Effect of centre and patient related factors on uptake of haemodiafiltration in Australia and New Zealand: A cohort study using ANZDATA. [Journal of the American Society of Nephrology]

Abstract

Background: We described the use of haemodiafiltration (HDF) in Australia and New Zealand over time, and any patient or centre-related associations with use of HDF. Method(s): We included all incident patients commencing haemodialysis in Australia and New Zealand between 2000-2014. The primary outcome was commencement of HDF over time, which was evaluated using multivariable logistic regression stratified by country. Result(s): Of 27,433 patients starting haemodialysis, 3,339 (14.4) of 23,194 patients in Australia and 810 (19.1) of 4,239 in New Zealand received HDF. Uptake increased over time in both countries but was more rapid in New Zealand. In Australia, HDF use was more likely in males (OR 1.13, 95CI 1.03-1.24, p=0.009) with BMI>30 kg/m2(OR 1.46, 95CI 1.33-1.61), and less likely in older patients (reference <40 years; 40-54 years OR 0.85, 95 confidence interval [CI] 0.72-0.99; 55-69 years OR 0.79, 95 CI 0.67-0.91; >70 years OR 0.48, 95 CI 0.41-0.56) and those with chronic lung disease (OR 0.84, 95CI 0.76-0.94, p<0.001), cerebrovascular disease (OR 0.76, 95CI 0.67-0.85, p<0.001) or peripheral vascular disease (OR 0.77, 95CI 0.70-0.85, p<0.001). Larger centres (defined by number of new patients/year) were more likely to prescribe HDF: 36-147/year OR 26.75 (95CI 18.54-38.59); 17-35/year OR 7.51 (95CI 5.35-10.55); 7-16/year OR 3.00 (95CI 2.19-4.13; <6/year reference. HDF was used more in private dialysis clinics (public OR 0.13, 95CI 0.05-0.32). In New Zealand, where there is no private dialysis, HDF use was more likely in Maori and Pacific Islanders (OR 1.32, 95CI 1.05 -1.66) compared to Caucasians and less likely in males (OR 0.76, 95CI 0.62 -0.94, p=0.01). In both countries, centres with higher HD:PD patient ratios were significantly more likely to prescribe HDF. Centre differences explained 36 of variability in HDF uptake in Australia and 48 in New Zealand. Conclusion(s): HDF uptake has increased over time, and was associated with similar centre characteristics, but different patient characteristics in each country.