K MAC1, J HEDLEY2, PJ KELLY2,3, V LEE1,3, JWM AGAR3,4, CM HAWLEY3,5, DW JOHNSON3,5, EJ SEE3,6, KR POLKINGHORNE3,6, KS RABINDRANATH3,7, K SUD3,8 AC WEBSTER1,3
1 Department of Nephrology, Westmead Hospital, Westmead, NSW; 2Sydney School of Public Health, University of Sydney, Sydney, NSW; 3Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA; 4Department of Nephrology, University Hospital Geelong, Geelong, VIC; 5Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, QLD; 6Department of Nephrology, Monash Health, Clayton, VIC; 7Department of Nephrology, Waikato District Hospital, Hamilton, NZ; 8Department of Nephrology, Nepean Hospital, Kingswood, NSW
Aim: To describe uptake of haemodiafiltration (HDF) in Australia and New Zealand over time and determine the factors associated with HDF use.
Background: HDF is increasingly common in clinical practice, despite uncertain comparative effects of HDF versus standard high flux haemodialysis on patient outcomes. The factors associated with increased HDF utilization have not been described previously in Australia and New Zealand.
Methods: We included incident haemodialysis (HD) patients in Australia and New Zealand between 2000-2014, using ANZDATA. The primary outcome was HDF uptake over time. We evaluated factors potentially associated with HDF including social determinacies, country, centre, private versus public, , body mass index, ethnicity, comorbidities, dialysis access and dialysis small solute clearance prior to HDF commencement.
Results: Of 27,432 starting HD, 3,339/23,193 (14.4%) patients in Australia and 810/4,239 (19.1%) in New Zealand received HDF. Uptake was quicker in New Zealand and increased over time in both countries. Younger patients <40years, with co-morbidity (lung, cerebrovascular or peripheral vascular disease), in larger hospitals (>30 new dialysis patients/year), were more likely to receive HDF (all P<0.001). There was no effect of race or sex, but in Australia greater BMI increased likelihood of receiving HDF, as did living in NSW, QLD, SA or Tasmania (all P<0.001). In addition, centre differences explained 34% of HDF uptake in Australia, and 65% in New Zealand. There was no difference for public versus private dialysis centres. Neither living remotely, nor lower socioeconomic status influenced modality.
Conclusions: HDF uptake was quicker in New Zealand than in Australia, but still represents <20% of all HD. HDF use appears to be driven predominantly by centre effects, but in Australia state differences persist.