H HASSAN1,2, K MURALI1
1Wollongong Hospital Renal Unit, Wollongong, Australia, 2University of Wollongong, Wollongong, Australia
Aim: Determine the characteristics of Australian patients on renal replacement therapy (RRT) who relocate.
Background: RRT patients have the risk of being tied down geographically to treatment centres. The need for receiving RRT can impact the relocation decisions of RRT patients.
Methods: Cohort epidemiological study of Australian adults commencing RRT (2005-2015) based on ANZDATA registry. Relocation defined as change in postcode. Dialysis modality, urbanity and patient characteristics examined. Remoteness areas (RA) defined by Accessibility / Remoteness index of Australia (ARIA).
Results: Out of 24,676 patients most (70.4%) commenced RRT in major city (MC) and majority (66.6%) started hospital haemodialysis. Prevalence of relocation was 23.9% with median time to relocation 1.6 years [IQR 0.7,3.4]. Relocation incidence increased by urbanity (7.2/100ptyrs (95%CI 6.5-7.8) in MC to 48.8/100ptyrs (95%CI 45.6-51.9) in Very Remote (VR)). Relocating patients were younger (55.4 vs 61.8 years, p<0.001). Patients with comorbidities relocated sooner (1.5 vs2.1 years, p<0.001). Majority (70.6%) relocations occurred within the same RA category indicating patient needs /choice. Australian Indigenous (OR 2.7, 95% CI 2.5-2.9) & Maori (OR 1.5, 95% CI 1.3-1.8) people, compared to Caucasians and VR (OR 7.2, 95% CI 6.2-8.3) & Remote (OR 1.8, 95% CI: 1.5-2.1) patients compared to MC, were more likely to relocate. Most VR (97.3%) and majority Remote (70%) patients relocated to higher RA category, with shorter relocation time (0.6 years VR, 1.1 R, 1.9 MC, p<0.001). Using a multi-variate model most of the Indigenous relocations were explained by the remoteness.
Conclusion: Most relocations in RRT patients are driven by patient needs/choice. Relocation patterns in VR / Remote patients and Indigenous subjects suggests that RRT treatment needs may be driving relocation, highlighting geographical disadvantage.
Consultant Nephrologist. Wollongong Hospital