Temporal Changes in Mortality Risk by Dialysis Modality in the Australian and New Zealand Dialysis Population

Marshall, Mark R., Polkinghorne, Kevan R., Kerr, Peter G., Agar, John W.M., Hawley, Carmel M. and McDonald, Stephen P. (2015) Temporal Changes in Mortality Risk by Dialysis Modality in the Australian and New Zealand Dialysis Population. American Journal of Kidney Diseases, 66 3: 489-498. doi:10.1053/j.ajkd.2015.03.014


Author Marshall, Mark R.
Polkinghorne, Kevan R.
Kerr, Peter G.
Agar, John W.M.
Hawley, Carmel M.
McDonald, Stephen P.
Title Temporal Changes in Mortality Risk by Dialysis Modality in the Australian and New Zealand Dialysis Population
Journal name American Journal of Kidney Diseases   Check publisher's open access policy
ISSN 1523-6838
0272-6386
Publication date 2015-09
Year available 2015
Sub-type Article (original research)
DOI 10.1053/j.ajkd.2015.03.014
Volume 66
Issue 3
Start page 489
End page 498
Total pages 10
Place of publication Maryland Heights, Missouri, United States
Publisher W.B. Saunders
Collection year 2016
Language eng
Formatted abstract
Background: In most studies, home dialysis associates with greater survival than facility hemodialysis (HD). However, the relationship between mortality risk and modality can vary by era. We describe and compare changes in survival with facility HD, peritoneal dialysis, and home HD over a 15-year period using data from The Australia and New Zealand Dialysis and Transplant Registry (ANZDATA).

Study Design: An observational inception cohort study, using Cox proportional hazards and competing-risks regression.

Setting & Participants: All adult patients initiating renal replacement therapy in Australia and New Zealand since March 31, 1998, followed up to December 31, 2012.

Predictor: Era at dialysis inception (1998-2002, 2003-2007, and 2008-2012). We adjusted for time-varying dialysis modality and comorbid conditions, demographics, initial state/country of treatment, late referral for nephrology care, primary kidney disease, and kidney function at dialysis inception.

Outcomes: 
Patient mortality.

Results: 
Survival on dialysis therapy has improved despite increasing patient comorbid conditions. Compared to 1998 to 2002, there has been a 21% reduction in mortality for those on facility HD therapy, a 27% reduction for those on peritoneal dialysis therapy, and a 49% reduction for those on home HD therapy.

Limitations: Potential for residual confounding from limited collection of comorbid conditions; analyses lack data for blood pressure, fluid volume status, socioeconomics, medication, and biochemical parameters.

Conclusions: 
Our study indicates that outcomes on dialysis therapy are improving with time and that this improvement is most marked with home dialysis modalities, especially home HD. This might be the result of better dialysis care (eg, improving predialysis care and more appropriate selection of patients for home dialysis). Other contributing factors are possible, such as improvements in general care of patient comorbid conditions and improvements in dialysis technology, although further research is needed to clarify these issues.
Keyword ANZDATA
competing risks
dialysis modality
epidemiology
era effect
facility hemodialysis
home dialysis
Index Words Home hemodialysis
multivariable analysis
patient mortality
peritoneal dialysis
secular change
survival
temporal change
time series
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
 
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