Peritoneal dialysis in rural Australia

Gray, Nicholas A., Grace, Blair S. and McDonald, Stephen P. (2013) Peritoneal dialysis in rural Australia. BMC Nephrology, 14 278.1-278.14. doi:10.1186/1471-2369-14-278

Author Gray, Nicholas A.
Grace, Blair S.
McDonald, Stephen P.
Title Peritoneal dialysis in rural Australia
Journal name BMC Nephrology   Check publisher's open access policy
ISSN 1471-2369
Publication date 2013-12
Year available 2013
Sub-type Article (original research)
DOI 10.1186/1471-2369-14-278
Open Access Status DOI
Volume 14
Start page 278.1
End page 278.14
Total pages 14
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2014
Language eng
Formatted abstract
Background: Australians living in rural areas have lower incidence rates of renal replacement therapy and poorer dialysis survival compared with urban dwellers. This study compares peritoneal dialysis (PD) patient characteristics and outcomes in rural and urban Australia.

Methods: Non-indigenous Australian adults who commenced chronic dialysis between 1 January 2000 and 31 December 2010 according to the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) were investigated. Each patient's residence was classified according to the Australian Bureau of Statistics remote area index as major city (MC), inner regional (IR), outer regional (OR), or remote/very remote (REM).

Results: A total of 7657 patients underwent PD treatment during the study period. Patient distribution was 69.0% MC, 19.6% IR, 9.5% OR, and 1.8% REM. PD uptake increased with increasing remoteness. Compared with MC, sub-hazard ratios [95% confidence intervals] for commencing PD were 1.70 [1.61-1.79] IR, 2.01 [1.87-2.16] OR, and 2.60 [2.21-3.06] REM. During the first 6 months of PD, technique failure was less likely outside MC (sub-hazard ratio 0.47 [95%CI: 0.35-0.62], P < 0.001), but no difference was seen after 6 months (sub-hazard ratio 1.05 [95%CI: 0.84-1.32], P = 0.6). Technique failure due to technical (sub-hazard ratio 0.57 [95%CI: 0.38-0.84], P = 0.005) and non-medical causes (sub-hazard ratio 0.52 [95%CI: 0.31-0.87], P = 0.01) was less likely outside MC. Time to first peritonitis episode was not associated with remoteness (P = 0.8). Patient survival while on PD or within 90 days of stopping PD did not differ by region (P = 0.2).

Conclusions: PD uptake increases with increasing remoteness. In rural areas, PD technique failure is less likely during the first 6 months and time to first peritonitis is comparable to urban areas. Mortality while on PD does not differ by region. PD is therefore a good dialysis modality choice for rural patients in Australia.
Peritoneal dialysis
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Medicine Publications
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Created: Tue, 31 Dec 2013, 13:43:00 EST by Dr Nicholas Gray on behalf of Sunshine Coast Clinical School