃ6ƒ…vyà (($ǂÃHh…puÃ! ÃÈà 8hˆ†r†Ã‚s Shpr 6trÃB…‚ˆƒ I‚ Urpuv„ˆr 9vhi U‚‡hy 9vhi 6†vh 6i‚… 8hˆp Hh‚…v QhpD† P‡ur… ($# 3$$ Ahvyˆ…r 6VTUS6GD6 Dsrp‡v‰r ! ($ ( %$ (%' #( ! #$ ! !' È ( $ ! Ã$$ # ' $$ # Ã% Ã% % SrqˆprqÃT‚yˆ‡r %# # ( ' % $ %( (! %' È ' # ( Dhqr„ˆh‡rÃVA %( ! !' ( !!$ # ! (% $ !( È ( ' % ' ! # % ' ' Urpuvphy ( #'# #! $ #! % ! $ $ $ È ! ' $ ! % % T‚pvhy !$ ( $% '#% # !# ( %$ %# È ! !' ! ( $ ! !% !' !( U‚‡hy ($ !#% !' !(( !'!( ' '( $ ! ! % $# I@XÃa@6G6I9 Dsrp‡v‰r # !! !! !% $! %% #% ! % È #! # # #' #( ( #% # SrqˆprqÃT‚yˆ‡r #$ %' #' ' %! #( È ! ' ! % Dhqr„ˆh‡rÃVA !( !% ! !$ ! ' ! $$ È ' $ # % %È $ % Urpuvphy $ ( ' $$ #' ' $% !( È # $ $ # $ $ $ $ T‚pvhy ' #$ ! !% $( !% (# ( !! È ! ! !! ( ( !$ ! !$ U‚‡hy #( $' $# ' $ ( #% '' 55
  14. 14. PERITONEAL DIALYSIS ANZDATA Registry 2001 Report ACHIEVED SOLUTE CLEARANCE Figure 6.30 Sryh‡v‚†uvƒÃ‚sÃSr†vqˆhyÃBASǂÃF‡W Achieved Kt/V March 2001 5 Australia New Zealand In Australia, 23% of patients are 4 achieving a total Kt/V of 1.8 (com- 3 pared with 33% reported in 2000). 2 In New Zealand there has also been a 1 Mean ± 1 SD similar decrease in the percent of 0 patients reporting a total clearance of =1 1-2 2 =1 1-2 2 1.8, 21% versus 25% in 2000. Residual GFR (mls/minute) These trends are likely to reflect increasing use of larger dialysis volumes on the one hand and an Figure 6.31 Sryh‡v‚†uvƒÃ‚sÃ8…rh‡vvrÃ8yrh…hprǂÃF‡W increasing rate of transfer from PD to Creatinine Clearance haemodialysis on the other. This latter March 2001 (Litres/Week) contention is borne out from data 200 presented in Figures 6.27-28 showing Australia New Zealand that dialysis failure as a cause of 150 technique failure has risen in Australia 100 from 15% in the epoch 1995 to 1998 to 21% in the epoch 1998 to 2001. 50 Similar changes have occurred in New Mean ± 1 SD Zealand. One hundred and twenty three 0 (8.1%) of all technique failures were =1 1-2 2 =1 1-2 2 due to inadequate solute clearance in Residual GFR (mls/minute) 1995 to 1998 compared with 245 (12.1%) in 1998 to 2001. Figure 6.32 It is clear from Figure 6.34 that FUWÃSryh‡rqǂÃW‚yˆ€rÂsÃ9vhy’†h‡r residual GFR plays a significant role 6ˆ†‡…hyvhÃÃÃÃÃHh…puÃ! in determining the total amount of clearance (Kt/V) that can be achieved. Prescribed Achieved KT/V (Total) This is even more the case with the Dialysate association between residual GFR and Volume ≤ 1.8 1.8 creatinine clearance. ≤ 56 L / week 127 (22.1%) 448 (77.9%) ≥ 70 L / week 168 (24.5%) 517 (75.5%) 295 965 Figure 6.33 Figure 6.34 FUWÃSryh‡rqǂÃW‚yˆ€rÂsÃ9vhy’†h‡r Sryh‡v‚†uvƒÃ‚sÃSr†vqˆhyÃBASǂÃFUW IrÃarhyhqÃÃÃÃÃHh…puÃ! Hh…puÃ! Prescribed Achieved KT/V (Total) Residual GFR KT/V (Total) + S.E Dialysate Volume ≤ 1.8 1.8 1 ml / min 1.90 ± 0.03 Aust 1 ml / min 2.47 ± 0.03 ≤ 56 L / week 35 (18.1%) 158 (81.9%) 1 ml / min 2.01 ± 0.03 ≥ 70 L / week 80 (23.1%) 266 (76.9%) NZ 1 ml / min 2.48 ± 0.04 115 424 56
  15. 15. ANZDATA Registry 2001 Report PERITONEAL DIALYSIS PERITONEAL TRANSPORT STATUS The Registry commenced collection Figure 6.35 of this data in October 1998 in patients new to CAPD with the aim of Q@UÃÃ9QÃ8…rh‡vvrÃh‡ÃA‚ˆ…ÃC‚ˆ…† using these measurements as another predictor of outcome. IrÃQ9ÃQh‡vr‡†Ãs…‚€Ã Pp‡(' Australia New Zealand Only 1022 patients (Australia) and Non Non Diabetic Diabetic 360 patients (New Zealand) had data Diabetic Diabetic supplied: 65% of all new patients in Australia and 66% of all new patients Mean + ISD 0.82 0.83 0.87 0.86 in New Zealand. Mean 0.70 0.70 0.72 0.72 The mean D/P creatinine ratios tend Mean – ISD 0.58 0.57 0.57 0.58 to be higher than proposed interna- tional means (Twardowski) with 32% of Australians and an even higher number of New Zealand patients commencing CAPD and being Figure 6.36 classified in the high transport category with only 3% of Australian Qr…v‡‚rhyÃU…h†ƒ‚…‡ÃT‡h‡ˆ† patients and 4% of New Zealand IrÃQh‡vr‡†Ã Pp‡ (('ǂà Hh…! patients in the low transport category. Australia New Zealand While this data must be viewed in the Non Non Diabetic Diabetic Diabetic Diabetic context of a large group without reported results it would appear that High 82 (32%) 243 (32%) 64 (47%) 91 (41%) the peritoneal transport status in the (0=0.8) New Zealand and Australian High Average (0.65-0.8) 85 (33%) 263 (34%) 40 (29%) 78 (35%) populations is systematically higher than that reported elsewhere for Low Average 83 (32%) 238 (31%) 26 (19%) 46 (21%) (0.50-0.64) reasons that are unclear. Low 7 (3%) 21 (3%) 7 (5%) 8 (4%) (0.5) There is a difference between the numbers of patients with significant residual renal function ( or = to 5ml/min) in relationship to D/P creatinine. Of those undertaking transport studies in the first 6 months, there were 35% of patients in Aus- Avtˆ…rÃ% tralia with significant residual renal function and a D/P creatinine 0.65 Gh‡rÃSrsr……hyÃ1ÃÀ‚‡u† compared with 31% of patients with a IrÃQh‡vr‡†Ã†vprà 6ƒ… (( D/P creatinine 0.65. By 6-12 U…rh‡€r‡Ãh‡Ã(Ãqh’† months of those with a high transport ˆ‡vyà 9rp! status, only 22.4% had mantained U…rh‡€r‡Ãh‡Ã(Ãqh’† Gh‡r @h…y’ significant residual renal function compared to 28.4% of those with a lower transport status. These figures 6ˆ†‡…hyvh (# ##( were similar to those in New Zealand Q9 È 'È where 21% of those with a high C9 %È %!È transport status maintained a higher residual renal function versus 33% of IrÃarhyhq ''% those with a lower transport status. Q9 'È (È This association needs further C9 %!È % È definition. 57
  16. 16. PERITONEAL DIALYSIS ANZDATA Registry 2001 Report LATE REFERRAL RELATED TO TREATMENT AT 90 DAYS Figure 6.38 Qh‡vr‡ÃTˆ…‰v‰hyÃSryh‡rqǂÃSrsr……hy Urpuv„ˆrÃTˆ…‰v‰hyÃSryh‡rqǂÃSrsr……hy C9ÃU…rh‡€r‡Ãh‡Ã(Ãqh’†Ã C9ÃU…rh‡€r‡Ãh‡Ã(Ãqh’†Ã ÃÃÃÃà ÃÃÃÃà 1997 to Mar-2001 Australia 1997 to Mar-2001 Australia 100% 100% 100% 100% 80% 80% 80% 80% 60% 60% 60% 60% Death Censored 40% 40% 40% 40% Early (2506) Early (2506) 20% Late (875) 20% 20% Late (875) 20% 0% 0% 0% 0% 0 1 2 3 0 1 2 3 Years Years Qh‡vr‡ÃTˆ…‰v‰hyÃSryh‡rqǂÃSrsr……hy Urpuv„ˆrÃTˆ…‰v‰hyÃSryh‡rqǂÃSrsr……hy Q9ÃU…rh‡€r‡Ãh‡Ã(Ãqh’†Ã Q9ÃU…rh‡€r‡Ãh‡Ã(Ãqh’†Ã ÃÃÃÃà ÃÃÃÃà 1997 to Mar-2001 Australia 1997 to Mar-2001 Australia 100% 100% 100% 100% 80% 80% 80% 80% 60% 60% 60% 60% Death Censored 40% 40% 40% 40% Early (1543) Early (1543) 20% Late (519) 20% 20% Late (519) 20% 0% 0% 0% 0% 0 1 2 3 0 1 2 3 Years Years Qh‡vr‡ÃTˆ…‰v‰hyÃSryh‡rqǂÃSrsr……hy Urpuv„ˆrÃTˆ…‰v‰hyÃSryh‡rqǂÃSrsr……hy C9ÃU…rh‡€r‡Ãh‡Ã(Ãqh’†Ã C9ÃU…rh‡€r‡Ãh‡Ã(Ãqh’†Ã ÃÃÃÃà ÃÃÃÃà 1997 to Mar-2001 New Zealand 1997 to Mar-2001 New Zealand 100% 100% 100% 100% 80% 80% 80% 80% 60% 60% 60% 60% Death Censored 40% 40% 40% 40% Early (347) Early (347) 20% Late (128) 20% 20% 20% Late (128) 0% 0% 0% 0% 0 1 2 3 0 1 2 3 Years Years Qh‡vr‡ÃTˆ…‰v‰hyÃSryh‡rqǂÃSrsr……hy Urpuv„ˆrÃTˆ…‰v‰hyÃSryh‡rqǂÃSrsr……hy Q9ÃU…rh‡€r‡Ãh‡Ã(Ãqh’†Ã Q9ÃU…rh‡€r‡Ãh‡Ã(Ãqh’†Ã ÃÃÃÃà ÃÃÃÃà 1997 to Mar-2001 New Zealand 1997 to Mar-2001 New Zealand 100% 100% 100% 100% 80% 80% 80% 80% 60% 60% 60% 60% Death Censored 40% 40% 40% 40% Early (539) Early (539) 20% Late (205) 20% 20% Late (205) 20% 0% 0% 0% 0% 0 1 2 3 0 1 2 3 Years Years 58
  17. 17. ANZDATA Registry 2001 Report PERITONEAL DIALYSIS LATE REFERRAL RELATED TO TREATMENT MODALITY In Australia there is an increased mortality in patients placed on haemodialysis (and surviving past 90 days) who have been referred to a renal physician less than three months before requiring dialysis. This data does not take account of mortality within the first 90 days. In contrast there is no apparent difference in survival on peritoneal dialysis. Technique survival from 90 days onwards isimilar in both early and late referrals whether or not they were on haemodialysis or peritoneal dialysis. In New Zealand, (patients who have survived more than 90 days on dialysis) there is no significant difference in mortality for early versus late referrals whether or not they were on PD or haemodialysis. There is however a significant transfer rate of late referral patients from haemodialysis to PD after 90 days in comparison to early referrals. This difference is likely to reflect the high rate of PD utilisation in New Zealand and constraints on hospital and satellite haemodialysis. TRANSPLANTATION IN PD PATIENTS In Australia in patients receiving first cadaveric grafts, those who are on haemodialysis had a higher frequency of delayed graft function (22.5%) than those on peritoneal dialysis (13%). (Figure 6.39) However, this did not have an effect on overall graft survival. (Figure 6.40) Figure 6.39 ÃÃ9ryh’rqÃB…hs‡ÃAˆp‡v‚Ãà ((ÃÃ! 6pp‚…qvtǂÃU’ƒrÂsÃ9vhy’†v† 89 ÃB…hs‡† Australia Chi-square p0.001 22.5% 13% PD HD Figure 6.40 Q…v€h…’Ã8hqh‰r…ÃB…hs‡ÃTˆ…‰v‰hyÃà ((ÃÃ! ÃÃ6pp‚…qvtǂÃU’ƒrÂsÃ9vhy’†v† 100% Australia 100% 80% 80% 60% 60% HD (n=2335) 40% p = n.s 40% PD (n=961) 20% 20% 1 2 3 4 5 6 7 8 9 10 Years 59

×