CHARACTERISTICS OF CLIENTS AT INCIDENT HAEMODIALYSIS TREATMENT: A RETROSPECTIVE AUDIT IN A NORTHERN AUSTRALIAN HOSPITAL

JT HUGHES1,2, SW MAJONI1,2,3 , F BARZI1, S SIGNAL2, J KAPOJOS2, A ABEYARATNE2, M SUNDARAM2, P GOLDRICK4, SL JONES4, R McFARLANE5, LT CAMPBELL3, D STEPHENS3, 4, A CASS1

1Menzies School of Health Research, Charles Darwin University, Darwin, NT; 2Department of Nephrology, Division of Medicine, Royal Darwin Hospital, NT; 3Northern Territory Clinical School, Flinders University, Darwin NT; 4Intensive Care Unit, Royal Darwin Hospital; 5Chemical Pathology, Territory Pathology, Department of Health, Darwin, NT

Background: The Northern Territory (NT) has the highest national prevalence of dialysis-dependent end stage kidney disease (ESKD). All haemodialysis initiation in the Top-End region occurs at the Royal Darwin Hospital dialysis unit (DU), or intensive care unit (ICU) with continuous veno-venous haemofiltration if critically unwell.

Aim: to describe the survival of clients presenting for an incident haemodialysis (i-HD) treatment in the Top-End NT between 1 January 2011 to 21 December 2012.

Methods: Admissions data describing the incident HD (i-HD) treatment in clients (>18 years) were identified from the ANZICS database and DU diary (available for 01/07/2011-31/12/2012).  Planned dialysis at i-HD was defined as admission within DU of <8 hours.  Survival was calculated to date of death or follow-up (censored at 31/12/2015).  Requirement for ongoing maintenance dialysis (mRRT) after 90 days was confirmed by ANZDATA and chart review.

Results: Admissions for i-HD occurred in 176 clients (52.7% male, Indigenous 71%, mean age 50.5 (range 18.5-87.1) years, median eGFR within 90 days of i-HD 24 (IQR 8-61) ml/min/1.73m2), at the DU 39.2%, ICU 47.2% or both units (DU-ICU) 13.6%.  In this period, 57 clients (32.4%) at i-HD continued with mRRT, though only 17/57 (29.8%) had i-HD as a planned-dialysis. 136 (77.2%) clients survived 30 days, with 50.6% overall survival.  Survival was higher in clients with i-HD in DU than ICU (69.6 v 37.3%%, p<0.001) or ICU-DU (69.6 v 41.7%, p=0.01).  Survival was unrelated to planned-dialysis (p=0.08).

Discussion: The Top-End NT has a high demand for dialysis support with incident haemodialysis in the context of critical illness and unplanned-dialysis; though only critical illness was associated with lower survival.  Further research understanding factors associated with unplanned dialysis is required.

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The ASM is hosted by Australian and New Zealand Society of Nephrology.

The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

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