Thirty Fifth
Annual Report
Australia and New Zealand
Dialysis and Transplant Registry
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
2012
Thirty Fifth
Annual Report
Edited by
Stephen McDonald
Philip Clayton
Kylie Hurst
Funded by
Australian Organ and Tissue Authority
New Zealand Ministry of Health
Kidney Health Australia
Supported by
AMGEN Australia Pty Ltd
Baxter Healthcare Pty Ltd
Genzyme Australasia Pty Ltd
Janssen-Cilag Pty Ltd
Novartis Pharmaceuticals Pty Ltd
Pfizer Pty Ltd
Roche Products Pty Ltd
Sanofi-Aventis Australia Pty Ltd
2012 Annual Report - 35th Edition
1
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Funding
Acknowledgments
ANZDATA Registry is funded by
Australian Organ and Tissue Authority
Kidney Health Australia
New Zealand Ministry of Health
ANZDATA Registry offers its most grateful appreciation to
everyone who helped make this 35th Annual Report possible,
especially the professionals and the staff of all the Renal Units
and Tissue Typing Laboratories, upon whose reporting of data
this enterprise ultimately depends.
Supported by Unrestricted Research Grants from
AMGEN Australia Pty Ltd
Baxter Healthcare Pty Ltd
Genzyme Australasia Pty Ltd
Janssen-Cilag Pty Ltd
Novartis Pharmaceuticals Pty Ltd
Pfizer Pty Ltd
Roche Products Pty Ltd
Sanofi-Aventis Australia Pty Ltd
Suggested Citation
An example of suggested citation for this report is as follows:
.. [Author’s name] ..
Peritoneal Dialysis .. [page numbers] ..
ANZDATA Registry Report 2012
Australia and New Zealand Dialysis and Transplant Registry
Adelaide, South Australia.
Editors: Stephen McDonald, Philip Clayton, Kylie Hurst
Coordinating Centre
ANZDATA Registry
9th Floor - East Wing
Royal Adelaide Hospital
North Terrace,
Adelaide, South Australia, 5000
Phone
Fax
Email
Web
+61 8 8222 0949
+61 8 8222 0985
anzdata@anzdata.org.au
www.anzdata.org.au
Prof G Russ
A/Prof S McDonald
Dr P Clayton
Ms K Hurst
Dr N Briggs
Ms A Gulyani
Ms Hannah Dent
Dr B Grace
Ms C Leitch
Ms K Textor
Chair of ANZDATA Executive
ANZDATA Executive Officer / Editor
Amgen Fellow in Epidemiology /Editor
Registry Manager / Editor
Biostatistician
Biostatistician
Biostatistician
Research Fellow
Administration
Administration
Printed in Adelaide, South Australia, 2013
© Copyright 2012 by the ANZDATA Registry
ISSN 1329-2870
i
Publications based upon ANZDATA Registry information reported
here or supplied upon request, must include the citation as noted
above and the following notice:
The data reported here have been supplied by the
Australia and New Zealand Dialysis and Transplant
Registry. The interpretation and reporting of these data
are the responsibility of the Editors and in no way
should be seen as an official policy or interpretation of
the Australia and New Zealand Dialysis and Transplant
Registry.
CONTENTS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Contents
Introduction
ANZDATA Committees
Privacy
Guidelines for Data Release
Contributing Authors
Definitions and Methods
Parent Hospitals, Transplanting Hospitals, Satellite
Haemodialysis Units
Publications 2011
Data Collection Form
Summary
Page
iii
iv
v
vi
viii
ix
x
xiii
6-23
6-24
6-26
6-27
6-28
6-29
6-30
6-31
6-32
Chapter 7
Transplant Waiting List
Stephen McDonald, Philip Clayton, Blair Grace,
Jeremy Chapman, Jenni Wright
Data from the National Organ Matching Scheme (Australia)
7-1
Chapter 8
Transplantation
Philip Clayton, Scott Campbell, Kylie Hurst,
Stephen McDonald, Steven Chadban
Transplants Performed in 2011
Transplant Rate of Patients Dialysed
Age of Recipients Transplanted in 2011
Ethnicity of Transplant Recipients
Australian Regional Activity
Functioning Transplants
Rates of Graft Loss
Immunosuppression
Use of Antibody Therapy
Rejection Rates
Short Term Primary Deceased Donor Survival
Long Term Primary Deceased Donor Survival
Short Term Deceased Second-Subsequent Survival
Long Term Deceased Second-Subsequent Survival
Short Term Primary Living Donor Survival
Long Term Primary Living Donor Survival
Long Term Living Second-Subsequent Survival
8-1
Stock and Flow
Blair Grace, Kylie Hurst, Stephen McDonald
1-1
Chapter 2
New Patients
Blair Grace, Kylie Hurst, Stephen McDonald
Intake of Patients and Age of New Patients
State of Origin of New Patients
Incidence Rates new RRT by State
Incidence Rates new RRT by age group
Late Referral
Co-morbid Conditions
Primary Renal Disease of New Patients
Miscellaneous Causes of ESRD
Biopsy of New Patients
2-1
Deaths
Stephen McDonald,
Introduction
Death Rates During Renal Replacement Therapy
Survival by Age & Comorbidity
Dialysis Mortality Rates
Cause of Deaths
Withdrawal from Dialysis
Causes of death due to Withdrawal
Peritoneal Dialysis (Continued)
Antibiotic Treatment
Outcomes
Haemoglobin
Haemoglobin by Treating Centre
Ferritin and Transferrin Saturation
Ferritin by Treating Centre
Serum Calcium - By Treating Centre
Serum Phosphate - By Treating Centre
Calcium-Phosphate - By Treating Centre
xviii
xxi
xxiii
Chapter 1
Chapter 3
Page
Chapter 6
2-2
2-3
2-4
2-5
2-6
2-8
2-10
2-11
2-12
3-1
3-2
3-3
3-4
3-5
3-6
3-8
3-9
Chapter 9
Kidney Donation
Philip Clayton
Deceased Kidney Donors
Living Kidney Donors
8-2
8-4
8-5
8-6
8-7
8-8
8-12
8-14
8-16
8-18
8-19
8-21
8-22
8-23
8-24
8-26
8-27
9-1
9-2
9-3
Chapter 4
Method and Location of Dialysis
Nancy Briggs,Kylie Hurst, Stephen McDonald
4-1
Chapter 10 Cancer Report
Angela Webster, Patrick J Kelly, Alex Peng
10-1
Chapter 5
Haemodialysis.
Kevan Polkinghorne, Aarti Gulyani, Kylie Hurst, Stephen
McDonald
Stock and Flow
Blood Flow Rates
Duration of Dialysis
Outcome Among Haemodialysis Patients
Membrane Type and Surface Areas
Anaemia
Haemoglobin
Haemoglobin by Treating Centre
Ferritin and Transferrin Saturation
Ferritin by Treating Centre
Serum Calcium - By Treating Centre
Serum Phosphate - By Treating Centre
Calcium-Phosphate - By Treating Centre
Urea Reduction Ratio
Urea Reduction Ratio by Treating Centre
Vascular Access at First Treatment
Prevalent Haemodialysis Access
Obesity Among Incident Haemodialysis Patients
5-1
Chapter 11 Paediatric Report
Sean Kennedy, Hannah Dent, Nancy Briggs, Kylie Hurst,
Stephen McDonald
Incidence and Prevalence 1991-2011
Causes of ESKD in Children and Adolescents
Modality of Treatment 2006-2011
Transplant Demographics
Immunosuppression
Transplant Outcomes
Rejection
11-1
Obesity Among Prevalent Haemodialysis Patients
Home Haemodialysis
Technique Failure
5-34
5-36
5-39
Peritoneal Dialysis
Fiona Brown, Stephen McDonald, Aarti Gulyani, Kylie Hurst
Stock and Flow
Peritoneal Dialysis Fluids
Outcome Among Peritoneal Dialysis Patients
Peritoneal Dialysis Technique Survival
Technique Failure
Peritonitis
Australian Peritonitis Registry
6-1
5-2
5-6
5-7
5-10
5-14
5-15
5-16
5-17
5-18
5-19
5-20
5-21
5-22
5-23
5-24
5-25
5-28
5-32
Chapter 12 End-Stage Kidney Disease Among Indigenous Peoples
of Australia and NZ
Stephen McDonald, Matthew Jose, Kylie Hurst
Introduction and New Patients
Incidence Rate
New Transplants
Prevalent Patients
Dialysis Modality
Estimated Glomerular Filtration Rate at Treatment Start
Incidence and Prevalence by State/Territory
Geographical Distribution
Late Referral
11-2
11-3
11-4
11-5
11-7
11-9
11-10
12-1
12-2
12-3-5
12-6
12-8
12-9
12-10
12-12
12-16
12-18
Supplement
Chapter 6
6-2
6-8
6-11
6-15
6-17
6-18
6-21
Summary of Dialysis and Transplantation Activity in 2011
Australia - Summary
Australia - Location of Dialysis Treatment
New Zealand - Summary
New Zealand - Location of Dialysis Treatment
Primary Renal Disease of New Patients
National and State - Summary
New Patients, Dialysis and Functioning Transplants Per Million
Population
Number of Renal Transplant Operations
S-2
S-4
S-10
S-11
S-12
S-12
S-13
S-13
ii
INTRODUCTION
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
INTRODUCTION
The ANZDATA Registry has great pleasure in presenting
the 2012 Annual Report. This is the 35th Annual Report
from the Registry and covers data collected until the 31st
December 2011.
The Report is a result of the commitment and involvement
of renal units throughout Australia. This commitment is a
reflection of the enormous time and work from staff of
these units. Participation of 100% of units in Australia and
New Zealand continues and we are confident that all the
patients who have received renal replacement therapy in
Australia and New Zealand in this time period are included.
There have been some innovations in this year’s report.
As foreshadowed in the 2011 Report, analysis of the
transplant waiting list data which is reported in Chapter 7
is an entirely new analysis. This analysis is based on a
linkage study which linked data from the Australian National Organ Matching System (NOMS) with ANZDATA.
This has allowed us to report the dynamics of the waiting
list, which has not previously been possible. We are hoping to be able to undertake similar analyses for New Zealand in next year’s report.
The other innovation appears in Chapter 9 regarding kidney donation. The format of this chapter has been substantially revised this year and there is a greater focus on
trends in donor demographics and it now includes living
donor data which were previously included in a separate
chapter.
The role of Executive Officer of the Registry continues to
be filled by Associate Professor Stephen McDonald.
Once again, he provides the intellectual and academic
leadership of the Registry and has been the driving force
in the dissemination of data and its analyses, both nationally and internationally.
Dr Philip Clayton continues as the Amgen Fellow in Epidemiology. He also has published and presented results of research projects utilising the database both nationally and
internationally. We are greatly indebted to Amgen who continue to make the commitment through the funding of this
position. For 10 years now this position has proven to be a
major stimulus for the academic output of the Registry. Dr.
Blair Grace has also continued to provide analysis of the
ANZDATA database as part of a collaborative NHMRC funded project supervised by Associate Professor McDonald.
Mrs Kylie Hurst enters her second year as Manager of the
ANZDATA Registry and we acknowledge the pivotal role that
she has played in generating new ideas and innovations in
the way the Registry functions. Christina Leitch continues to
provide administrative support. Biostatistical expertise has
been provided by Nancy Briggs, Hannah Dent and Aarti Gulyani.
Professor Steven Chadban continues to Chair the ANZDATA
Registry Steering Committee. His enthusiasm and ongoing
interest in the Registry and its operations and output are
acknowledged. The members of the ANZDATA Registry
Committees and Working Groups are listed on page vii of this
report. The Executive gratefully acknowledges the involvement and contribution of these many individuals.
Major funding for the Registry has been provided from the
Australian Commonwealth Department of Ageing through the
Australian Organ and Tissue Donation and Transplant
Authority, Kidney Health Australia and the New Zealand Ministry of Health.
We also gratefully acknowledge industry support which in
2012 consisted of non-tied grants from Baxter, Genzyme,
Novartis and Roche.
GRAEME R RUSS
CHAIR ANZDATA EXECUTIVE
DECEMBER 2012
iii
ANZDATA EXECUTIVE COMMITTEE
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
ANZDATA REGISTRY EXECUTIVE COMMITTEE
Professor Graeme Russ - Chair
A/Professor Stephen McDonald - Executive Officer
Mrs Kylie Hurst - Registry Manager
ANZDATA REGISTRY STEERING COMMITTEE (2011 MEMBERS)
Professor Steven Chadban - Chair
Professor Graeme Russ
A/Professor Stephen McDonald
Mrs Kylie Hurst
Dr Phillip Clayton (Fellow in Epidemiology)
Dr Fiona Brown (Project Manager - Peritoneal Dialysis)
Dr Scott Campbell (Project Manager - Transplantation)
Dr Matthew Jose (Project Manager - Indigenous Interest Group)
Dr Wai Lim
Dr Grant Pidgeon (New Zealand Representative)
Dr Helen Pilmore
Dr Nicholas Gray
A/Professor Robyn Langham
Dr Timothy Mathew (Kidney Health Australia)
Dr Sean Kennedy (Project Manager - Paediatric Group)
A/Professor Kevan Polkinghorne (Project Manager - Haemodialysis)
Dr Angela Webster (Project Manager - Cancer)
Dr Germaine Wong (Fellow in Cancer Epidemiology)
Mr Damian Harding (Consumer Representative)
Ms Cathy Hill (Nursing Representative)
ANZDATA REGISTRY WORKING GROUPS (2011 MEMBERSHIP)
Transplant Working Group
Haemodialysis Working Group
Dr Scott Campbell (Project Manager)
A/Professor Stephen McDonald
Professor Graeme Russ
Professor Steven Chadban
Dr Wai Lim
A/Professor Kevan Polkinghorne (Project Manager)
A/Professor Stephen McDonald
Professor Richard Allan
A/Prof Rowan Walker
Dr Mark Marshall
Dr Vincent Lee
Cancer Working Group
Dr Angela Webster (Project Manager)
Dr Germaine Wong (Fellow in Cancer Epidemiology)
A/Professor Stephen McDonald
Professor Randall Faull
Professor Adrian Hibberd
Dr Rob Carroll
Peritoneal Dialysis Working Work
Dr Fiona Brown (Project Manager)
Professor David Johnson
A/Professor Stephen McDonald
A/Professor Kym Bannister
Dr Kate Wiggins
Indigenous Interest Group
Dr Matthew Jose (Project Manager)
A/Professor Stephen McDonald
A/Professor Mark Thomas
Ms Gillian Gorham
Professor John Collins
Dr Natasha Rogers
Dr Jacqueline Hughes
Ms Lesley Salem
Paediatric Working Group
Dr Steven McTaggart (Project Manager)
A/Professor Stephen McDonald
Dr Paul Henning
Dr Lily Johnstone
iv
PRIVACY
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
PRIVACY ASPECTS
OF DATA
COLLECTION
In December 2001 changes to the Commonwealth Privacy Act were introduced which have led to
changes to the collection of personal information. Essentially these extend to the private sector a number
of changes based around 10 “National Privacy Principles” (NPP’s). A detailed exposition of these can be
found at the Privacy Commissioner’s website (www.privacy.gov.au). Briefly, however, health information
is treated as “sensitive” information, which must usually be collected and handled with consent of the
person, unless certain conditions are met. Patients are entitled to view the information the Registry holds
about them, and request alterations if the data is thought to be inaccurate.
Each Australian State has also enacted similar provisions which cover practice and patients in public
hospitals.
ANZDATA does not release data identifiable by patient name. Results are published/released in tabular
or graphic format only. Requests for data are met using deindentified data only. On occasion, when data
identifying particular hospitals is involved, consent from the Director of the relevent renal unit is sought
prior to the release of information.
ANZDATA spent some time during 2002 formulating an appropriate response to these issues including
seeking advice from a variety of sources. The approach taken has been that of a “opt-out” consent,
whereby patients are distributed information outlining the nature and purpose of the information collected,
offered an opportunity to view that data and ask questions, and the opportunity to request withdrawal of
part or all of their data. This approach is explicitly suggested for Registries by the Privacy Commissioner
in his “Guidelines for the Health Sector”. To this end ANZDATA has circulated to all participating
hospitals a patient information sheet (see opposite), for each hospital to use (or a locally modified version
if appropriate) to inform patients.
At the time of data collection each unit is asked to certify that they have complied with measures under
the relevant privacy measures.
Tissue Typing Data and Transplant Waiting List data are collected in each Tissue Typing Laboratory and
entered into the National Organ Matching System database. These data are transmitted to ANZDATA for
inclusion in the ANZDATA database and for this Report.
v
PRIVACY
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
AUSTRALIA
ANZDATA REGISTRY
AND
NEW ZEALAND DIALYSIS
C/- Royal Adelaide Hospital
North Terrace,
Adelaide, 5000
South Australia
AND
TRANSPLANT REGISTRY
Phone: (08) 8222.0949
Fax: (08) 8222.0985
Email: anzdata@anzdata.org.au
Web: http://www.anzdata.org.au
Important Privacy Information
As part of routine medical care of people receiving treatment with dialysis or kidney transplantation, your
kidney specialist collects certain information about the patients they treat. All kidney specialists throughout
Australia and New Zealand report this information every twelve months to the Australia and New Zealand
Dialysis and Transplant Registry (ANZDATA). ANZDATA collects the information for the purpose of
monitoring treatments and performing analyses to improve quality of care for people with kidney failure.
1. What is ANZDATA ?
ANZDATA is an organization set up by Kidney Health Australia and the Australia and New Zealand Society of
Nephrology to monitor dialysis and transplant treatments. ANZDATA is funded by the Australian and New
Zealand Governments and Kidney Health Australia.
2. What information is collected about you ?
This information includes your name, age, gender, racial origin, hospital of treatment, some aspects of your
medical condition (such as whether you have diabetes) and details about the type of kidney treatment you are
receiving (dialysis or transplant).
We DO NOT collect details about your address, telephone number, medical insurance, or non-medical
matters such as occupation, income, etc.
3. Is personal data ever released ?
The identity of people in the database IS NOT released publicly nor in any reports. Measures have been
put into place to ensure the security of all collected information.
4. What is this information used for ?
The information is used primarily for quality assurance, investigating patterns of kidney disease, and planning
appropriate health services. We release reports on a variety of topics, including an Annual Report examining
the rates and treatment of kidney failure in Australia and New Zealand. We also have a major role in ensuring
the quality of patient care by sending to each kidney unit each year a report outlining their activity. These
reports also compare the outcome of the treatment they provide with that of other units throughout the two
countries.
Reports are also produced at a state and national level, and from time to time analyses are also produced for
renal units, government health departments and industry concentrating on particular aspects of renal failure
management e.g. peritoneal dialysis, transplantation, haemodialysis.
5. Can you see what personal information ANZDATA collects and the reports that it produces ?
Individuals are able to view their own information on request. You can request alterations if you believe it is
inaccurate. You may also opt not to have your treatment included in this database, and you should let your
kidney specialist know if this is the case. You can also choose not to have some information (eg racial origin)
recorded. However, if your information is not included in the Registry, the ability to compare results in
Australia and New Zealand or to analyse the results of different treatment methods and for different patient
types (eg diabetics) will be compromised.
The national reports and much other material produced by ANZDATA are available free on the Internet at
www.anzdata.org.au, or they can be sent to you on request to the address above. Your kidney specialist will
also have copies of many of the reports.
If you wish to discuss any of the issues raised here, please let your doctor know or telephone the ANZDATA
Registry direct on [08] 8222 0949. You may also write to us (ANZDATA Registry, C/- Royal Adelaide Hospital,
DX800, Mail Point 117, North Terrace, Adelaide, SA. 5000) or send us an e-mail (anzdata@anzdata.org.au).
vi
POLICY
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
GUIDELINES FOR DATA RELEASE
The policy for release of data to investigators, renal units and others was revised during 2013 and is
summarised on the Website. ANZDATA encourages the analysis, use and citation of its data, and
receives many data requests annually which vary in size and complexity. At times these overwhelm
the limited resources within the Registry, and must be prioritised. Generally, formal requests for data
are preceded by a period of consultation with a member of the Registry staff. Requests are welcome
from Renal Physicians, other staff members of Renal Units, Charitable Bodies, Academic Institutions,
Government Departments and Industry. Requests dealing with identifiable Hospital data (i.e. data
which identifies outcomes of an individual hospital) will only be fulfilled with the explicit consent of the
Heads of the relevant Hospital Units. Individual patient identified data (names) is not released.
ATTRIBUTION OF PUBLICATIONS
The policy on attribution of publications which incorporate ANZDATA sourced data was revised during
2002, following a period of consultation with participating physicians.
Where a member of a participating unit has analysed data provided by ANZDATA and subsequently
prepared a manuscript, then “ANZDATA Registry” should be acknowledged as a secondary institution
in addition to the author’s Hospital or University. This applies whether the primary data analysis is
performed by the author or by ANZDATA staff. Where the author is an ANZDATA office holder or staff
member then the primary attribution should be “ANZDATA Registry”.
Where ANZDATA data is only a minor portion of the work, then it may be more appropriate to
acknowledge the source explicitly in the “Acknowledgements” section.
In both cases the disclaimer on page ii of this report should be included.
In all cases the source and treatment of the data should be made clear in the “Methods” section.
Preferably the abstract (and keywords if applicable) should also include “ANZDATA” which would
allow for searching Registry publications.
vii
CONTRIBUTING AUTHORS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
CONTRIBUTING AUTHORS
Dr Nancy Briggs
Biostatistician
ANZDATA Registry
Royal Adelaide Hospital, North Terrace
Adelaide, South Australia, 5000
Dr Matthew Jose
Nephrologist
Department of Nephrology
Royal Hobart Hospital
Hobart, Tasmania, 7000
Dr Fiona Brown
Nephrologist
Department of Nephrology
Monash Medical Centre
Clayton Road, Clayton, Victoria, 3168
Dr Sean Kennedy
Paediatric Nephrologist
Nephrology Department
Sydney Children’s Hospital
Randwick, NSW, 2031
Dr Scott Campbell
Nephrologist and Transplant Physician,
Princess Alexandra Hospital, Ipswich Road
Woolloongabba, Queensland, 4102
Dr Patrick Kelly
Senior Lecturer Biostatistics
School of Public Health
University of Sydney, NSW, 2006
Professor Steven Chadban
Chair - ANZDATA Registry
Nephrologist and Transplant Physician
Royal Prince Alfred Hospital, Missenden Road
Camperdown. New South Wales, 2000
Associate Professor Stephen McDonald
Executive Officer, ANZDATA
Nephrologist
Royal Adelaide Hospital, North Terrace
Adelaide, South Australia, 5000
Dr Philip Clayton
Epidemiologist / ANZDATA Registry
Royal Adelaide Hospital, North Terrace
Adelaide, South Australia, 5000
Dr Steven McTaggart
Paediatric Nephrologist
Queensland Child and Adolescent Renal service
Mater Children’s Hospital
Raymond Terrace
South Brisbane, Qld 4101
Dr Ian Dittmer
Transplant Physician
Auckland Renal Transplant Group
Clinical Director
Department of Renal Medicine
Auckland City Hospital
Dr Blair Grace
ANZDATA Registry / Research Fellow
Royal Adelaide Hospital, North Terrace
Adelaide, South Australia, 5000
Mrs Aarti Gulyani
Biostatistician
ANZDATA Registry
Royal Adelaide Hospital, North Terrace
Adelaide, South Australia, 5000
Mrs Hannah Dent
Biostatistician
ANZDATA Registry
Royal Adelaide Hospital, North Terrace
Adelaide, South Australia, 5000
Mrs Kylie Hurst
ANZDATA Registry Manager
Royal Adelaide Hospital, North Terrace
Adelaide, South Australia, 5000
Dr Lilian Johnstone
Paediatric Nephrologist
Department of Paediatric Nephrology
Monash Children's at Clayton, Southern Health
Clayton, Victoria, 3168
Associate Professor Kevan Polkinghorne
Nephrologist
Department of Nephrology
Monash Medical Centre
Clayton Road, Clayton, Victoria, 3168
Professor Graeme Russ
Chair ANZDATA Executive
Co-Director Renal Unit
Royal Adelaide Hospital, North Terrace
Adelaide, South Australia, 5000
Dr Angela Webster
Senior Lecturer (Clinical Epidemiology) / Nephrologist
School of Public Health
Edward Ford Building A27
University of Sydney, NSW, 2006
Dr Germaine Wong
Fellow in Cancer Epidemiology
ANZDATA Registry
Royal Adelaide Hospital, North Terrace
Adelaide, South Australia, 5000
Alex Peng
Research Assistant
Sydney School of Public Health
University of Sydney, NSW, 2006
viii
DEFINITIONS AND METHODS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
A number of definitions given below are used throughout this report unless otherwise stated.
1. Wording
Throughout this report ‘treatment’ refers to renal replacement therapy, including haemodialysis, peritoneal dialysis and
transplantation. In places the word “graft” (or “allograft”) is used for kidney transplant.
HD = haemodialysis
CAPD = continuous ambulatory peritoneal dialysis
ESKD = end stage kidney disease
APD = automated peritoneal dialysis
2. Data collection
ANZDATA collects information from all renal units in Australia and New Zealand. Data collection occurs at two time points.
Key events (new patients, deaths, transplants) are notified as they occur, with units requested to send this at least monthly.
This can occur either via a web-based interface or paper submission. An extensive cross-sectional survey is then performed
twelve monthly (for data to 31st December). Currently this is by a paper-based system, with manual completion of the form
and manual data entry. No formal audit mechanism is in place at this stage.
For kidney transplants, HLA matching and panel reactive antibodies are obtained direct from the National Organ Matching
System.
Monthly summaries are distributed to the contributing units. Results contained in this (and other reports) are based on a final
database locked and prepared after the end of year survey returns are received.
3. Inclusion criteria
Included in the Registry are all patients resident in Australia or New Zealand receiving renal replacement therapy where the
intention to treat is long-term, ie medical opinion is that renal function will not recover. Cases of acute renal failure are
excluded. People who move overseas permanently are censored at date of last treatment (or departure in the case of
transplant recipients).
4. Modality attribution
For survival analysis the initial mode of dialysis is generally determined at 90 days after first treatment, to allow for early
changes and maturation of access. Other transfers (between modalities, or from satellite to hospital haemodialysis etc.) are
not analysed if less than 30 days, except for transfers between dialysis centres to which a 60 day rule is applied to allow for
holiday movements.
5. Underlying renal disease
This is recorded by the treating hospital according to a modified EDTA coding system (details on back of survey form).
6. Deaths
Death rate is predominantly reported as number of patients died/total number of years of treatment of all patients treated
at any time during the year. It is expressed as deaths per 100 patient years (pt yrs) at risk.
7. Comorbid conditions
These are recorded by the treating hospital. No formal definitions are supplied; the treating clinician is asked to record
whether the patient has coronary artery disease, chronic lung disease, cerebrovascular disease, peripheral vascular disease
or diabetes according to their clinical opinion on a yes / suspected / no basis.
8. Transplant Waiting List
The active transplant waiting list is based on data from the National Organ Matching System (Australia) cross-checked with
ANZDATA.
9. Derived measures
9.1 Haemoglobin
Haemoglobin is recorded as the last available measurement before the end of the survey period.
9.2 Erythropoietic agents
Erythropoietin agent use is recorded as “yes” if these agents were used at any time during the survey period.
9.3 Iron studies
Iron studies are requested within the last three months of the survey period.
9.4 Estimated creatinine clearance
Where creatinine clearance is estimated from serum creatinine at entry or post transplantation, the 4-variable MDRD formula is used [1]
eGFR
= 186 x Cr^-1.154 x age^-0.203 x 1.212
(where Cr is creatinine in mg/dL and age is age in years)
if
black
x
0.742
if
female
The weight term used for this is lean body mass, calculated using the equation LBW=(0.9*[height-152])+(50 if male,
45.5 if female) [2]
9.5 Urea reduction ratio / Kt/V
Results are requested in one of these formats, using the stop flow method on a mid-week dialysis. Single pool Kt/V is
collected, along with the method used. For conversion of URR to Kt/V urea the formula used [3] is
Kt/V = 0.023*PRU - 0.284 (note that PRU = percent reduction in urea and not URR).
ix
DEFINITIONS AND METHODS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
9.6 Body mass index
Body mass index (BMI) is calculated as weight (kg)
(height (m))2
The categories used are : underweight <20 kg/m2 , normal 20-24.9 kg/m2, overweight 25-29.9 kg/m2,
obese >=30 kg/m2
9.7 Peritoneal dialysis measures
These are the standard measures, often calculated by computerised patient management programs.
9.7.1 Residual renal function
The measure used is the arithmetic mean of urea and creatinine clearance from a 24-hour urine collection and serum
creatinine and urea.
9.7.2 Peritoneal equilibration test
The ratio of dialysate to plasma glucose is used, following a 4 hour dwell of a 2 litre 2.5% bag of dialysate, performed
within 6 months after initiation of peritoneal dialysis.
10. Rates and Measures
10.1 Incidence rates
Except where otherwise stated, quoted incidence rates are per calendar year, and are expressed per million population.
10.2 Prevalence rates
Except where otherwise specified, prevalence rates are point prevalence rates at 31st December 2011.
10.3 Population denominator
All populations used in this report were stratified by age and sex.
Australian populations were taken from the Australian Bureau of Statistics (ABS).
All populations used were for 30 June of each year, except for total New Zealand populations, where data for 31 December were readily available, and all websites were accessed 20th September 2012.
Population data for each Australian state and territory came from ABS 3101.0 series (4)
Population data for Indigenous Australians were taken from ABS 3238.0(5), using series A (the most conservative estimates) for populations after 2006.
Populations serviced by the Greater Southern Area Health Service were estimated by the South Eastern Region of NSW.
These estimates were taken from ABS 3235.0(6)
All New Zealand population estimates were taken from Statistics New Zealand (SNZ). Total populations were taken from
NZ Infoshare (7) and Maori populations were taken from NZ Infoshare Maori population estimates (8).
Estimates of resident Pacific People populations after were taken from (9) for years 2006 onwards. Prior to this, populations of Pacific people before 2006 were only available for years 1996, 2001 (and 2006), and we used linear interpolation
to estimate populations for each age and sex group for the years 1997-2001 and 2002-2005.
10.4 Survival rates
For transplant recipients, survival rates exclude those who were transplanted overseas or were recipients of multiple
organ grafts.
Graft survival (unless otherwise qualified) includes both cessation of graft function (ie return to dialysis) and patient
death.
Rates for patient survival for fixed periods for transplantation are calculated according to the life-table method and thus
include an adjustment to the risk-set of ½ of those censored without failure over the interval to create an “average” risk
set.
10.5 Graft survival
For outcomes of kidney transplants, graft failure includes both loss of graft function (ie return to dialysis) and death of
patients (with graft function). Calculations of patient survival for transplant recipients includes all subsequent modalities
(i.e. deaths after graft failure are included). Patients transplanted overseas are excluded from calculations.
10.6 Dialysis Survival
Patient and technique survivals for haemodialysis and peritoneal dialysis are based on the dialysis modality at 90 days
after first treatment for patients not transplanted during that period. Patients are followed up until they are either
transplanted (at which point they are censored) or until they have a ‘permanent’ change of dialysis modality or until
death or most recent follow up date. A ‘permanent’ change of dialysis is defined as any change in excess of 30 days.
Peritonitis survivals are calculated from first peritoneal dialysis (ignoring all earlier treatments) to date of first peritonitis
episode. If there were no episodes of peritonitis then calculation is censored at change of treatment from peritoneal
dialysis to haemodialysis or transplantation. Peritoneal dialysis includes automated peritoneal and continous ambulatory
peritoneal dialysis. Excluded are patients who had peritonitis before commencing peritoneal dialysis.
10.8 Death and other event rates
Rates are expressed per 100 person years at risk (unless otherwise stated). Some analyses include survival of all patients,
others exclude the first 90 days of followup. This is stated in the individual analyses.
10.9 Age standardisation
All rates are crude, not age-standardised. The age distribution of the populations for Australia and New Zealand
x
DEFINITIONS AND METHODS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Can be obtained by contacting the Registry.
10.10 Peritonitis rates
Peritonitis rates are present using episodes of peritonitis reported during periods of peritoneal dialysis - episodes
reported prior to commencement of peritoneal dialysis (for example between Tenckhoff catheter insertion and
commencement of peritoneal dialysis) are not included in these calculations.
11. Database
Data is stored on a relational database using Oracle version 9I.
12. Statistics
Statistical analyses were performed using Stata version 12.
13. References
1) Levey A, Greene T, Kusek J, Beck G. A simplified equation to predict glomerular filtration rate from serum
creatinine (abstract). J Am Soc Nephrol. 2000 May 20;11(11):155A.
2) Zasadny KR, Wahl RL: Standardized uptake values of normal tissues at PET with 2-[fluorine-18]-fluoro-2deoxy-D-glucose: variation with body weight and method for correction. Radiology 1993: 189;847-850.
3) Basile C, Casino F, Lopez T: Percent reduction in blood urea concentration during dialysis estimates Kt/V in a
simple and accurate way. Am J Kidney Dis 1990: 15;40-45.
4) http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3101.0Jun%202011?OpenDocument
5) http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3238.01991%20to%202021?OpenDocument
6) http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3235.02011?OpenDocument
7) http://www.stats.govt.nz/infoshare/SelectVariables.aspx?pxID=59949f0f-e948-429b-8ed7-7d702c1b39c0
8) http://www.stats.govt.nz/~/media/Statistics/browse-categories/population/estimates-projections/national-popestimates/Maori-population-estimates-30-June-19912011.xls
9) http://nzdotstat.stats.govt.nz/wbos/Index.aspx?DataSetCode=TABLECODE31
xi
HOSPITALS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Parent hospitals, transplanting unit and satellite dialysis units together with their state and unit codes are listed below. In
some cases, these have combined as part of a regional network and this is also indicated. The definition of a ‘parent hospital’ is a pragmatic one, and refers to units which offer a full range of dialysis services (i.e. can commence patients on
dialysis, have on-site nephrologist presence and can deal with patients of all degrees of complexity).
In contrast, satellite units provide haemodialysis treatments to selected patients, usually with lower staff ratios and no onsite nephrologist.
NOTE: The states listed below are in no particular order.
QUEENSLAND
(STATE CODE 4)
PARENT HOSPITALS
Unit Code
SATELLITE DIALYSIS UNITS
Unit Code
Allamanda Private Hospital (Fresenius)
ALLA
Atherton Private Hospital
ATHR
Bundaberg Base Hospital
Cairns Base Hospital
Chermside Dialysis Unit (Fresenius)
Child and Adolescent Renal Service
Gold Coast Hospital
Greenslopes Private Hospital (Baxter)
Hervey Bay Hospital
John Flynn Hospital
Mackay Base Hospital
Princess Alexandra Hospital
Queensland Renal Transplant Service
Rockhampton Base Hospital
Royal Brisbane Hospital
St Andrew’s Dialysis Clinic (Diaverum)
Sunshine Coast Health District
Caloundra Private Hospital
Nambour General Hospital
Nambour Selangor Private Hospital
The Townsville Hospital
Toowoomba Hospital
Wesley Private Hospital
BUND
CAIR
CHER
CARS
GOLD
GREN
HERV
FLYN
MACK
PSAH
QRTS
ROCK
RBSH
GSTA
Cairns Home Training Unit
CHTR
Cairns Private Hospital Satellite
CPRV
Caloundra Public Hospital
CAPU
Cooktown Satellite
COOK
East Street Self Care Dialysis Unit
EAST
TRANSPLANTING UNIT
Redcliffe Satellite
REDC
Unit Code
Redlands Satellite
REDL
Queensland Renal Transplantation Service
QRTS
St Vincent’s Robina Satellite
STVR
CALO
NAMB
NPRV
TOWN
TWMB
WSLY
Gympie Satellite
GYMP
Home Hill Satellite
HILL
Innisfail Hospital
INNI
Ipswich Satellite
IPSW
Kingaroy Satellite
KROY
Logan Satellite
LOGN
Maryborough Hospital
MARY
Mossman Satellite
MOSS
Mt. Isa Satellite
MTIS
Noosa Satellite
NOOS
North Lakes Dialysis Unit
NLAK
North Ward Satellite
NWAR
Palm Island Satellite
PISL
Princess Alexandra Hospital (Adult and Paediatric)
Director of Transplantation
Dr Tony Griffin
Ipswich Road
Woolloongabba 4102
AUSTRALIAN CAPITAL TERRITORY (ACT)
(STATE CODE 9)
PARENT HOSPITALS
Unit Code
SATELLITE DIALYSIS UNITS
Unit Code
The Canberra Hospital
CANB
Canberra Community Satellite
CSAT
Northside Dialysis Clinic (Fresenius)
NSID
TASMANIA
(STATE CODE 7)
PARENT HOSPITALS
Unit Code
SATELLITE DIALYSIS UNITS
Unit Code
Launceston General Hospital
LAUN
Launceston Community Centre Satellite
LCCS
Royal Hobart Hospital
RHBT
North West Renal Unit, Burnie
NWRU
xii
ANZDATA Registry 2012 Report
HOSPITALS
_____________________________________________________________________________________
SOUTH AUSTRALIA
PARENT HOSPITALS
Unit Code
Flinders Medical Centre
FMDC
Central Northern Adelaide Transplant Service
CNAR
The Queen Elizabeth Hospital
QEZB
Royal Adelaide Hospital
RADL
Women’s and Children’s Hospital
WCHL
TRANSPLANTING UNIT
Unit Code
Central Northern Adelaide Transplant Service
Royal Adelaide Hospital
Director - Professor Graeme Russ
North Terrace
Adelaide 5000
CNAR
Women’s and Children’s Hospital
Director - Dr Paul Henning
72 King William Road
North Adelaide 5006
WCHL
NORTHERN
PARENT HOSPITALS
(STATE CODE 5)
SATELLITE DIALYSIS UNITS
Unit Code
Berri Satellite
Ceduna Hospital
Clare Satellite
Hampstead Rehabilitation Satellite
Hartley Private Hospital (Fresenius)
Port Lincoln Satellite Centre
Lyell McEwin Satellite
Millicent Hospital
Maitland Hospital
Modbury Satellite (Fresenius)
Mount Gambier Satellite
Murray Bridge Hospital
Noarlunga Satellite
Payneham Satellite (Baxter)
Port Augusta Hospital
Port Piri Satellite
Victor Harbour Satellite
Wayville Satellite Centre
Whyalla Satellite Centre
BERI
CEDU
CLAR
HAMP
HART
LINC
LMCK
MILL
MLAN
MSAT
MTGA
MURR
NOAR
PAYN
PTAG
PIRI
VHAR
WAYV
WHYA
TERRITORY (STATE
Unit Code
Alice Springs Hospital
ALIC
Royal Darwin Hospital
DARW
xiii
PARENT HOSPITALS
Unit Code
FREM
Princess Margaret Hospital for Children
PMHC
Royal Perth Hospital
RLPT
Sir Charles Gairdner Hospital
SCGH
TRANSPLANTING UNIT
Unit Code
Princess Margaret Hospital for Children
Director - Dr Ian Hewitt
Roberts Road
Subiaco 6008
PMHC
Royal Perth Hospital
Director - Dr Kevin Warr
Wellington Street
Perth 6001
RLPT
Sir Charles Gairdner Hospital
Director - Dr Harry Moody
Verdun Street
Nedlands 6009
SCGH
1)
SATELLITE DIALYSIS UNITS
Unit Code
Flynn Drive Satellite
Katherine Dialysis Unit
Nightcliff Community Centre
Palmerston Satellite
Tennant Creek Hospital
Tiwi Dialysis Centre
FDVE
KATH
NTCL
PTON
TENN
TIWI
WESTERN AUSTRALIA
Fremantle Hospital
CODE
(STATE CODE 6)
SATELLITE DIALYSIS UNITS
Unit Code
Albany
Armadale Satellite
Bunbury Satellite
Busselton Satellite
Cannington Dialysis Clinic (Diaverum)
Derby Satellite
Geraldton Hospital
Joondalup Satellite
Hollywood Private Hospital
Kalgoorlie Dialysis Unit
Kimberley Dialysis Centre
Melville Satellite
Midland Private Dialysis Centre (Baxter)
Murdoch
Peel Health Campus
Port Hedland Dialysis Unit (Pilbara)
Rockingham Satellite
Spearwood Satellite
Stirling Dialysis Clinic (Diaverum)
ALBA
ARMA
BUNB
BUSS
CANN
DERB
GRLD
JOON
HPRH
KALG
KIMB
MELV
MIDL
STJM
MAND
PTHD
RHAM
SPEA
STIR
St. John of God Private Hospital
Subiaco
SJOG
ANZDATA Registry 2012 Report
HOSPITALS
_____________________________________________________________________________________
VICTORIA
(STATE CODE 3)
PARENT HOSPITALS
Unit Code
SATELLITE DIALYSIS UNITS
Unit Code
Alfred Hospital
Austin Health
Bendigo Hospital
Eastern Health Integrated Renal Services
Epworth Hospital
Forest Hill Dialysis Centre (Fresenius)
Geelong Hospital
Kew Private Dialysis Centre
Malvern Dialysis Centre (Fresenius)
Monash Medical Centre – Adult
Monash Medical Centre – Paediatric
North West Dialysis Service
Royal Melbourne Hospital
Royal Children’s Hospital
St. Vincent’s Hospital
Western Health
ALFD
AUST
BEND
EHRS
EPWT
FORE
GLNG
KEWP
MALV
MMCA
MMCP
NWDS
RMBH
RCHL
SVIN
WSTH
Coburg Satellite
Cohuna Hospital
Colac Hospital
Corryong Satellite
Craigieburn Satellite
Cranbourne Satellite
Dandenong Satellite
Daylesford Hospital
Diamond Valley Dialysis Clinic (Diaverum)
Donald Hospital
Eastern Health Incentre Dialysis
Echuca Hospital
Edenhope Hospital
Epping Dialysis Unit
Frankston Satellite
Goulburn Valley Hospital
Hamilton Hospital
Hastings Hospital
Heidelberg Hospital
Horsham Satellite
Kyabram Satellite
Kyneton Hospital
Latrobe Regional Satellite
Mansfield District Hospital
Maroondah Satellite
Maryborough Hospital
Melton Hospital
Mildura Hospital
Moorabbin Satellite
Myrtleford Hospital
Newcomb Satellite
Nhill Hospital Satellite
Northern Hospital Satellite
North East Kidney Service
North Melbourne Dialysis Clinic (Diaverum)
Orbost Hospital
Peter James Centre
Portland District Health
Robinvale Hospital
Rosebud Hospital
Sale Hospital
Sandringham Satellite
Seymour Hospital
South Geelong Satellite
St. George’s Hospital
Sunbury Satellite
Sunshine Satellite Centre
Swan Hill Hospital
Terang Hospital
Wagga Hospital
Wangaratta Hospital
Warnnambool Hospital
Werribee Mercy Hospital
Western Gippsland Hospital
Williamstown Satellite
Wodonga Regional Health Service
Wonthaggi Hospital
Yarawonga District Hospital
Yarram Hospital
COBG
COHU
COLA
CORR
CRAI
CRAN
DAND
DAYL
GDIA
DONA
EHUB
ECHU
EDEN
EPPG
FRAN
GVAL
HAML
HSTG
HEDG
HORS
KYAB
KYNE
LATR
MANS
MARO
MRYB
MELT
MILD
MOOR
MYRT
NCOM
NHIL
NSAT
NEKS
NMDC
ORBO
PJAM
PORT
ROBV
ROSE
SALE
SNDR
SEYM
SGEO
SGRU
SUNB
SUNS
SWAN
TERA
WAGG
WANG
WARN
WERR
WGIP
WILL
WDGA
WONT
YARA
YARM
TRANSPLANTING UNIT
Unit Code
Alfred Hospital
ALFD
Director - Professor Napier Thomson
Commercial Road
Prahran 3181
Austin Health
Director - Dr David Power
Burgundy Road
Heidelberg 3084
AUST
Monash Medical Centre (Paediatric)
Director - Dr Amanda Walker
246 Clayton Road
Clayton 3165
MMCP
Monash Medical Centre (Adult)
Director - Professor Peter Kerr
246 Clayton Road
Clayton 3165
MMCA
Royal Children’s Hospital
Director - Dr Colin Jones
Flemington Road
Parkville 3052
RCHL
Royal Melbourne Hospital
Director - Professor Gavin Becker
Parkville 3052
RMBH
St. Vincent’s Hospital
Director - Professor Robyn Langham
41 Victoria Parade
Fitzroy 3065
SVIN
SATELLITE DIALYSIS UNITS
Unit Code
Broadmeadows Satellite
Brunswick Satellite
Casey Hospital
BRDM
BRUN
CASE
Casterton Hospital
CAST
Caulfield General Medical Centre
CAUL
xiv
ANZDATA Registry 2012 Report
HOSPITALS
_____________________________________________________________________________________
NEW SOUTH WALES
(STATE CODE 2)
PARENT HOSPITALS
Unit Code
TRANSPLANTING UNIT
Coffs Harbour Hospital
Dubbo Base Hospital
East Coast Renal Service
Prince of Wales Hospital
St. George Hospital
St. Vincent’s Hospital
Sydney Children’s Hospital
Wollongong Hospital
Gosford Hospital
John Hunter Hospital
Lismore Hospital
Lismore Private Dialysis Clinic
Macleay Dialysis Centre - Kempsey
Manning Rural Referral Hospital
Mater Misericordiae Hospital
Mayo Private - Taree
Port Macquarie Base Hospital
Port Macquarie Private Hospital
Royal North Shore Hospital
South West Sydney Renal Services
Liverpool Hospital
Statewide Renal Services
Concord Hospital
Royal Prince Alfred Hospital
Sydney Adventist Hospital
Tamworth Hospital
The Children’s Hospital at Westmead
The Tweed Hospital
Western Renal Network
Nepean Hospital
Orange Hospital
COFF
DUBB
Sydney Children’s Hospital
Westmead Hospital
POWH
STGH
STVI
SCHL
WGNG
GOSF
HUNT
LISM
LPDC
MACL
MANN
MATR
MAYO
PTMQ
PMPH
RNSH
SSYD
LVPL
SWRS
CONC
RPAH
SADV
TAMW
NEWC
TWHD
NEPN
ORAN
WEST
TRANSPLANTING UNIT
Unit Code
John Hunter Hospital
HUNT
Director of Transplantation -
(CONT)
Unit Code
SCHL
Director - Dr Andrew Rosenberg
C/- Department of Nephrology
Prince of Wales Hospital
Barker Street
Randwick 2031
The Children’s Hospital at Westmead
NEWC
Director - Dr Stephen Alexander
Cnr Hawkesbury and Hainsworth Street
Westmead 2145
Westmead Hospital
WEST
Director - Professor Jeremy Chapman
Cnr Hawkesbury and Darcy Road
Westmead 2145
SATELLITE DIALYSIS UNITS
Unit Code
Armidale Hospital
ARMD
Auburn Satellite
AUBN
Ballina Hospital
BLNA
Bankstown Hospital
BANK
Bathurst Satellite Dialysis Centre
BATH
Bega Satellite
BEGA
Blacktown Regional Dialysis
BLAK
Bondi Dialysis Unit (Diaverum)
BOND
Brewarrina Hospital
BREW
Broken Hill Hospital
BROK
Campbelltown Satellite
CAMP
Concord Repatriation Satellite Unit
CRSU
Condobolin Hospital
COND
Professor Adrian Hibberd
Coonamble Hospital
COON
Lookout Road
Dame Eadith Walker
DEWE
New Lambton Heights
Eora Satellite
EORA
Newcastle 2304
Fairfield Satellite
FAIR
Forbes Hospital
FORB
Prince of Wales Hospital
POWH
Gilgandra Satellite
GILG
Director - Professor Bruce Pussell
Gosford Satellite
GOSS
Barker Street
Goulburn Satellite (Fresenius)
GLBN
Randwick 2031
Grafton Hospital
GRFT
Griffith Base Hospital
GRIF
Invarell Satellite
INVR
Director - Dr Bruce Cooper
Lakehaven Satellite
LAKE
Pacific Highway
Lanceley Cottage
LANC
St Leonards 2065
Lindfield Dialysis Unit (Diaverum)
LIND
Liverpool Community Centre
LCOM
Maitland Hospital
MAIT
Mona Vale Satellite
MNVL
Moree Satellite
MORE
Moruya Satellite (Fresenius)
MORU
Muswellbrook
MUSW
Royal North Shore Hospital
Statewide Renal Services
RNSH
SWRS
Royal Prince Alfred Hospital
RPAH
Director of Transplantation - Professor
Steven Chadban
Missenden Road
Camperdown 2050
xv
HOSPITALS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
NEW SOUTH WALES
SATELLITE DIALYSIS UNITS
Unit Code
Norfolk Island Hospital
NORF
Penrith Community Dialysis Centre
PCDC
Shellharbour
SHEL
Shoalhaven Satellite (Nowra)
SHOA
Singleton Satellite
SING
Sutherland Hospital
SUTH
Sydney Dialysis Centre
SYDC
Taree Community Dialysis
NITA
Wagga Wagga Base Hospital
WAGG
Wansey Satellite
WANS
Wellington Hospital
WGTN
Wollongong Satellite
WSAT
NEW ZEALAND
(CONT)
(CODE 8)
PARENT HOSPITALS
Unit Code
TRANSPLANTING UNIT
Unit Code
Auckland City Hospital
AUCK
Auckland City Hospital
AUCK
Starship Children’s Hospital
STAR
Director - Dr Ian Dittmer
Christchurch Hospital
CHCH
Park Road
Dunedin Hospital
DUND
Grafton, Auckland
Hawkes Bay Hospital
HAWK
Middlemore Hospital
MIDM
Christchurch Hospital
Palmerston North Hospital
PALM
Director - Dr David McGregor
Taranaki Base Hospital
TARA
Riccarton Avenue
Waikato Hospital
WKTO
Christchurch
Wellington Hospital
WELN
Whangarei Area Hospital
WHAN
Starship Children’s Hospital
Waitemata
WMAT
Director - Dr William Wong
CHCH
STAR
Park Road
SATELLITE DIALYSIS UNITS
Unit Code
Auckland Home Training Unit
AHOM
Bay of Islands Hospital
BAYI
Wellington Hospital
Carrington Satellite
CARR
Director - Dr Grant Pidgeon
Grafton Training Unit
GRAF
Riddiford Street
Greenlane Hospital
GLNE
Newtown, Wellington South
Kaitaia Hospital
KAIT
Kawakawa Hospital
KAWA
Manukau Satellite
MANU
Nephrocare
NEPH
Nelson Hospital
NELS
Porirua Community Dialysis
PORI
Rotarua Hospital
ROTO
Tauranga Hospital
TAUR
Waitakere Satellite
WAIT
Grafton, Auckland
WELN
xvi
ANZDATA Registry 2012 Report
PUBLICATIONS
_____________________________________________________________________________________
Publications in peer-reviewed journals based substantially on data from ANZDATA and released
during the period of data covered by this report and during 2011 are listed below.
2011
Lim WH, Dogra GK, McDonald SP, Brown FG, Johnson DW. Compared with younger peritoneal dialysis patients, elderly patients have similar peritonitis-free survival and lower risk of technique failure, but higher risk of
peritonitis-related mortality. Perit Dial Int. 2011 Nov;31(6):663-71.
Bose B, McDonald SP, Hawley CM, Brown FG, Badve SV, Wiggins KJ, et al. Effect of dialysis modality on survival of hepatitis C-infected ESRF patients. Clin J Am Soc Nephrol. 2011 Nov;6(11):2657-61.
Marshall MR, Hawley CM, Kerr PG, Polkinghorne KR, Marshall RJ, Agar JWM, et al. Home hemodialysis and
mortality risk in Australian and New Zealand populations. Am J Kidney Dis. 2011 Nov;58(5):782-93.
Ghali JR, Bannister KM, Brown FG, Rosman JB, Wiggins KJ, Johnson DW, et al. Microbiology and outcomes of
peritonitis in Australian peritoneal dialysis patients. Perit Dial Int. 2011 Nov;31(6):651-62.
McDonald SP, Tong B. Morbidity burden of end-stage kidney disease in Australia: hospital separation rates
among people receiving kidney replacement therapy. Nephrology (Carlton, Vic). 2011 Nov;16(8):758-66.
Lim WH, Boudville N, McDonald SP, Gorham G, Johnson DW, Jose M. Remote indigenous peritoneal dialysis
patients have higher risk of peritonitis, technique failure, all-cause and peritonitis-related mortality. Nephrol Dial
Transplant. 2011 Oct;26(10):3366-72.
Siva B, McDonald SP, Hawley CM, Rosman JB, Brown FG, Wiggins KJ, et al. End-stage kidney disease due to
scleroderma--outcomes in 127 consecutive ANZDATA registry cases. Nephrol Dial Transplant. 2011 Oct;26
(10):3165-71.
Burke M, Hawley CM, Badve SV, McDonald SP, Brown FG, Boudville N, et al. Relapsing and recurrent peritoneal dialysis-associated peritonitis: a multicenter registry study. Am J Kidney Dis. 2011 Sep;58(3):429-36.
Clayton P, McDonald S, Chadban S. Steroids and recurrent IgA nephropathy after kidney transplantation. Am J
Transplant. 2011 Aug;11(8):1645-9.
Roberts MA, Polkinghorne KR, McDonald SP, Ierino FL. Secular trends in cardiovascular mortality rates of patients receiving dialysis compared with the general population. Am J Kidney Dis. 2011 Jul;58(1):64-72.
Ferrari P, Lim W, Dent H, McDonald SP. Effect of donor-recipient age difference on graft function and survival
in live-donor kidney transplantation. Nephrol Dial Transplant. 2011 Feb;26(2):702-8.
Lindsay RM, Suri RS, Moist LM, Garg AX, Cuerden M, Langford S, et al. International quotidian dialysis registry: Annual report 2010. Hemodialysis international International Symposium on Home Hemodialysis. 2011 Jan.
Dobler CC, McDonald SP, Marks GB. Risk of tuberculosis in dialysis patients: a nationwide cohort study. PLoS
ONE. 2011;6(12):e29563.
2012
Jiang SH, Roberts DM, Clayton PA, Jardine M. Non-tuberculous mycobacterial PD peritonitis in Australia. Int
Urol Nephrol. 2012 Nov 18.
Grace BS, Clayton P, Cass A, McDonald SP. Socio-economic status and incidence of renal replacement therapy: a registry study of Australian patients. Nephrol Dial Transplant. 2012 Nov;27(11):4173-80.
Lim WH, Clayton P, Wong G, Dogra G, Budgeon CA, Murray K, et al. Association between initial and pretransplant dialysis modality and graft and patient outcomes in live- and deceased-donor renal transplant recipients.
Transpl Int. 2012 Oct;25(10):1032-40
xvii
PUBLICATIONS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Johnson DW, Clayton P, Cho Y, Badve SV, Hawley CM, McDonald S, et al. Weekend compared with weekday
presentations of peritoneal dialysis-associated peritonitis. Perit Dial Int. 2012 Sep;32(5):516-24.
Jiang S, Stewart G, Barnes E, Jardine M, Razavian M, Gallagher M. Effect of a Vascular Access Surveillance Program on Service Provision and Access Thrombosis. Seminars in dialysis. 2012 Sep.
RITCHIE AG, Clayton PA, MACKIE FE, Kennedy SE. Nationwide survey of adolescents and young adults with endstage kidney disease. Nephrology (Carlton, Vic). 2012 Aug;17(6):539-44.
Boudville N, Kemp A, Clayton P, Lim W, Badve SV, Hawley CM, et al. Recent Peritonitis Associates with Mortality
among Patients Treated with Peritoneal Dialysis. J Am Soc Nephrol. 2012 Aug;23(8):1398-405.
Gray NA, Dent H, McDonald SP. Dialysis in public and private hospitals in Queensland. Internal medicine journal.
2012 Aug;42(8):887-93.
Zrim S, Furlong T, Grace BS, Meade A. Body mass index and postoperative complications in kidney transplant recipients. Nephrology (Carlton, Vic). 2012 Aug;17(6):582-7.
Clayton PA, McDonald SP, Chapman JR, Chadban SJ. Mycophenolate versus azathioprine for kidney transplantation: a 15-year follow-up of a randomized trial. Transplantation. 2012 Jul 27;94(2):152-8.
Lim WH, Chadban SJ, Clayton P, Budgeon CA, Murray K, Campbell SB, et al. Human leukocyte antigen mismatches associated with increased risk of rejection, graft failure, and death independent of initial immunosuppression in
renal transplant recipients. Clin Transplant. 2012 Jul;26(4):E428-37.
Cho Y, Badve SV, Hawley CM, McDonald SP, Brown FG, M NB, et al. The effects of living distantly from peritoneal
dialysis units on peritonitis risk, microbiology, treatment and outcomes: a multi-centre registry study. BMC Nephrol
[Internet]. 2012 Jun 15;13(41):41. Foote C, Ninomiya T, Gallagher M, Perkovic V, Cass A, McDonald SP, et al. Survival of elderly dialysis patients is predicted by both patient and practice characteristics. Nephrol Dial Transplant.
2012 May 7;27(9):3581-7.
Cho Y, Badve SV, Hawley CM, McDonald SP, Brown FG, Boudville N, et al. Seasonal variation in peritoneal dialysis-associated peritonitis: a multi-centre registry study. Nephrol Dial Transplant. 2012 May;27(5):2028-36.
Chan HW, Clayton PA, McDonald SP, Agar JWM, Jose MD. Risk factors for dialysis withdrawal: an analysis of the
Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, 1999-2008. Clin J Am Soc Nephrol. 2012
May;7(5):775-81.
Gray NA, Dent H, McDonald SP. Renal replacement therapy in rural and urban Australia. Nephrol Dial Transplant.
2012 May;27(5):2069-76.
Lim WH, Dogra G, Chadban SJ, Campbell SB, Clayton P, Cohney S, et al. Lack of impact of donor age on patient
survival for renal transplant recipients >/=60years. Transpl Int. 2012 Apr;25(4):401-8.
Thirugnanasambathan T, Hawley CM, Badve SV, McDonald SP, Brown FG, Boudville N, et al. Repeated peritoneal
dialysis-associated peritonitis: a multicenter registry study. Am J Kidney Dis. 2012 Jan;59(1):84-91.
Grace BS, Clayton P, McDonald SP. Increases in renal replacement therapy in Australia and New Zealand: understanding trends in diabetic nephropathy. Nephrology (Carlton, Vic). 2012 Jan;17(1):76-84.
Badve SV, Hawley CM, McDonald SP, Brown FG, Boudville NC, Wiggins KJ, et al. Use of aminoglycosides for peritoneal dialysis-associated peritonitis does not affect residual renal function. Nephrol Dial Transplant. 2012 Jan;27
(1):381-7.
Tang W, Mohandas J, McDonald SP, Hawley CM, Badve SV, Boudville N, et al. End-stage kidney disease due to
haemolytic uraemic syndrome - outcomes in 241 consecutive ANZDATA registry cases. BMC Nephrol.
2012;13:164.
Wong G, Howard K, Chapman JR, Chadban S, Cross N, Tong A, et al. Comparative survival and economic benefits of deceased donor kidney transplantation and dialysis in people with varying ages and co-morbidities. PLoS
ONE. 2012;7(1):e29591
xviii
ANZDATA Registry 2012 Report
DATA COLLECTION FORM
_____________________________________________________________________________________
xix
DATA COLLECTION FORM
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
xx
This page is intentionally left blank
2011
ANNUAL REPORT
SUMMARY
Kylie Hurst
Philip Clayton
Stephen McDonald
2012 Annual Report—35th Edition
KEY SUMMARY POINTS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
AUSTRALIA
Chapter 1 - Stock and Flow
Chapter 7 - Transplant Waiting list



There were 19,751 (885 per million population) receiving
renal replacement therapy (RRT) at 31st Dec 2011.
Of these 8753 (392 per million) had a functioning kidney
transplant and 10,998 (493 per million) were receiving
dialysis treatment.

There were 1299 active patients on the deceased donor
kidney waiting list at the 1Jan and 1141 active on 31 Dec
2010. 651 were made active during the year and 160 were
taken off the list, 6 died.
The numbers of both dialysis patients and transplants vary
with age; As expected, numbers listed 65 years or older
are much lower than for younger age groups, and the proportion removed from the list is higher.
Chapter 2 - New Patients
Chapter 8 - Transplantation





2453 people commenced RRT in Australia in 2011(110 per
million per year).
Incidence rates have stabilized over the past five years.
The mean age of patients entering programs in Australia in
2011 was 60 years and the median 62.3 years.
35% of all new patients had diabetic nephropathy attributed as their Cause of end stage renal disease, 23% had
glomerulonephritis and 15% hypertension.


The 825 transplant operations performed in 2011 represent a decrease over 2010. This was primarily driven by a
14% decrease in the number of live donor transplants performed compared with 2010, The 2011 numbers represents a transplant rate of 37 per million population per
year.
The median age of transplant recipients in 2011 was 50
years.
There have been 19,859 transplant operations performed
on 17,135 patients since 1963. Of these, 8,753 grafts were
functioning at 31st December 2011.
Chapter 3 - Deaths
Chapter 9 - Kidney Donation




The mortality rate per 100 patient years was 13.7 for dialysis dependent patients and 2.4 for those with a functioning
kidney transplant.
Of the 1,476 deaths among dialysis dependent patients in
2011, 33% were due to withdrawal from treatment, 32%
were due to cardiovascular causes, 11% to infection.
In Australia there is steady improvement in mortality rates
in most age groups over time.



In Australia there has been a large increase in the number
of deceased donors since 2008, driven by an increase in
expanded criteria (ECD) and in particular cardiac death
(DCD) donors.
In Australia the mean deceased donor age has increased
steadily from 36 years in 1992 to 47 years in 2011.
There were 255 living donor kidney transplants performed
in 2011 in Australia, representing 31% of all transplant
operations.
The proportion of all primary living donor transplants performed “pre-emptively” in Australia was 37%.
Chapter 4 - Method and Location of Dialysis
Chapter 10 - Cancer Report

There has been an increase of 321 (3%) in the total
number of prevalent dialysis patients.

Twelve percent of all prevalent dialysis patients were using
automated peritoneal dialysis, a further 7% continuous
ambulatory peritoneal dialysis, 22% hospital based
haemodialysis, 50% satellite haemodialysis and 9% home
haemodialysis.


Between 1982 and 2009, 2,568 people on dialysis (5.1 %)
had at least one cancer.
During this time 2180 transplant recipients (12.7 %) had at
least one cancer.
Chapter 5 - Haemodialysis
Chapter 11 - Paediatric Report




There were 8,929 patients receiving HD treatment at 31st
December 2011, an increase of 4%; of these 22% were
hospital based, 50% were in satellite centres and 9% at
home.
A total of 1,811 patients received HD for the first time
during the year, a slight increase from previous years.
Chapter 6 - Peritoneal Dialysis



XXIII

There were 517 transplant operations to people receiving
HD treatment, 6% of all HD patients dialysing and 12% of
those patients < 65 years.
Peritoneal dialysis was used to treat 19% of all dialysis
patients in 2011 (APD-1283,CAPD-786,total 10998).
There were 820 new peritoneal dialysis patients in the
calendar year 2011; of these 543 patients (66%) started
renal replacement therapy with peritoneal dialysis and 277
(34%) had previously been treated with haemodialysis or a
transplant.
Median time to first peritonitis was 22 months, with 30% of
patients completely free of peritonitis at three years
Overall, glomerulonephritis remains the most common
cause of ESKD in children and adolescents (30%) but
causes vary significantly with age. In young children renal
hypoplasia/dysplasia is the most common cause while
reflux nephropathy is a common cause of ESKD in adolescents.
Around 20% of children and adolescents receive preemptive kidney transplants. Of the remainder, 37% commence renal replacement therapy with haemodialysis compared with 43% starting with peritoneal dialysis.
Chapter 12 - End-Stage Kidney Disease Among
Indigenous Peoples of Australia
and New Zealand


A total of 250 Aboriginal and Torres Strait Islander People
commenced dialysis in Australia during 2011.
Over the period 2001-11 there has been an increase in the
number of transplants from deceased donors. Numbers
from living donors remain extremely low.
KEY SUMMARY POINTS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
NEW ZEALAND
Chapter 1 - Stock and Flow
Chapter 7 - Transplant Waiting list



There were 3,862 (877 per million population) receiving
renal replacement therapy (RRT) at 31st Dec 2011
We anticipate incorporating detailed NZ waiting list stack
and flow analyses in next year’s Report.
Of these 1481(336 per million) had a functioning kidney
transplant and 2,381 (541 per million) were receiving dialysis treatment.
Chapter 2 - New Patients
Chapter 8 - Transplantation




477 people commenced RRT in New Zealand in 2011 (108
per million per year).
The mean age of patients entering programs in new Zealand in 2011 was 57.5 years and the median 59.1 years.

42% of all new patients had diabetic nephropathy attributed as their Cause of end stage renal disease, 24% had
glomerulonephritis and 11% hypertension.

The number of transplant operations (118) performed in
2011 represents a transplant rate of 27 per million population per year compared with 25 in 2010 .
The median age of transplant recipients in 2011 was 50
years.
There have been 3,746 operations performed on 3,188
patients since 1965 with 1,481 grafts still functioning at 31st
December 2011
Chapter 3 - Deaths
Chapter 9 - Kidney Donation



The mortality rate per 100 patient years was 15.5 for dialysis dependent patients and 2.8 for those with a functioning
kidney transplant.
Of the 412 deaths among dialysis dependent patients in
2011, 25% were due to withdrawal from treatment, 32%
were due to cardiovascular causes, 13% to infection.



The deceased donor numbers are steady and the proportion of ECD and DCD donors are much lower than in Australia.
In New Zealand the mean donor age in 2011 was 36
years.
The number of living donor transplants decreased by 5%
(57 donors) in New Zealand in 2011.
The proportion of pre-emptive primary living donor transplants in New Zealand was 23% in 2011.
Chapter 4 - Method and Location of Dialysis
Chapter 10 - Cancer Report



There were 2381 prevalent dialysis patients in 2011 which
is stable compared to previous years.
Together, hospital haemodialysis and satellite dialysis
accounted for 48% of patients in 2011, the same as the
previous two years. Satellite haemodialysis numbers decreased 9% in 2011 (368 patients), after increases of 5%
(396 patients) in 2010 and 8% (413 patients) in 2009.
Chapter 5 - Haemodialysis



st
There were 1,591 patients receiving treatment at 31
December 2011, Hospital based HD (44%), satellite HD
(29%) and home HD (27%) have all remained the same for
the past three years.
There were 62 HD patients who received transplants in
2011 (47 in 2010). Four patients ≥ 65 years were transplanted.
Refer to Australian Summary points
Chapter 11 - Paediatric Report

Refer to Australian Summary points
Chapter 12 - End-Stage Kidney Disease
Among Indigenous Peoples of
Australia and New Zealand


The number of Maori and Pacific People starting dialysis
decreased in 2011 (126 patients and 94 patients) respectively.
The number of transplants to Maori and Pacific Peoples
recipients remains stable.
There were 403 patients who received HD for the first time
in 2011, similar to previous years. Seventy eight percent
were having their initial dialysis treatment, 20% were previously dialysing with peritoneal dialysis and 2% were failed
transplants.
Chapter 6 - Peritoneal Dialysis



Peritoneal dialysis accounted for 33% of all dialysis
patients and 64% of all patients dialysing at home.
There were 239 new peritoneal dialysis patients in the
calendar year 2011; of these 147 patients started renal
replacement therapy with peritoneal dialysis and 90 had
previously been treated with haemodialysis or a transplant.
The median time to first peritonitis was 19.4 months, with
31% of patients free of peritonitis at three years.
XXIV
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
This page is intentionally left blank
XXV
ANZDATA Registry 2012 Report
STOCK and FLOW
_____________________________________________________________________________________
CHAPTER 1
STOCK AND FLOW
Blair Grace
Stephen McDonald
Kylie Hurst
2012 Annual Report - 35th Edition
1-1
STOCK and FLOW
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
The number of new patients in Australia increased slightly
to 2453 in 2011. While there is variation in this rate from
year to year, the rate has clearly stabilised over the period
from 2007. Reflecting both the changes in numbers of new
patients and higher number of transplants, the number of
prevalent dialysis patients (people receiving dialysis at the
end of 2011) has slowly increased.
The overall number of new transplants (825) decreased
by 3% in 2011. Recent years have seen substantial
changes in the mix of living verses deceased donor
transplants. Further information is shown in the transplant chapter. In 2011, there were 255 live donor transplants reported, a 14% decrease after the 9% decrease
in 2010 (296 transplants).
In New Zealand there was greater variability reflecting a
smaller population base.
In New Zealand the number of new transplants remained similar in 2011 (118 transplants), and numbers
of live donor transplants (57) have decreased by (3)
from 2010.
Rates of prevalent patients and new patients are shown in
Figures 1.1 to 1.2. Further data about stock and flow is
shown in Figures 1.6 to 1.14.
Figure 1.1
Patient Flow Summary
2007 - 2011
(Number Per Million Population at 31st December)
* Country of Transplant
2007
2008
2009
2010
2011
2382 (113)
2549 (119)
2421 (111)
2319 (105)
2453 (110)
615 (29)
813 (38)
773 (35)
846 (38)
825 (37)
Living Donor Transplants
271
354
327
296
255
Subsequent Transplants
88
105
99
102
81
1629
1674
1690
1593
1680
Dialysis Patients
1459
1493
1538
1414
1476
Transplant Patients
170
181
152
179
204
Total New Patients
468 (111)
497 (116)
583 (135)
512 (117)
477 (108)
Total New Transplants *
123 (29)
122 (29)
121 (28)
110 (25)
118 (27)
Living Donor Transplants
58
69
67
60
57
Subsequent Transplants
11
11
12
6
8
343
388
365
354
412
Dialysis Patients
296
360
331
319
368
Transplant Patients
47
28
34
35
44
Australia
Total New Patients
Total New Transplants *
Total Deaths
New Zealand
Total Deaths
Figure 1.2
Prevalent Patients
2007 - 2011
(Number Per Million Population at 31st December)
2007
2008
2009
2010
2011
19751 (885)
Australia Total
16845 (802)
17667 (826)
18342 (842)
19027 (862)
No. Functioning Transplants • #
7115 (339)
7501 (351)
7891 (362)
8350 (378)
8753 (392)
No. Dialysis Patients
9730 (463)
10166 (475)
10451 (480)
10677 (484)
10998 (493)
Proportion Home *
31%
31%
30%
28%
27%
Proportion Satellite HD
45%
46%
47%
50%
50%
Proportion CAPD/APD
22%
22%
21%
19%
19%
New Zealand Total
3354 (793)
3454 (809)
3679 (852)
3822 (875)
3862 (877)
No. Functioning Transplants • #
1283 (303)
1348 (316)
1399 (324)
1437 (329)
1481 (336)
No. Dialysis Patients
2071 (490)
2106 (493)
2280 (528)
2385 (546)
2381 (541)
Proportion Home *
52%
52%
51%
52%
51%
Proportion Satellite HD
18%
19%
18%
17%
15%
Proportion CAPD/APD
36%
36%
35%
35%
33%
• Country of Transplant
# Patients lost to follow up are not included
* Proportion of all patients dialysing currently receiving home-based treatment (either PD or HD)
1-2
ANZDATA Registry 2012 Report
STOCK and FLOW
_____________________________________________________________________________________
Figure 1.3
600
2500
2000
400
1500
1000
200
500
0
New patients, NZ
New patients, Australia
New Patients
Australia and New Zealand
0
1960
1970
1980
1990
2000
2010
Year
Australia
NZ
Figure 1.4
2500
400
2000
200
1500
0
1000
-200
500
0
-400
1980
1990
2000
Change from previous year
New patients
New Patients and Change
Australia
2010
Year
New patients
Change from previous year
Figure 1.5
600
80
New patients
500
40
400
0
300
-40
200
100
-80
1980
1990
2000
Change from previous year
New Patients and Change
New Zealand
2010
Year
New patients
Change from previous year
1-3
STOCK and FLOW
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Figure 1.6
Prevalent Dialysis and Transplant
Australia (at 31 December)
Home HD
Hosp / Sat HD
PD
Functioning Tx
12,000
Number of patients
10,000
8,000
6,000
4,000
2,000
0
Dial Tx
Dial Tx
Dial Tx
Dial Tx
Dial Tx
2007
2008
2009
2010
2011
Figure 1.7
Prevalent Dialysis and Transplant
New Zealand (at 31 December)
Home HD
Hosp / Sat HD
PD
Functioning Tx
Number of patients
2,500
2,000
1,500
1,000
500
0
Dial Tx
Dial Tx
Dial Tx
Dial Tx
Dial Tx
2007
2008
2009
2010
2011
The incidence rate among Australian Aboriginal, Maori and Pacific People is substantially higher than among non
-indigenous people. Although interpretation is complicated by fluctuations from year to year, among Australian
Aboriginal people the incidence rate may have stabilised over the past 5 years (after a long period of steady increase since 1990). In New Zealand, rates among Maori appear to be dropping, while those among Pacific Peoples are increasing compared to non indigenous groups. Lower rates of transplantation leads to higher rates of
prevalent dialysis patients (Figure 1.8).
Figure 1.8
Prevalence and Incidence by Indigenous Racial Origin, 2007 - 2011
(Number Per Million Population Per Year)
Race
2007
2008
2009
2010
2011
Australia
New Patients
Dialysis
Aboriginal
and Torres Functioning Transplants *
Strait
Transplant Operations
Islanders #
Deaths
239 (453)
250 (464)
196 (356)
204 (363)
250 (436)
1094 (2075)
1162 (2158)
1183 (2152)
1211 (2156)
1302 (2269)
148 (281)
159 (295)
160 (291)
177 (315)
189 (329)
18 (34)
31 (58)
24 (44)
28 (50)
28 (49)
134 (254)
164 (305)
174 (316)
162 (288)
145 (253)
New Zealand
Maori
New Patients
146 (231)
157 (244)
176 (270)
155 (233)
126 (187)
Dialysis
688 (1087)
689 (1072)
732 (1121)
760 (1145)
742 (1102)
Functioning Transplants *
113 (179)
117 (182)
126 (193)
138 (208)
151 (224)
17 (27)
12 (19)
19 (29)
20 (30)
20 (30)
134 (212)
152 (236)
126 (193)
114 (172)
130 (193)
Transplant Operations
Deaths
New Patients
Pacific
People
Dialysis
Functioning Transplants *
Transplant Operations
Deaths
77 (249)
87 (274)
103 (315)
108 (322)
94 (272)
410 (1324)
434 (1365)
490 (1500)
542 (1615)
567 (1643)
78 (252)
85 (267)
87 (266)
89 (265)
91 (264)
6 (19)
10 (31)
6 (18)
9 (27)
9 (26)
34 (110)
55 (173)
48 (147)
50 (149)
61 (177)
* By Transplanting Country
1-4
# Aboriginal and Torres Strait Islanders Combined
ANZDATA Registry 2012 Report
STOCK and FLOW
_____________________________________________________________________________________
State by State rates are shown in figures (1.9) .
Figures 1.10 to 1.14 deal with the number of prevalent dialysis and transplant patients, showing trends over the
past 25 years (Figure 1.10) and state-by-state comparisons.
Figure 1.9
National and State Stock and Flow 1-Jan-2011 to 31-Dec-2011
(31-Dec-2010 Figures)
Deaths
Transplant
Operations *
Queensland
443 (448)
146 (141)
314 (296)
46 (39)
2005 (2001)
1699 (1626)
3704 (3627)
New South Wales
761 (721)
218 (239)
475 (454)
74 (57)
3555 (3484)
2466 (2370)
6021 (5854)
Aust. Capital Territory
Victoria
Tasmania
South Australia
Dialysis
Transplant
Dialysis
Dependent +
Functioning
New
Patients
State
Total
Transplants # * +
53 (53)
20 (21)
27 (27)
8 (3)
264 (245)
215 (213)
479 (458)
595 (573)
253 (247)
338 (298)
33 (28)
2693 (2612)
2327 (2177)
5020 (4789)
52 (47)
23 (31)
23 (28)
1 (2)
204 (192)
220 (205)
424 (397)
182 (179)
68 (82)
108 (115)
20 (24)
712 (676)
929 (904)
1641 (1580)
Northern Territory
83 (65)
12 (5)
45 (43)
3 (0)
468 (441)
69 (69)
537 (510)
Western Australia
284 (233)
88 (80)
146 (153)
63 (61)
1097 (1026)
857 (813)
1954 (1839)
2453 (2319)
828 (846)
1476 (1414)
204 (179)
10998 (10677)
8782 (8377)
19780 (19054)
477 (512)
118 (110)
368 (319)
44 (35)
2381 (2385)
1453 (1410)
3834 (3795)
Australia
New Zealand
# Patients lost to follow-up are not included
* Resident State
+ Point Prevalence at 31 December
Figure 1.10
Prevalent Transplant and Dialysis Patients
1985 to 2011
Country of Transplant
(Number Per Million Population at 31 December)
Australia
Year
Transplant #
Dialysis
New Zealand
Total
Transplant #
Dialysis
Total
1991
3493 (202)
3138 (182)
6631 (384)
607 (174)
630 (180)
1237 (354)
1992
3699 (211)
3383 (193)
7082 (405)
677 (192)
674 (191)
1351 (383)
1993
3872 (219)
3703 (210)
7575 (429)
705 (197)
721 (202)
1426 (399)
1994
4064 (228)
4099 (230)
8163 (457)
731 (202)
784 (217)
1515 (419)
1995
4236 (234)
4518 (250)
8754 (484)
783 (213)
850 (231)
1633 (445)
1996
4450 (243)
4882 (267)
9332 (510)
824 (221)
934 (250)
1758 (471)
1997
4698 (254)
5190 (280)
9888 (534)
882 (233)
1017 (269)
1899 (502)
1998
4923 (263)
5536 (296)
10459 (559)
936 (245)
1126 (295)
2062 (540)
2213 (577)
1999
5093 (269)
6019 (318)
11112 (587)
983 (256)
1230 (321)
2000
5296 (277)
6409 (335)
11705 (611)
1023 (265)
1331 (345)
2354 (610)
2001
5509 (284)
6851 (353)
12360 (637)
1063 (274)
1462 (377)
2525 (651)
2002
5784 (294)
7263 (370)
13047 (664)
1116 (283)
1594 (404)
2710 (686)
2003
6006 (302)
7719 (388)
13725 (690)
1168 (290)
1711 (425)
2879 (715)
2004
6295 (313)
8004 (398)
14299 (711)
1221 (299)
1774 (434)
2995 (733)
2005
6548 (321)
8641 (424)
15189 (745)
1239 (300)
1878 (454)
3117 (754)
2006
6862 (332)
9262 (448)
16124 (779)
1247 (298)
1997 (477)
3244 (775)
2007
7115 (339)
9730 (463)
16845 (802)
1283 (303)
2071 (490)
3354 (793)
2008
7501 (351)
10166 (475)
17667 (826)
1348 (316)
2106 (493)
3454 (809)
2009
7891 (362)
10451 (480)
18342 (842)
1399 (324)
2280 (528)
3679 (852)
19027 (862)
1437 (329)
2385 (546)
3822 (875)
19751 (885)
1481 (336)
2381 (541)
3862 (877)
2010
8350 (378)
10677 (484)
2011
8753 (392)
10998 (493)
# Patients Lost of Follow-up are not included
1-5
STOCK and FLOW
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Figure 1.13
Figure 1.11
Australia
New Zealand
Prevalent Patients per Million
Prevalent Patients per Million
339
364
352
493
484
480
475
463
2007
2008
2009
Transplant
2010
2011
318
310
300
2007
2008
Dialysis
546
528
493
490
393
380
2009
Transplant
541
330
323
2010
2011
Dialysis
There is substantial variation in prevalence of RRT and transplantation between states rates leading
to differences between dialysis and transplantation (Figures 1.11 to 1.14). The proportionally large
number per million population of dialysis patients in the Northern Territory reflects the higher proportion of indigenous population.
Figure 1.13
Comparison of Prevalent Transplant and Dialysis Dependent Patients
2007 - 2011
(Number Per Million Population at 31 December)
2007
2008
2009
2010
2011
Queensland
1403 (336)
1483 (347)
1554 (356)
1626 (368)
1699 (380)
New South Wales*
2034 (305)
2131 (315)
2234 (326)
2370 (342)
2466 (352)
Aust. Capital Territory*
194 (353)
198 (355)
199 (352)
213 (371)
215 (369)
Victoria
1766 (339)
1887 (357)
2025 (375)
2177 (398)
2327 (420)
Transplants #
Tasmania
165 (334)
179 (359)
192 (381)
205 (403)
220 (430)
South Australia
785 (496)
831 (520)
863 (535)
904 (555)
929 (567)
Northern Territory
78 (363)
74 (335)
67 (295)
69 (300)
69 (298)
Western Australia
703 (333)
743 (341)
782 (348)
813 (354)
857 (364)
Australia
7128 (339)
7526 (352)
7916 (364)
8377 (380)
8782 (393)
New Zealand
1270 (300)
1323 (310)
1374 (318)
1410 (323)
1453 (330)
#By Resident State and Country
Dialysis
Queensland
1807 (433)
1885 (441)
1957 (448)
2001 (452)
2005 (448)
New South Wales*
3194 (478)
3360 (497)
3426 (500)
3484 (503)
3555 (508)
Aust. Capital Territory*
215 (391)
235 (422)
239 (423)
245 (427)
264 (453)
Victoria
2412 (463)
2485 (469)
2528 (469)
2612 (478)
2693 (487)
Tasmania
175 (355)
179 (359)
199 (395)
192 (378)
204 (399)
South Australia
626 (396)
630 (394)
683 (423)
676 (415)
712 (435)
Northern Territory
368 (1711)
398 (1801)
417 (1838)
441 (1915)
468 (2023)
Western Australia
933 (441)
994 (456)
1002 (446)
1026 (447)
1097 (466)
Australia
9730 (463)
10166 (475)
10451 (480)
10677 (484)
10998 (493)
New Zealand
2071 (490)
2106 (493)
2280 (528)
2385 (546)
2381 (541)
* NSW population excludes residents of the Southern Area Health Service
* ACT population includes residents of the Southern Area Health Service
(Medical services in the ACT service this Southern Area Region)
Transplanted patients lost to follow up have been excluded
1-6
ANZDATA Registry 2012 Report
STOCK and FLOW
_____________________________________________________________________________________
Figure 1.14
Comparison of Transplant and Dialysis Dependent Patients 2006 - 2010
Note: Y scales vary between states
Queensland
New South Wales
Prevalent Patients per Million
2007
2008
2009
Transplant
353
380
368
356
347
336
452
448
441
433
Prevalent Patients per Million
448
2010
2011
2007
2010
Victoria
Prevalent Patients per Million
355
423
422
352
2008
2009
Transplant
2010
369
339
2011
469
463
453
2007
375
357
2008
Dialysis
478
469
2009
Transplant
398
2010
Tasmania
South Australia
Prevalent Patients per Million
359 359
2007
2008
381 395
403 378
430
399
396
2009
Transplant
2010
2011
2007
423
394
2008
Dialysis
2009
Transplant
2010
Western Australia
Prevalent Patients per Million
1915
2023
333
335
295
2008
2009
Transplant
300
2010
Dialysis
456
441
2011
466
447
446
348
341
435
Dialysis
Northern Territory
1838
2011
415
Prevalent Patients per Million
1801
487
567
555
535
520
496
420
Dialysis
Prevalent Patients per Million
334 355
1711
371
427
2011
Dialysis
Prevalent Patients per Million
2007
2007
2009
Transplant
Australian Capital Territory
391
363
2008
Dialysis
352
342
326
315
305
508
503
500
497
478
354
364
298
2011
2007
2008
2009
Transplant
2010
2011
Dialysis
1-7
STOCK and FLOW
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
This page is intentionally left blank
1-8
CHAPTER 2
NEW PATIENTS
(Commencing treatment in 2011)
Blair Grace
Stephen McDonald
Kylie Hurst
2012 Annual Report - 35th Edition
NEW PATIENTS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Figure 2.1
INTAKE
Annual Intake of New Patients
2007 - 2011
2008
2009
2010
Queensland
467 (112)
534 (125)
490 (112)
448 (101)
443 (99)
New South Wales
760 (114)
812 (120)
761 (111)
721 (104)
761 (109)
2011
Aust. Capital Territory
55 (100)
61 (109)
41 (73)
53 (92)
53 (91)
Victoria
545 (105)
540 (102)
547 (101)
573 (105)
595 (108)
Tasmania
55 (111)
54 (108)
58 (115)
47 (92)
52 (102)
South Australia
166 (105)
185 (116)
207 (128)
179 (110)
182 (111)
Northern Territory
76 (353)
90 (407)
72 (317)
65 (282)
83 (359)
Western Australia
258 (122)
273 (125)
245 (109)
233 (101)
284 (121)
Australia
2382 (113)
2549 (119)
2421 (111)
2319 (105)
2453 (110)
New Zealand
468 (111)
497 (116)
583 (135)
512 (117)
Figure 2.2
Patients per million population
400
300
Total
0-19 yrs
20-44 yrs
45-64 yrs
65-74 yrs
75-84 yrs
85+ yrs
200
100
0
2007
2008
2009
2010
2011
Year
Figure 2.3
New Patients
Age Specific Rates - New Zealand
Patients per million population
500
400
300
Total
0-19 yrs
20-44 yrs
45-64 yrs
65-74 yrs
75-84 yrs
85+ yrs
200
100
0
2006
2007
2008
2009
Year
2-2
2010
In New Zealand, the number of new patients
commencing renal replacement treatment
was 477, a rate of 108 per million of
population. This rate has been essentially
stable since 2007.
OF
NEW PATIENTS
In Australia in 2011, all age groups except 65-74 and
85+ years showed increased rates for acceptance of new
patients compared to 2010.The largest increases were in
the groups 65-69 years, and the 75-79 year group, from
489 to 524 per million (Figure 2.4).
500
2006
Incidence rates have stabilised over the past
5 years.
477 (108)
AGE
New Patients
Age Specific Rates - Australia
NEW PATIENTS
There were 2453 patients who commenced
treatment for end-stage renal failure in Australia in 2011, a rate of 110
per million population.
(Number Per Million Population)
2007
OF
2011
The mean age of patients entering programs in Australia
in 2011 was 60 years and the median 62.3 years (Figure
2.5).
In New Zealand, the mean age of patients entering was
57.5 years and the median 59.1 years (Figure 2.5).
ANZDATA Registry 2012 Report
NEW PATIENTS
_____________________________________________________________________________________
Figure 2.4
Within the older age groups in Australia,
only the 70-74 and ≥ 85 year age
groups decreased in numbers in 2011
(Figure 2.4).
Acceptance of Elderly New Patients
2007 - 2011
(Number Per Million Population)
Country
Age Groups
2007
2008
2009
2010
2011
In New Zealand there were decreases in
60-64 and 70-79 age groups in 2011.
60-64 years
273 (257)
287 (255)
268 (229)
277 (230)
281 (227)
65-69 years
248 (308)
302 (364)
286 (330)
251 (277)
289 (303)
Rates in most age groups ≥ 70 years,
were higher in Australia than in New
Zealand, particularly for those 75 years
or older.
70-74 years
297 (460)
317 (480)
302 (444)
288 (411)
270 (375)
75-79 years
284 (514)
285 (517)
295 (535)
270 (489)
292 (524)
80-84 years
179 (432)
194 (458)
169 (392)
155 (353)
156 (352)
>=85 years
49 (144)
61 (172)
66 (179)
77 (200)
63 (156)
Total
1330 (348)
1446 (366)
1386 (341)
1318 (314)
1351 (313)
60-64 years
58 (294)
65 (307)
72 (325)
93 (404)
59 (249)
65-69 years
56 (343)
65 (392)
75 (437)
70 (397)
75 (416)
70-74 years
47 (384)
51 (405)
66 (507)
48 (350)
47 (324)
75-79 years
29 (278)
29 (277)
49 (468)
33 (314)
22 (208)
80-84 years
9 (119)
7 (90)
16 (202)
18 (223)
19 (230)
>=85 years
4 (66)
0 (0)
4 (60)
3 (43)
4 (55)
Total
203 (280)
217 (290)
282 (364)
265 (331)
226 (274)
Australia
New
Zealand
STATE
ORIGIN
OF
OF
NEW PATIENTS
The age at start of dialysis varied little between States (Figure 2.5) except Northern Territory. The highest
acceptance rates were in the Northern Territory (350 per million) ( Figure 2.6).
Figure 2.5
Age and Gender of New Patients
1-Jan-2011 to 31-Dec-2011
(n = Number of Patients)
Age
Groups
Years
QLD
(n=443)
F
NSW
(n=761)
ACT
(n=53)
VIC
(n=595)
TAS
(n=52)
SA
(n=182)
NT
(n=83)
WA
(n=284)
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
AUST
(n=2453)
(n=477)
F
F
M
NZ
M
00-04
0
2
4
1
0
0
1
4
0
0
0
1
0
0
0
1
5
9
1
2
05-14
5
2
3
5
0
0
0
4
0
0
2
0
0
0
1
0
11
11
2
0
15-24
5
9
9
10
1
0
7
8
0
0
0
4
3
2
1
2
26
35
2
10
25-34
8
13
13
12
2
2
11
16
0
2
5
4
4
1
6
6
49
56
6
16
35-44
20
23
21
36
1
3
27
25
1
6
6
10
14
6
24
15
114
124
20
30
45-54
32
41
46
64
2
4
34
47
3
3
15
23
15
11
15
32
162
225
37
53
55-64
30
57
69
106
4
7
52
83
7
6
15
23
15
8
32
42
224
332
54
77
65-74
43
67
79
104
2
12
57
99
4
7
16
20
3
1
19
26
223
336
45
77
75-84
38
36
62
105
2
7
30
74
3
10
10
22
0
0
16
33
161
287
10
31
>=85
3
9
5
7
1
3
2
14
0
0
2
4
0
0
4
9
17
46
1
3
Total
184
259
311
450
15
38
221
374
18
34
71
111
54
29
118
166
992
1461
178
299
Mean age
59
59.3 60.6 61.8 58.2
64.9
58.6
61.6
48.3
48.3
57.6
61.3
58.7
60.9
57.1
63.8 61.2 58.4 59.9
57.7
Mean age
59.2
61.3
63
60.5
62.1
59.3
48.3
59.7
60
57.5
Median age
61.5
64.1
65.3
63.4
64.3
60.6
49.9
60.5
62.3
59.1
Age range
2.7 - 90.7
0.2 - 89.3
16.7 - 90.2
0 - 89.8
26.4 - 84.2
3.5 - 90
19.6 - 67.6
3.7 - 90.7
0 - 90.7
1.5 - 87.1
2-3
NEW PATIENTS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
INCIDENCE RATES FOR NEW RRT PATIENTS BY STATE
Figure 2.6
Incidence rates (95% confidence intervals) for new RRT patients by State. Note the Y axis scales for each
State are different. ACT population data includes the adjacent area of NSW (serviced by Canberra).
New RRT Rates - Queensland
New RRT Rates - New South Wales
130
New RRT (per million per year)
New RRT (per million per year)
140
130
120
110
100
90
120
110
100
90
2005
2006
2007
2008
2009
2010
2011
2005
2006
2007
Year
New RRT Rates - Northern Territory
New RRT (per million per year)
New RRT (per million per year)
400
300
2011
2010
2011
110
100
90
2005
2006
2007
2008
2009
2010
2011
2005
2006
2007
Year
2008
2009
Year
New RRT Rates - Tasmania
New RRT Rates - South Australia
150
160
New RRT (per million per year)
New RRT (per million per year)
2010
New RRT Rates - Victoria
200
100
50
140
120
100
80
2005
2006
2007
2008
2009
2010
2011
2005
2006
2007
Year
2008
2009
2010
2011
Year
New RRT Rates - Northern Territory
New RRT Rates - Western Australia
140
New RRT (per million per year)
500
New RRT (per million per year)
2009
120
500
400
300
130
120
110
100
90
200
2005
2006
2007
2008
Year
2-4
2008
Year
2009
2010
2011
2005
2006
2007
2008
Year
2009
2010
2011
ANZDATA Registry 2012 Report
NEW PATIENTS
_____________________________________________________________________________________
INCIDENCE RATES FOR NEW RRT PATIENTS BY AGE GROUPS
Figure 2.7
Incidence rates (95% confidence intervals) for new RRT patients by state and age groups. Note the Y axis scales for
each state are different. ACT population data includes the adjacent area of NSW (serviced by Canberra).
New RRT Rates By Age Group
Queensland
New RRT Rates By Age Group
New South Wales
500
400
200
65+
45-64
25-44
<25
0
2005
2006
2007
2008
2009
2010
New RRT (per million per year)
New RRT (per million per year)
600
200
65+
45-64
25-44
<25
100
0
2005
2006
2007
2009
2010
Year
New RRT Rates By Age Group
Australian Capital Territory
New RRT Rates By Age Group
Victoria
2011
600
400
65+
45-64
25-44
<25
200
2005
2006
2007
2008
2009
2010
New RRT (per million per year)
500
0
400
300
200
65+
45-64
25-44
<25
100
0
2011
2005
2006
2007
2008
2009
2010
Year
Year
New RRT Rates By Age Group
Tasmania
New RRT Rates By Age Group
South Australia
2011
600
500
400
300
200
65+
45-64
25-44
<25
100
0
2005
2006
2007
2008
2009
2010
400
200
65+
45-64
25-44
<25
0
2011
2005
2006
2007
Year
2008
2009
2010
2011
Year
New RRT Rates By Age Group
Northern Territory
New RRT Rates By Age Group
Western Australia
600
2000
1500
1000
65+
45-64
25-44
<25
500
0
2005
2006
2007
2008
Year
2009
2010
2011
New RRT (per million per year)
New RRT (per million per year)
2008
Year
New RRT (per million per year)
New RRT (per million per year)
300
2011
800
New RRT (per million per year)
400
400
200
65+
45-64
25-44
<25
0
2005
2006
2007
2008
2009
2010
2011
Year
2-5
NEW PATIENTS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
LATE REFERRAL
In total 22% of all new patients in Australia and New Zealand both were referred “late” to nephrological care, i.e.
less than three months before first treatment (Figure 2.8). There is some variation with age and patterns differ
between Australia and New Zealand (Figure 2.9). Late referral rates have been essentially stable for a number of
years (Figure 2.10).
Among the states/territories, the lowest rate was 8% in the Tasmania ranging to 40% in Northern Territory.
Variation with racial origin is shown in Figure 2.11. Higher rates are seen among ATSI and Maori’s.
Figure 2.8
Late Referral of New Patients
Number of Patients (% Patients)
Primary Renal
Disease
QLD
NSW
ACT
VIC
TAS
SA
NT
WA
AUST
NZ
0 (0%)
1 (1%)
0 (0%)
0 (0%)
0 (0%)
0 (0%)
0 (0%)
1 (2%)
2 (0%)
1 (1%)
0 (0%)
2 (4%)
LATE REFERRAL
Analgesic
T1 diabetes
2 (2%)
4 (2%)
0 (0%)
6 (5%)
0 (0%)
0 (0%)
T2 diabetes
25 (25%)
44 (22%)
1 (8%)
34 (26%)
0 (0%)
5 (24%)
24 (73%) 22 (46%)
14 (3%)
2 (2%)
155 (28%)
31 (30%)
Glomerulonephritis
23 (23%)
49 (25%)
2 (15%)
37 (28%)
0 (0%)
6 (29%)
1 (3%)
11 (23%)
129 (24%)
28 (27%)
Hypertension
13 (13%)
39 (20%)
3 (23%)
12 (9%)
1 (25%)
3 (14%)
2 (6%)
6 (13%)
79 (14%)
6 (6%)
Miscellaneous
24 (24%)
39 (20%)
3 (23%)
30 (23%)
2 (50%)
2 (10%)
2 (6%)
4 (8%)
106 (19%)
23 (22%)
Polycystic
3 (3%)
7 (4%)
0 (0%)
2 (2%)
0 (0%)
1 (5%)
0 (0%)
1 (2%)
14 (3%)
2 (2%)
Reflux
2 (2%)
1 (1%)
1 (8%)
1 (1%)
0 (0%)
1 (5%)
3 (9%)
0 (0%)
9 (2%)
3 (3%)
Uncertain
10 (10%)
13 (7%)
3 (23%)
8 (6%)
1 (25%)
3 (14%)
1 (3%)
1 (2%)
40 (7%)
7 (7%)
Subtotals
102 (23%)
197 (26%)
4 (8%)
21 (12%) 33 (40%) 48 (17%)
548 (22%)
103 (22%)
5 (1%)
20 (4%)
30 (2%)
4 (1%)
13 (25%) 130 (22%)
NOT LATE REFERRAL
Analgesic
0 (0%)
3 (1%)
0 (0%)
1 (1%)
0 (0%)
1 (0%)
21 (5%)
8 (17%)
8 (5%)
1 (2%)
5 (2%)
T1 diabetes
17 (5%)
23 (4%)
1 (3%)
T2 diabetes
107 (31%)
180 (32%)
9 (23%)
Glomerulonephritis
65 (19%)
112 (20%)
10 (25%) 130 (28%) 10 (21%) 38 (24%)
5 (10%)
Hypertension
61 (18%)
89 (16%)
7 (18%)
49 (11%)
6 (13%)
18 (11%)
Miscellaneous
29 (9%)
64 (11%)
6 (15%)
55 (12%)
4 (8%)
Polycystic
20 (6%)
33 (6%)
3 (8%)
36 (8%)
Reflux
11 (3%)
13 (2%)
2 (5%)
10 (2%)
Uncertain
26 (8%)
27 (5%)
2 (5%)
18 (4%)
Subtotals
341 (77%)
561 (74%)
443
758
Total (100%)
84 (4%)
17 (5%)
616 (32%)
149 (40%)
63 (27%)
433 (23%)
85 (23%)
8 (16%)
41 (17%)
279 (15%)
44 (12%)
14 (9%)
1 (2%)
18 (8%)
191 (10%)
26 (7%)
3 (6%)
16 (10%)
1 (2%)
14 (6%)
126 (7%)
24 (7%)
1 (2%)
4 (2%)
1 (2%)
3 (1%)
45 (2%)
6 (2%)
3 (6%)
13 (8%)
3 (6%)
4 (2%)
96 (5%)
14 (4%)
1900 (78%)
369 (78%)
2448
472
143 (31%) 13 (27%) 49 (30%) 29 (59%) 86 (37%)
40 (75%) 465 (78%) 48 (92%) 161 (88%) 49 (60%) 235 (83%)
53
595
52
182
82
283
NOTE; Diabetes Type 2 non insulin requiring and Diabetes Type 2 requiring insulin are now combined
2-6
ANZDATA Registry 2012 Report
NEW PATIENTS
_____________________________________________________________________________________
Figure 2.9
Late Referral - All Modes of Treatment Including Pre-emptive Transplants
New Patients 1-Jan-2007 to 31-Dec-2011
Country
Age Groups
0-14
15-24
25-34
35-44
45-54
55-64
65-74
75-84
>=85
Total
Australia
Late referral
31 (20%)
95 (35%)
148 (26%)
265 (24%)
420 (22%)
555 (21%)
606 (21%)
476 (21%)
95 (30%)
2691 (22%)
Not late referral
123 (80%)
178 (65%)
423 (74%)
853 (76%)
1501 (78%)
2082 (79%)
2243 (79%)
1802 (79%)
221 (70%)
9426 (78%)
Total
154
273
571
1118
1921
2637
2849
2278
316
12117
New Zealand
Late referral
12 (40%)
37 (49%)
29 (25%)
61 (23%)
113 (22%)
97 (14%)
95 (16%)
47 (20%)
0 (0%)
491 (19%)
Not late referral
18 (60%)
39 (51%)
88 (75%)
201 (77%)
411 (78%)
580 (86%)
505 (84%)
183 (80%)
15 (100%)
2040 (81%)
Total
30
76
117
262
524
677
600
230
15
2531
Figure 2.10
Late Referral - All Modes of Treatment
Including Pre-emptive Transplants 2007 to 2011
Country
Years
2007
2008
2009
2010
2011
Australia
Late referral
562 (24%)
556 (22%)
507 (21%)
518 (22%)
548 (22%)
Not late referral
1820 (76%)
1993 (78%)
1914 (79%)
1799 (78%)
1900 (78%)
Total
2382
2549
2421
2317
2448
Late referral
96 (21%)
112 (23%)
97 (17%)
83 (16%)
103 (22%)
Not late referral
372 (79%)
385 (77%)
486 (83%)
428 (84%)
369 (78%)
Total
468
497
583
511
472
New Zealand
Figure 2.11
Late Referral - All Modes of Treatment
Including Pre-emptive Transplants
By Race 2007 to 2011
Race
Country
Asian
Aboriginal/
TSI
Caucasian
Maori
Pacific
People
Other
Australia
Late referral
224 (22%)
307 (27%)
2025 (21%)
25 (25%)
57 (27%)
53 (27%)
Not late referral
797 (78%)
831 (73%)
7432 (79%)
75 (75%)
151 (73%)
140 (73%)
Total
1021
1138
9457
100
208
193
New Zealand
Late referral
27 (14%)
-
204 (18%)
162 (21%)
96 (21%)
2 (17%)
Not late referral
160 (86%)
-
901 (82%)
597 (79%)
372 (79%)
10 (83%)
Total
187
-
1105
759
468
12
Notes: Maori and Pacific Peoples who were resident and commenced treatment in Australia are also shown.
Figures presented in the 2011 Annual Report included years 2005 - 2010.
2-7
NEW PATIENTS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
CO-MORBID CONDITIONS
Co-morbid conditions at entry to RRT are shown in Figures 2.12 - 2.18. In Australia, the proportion of people with
reported coronary artery disease, chronic lung disease and peripheral vascular disease at the onset of dialysis is
gradually climbing (Figure 2.13). See Appendix II and III for further analyses of co-morbid conditions.
Figure 2.12
Co-morbid Conditions at Entry to Program 2011
Number of Patients (% Patients)
Chronic
Lung
Disease
Coronary
Artery
Disease
Peripheral
Vascular
Disease
CerebroVascular
Disease
Yes
347 (14%)
832 (34%)
442 (18%)
278 (11%)
Current
298 (12%)
Type 1
104 (4%)
Suspected
130 (5%)
218 (9%)
224 (9%)
95 (4%)
Former
1036 (42%)
Type 2
1035 (42%)
Country
Australia
Smoking
n=2453
No
1976 (81%)
1403 (57%)
1787 (73%)
2080 (85%)
Never
1110 (45%)
No
1315 (54%)
New
Zealand
Yes
65 (14%)
115 (24%)
64 (13%)
49 (10%)
Current
79 (17%)
Type 1
19 (4%)
n=477
No
Suspected
25 (5%)
41 (9%)
23 (5%)
9 (2%)
Former
195 (41%)
Type 2
217 (46%)
387 (81%)
321 (67%)
390 (82%)
419 (88%)
Never
196 (42%)
No
240 (50%)
Comorbid Conditions at Entry to RRT
Australia
Percentage of all patients
Figure 2.13
40
30
20
Coronary
Peripheral Vascular
Cerebrovascular
Lung
10
0
2005
2006
2007
2008
2009
2010
2011
Year starting RRT
(Suspected cases included)
Comorbid Conditions at Entry to RRT
New Zealand
Percentage of all patients
Figure 2.14
40
30
20
Coronary
Peripheral Vascular
Cerebrovascular
Lung
10
0
2005
2006
2007
2008
2009
2010
Year starting RRT
(Suspected cases included)
2-8
Diabetes
(Including
Diabetic Nephropathy )
2011
ANZDATA Registry 2012 Report
NEW PATIENTS
_____________________________________________________________________________________
Figure 2.16
Figure 2.15
Smoking Status at Entry to RRT
New Zealand
48
46
48
48
47
45
40
41
39
41
42
42
12
2006
13
2007
13
2008
11
2009
12
11
2010
Never
Former
Current
Percentage of all patients
Percentage of all patients
Smoking Status at Entry to RRT
Australia
2011
40
40
42
43
42
4
3
3
3
4
4
2007
56
2008
55
2009
53
54
2010
2011
Type 2 DM
Type 1 DM
Non-DM
Percentage of all patients
Percentage of all patients
40
2006
50
47
49
42
36
34
38
38
42
41
15
17
16
15
14
17
2006
2007
2008
2009
2010
2011
Never
Former
Current
Diabetes Status at Entry to RRT
New Zealand
Diabetes Status at Entry to RRT
Australia
57
47
Figure 2.18
Figure 2.17
56
42
46
44
2
2
52
2006
47
51
54
3
2
2
53
49
47
44
2007
2008
2009
2010
46
4
50
Type 2 DM
Type 1 DM
Non-DM
2011
2-9
NEW PATIENTS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
PRIMARY RENAL DISEASE OF
NEW PATIENTS
The coding of primary renal disease in ANZDATA
has remained unchanged for many years. During
that time, a number of new disease entities have
emerged, and the understanding of others
considerably evolved. To better reflect this, a
project is underway to review and modify the
categories used to report primary renal disease in
future reports. It is likely the introduction of these
codes will be staged over several years.
AUSTRALIA
Figure 2.19
Causes of ESRD 2008 - 2011
Number of Patients (% Patients)
Disease
2008
2009
2010
2011
575 (23%)
589 (24%)
497 (21%)
563 (23%)
Australia
Glomerulonephritis
Analgesic Nephropathy
51 (2%)
41 (2%)
37 (2%)
32 (1%)
Polycystic Kidney Disease
161 (6%)
176 (7%)
167 (7%)
140 (6%)
76 (3%)
80 (3%)
60 (3%)
54 (2%)
366 (14%)
344 (14%)
318 (14%)
358 (15%)
Reflux
Hypertension
Diabetic nephropathy (35% of all new
patients), continued as the most common cause of
primary renal disease (Figure 2.19).
Diabetic Nephropathy
867 (34%)
781 (32%)
823 (35%)
870 (35%)
Miscellaneous
263 (10%)
264 (11%)
284 (12%)
298 (12%)
Uncertain diagnosis
190 (7%)
146 (6%)
133 (6%)
138 (6%)
Glomerulonephritis (23%) was the next
most common cause of ESRD, followed by
hypertension (15%), polycystic kidney disease
(6%), reflux nephropathy (2%).
Australia Total
2549
2421
2319
2453
IgA + mesangioproliferative GN (26% of all GN)
was the most common histologically proven form of
glomerulonephritis (Figure 2.20).
Miscellaneous diseases causing end stage renal
failure are tabulated in Figure 2.21.
A renal biopsy based diagnosis was reported in
31% of cases: glomerulonephritis 76%,
hypertension 21% and diabetes (types I and II)
15%, (Figure 2.22).
NEW ZEALAND
New Zealand
Glomerulonephritis
103 (21%)
125 (21%)
111 (22%)
114 (24%)
Analgesic Nephropathy
2 (0%)
2 (0%)
2 (0%)
5 (1%)
Polycystic Kidney Disease
23 (5%)
34 (6%)
17 (3%)
26 (5%)
Reflux
14 (3%)
9 (2%)
8 (2%)
9 (2%)
Hypertension
44 (9%)
62 (11%)
58 (11%)
51 (11%)
Diabetic Nephropathy
227 (46%)
278 (48%)
259 (51%)
200 (42%)
Miscellaneous
62 (12%)
54 (9%)
41 (8%)
49 (10%)
Uncertain diagnosis
22 (4%)
19 (3%)
16 (3%)
23 (5%)
497
583
512
477
NZ Total
Figure 2.20
Types of Glomerulonephritis
1-Jan-2011 to 31-Dec-2011
Diabetic nephropathy (42%) was the most
common cause of ESRD followed by
glomerulonephritis (24%) and hypertension (11%).
IgA nephropoathy and focal sclerosis are the most
common forms of GN in New Zealand (causing end
-stage kidney disease).
Number (% of all GN)
Australia
New Zealand
Advanced GN (unclassified=end stage)
13 (2%)
7 (6%)
Extra and intra capillary GN (rapidly progressive)
15 (3%)
0 (0%)
Familial GN (including alports)
16 (3%)
2 (2%)
Focal and segmental proliferative GN
28 (5%)
4 (4%)
Focal sclerosing GN (including hyalinosis)
33 (6%)
6 (5%)
GN other (specify)
13 (2%)
4 (4%)
GN with systemic disease (specify)
3 (1%)
0 (0%)
Goodpastures with linear IgG and lung haemorrhage
15 (3%)
3 (3%)
Henoch-schonlein purpura
5 (1%)
1 (1%)
Membranous GN
38 (7%)
5 (4%)
147 (26%)
19 (17%)
Mesangial proliferative (IgA-)
5 (1%)
1 (1%)
Mesangial proliferative (no if studies)
2 (<1%)
1 (1%)
Mesangiocapillary GN (dense deposit disease)
4 (1%)
0 (0%)
Mesangial proliferative (IgA+)
Mesangiocapillary GN (double contour)
10 (2%)
3 (3%)
Microscopic polyarteritis
19 (3%)
4 (4%)
Presumed GN (no biopsy)
87 (15%)
21 (18%)
Primary focal sclerosing GN/focal glomerular sclerosis
47 (8%)
13 (11%)
Proliferative GN with linear IgG and no lung haemorrhage
2 (<1%)
1 (1%)
S.L.E.
27 (5%)
9 (8%)
Scleroderma
4 (1%)
1 (1%)
Secondary focal sclerosing GN
7 (1%)
4 (4%)
Wegeners granulomatosis
23 (4%)
5 (4%)
563
114
Totals
2-10
ANZDATA Registry 2012 Report
NEW PATIENTS
_____________________________________________________________________________________
Figure 2.21
Miscellaneous Causes of ESRD
1-Jan-2011 to 31-Dec-2011
Aust
(298)
NZ
(49)
Lead nephropathy
2
49
Medullary cystic disease
10
0
Cadmium toxicity
0
0
Calculi
24
5
Renal Disease
Aust
(298)
Renal Disease
NZ
(49)
Interstitial nephritis
32
1
Loss of single kidney (trauma-surgery)
1
5
Haemolytic uraemic syndrome
7
1
Oxalosis
3
1
Cortical necrosis
15
0
Cystinosis
1
0
Lithium toxicity
19
0
Congenital renal hypoplasia and dysplasia
18
2
Calcineurin inhibitor toxicity
9
3
Obstructed megaureter
1
0
Gout
2
3
Amyloid disease
23
4
Posterior urethral valves
4
0
Paraproteinaemia (including multiple myeloma)
39
9
Neuropathic bladder
1
0
Light chain nephropathy (not malignant)
2
1
Spina bifida or myelomeningocoele
3
0
Bladder neck obstruction (incl. prostatomegaly)
5
2
Renal cell carcinoma (Grawitz)
9
4
Other lower urinary tract abnormalities (with 2nd.reflux)
4
0
Transitional cell carcinoma urinary tract
5
0
Other
27
2
Ureteric obstructive nephropathy
9
2
Obstructive nephropathy
23
4
RENAL BIOPSY RATES
Renal biopsy rates vary widely with different types of disease (Figure 2.23). In 2011 in Australia, 33% of
patients were biopsied, continuing a slow trend over the last 4 years. Rates in New Zealand are somewhat lower, and stable.
Figure 2.22
Biopsy Rates
New Zealand
40
40
30
30
Biopsy rate (%)
Biopsy rate (%)
Biopsy Rates
Australia
20
10
0
20
10
0
2002
2003
2004
2005
2006
2007
Year
2008
2009
2010
2011
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Year
2-11
NEW PATIENTS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Figure 2.23
Biopsy of New Patients
Biopsy
Yes
Primary Renal Disease
Qld
NSW
ACT
Vic
Tas
SA
NT
WA
Aust
Analgesic Nephropathy
0
2
0
0
0
0
0
0
2
Diabetes T1
4
9
0
6
3
2
0
2
26
2
Diabetes T2
12
43
3
21
2
8
2
11
102
15
Glomerulonephritis
68
122
9
142
8
39
3
52
443
88
Hypertension
18
23
5
13
3
8
0
8
78
6
Miscellaneous
19
40
7
31
2
3
2
9
113
18
Polycystic Kidney Disease
Reflux
3
2
7
2
1
0
2
1
0
0
4
2
1
0
1
0
19
7
1
0
Uncertain diagnosis
NZ
0
6
4
0
1
0
3
0
0
14
5
132
252
25
217
18
69
8
83
804
135
Analgesic Nephropathy
5
19
0
3
0
1
0
2
30
5
Diabetes T1
15
18
1
21
5
6
1
5
72
17
Diabetes T2
120
182
7
156
11
46
51
96
669
163
Glomerulonephritis
20
39
3
25
2
5
3
23
120
26
Hypertension
56
105
5
48
4
13
10
39
280
44
Miscellaneous
34
63
2
54
4
13
1
13
184
31
Polycystic Kidney Disease
20
33
2
36
3
13
0
14
121
25
Reflux
11
11
3
10
1
3
4
3
46
9
Uncertain diagnosis
30
37
5
25
4
13
4
5
123
16
Sub Total
311
507
28
378
34
113
74
200
1645
336
Total
443
761
53
595
52
182
83
284
2453
477
Sub Total
No
2011
NOTE; Diabetes Type 2 non insulin requiring and Diabetes Type 2 requiring insulin are now combined
Figure 2.24
Biopsy Rates - Glomerulonephritis
New Zealand
100
100
75
75
Biopsy rate (%)
Biopsy rate (%)
Biopsy Rates - Glomerulonephritis
Australia
50
25
50
25
0
0
2002
2003
2004
2005
2006
2007
2008
2009
2010
2002
2011
2003
2004
2005
2006
2007
2008
2009
2010
2011
Year
Year
Figure 2.25
Biopsy Rates - Diabetic Nephropathy
Australia
Biopsy Rates - Diabetic Nephropathy
New Zealand
25
20
20
Biopsy rate (%)
Biopsy rate (%)
25
15
10
10
5
5
Type 1 DM
Type 2 DM
0
2-12
15
Type 1 DM
Type 2 DM
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year
Year
CHAPTER 3
DEATHS
Stephen McDonald
2012 Annual Report - 35th Edition
DEATHS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
INTRODUCTION
The format of the deaths chapter continues to evolve in this report, with greater tabular data on the survival of people
during renal replacement therapy. There is a particular emphasis on outcomes during dialysis treatment.
Observed survival for non-indigenous patients who started in the period 2002-2011 is shown in Figure 3.1. These
data are censored at transplantation (that is, events after the date of first transplantation are not included in analyses). Survival after transplantation and survival of indigenous peoples during dialysis is covered in later chapters.
Crude unadjusted death rates for dialysis and transplantation are shown in Figure 3.2 for various groups. This is a
different way of looking at the same question. This table includes all episodes of dialysis and transplantation (i.e.
analyses are not censored at first transplant date), and deaths are attributed to the modality in use at the time of
death. For this table, episodes of treatment include all people treated in 2011, regardless of year of first treatment.
Mortality rates are generally higher with older age, diabetes and coronary artery disease. The comparison between
indigenous rates (and some other comparisons) will be subject to several confounders. Comparisons of mortality
rates with the general population (stratified by gender) are shown in Figures 3.3 and 3.4.
Figure 3.1
Survival among People who Commenced
Dialysis 2002 - 2011 (Non-Indigenous) % (95% CI)
Age at Start
Time Point
(Number of Years
from dialysis start)
Proportion Surviving
Aust (95 % CI)
Proportion Surviving
NZ (95 % CI)
0– 24
1
97 (95-98)
96 (90-98)
2
93 (90-96)
94 (86-97)
25—44
45—64
65—74
75—84
85 +
3-2
5
90 (85-93)
78 (56-90)
1
97 (96-97)
99 (97-100)
2
91 (90-92)
94 (90-96)
5
80 (78-83)
73 (64-80)
1
92 (91-92)
91 (89-92)
2
84 (83-85)
81 (78-83)
5
60 (58-61)
53 (49-58)
1
85 (84-86)
84 (81-87)
2
72 (71-74)
71 (67-75)
5
41 (39-42)
34 (29-38)
1
80 (79-81)
76 (72-80)
2
64 (62-65)
55 (50-60)
5
27 (25-28)
19 (14-24)
1
69 (65-73)
65 (46-78)
2
51 (46-55)
43 (26-59)
5
17 (13-22)
13 (3-31)
ANZDATA Registry 2012 Report
DEATHS
_____________________________________________________________________________________
Figure 3.2
Death Rates During Renal Replacement Therapy
All Patients Included who Received Treatment During 2011
Dialysis
Mortality Rate
(per 100 patient years, 95% CI)
Group
Rate
Overall
Transplant
Mortality Rate
(per 100 patient years, 95% CI)
Confidence Intervals
Rate
Confidence Intervals
Per 100 patient
years
Lower
Upper
Per 100 patient
years
Lower
Upper
Australia
13.7
13.0
14.4
2.4
2.1
2.7
New Zealand
15.5
14.0
17.2
2.8
2.1
3.8
< 25
1.9
0.8
4.7
0.4
0.1
1.6
25—44
4.9
3.9
6.1
0.6
0.4
1.0
45—64
9.5
8.7
10.4
2.1
1.8
2.6
AGES (YEARS)
65—84
19.2
18.1
20.4
6.2
5.2
7.5
≥ 85
35.8
30.8
41.6
48.7
20
~
Non-diabetic
12.1
11.3
18.9
2.3
2.0
2.6
Type 1
16.9
13.1
21.9
2.8
1.7
4.5
Type 2
1.5
15.4
17.6
4.9
3.4
7.1
DIABETES (AT RRT START)
CORONARY ARTERY DISEASE (AT RRT START)
No
10.7
10.0
11.4
2.2
2.0
2.6
Yes
20.1
18.9
21.4
4.9
3.5
6.8
Non-Indigenous (Australia)
14.3
13.5
15.0
2.4
2.1
2.7
Non-Indigenous (New Zealand)
16.8
14.5
19.4
2.9
2.1
4.0
Aboriginal /Torres Strait Islanders
11.3
9.5
13.3
2.7
1.1
6.5
Maori (in Australia)
11.1
6.3
19.5
No events
Maori (in New Zealand)
16.8
14.1
20.1
3.3
1.4
8.0
Pacific People (in Australia)
4.8
2.7
8.4
2.8
0.7
11.3
Pacific People (in New Zealand)
11.1
8.7
14.3
1.1
0.1
7.5
INDIGENOUS
Figure 3.4
Figure 3.3
Mortality among prevalent transplant patients
Mortality among prevalent dialysis patients
vs. general population
vs. general population
Female
Female
Male
Male
.6
.4
.1
Mortality per year
Mortality per year
.2
.01
.001
.6
.4
.2
.1
.01
.001
20
40
60
80
20
Age (years)
Stratified by gender
ANZDATA and ABS data for year 2011
40
60
80
20
40
60
80
20
40
60
80
Age (years)
Stratified by gender
ANZDATA and ABS data for year 2011
3-3
DEATHS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Another perspective on survival during dialysis is presented in Figures 3.5 and 3.6. Median survival is the time to which
50% of people can expect to survive. Figure 3.5 shows the median survival of people who started dialysis treatment from 1
January 2002, by various categories.
These survival data are censored at the time of transplantation, and include those who started dialysis in the period 20022011. In addition to the median, the 25 and 75th centiles are included to give an indication of the range of observed survivals. Some figures are not observed - for example if half of a cohort have not yet died it is not possible to observe a median
survival; in other groups the small numbers of events mean the median and 25th/75th centiles are the same. These occurrences are indicated by * in the tables.
The survival amongst younger people are likely to be strongly affected by the selection bias (fitter people will be progressively transplanted and not be included in the analysis from that point).
Figure 3.6 shows the survival figures in more detail, categorised by the presence or absence of any vascular comorbidity
and diabetes, with a particular focus on older groups.
Figure 3.6
Figure 3.5
Survival by Age & Comorbidity
Survival of Dialysis Patients by age
Age Groups at start of
treatment
amongst older age groups
Median (25th and 75th centiles), years
Median (25th and 75th
centiles), years
Age Groups
Australia
0-24 years
*
65-69 years
Any Vascular
Disease
Diabetes
Australia
New Zealand
No
No
5.32 (2.04 -)
6.01 (2.67-7.68)
Yes
3.95 (1.93-8.29)
5.23 (4.20-8.69)
25-44 years
9.26 (5.37-*)
No
45-64 years
6.26 (3.01-2.65)
Yes
No
4.30 (2.08-7.04)
2.36 (0.87-4.81)
65-74 years
4.10 (1.84-7.01)
Yes
Yes
4.31 (1.41-6.96)
4.03 (1.41-4.27)
75-84 years
2.97 (1.30-5.27)
No
No
5.89 (3.24-8.38)
3.33 (2.27-4.41)
85+ years
2.03 (0.73-3.97)
70-74 years
New Zealand
0-24 years
9.64 (7.92-*)
25-44 years
7.28 (4.12-*)
45-64 years
4.97 (2.65-8.05)
65-74 years
3.59 (1.81-5.93)
75-84 years
2.51 (1.07-4.26)
85+ years
1.69 (0.96-3.58)
75-79 years
80-84 years
85-89 years
No
Yes
5.59 (2.39- )
3.92 (3.92-4.39)*
Yes
No
3,46 (0.96-5.81)
2.55 (1.63-4.45)
Yes
Yes
3.65 (1.80-4.97)
3.33 (1.78-4.88)
No
No
5.47 (2.14-8.31)
3.43 (3.43-3.43)*
No
Yes
5.59 (2.39- )
3.92 (3.92-4.39)*
Yes
No
4.00 (1.85-6.35)
1.42 (0.57-2.43)
Yes
Yes
3.08 (1.04-5.48)
2.97 (1.49-5.74)
No
No
3.41 (2.02-6.41)
2.69 (1.65-3.09)
No
Yes
4.34 (2.70-6.17)
0.67 (0.67-0.67)*
Yes
No
2.28(1.09-4.90)
2.82 (2.82-2.82)*
Yes
Yes
2.37 (1.29-4.55)
2.82 )2.82-2.82)*
No
No
2.25 (0.63-7.79)
*
No
Yes
2.39 (0.63-)
*
Yes
No
2.17 (1.32-3.58)
1.38 (1.38-4.91)*
Yes
Yes
1.57 (0.37-6.09)
*
The evolution of mortality rates over time is shown in Figures 3.7 and 3.8. In Australia, there is steady improvement in most
groups over time. For New Zealand, the trends are less clear, in part reflecting the lower precision with smaller numbers.
3-4
ANZDATA Registry 2012 Report
DEATHS
_____________________________________________________________________________________
Figure 3.7 Australia
2001-
2003-
200520072009Year of dialysis start
2011-
(2-3] years
.18
.16
.14
.12
2001-
200320052007Year of dialysis start
2009-
Mortality rate per year
(0-1] year
.15
.14
.13
.12
.11
.1
Mortality rate per year
Mortality rate per year
Mortality rate per year
Dialysis mortality rates
(1-2] years
.16
.14
.12
.1
2001-
200320052007Year of dialysis start
2009-
(3-5] years
.2
.18
.16
.14
.12
2001-
20032005Year of dialysis start
2007-
ANZDATA, censored at transplantation
Australia only
Figure 3.8 New Zealand
2001-
2003-
200520072009Year of dialysis start
2011-
(2-3] years
.25
.2
.15
.1
2001-
200320052007Year of dialysis start
2009-
Mortality rate per year
(0-1] year
.16
.14
.12
.1
.08
.06
Mortality rate per year
Mortality rate per year
Mortality rate per year
Dialysis mortality rates
(1-2] years
.18
.16
.14
.12
.1
2001-
200320052007Year of dialysis start
2009-
(3-5] years
.24
.22
.2
.18
.16
.14
2001-
20032005Year of dialysis start
2007-
ANZDATA, censored at transplantation
NZ only
3-5
DEATHS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
CAUSE
OF
DEATHS
This section contains a summary of trends in various areas. The focus on this section is on deaths reported during
2011. The cause of death reported to ANZDATA is not necessarily the same as that reported on the death certificate. In particular, ANZDATA specifically records a range of reasons for “withdrawal from treatment”. Clearly, the
actual cause of death in these instances is uraemia, however the key issues presented here are the “cause” of the
withdrawal, in many cases this is related to an underlying comorbidity (these figures are explored further on pages
3-8 and 3-9)
For the purposes of Figures 3.9 - 3.11, deaths were attributed to the modality in use at the time of death.
In both Australia and New Zealand, similar trends are seen although there is a larger proportion of deaths coded
as “other” from New Zealand (Figure 3.9). In particular there are a greater proportion of deaths due to cancer
among patients with kidney transplants, whereas among dialysis patients deaths to cardiovascular and infective
causes predominate.
Figure 3.9
Cause of death
Deaths occurring during 2011
Australia
New Zealand
100
Percent
80
60
40
20
0
HD
PD
Graft
Cardiovascular
Infection
Graph by country and dialysis modality at time of death
3-6
HD
Withdrawal
Other
PD
Graft
Cancer
ANZDATA Registry 2012 Report
DEATHS
_____________________________________________________________________________________
The distribution of types of death changes with different age groups. Although one might expect the numbers of
deaths reported as treatment withdrawals to increase with age, the proportion of deaths reported as related to withdrawal of dialysis is still substantial in a number of the younger age groups (among dialysis patients) (Figure 3.11)
Figure 3.10
Cause of death
Deaths occurring during 2011
Australia, HD
Percent
100
80
60
40
20
0
0-
45-
65-
Australia, PD
75-
0-
New Zealand, HD
100
80
60
40
20
0
0-
45-
65-
45-
65-
Australia, Graft
75-
0-
New Zealand, PD
75-
0-
45-
Cardiovascular
Infection
65-
45-
65-
75-
New Zealand, Graft
75-
0-
45-
Withdrawal
Other
65-
75-
Cancer
Graph by country and dialysis modality at time of death
Figure 3.11
Modality at time of death and age at death –2011
Haemodialysis
Cause of Death
0 - 44
Peritoneal Dialysis
45 - 64
65 - 74
≥75
117
92
159
0 - 44
Transplant
45 - 64
65 - 74
≥75
2
24
39
32
3
13
18
36
4
6
6
0 - 44
45 - 64
65 - 74
≥75
5
16
19
3
3
4
4
31
27
8
Australia
Cardiovascular
16
7
Withdrawal
15
61
110
229
Cancer
2
15
30
29
Infection
6
40
44
54
6
5
13
2
20
9
7
Other
17
56
53
74
12
17
21
3
17
10
10
Cardiovascular
5
45
19
15
26
13
8
7
1
1
Withdrawal
1
11
30
24
8
12
16
1
3
2
2
1
5
2
Infection
4
13
9
9
4
6
4
4
1
1
3
2
Other
4
14
14
7
3
10
10
7
2
9
1
1
New Zealand
Cancer
2
2
4
3-7
DEATHS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
WITHDRAWAL FROM DIALYSIS
During 2011 there were 495 deaths in Australia and 107 in New Zealand attributed to withdrawal from therapy. The vast
majority of these were among patient receiving dialysis therapy. In the transplant group, malignancy figures prominently as a
cause for the withdrawal decision.
The pattern differed between patients by the modality of treatment prior to death. “Psychosocial” reasons were more commonly cited among patient receiving PD prior to death than among HD patients. Figure 3.12 gives broad categories and 3.13
detailed breakdown of the causes for withdrawal. However, the coding of these categories is clearly somewhat subjective.
Figure 3.12
Country at time of death and Modality at death among those
who withdrew from dialysis and died in 2011 AUSTRALIA
Cause of Death
NEW ZEALAND
HD
PD
GRAFT
HD
PD
GRAFT
Cardiovascular
384
97
42
84
49
9
Withdrawal
415
70
10
66
36
5
Cancer
76
16
70
5
6
10
Infection
144
24
38
35
18
7
Other
200
50
40
39
30
13
Figure 3.13
Death due to withdrawal-2011
(Modality at time of death)
Withdrawal
Haemodialysis
Peritoneal Dialysis
Transplant
Total
Australia
Psychosocial
177
31
6
214
Patient refused further
2
0
0
2
Suicide
0
1
0
1
Cardiovascular comorbidity
75
13
1
89
42
Cerebrovascular comorbidity
36
6
0
Peripheral vascular comorbidity
24
8
1
33
Malignancy related withdrawal
82
7
2
91
Withdrawal due to dialysis
19
4
0
23
Total
415
70
10
495
Psychosocial
24
11
2
37
Patient refused further
0
0
1
1
Suicide
0
0
0
0
Cardiovascular comorbidity
17
9
1
27
New Zealand
3-8
Cerebrovascular comorbidity
5
3
0
8
Peripheral vascular comorbidity
8
10
0
18
Malignancy related withdrawal
11
3
1
15
Withdrawal due to dialysis
1
0
0
1
Total
66
36
5
107
ANZDATA Registry 2012 Report
DEATHS
_____________________________________________________________________________________
Figures 3.14 show the breakdown of the dialysis group by age and by time from start of dialysis. This area
within ANZDATA has been examined in some detail in a recent publication (Chan et al Clin J Am Soc Nephrol
2012; 7: 775-781 ). The pie graphs are graphical representation of tables 3.12 and 3.13.
Figure 3.14
Dialysis patients who withdrew by age at death
time from first RRT-2011
Time from
first RRT
0
AUSTRALIA
NEW ZEALAND
0 - 44
45 - 64
65 - 74
≥75
Total
0 - 44
3
13
31
30
77
0
45 - 64
1
65 - 74
≥75
Total
8
3
12
1
3
7
13
34
57
0
4
4
2
10
2
6
25
45
96
172
0
5
17
16
38
5
6
32
42
109
189
2
12
14
19
47
Total
18
77
131
269
495
2
22
43
40
107
Figure 3.15
Causes of death
Deaths occurring in 2011
Australia, HD
Australia, PD
Australia, Graft
New Zealand, HD
New Zealand, PD
New Zealand, Graft
Cardiovascular
Cancer
Other
Withdrawal
Infection
Graphs by Country at time of death and Modality at time of death
Figure 3.16
Causes of deaths attributes to withdrawal
Deaths occurring in 2011
Australia, HD
Australia, PD
New Zealand, HD
New Zealand, PD
Psychosocial
Patient refused further treatment
Suicide
Cardiovascular comorbidity
Cerebrovascular comorbidity
Perpheral vascular comorbidity
Malignancy related withdrawal
Withdrawal due to dialysis access issues
Graphs by Country at time of death and Modality at time of death
3-9
DEATHS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
This page is intentionally left blank
3-10
CHAPTER 4
METHOD AND LOCATION
OF DIALYSIS
Nancy Briggs
Stephen McDonald
Kylie Hurst
2012 Annual Report - 35th Edition
METHOD AND LOCATION OF DIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
AUSTRALIA
Figure 4.1
Method and Location of Dialysis 2007 - 2011
Mode of Treatment
Peritoneal
Dialysis
Aust
HD
Peritoneal
Dialysis
NZ
HD
2007
2008
2009
2010
2011
APD
1150
1271
1313
1279
1281
CAPD
987
971
887
803
788
Total
2137
2242
2200
2082
2069
Hospital
2302
2326
2343
2321
2427
Home
949
951
977
974
972
Satellite
4342
4647
4931
5300
5530
Total
7593
7924
8251
8595
8929
APD
246
288
336
358
351
CAPD
500
475
463
474
439
Total
746
763
799
832
790
Hospital
615
622
690
731
790
Home
327
331
378
424
433
Satellite
383
390
413
398
368
Total
1325
1343
1481
1553
1591
Prevalence of Dialysis Dependent Patients
By State 2007 - 2011
(per Million Population)
2007
2008
2009
2010
2011
Queensland
1807 (433)
1885 (441)
1957 (448)
2001 (452)
2005 (448)
New South Wales*
3194 (478)
3360 (497)
3426 (500)
3484 (503)
3555 (508)
Aust. Capital Territory**
215 (391)
235 (422)
239 (423)
245 (427)
264 (453)
Victoria
2412 (463)
2485 (469)
2528 (469)
2612 (478)
2693 (487)
Tasmania
175 (355)
179 (359)
199 (395)
192 (378)
204 (399)
South Australia
626 (396)
630 (394)
683 (423)
676 (415)
712 (435)
Northern Territory
368 (1711)
398 (1801)
417 (1838)
441 (1915)
468 (2023)
Western Australia
933 (441)
994 (456)
1002 (446)
1026 (447)
1097 (466)
Australia
9730 (463)
10166 (475) 10451 (480)
10677 (484)
10998 (493)
New Zealand
2071 (490)
2106 (493)
2385 (546)
2381 (541)
* NSW population excludes residents of the Southern Area Health Service
* ACT population includes residents of the Southern Area Health Service
(Medical services in the ACT service the Southern Area Region of NSW)
4-2
The distribution of these patients across the
modalities continues to change (Figures 4.1 and
4.3). The majority (73%) of haemodialysis patients were out of hospital: 11% were dialysing
at home and 62% in satellite centres.
The proportion of patients receiving haemodialysis (particularly satellite HD) continues to steadily increase while the proportion receiving peritoneal dialysis (APD and CAPD) decreased by 1%
in 2011 after a 6% decrease in 2010.
Twelve percent of all prevalent dialysis patients
were using automated peritoneal dialysis, a further 7% continuous ambulatory peritoneal
dialysis, 22% hospital based haemodialysis,
50% satellite haemodialysis and 9% home
haemodialysis.
Automated peritoneal dialysis increased in 2011
to 1281 patients, however continuous ambulatory peritoneal dialysis decreased to 788 patients.
The number of patients receiving dialysis treatment rose in all State/Territories in 2011. The
number of dialysis patients in relation to population in each state is shown in Figure 4.2.
Fifty percent of all prevalent dialysis patients
were 65 years or older, and 472 patients (4%)
were 85 years or older.
Figure 4.2
2280 (528)
During the past year, there was an increase of
321 (3%) in the total number of prevalent
dialysis patients. There were 10,998 patients
(493 per million) receiving dialysis treatment at
31st December 2011.
ANZDATA Registry 2012 Report
METHOD AND LOCATION OF DIALYSIS
_____________________________________________________________________________________
AUSTRALIA
For those <15 years, peritoneal dialysis was used in 74%, compared with 28% for 15-24 years, 24% for 2534 years, 19% for 65-84 years and 12% for ≥ 85 years.
Relative to State/Territory population, the highest prevalence rate of dialysis patients was in the Northern
Territory (2,023 per million), with rates in other States/Territories ranging from 508 per million in New South
Wales to 435 per million in South Australia and 399 per million in Tasmania (Figure 4.2).
The age distribution of Patients is shown in Figure 4.4.
Figure 4.3
Method and Location of Dialysis
Australia, 2007-2011
5500
5000
4500
4000
3500
3000
2500
2000
1500
1000
500
0
5500
5000
4500
4000
3500
3000
2500
2000
1500
1000
500
0
2007
2008
2009
2010
Method N (%)
SATT HD 5530 (50%)
HOSP HD 2427 (22%)
CAPD 788 (7%)
HOME HD 972 (9%)
APD 1281 (12%)
2011
Year
Figure 4.4
Prevalent Dialysis Patients (Australia)
Prevalent Dialysis Patients (Australia)
31 December 2011
31 December 2011
2648
Number of Patients
Total=10,998
2384
Patients per Million
(Overall Rate 493)
2374
2370
1639
1584
17
19
0-4
5-14
152
15-24
472
381
25-34
35-44
1170
927
912
45-54
Age Group
55-64
65-74
75-84
85+
12
7
50
119
0-4
5-14
15-24
25-34
289
35-44
538
45-54
55-64
65-74
75-84
85+
Age Group
4-3
METHOD AND LOCATION OF DIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
NEW ZEALAND
New Zealand data are shown in Figures 4.1, 4.2, 4.5 and 4.6.
There was an decrease of four dialysis patient in 2011 (2381 patients from 2,385 ), after rises of 4% last
year and 8% in 2009.
There were increases in five of the age groups in 2011. The increases ranged from 9% (4 and 5 patients)
in the 15-24 and 85+ age groups to 10% (16, 21 and 14 patients) in the 45-54, 55-64 and 65-74 year age
groups.
Fifty one percent of patients were treated with a form of home dialysis (of whom 50% were peritoneal
dialysis patients). Numbers treated with automated peritoneal dialysis were similar in 2011 to 2010
(Figure 4.5)
In 2011, continuous ambulatory peritoneal dialysis decreased to 439 patients (compared with 477 in
2010) following a increase from 403 patients in 2009.
Together, hospital haemodialysis and satellite dialysis accounted for 48% of patients in 2011, the same
as the previous two years. Satellite haemodialysis numbers decreased 9% in 2011 (368 patients), after
increases of 5% (396 patients) in 2010 and 8% (413 patients) in 2009.
In contrast to Australia a greater percentage of patients were at home. Of those not at home, a greater
proportion were in hospital rather than satellite HD.
Figure 4.5
Method and Location of Dialysis
New Zealand, 2007-2011
800
800
700
700
600
600
500
500
400
400
300
300
200
200
100
100
0
Method N (%)
SATT HD 368 (15%)
HOSP HD 790 (33%)
CAPD 439 (18%)
HOME HD 433 (18%)
APD 351 (15%)
0
2007
2008
2009
2010
2011
Year
Figure 4.6
Prevalent Dialysis Patients (New Zealand)
Prevalent Dialysis Patients (New Zealand)
31 December 2011
31 December 2011
1742
684
Patients per Million
(Overall Rate 541)
567
Number of Patients
Total=2,381
1383
1252
451
2
8
0-4
5-14
63
15-24
383
116
25-34
35-44
45-54
Age Group
4-4
730
236
231
55-64
65-74
75-84
23
6
14
85+
0-4
5-14
98
15-24
315
205
25-34
35-44
45-54
Age Group
55-64
65-74
75-84
85+
ANZDATA Registry 2012 Report
METHOD AND LOCATION OF DIALYSIS
_____________________________________________________________________________________
Home RRT modalities by country
The remainder of the chapter explores differences in home-based renal replacement therapies (peritoneal
dialysis, home haemodialysis and transplantation). Figures 4.7 and 4.8 shown the distribution of prevalent renal replacement modality by country. Home dialysis therapies (HD and PD) are utilized more frequently in
New Zealand, although the prevalence of transplantation is higher in Australia.
Figure 4.7
RRT by country
Australia
New Zealand
10%
20%
5%
38%
45%
11%
40%
30%
PD
Other HD
Home HD
Graft
Modality at end 2011
Figure 4.8
Dialyis modality by country
Australia
New Zealand
19%
33%
9%
49%
72%
18%
PD
Other HD
Home HD
Modality at end 2011, dialysis only
4-5
METHOD AND LOCATION OF DIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
The variation in renal replacement therapy modality between states at the end of 2011 is shown in Figures
4.9 and 4.10. There is considerable variation in the pattern between states, both in the split of patients treated
with kidney transplantation vs dialysis and between the differing modalities of dialysis
Figure 4.9
RRT modality by state
at end 2011
100
Percent
80
60
40
20
0
NT
NSW/ACT
Vic
Qld
SA
APD
Hospital HD
Home HD
WA
Tas
NZ
CAPD
Satellite HD
Graft
Figure 4.10
RRT modality by state
at end 2011
100
Percent
80
60
40
20
0
NT
NSW/ACT
Vic
Qld
PD
Other HD
4-6
SA
WA
Tas
Home HD
NZ
ANZDATA Registry 2012 Report
METHOD AND LOCATION OF DIALYSIS
_____________________________________________________________________________________
Home Dialysis Over Time
There has been a growing interest in home therapies in recent years; the temporal trends in utilisation of
home dialysis therapies are shown in Figure 4.11. For Australia, although there has been some increase
in numbers over the last 10 years treated with both home haemodialysis and home peritoneal dialysis, this
increase is less than the overall increase in number of prevalent patients, hence the proportion treated at
home has fallen. For New Zealand, there has been continued growth in home haemodialysis over the last
5-10 years, but it can be seen the proportion of patients treated at home is also falling over time.
Figure 4.11
Australia
New Zealand
2,500
10,000
Number
2,000
1,500
5,000
1,000
500
PD
Other HD
0
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
0
Home HD
Graft
Prevalent numbers at year end
The trends in home dialysis modality utilisation between states, and across age groups, are shown in Figures
4.11 - 4.14.
There have been different patterns in utilisation of these therapies in different states. Perhaps the most striking example
is WA where there has been a large increase in the numbers receiving home HD, whereas the numbers receiving PD
treatment have been static.
For both countries strong growth is seen in numbers of home HD patients in all age groups over 45 years. In contrast,
numbers of people treated with PD are stable or in many cases falling.
4-7
METHOD AND LOCATION OF DIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Figure 4.12
PD numbers at end year
NT
NSW/ACT
40
30
20
10
0
1000
800
600
400
Number
Qld
500
400
300
200
Vic
450
400
350
300
250
SA
150
100
50
WA
250
200
150
100
1990 1995 2000 2005 2010
Tas
50
40
30
20
NZ
800
600
400
200
1990 1995 2000 2005 2010
1990 1995 2000 2005 2010
Year
ANZDATA, prevalent numbers
Figure 4.13
Home HD numbers at end year
NT
30
20
10
0
NSW/ACT
Number
220
200
180
160
140
500
450
400
350
300
Qld
200
150
100
50
SA
40
30
20
10
WA
50
40
30
20
1990 1995 2000 2005 2010
Tas
15
10
5
0
NZ
500
400
300
200
1990 1995 2000 2005 2010
1990 1995 2000 2005 2010
Year
Graphs by Current state
4-8
Vic
ANZDATA Registry 2012 Report
METHOD AND LOCATION OF DIALYSIS
_____________________________________________________________________________________
Figure 4.14
Home HD numbers at end year
0-
25-
110
100
45-
0-
350
500
80
300
400
60
25200
120
150
100
90
70
250
300
200
200
40
1991
65-
2001
2011
75-
Number
80
Number
45-
140
100
80
20
60
50
1991
65-
100
15
40
80
10
30
60
5
2001
2011
758
6
4
40
20
2
10
0
1991
2001
2011
1991
2001
2011
0
1991
2001
2011
1991
Year
2001
2011
Year
Australia prevalent numbers
Australian
prevalent numbers
NZ prevalent numbers
New Zealand prevalent numbers
Figure 4.15
PD numbers at end year
0-
25-
45-
120
350
1000
100
300
800
250
600
200
Number
60
40
400
65-
75400
500
300
400
200
300
100
2001
2011
45-
140
400
120
300
100
200
80
30
1991
600
25-
50
Number
80
060
100
1991
65-
2001
2011
7580
200
60
150
40
100
200
20
50
0
1991
2001
2011
1991
2001
2011
0
1991
2001
Year
Australia prevalent numbers
Australian prevalent numbers
2011
1991
2001
2011
Year
NZ prevalent numbers
New Zealand prevalent numbers
4-9
METHOD AND LOCATION OF DIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Figure 4.16 shows the numbers of patients (of all ages) in each state performing home dialysis modalities, compared with other (satellite and incentre) HD.
Figure 4.16
Home Modality (HD & PD) numbers by States
Current state
PD
Home HD
Other HD
Total
NT
30
27
411
468
NSW/ACT
910
489
2,420
3,819
Vic
387
191
2,115
2,693
Qld
363
184
1,458
2,005
SA
114
18
580
712
WA
219
52
826
1,097
Tas
46
11
147
204
NZ
790
433
1,158
2,381
2,859
1,405
9,115
13,379
Total
The information in figure 4.17 shows in more detail the trend in each of the home modalities by state (≥65 years)
over the past 5 years. Figure 4.16 shows the numbers receiving each of the dialysis modalities at the end of 2011
by treating jurisdiction.
Figure 4.17
Home Dialysis ≥65 years
By Australian State and Country
Year
2007
2008
2009
2010
2011
4-10
Australia
NT
NSW/ACT
Vic
Qld
SA
WA
Tas
Total
New
Zealand
PD
3
430
174
195
65
96
20
983
301
Home HD
1
88
38
28
0
0
2
157
58
PD
5
472
169
172
79
101
23
1021
281
Home HD
1
97
45
36
0
4
2
185
58
PD
5
489
164
176
74
101
21
1030
298
Home HD
1
101
43
37
0
5
2
189
66
PD
8
474
166
157
65
95
21
986
331
Home HD
1
102
47
41
3
8
4
206
70
PD
5
459
169
146
60
97
25
961
317
Home HD
1
109
47
45
4
9
4
219
78
Dialysis
CHAPTER 5
HAEMODIALYSIS
(including Home Haemodialysis)
Kevan Polkinghorne
Aarti Gulyani
Stephen McDonald
Kylie Hurst
2012 Annual Report - 35th Edition
HAEMODIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
STOCK
AND
FLOW
AUSTRALIA
The annual stock and flow of HD patients during the period
2007-2011 is shown in Figures 5.1, 5.2 and 5.3.
There were 8,929 patients receiving HD treatment at 31st
December 2011, an increase of 4%; of these 22% were
hospital based, 50% were in satellite centres and 9% at
home. Home haemodialysis is presented in detail from page
5.36.
A total of 1,811 patients received HD for the first time during
the year, a slight increase from previous years.
The proportion of all HD patients in each age group is shown
in Figure 5.7. There were 2,400 people ≥ 75 years receiving
haemodialysis, including 422 people ≥ 85 years, a rise of 7%
from 2010, following a 21% rise for the previous year.
There were 517 transplant operations to people receiving HD
treatment, 6% of all HD patients dialysing and 12% of those
patients < 65 years.
There were 1,220 deaths in 2011.
Figure 5.1
NEW ZEALAND
Stock and Flow of Haemodialysis Patients
2007 - 2011
2007
2008
2009
2010
2011
The annual stock and flow of HD patients
during the period 2007-2011 is shown in
Figures 5.1, 5.4 and 5.5.
2020
2153
2070
2036
2141
There were 1,591 patients receiving
treatment at 31st December 2011, a continuation of the trend from 2008-2010.
Australia
Patients new to HD
First Dialysis Treatment
1729
1792
1717
1722
1811
Previous Dialysis (PD)
268
321
314
279
297
Failed Transplant
23
40
39
35
33
Transplanted
405
535
495
550
517
Deaths
1163
1201
1226
1149
1220
Never Transplanted
1084
1138
1150
1081
1145
Previous Transplant
79
63
76
68
75
Transfer to PD
436
488
428
367
371
Patients Dialysing (HD) at 31 December
7593
7924
8251
8595
8929
Patients Dialysing (HD) at Home at 31 December
949
951
977
974
972
% of all Home Dialysis (HD and PD) Patients
31%
30%
31%
32%
32%
New Zealand
380
394
429
398
403
First Dialysis Treatment
311
320
360
333
313
Previous Dialysis (PD)
57
66
59
58
80
Failed Transplant
12
8
10
7
10
Transplanted
60
69
61
47
62
Deaths
Patients new to HD
177
236
205
205
229
Never Transplanted
167
219
192
182
219
Previous Transplant
10
17
13
23
10
Transfer to PD
146
158
118
162
123
Patients Dialysing (HD) at 31 December
1325
1343
1481
1553
1591
Patients Dialysing (HD) at Home at 31 December
327
331
378
424
433
% of all Home Dialysis (HD and PD) Patients
31%
30%
32%
34%
36%
5-2
Hospital based HD (44%), satellite HD
(29%) and home HD (27%) have all remained the same for the past three
years.
New Zealand is continued on page 4-5.
ANZDATA Registry 2012 Report
HAEMODIALYSIS
_____________________________________________________________________________________
Figure 5.2
Stock and Flow of Haemodialysis Patients
Australia 2007-2011
10000
8929 Patients
9000
8000
7000
6000
5000
4000
New Patients
Transplants
Perm. Transfer
Deaths
No. Dialysing
3000
2000
1000
0
2007
2008
2009
2010
2011
Figure 5.3
Stock and Flow of Haemodialysis Patients
Australia 2007 - 2011
Number (%)
Age Groups
2007
2008
2009
2010
2011
00-14 years
9 (0%)
13 (1%)
9 (0%)
14 (1%)
17 (1%)
15-24 years
45 (2%)
42 (2%)
45 (2%)
43 (2%)
43 (2%)
New Patients *
25-34 years
94 (5%)
101 (5%)
88 (4%)
78 (4%)
81 (4%)
35-44 years
187 (9%)
173 (8%)
178 (9%)
172 (8%)
196 (9%)
45-54 years
315 (16%)
345 (16%)
313 (15%)
314 (15%)
323 (15%)
55-64 years
437 (22%)
448 (21%)
447 (22%)
441 (22%)
478 (22%)
65-74 years
484 (24%)
542 (25%)
516 (25%)
482 (24%)
522 (24%)
75-84 years
405 (20%)
432 (20%)
416 (20%)
408 (20%)
418 (20%)
>=85 years
44 (2%)
57 (3%)
58 (3%)
84 (4%)
63 (3%)
2020 (100%)
2153 (100%)
2070 (100%)
2036 (100%)
2141 (100%)
00-14 years
15-24 years
25-34 years
35-44 years
45-54 years
55-64 years
65-74 years
75-84 years
>=85 years
5 (0%)
98 (1%)
305 (4%)
737 (10%)
1211 (16%)
1619 (21%)
1803 (24%)
1602 (21%)
213 (3%)
10 (0%)
88 (1%)
290 (4%)
693 (9%)
1275 (16%)
1721 (22%)
1895 (24%)
1685 (21%)
267 (3%)
9 (0%)
91 (1%)
292 (4%)
695 (8%)
1316 (16%)
1781 (22%)
1985 (24%)
1772 (21%)
310 (4%)
10 (0%)
99 (1%)
291 (3%)
694 (8%)
1314 (15%)
1861 (22%)
2064 (24%)
1871 (22%)
391 (5%)
12 (0%)
108 (1%)
285 (3%)
725 (8%)
1335 (15%)
1931 (22%)
2133 (24%)
1978 (22%)
422 (5%)
Total
7593 (100%)
7924 (100%)
8251 (100%)
8595 (100%)
8929 (100%)
484 (24%)
46 (2%)
319 (16%)
127 (6%)
56 (3%)
642 (32%)
215 (11%)
131 (6%)
463 (22%)
46 (2%)
322 (15%)
125 (6%)
59 (3%)
748 (35%)
233 (11%)
157 (7%)
506 (24%)
40 (2%)
288 (14%)
123 (6%)
61 (3%)
686 (33%)
231 (11%)
135 (7%)
426 (21%)
38 (2%)
285 (14%)
136 (7%)
43 (2%)
741 (36%)
250 (12%)
117 (6%)
477 (22%)
27 (1%)
326 (15%)
122 (6%)
49 (2%)
774 (36%)
252 (12%)
114 (5%)
2020 (100%)
2153 (100%)
2070 (100%)
2036 (100%)
2141 (100%)
Total
Patients Dialysing
Primary Renal Disease *
Glomerulonephritis
Analgesic Nephropathy
Hypertension
Polycystic Disease
Reflux Nephropathy
Diabetic Nephropathy
Miscellaneous
Uncertain
Total
* New patients receiving first haemodialysis treatment
5-3
HAEMODIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Figure 5.4
Stock and Flow of Haemodialysis Patients
New Zealand 2007-2011
1800
1591 Patients
1600
1400
1200
1000
800
New Patients
Transplants
Perm. Transfer
Deaths
No. Dialysing
600
400
200
0
2007
2008
2009
2010
2011
Figure 5.5
Stock and Flow of Haemodialysis Patients
New Zealand 2007 - 2011
Number (%)
Age Groups
New Patients *
2007
2008
2009
2010
2011
00-14 years
3 (1%)
5 (1%)
2 (0%)
1 (0%)
1 (0%)
15-24 years
21 (6%)
19 (5%)
10 (2%)
12 (3%)
15 (4%)
25-34 years
17 (4%)
15 (4%)
24 (6%)
12 (3%)
19 (5%)
35-44 years
45 (12%)
34 (9%)
54 (13%)
40 (10%)
44 (11%)
45-54 years
63 (17%)
84 (21%)
89 (21%)
97 (24%)
78 (19%)
55-64 years
100 (26%)
117 (30%)
103 (24%)
112 (28%)
105 (26%)
65-74 years
88 (23%)
89 (23%)
93 (22%)
82 (21%)
100 (25%)
75-84 years
39 (10%)
30 (8%)
51 (12%)
39 (10%)
38 (9%)
>=85 years
4 (1%)
1 (0%)
3 (1%)
3 (1%)
3 (1%)
380 (100%)
394 (100%)
429 (100%)
398 (100%)
403 (100%)
Total
Patients Dialysing
00-14 years
3 (0%)
3 (0%)
3 (0%)
4 (0%)
1 (0%)
15-24 years
39 (3%)
38 (3%)
41 (3%)
45 (3%)
40 (3%)
25-34 years
80 (6%)
76 (6%)
90 (6%)
89 (6%)
90 (6%)
35-44 years
160 (12%)
149 (11%)
162 (11%)
165 (11%)
172 (11%)
45-54 years
261 (20%)
275 (20%)
309 (21%)
329 (21%)
331 (21%)
55-64 years
364 (27%)
373 (28%)
403 (27%)
431 (28%)
448 (28%)
65-74 years
297 (22%)
293 (22%)
316 (21%)
323 (21%)
343 (22%)
75-84 years
108 (8%)
126 (9%)
146 (10%)
152 (10%)
147 (9%)
>=85 years
13 (1%)
10 (1%)
11 (1%)
15 (1%)
19 (1%)
1325 (100%)
1343 (100%)
1481 (100%)
1553 (100%)
1591 (100%)
89 (23%)
72 (18%)
97 (23%)
89 (22%)
98 (24%)
3 (1%)
1 (0%)
1 (0%)
Hypertension
43 (11%)
33 (8%)
43 (10%)
38 (10%)
41 (10%)
Polycystic Disease
15 (4%)
14 (4%)
18 (4%)
13 (3%)
19 (5%)
Reflux Nephropathy
8 (2%)
9 (2%)
3 (1%)
6 (2%)
8 (2%)
Diabetic Nephropathy
163 (43%)
204 (52%)
212 (49%)
205 (52%)
173 (43%)
Miscellaneous
47 (12%)
46 (12%)
41 (10%)
36 (9%)
39 (10%)
Uncertain
12 (3%)
15 (4%)
14 (3%)
11 (3%)
23 (6%)
380 (100%)
394 (100%)
429 (100%)
398 (100%)
403 (100%)
Total
Primary Renal Disease *
Glomerulonephritis
Analgesic Nephropathy
Total
* New patients receiving first haemodialysis treatment
5-4
2 (0%)
ANZDATA Registry 2012 Report
HAEMODIALYSIS
_____________________________________________________________________________________
Figure 5.6
Figure 5.7
Age (%) of New Haemodialysis Patients 2011
Australia
24
Number of Patients = 2141
25
Age (%) of Current Haemodialysis Patients
Australia 31-Dec-2011
22
24
Number of Patients = 8929
25
22
20
20
15
Percent
Percent
20
15
9.2
10
5
0
22
.8
2
15
15
3.8
2.9
5
15-24
1.2
.1
0
0-14
8.1
10
25-34
35-44
45-54
55-64
65-74
75-84
>=85
0-14
15-24
4.7
3.2
25-34
35-44
45-54
55-64
65-74
75-84
>=85
NEW ZEALAND (continued from page 5-2)
There were 403 patients who received HD for the first time in 2011, similar to previous years. Seventy eight percent were
having their initial dialysis treatment, 20% were previously dialysing with peritoneal dialysis and 2% were failed transplants.
The modal age group for new HD patients was 55-64 years (26%), 9% were <35 years and 35% ≥ 65 years (Figures 5.5
and 5.8). The age distribution of the prevalent HD population was similar (Figure 5.10).
There were 62 HD patients who received transplants in 2011 (47 in 2010). Four patients ≥ 65 years were transplanted.
There were 229 deaths in 2011.
Figure 5.9
Figure 5.8
Age (%) of Current Haemodialysis Patients
New Zealand 31-Dec-2011
Age (%) of New Haemodialysis Patients 2011
New Zealand
26
Number of Patients = 403
25
25
Number of Patients = 1591
20
Percent
Percent
20
11
9.4
5
2.5
.7
15-24
25-34
35-44
45-54
55-64
65-74
75-84
>=85
1.2
.1
0
0-14
9.2
5.7
4.7
.2
0
11
10
10
3.7
22
21
19
15
28
30
0-14
15-24
25-34
35-44
45-54
55-64
65-74
75-84
>=85
5-5
HAEMODIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
AUSTRALIA
Blood flow rates in Australia showed a similar picture in 2011 and continued to slowly rise. The proportion receiving a
prescribed blood flow rate of 300 mls/minute or higher was 83% in 2011.
Only 3.4% (298 patients) were prescribed < 250 mls/minute.
Blood flow rates are lower in patients dialysing using central venous catheters than in those using AVFs or AVGs
(Figure 5.11).
Figure 5.10
NEW ZEALAND
Blood Flow Rates (mls/minute) 2007 - 2011
In December 2011, 72% of
patients were prescribed
300 mls/minute or higher.
No.
Pts
*CVV HD
excluded
NR
**
December 2011
8844
0
December 2010
8581
3
December 2009
8250
December 2008
Country
There were 7% using < 250
mls/minute, many of these
were receiving long hour
HD.
Aust
NZ
Mls/Minute
<200
200-249
250-299
300-349 350-399
>400
85
28
270
1242
5163
1867
274
11
39
296
1226
4983
1721
316
1
0
47
293
1208
4742
1629
331
7923
0
1
52
350
1282
4340
1590
309
December 2007
7589
2
2
36
344
1400
4036
1479
294
December 2011
1588
0
3
4
107
330
906
222
19
December 2010
1553
0
0
5
96
393
768
259
32
December 2009
1480
1
0
4
94
368
680
300
34
December 2008
1343
0
0
6
101
426
553
232
25
December 2007
1325
0
0
6
87
381
545
278
28
Figure 5.11
Blood Flow Rate by Type of Access
December 2011
Australia
Blood
Flow Rate
AVF
<200
AVG
New Zealand
CVC*
NR**
AVF
AVG
CVC
NR**
0
10 (.1%)
1 (.1%)
17 (1.5%)
0
3 (.3%)
0
1 (.3%)
200-249
174 (2.5%)
34 (4.9%)
62 (5.3%)
0
64 (5.5%)
3 (3.8%)
40 (11.5%)
0
250-299
840 (12%)
98 (14.2%)
302 (25.9%)
2 (2.2%)
190 (16.4%)
25 (31.3%)
114 (32.9%)
1 (33.3%)
300-349
4051 (58%)
421 (61.1%)
684 (58.7%)
7 (7.9%)
671 (57.8%)
49 (61.3%)
186 (53.6%)
0
350-399
1653 (23.7%)
119 (17.3%)
93 (8%)
2 (2.2%)
213 (18.3%)
3 (3.8%)
6 (1.7%)
0
253 (3.6%)
15 (2.2%)
5 (.4%)
1 (1.1%)
19 (1.6%)
0
0
0
NR**
5 (.1%)
1 (.1%)
2 (.2%)
77 (86.5%)
1 (.1%)
0
0
2 (66.7%)
Total
6986 (100%)
689 (100%)
1165 (100%)
89 (100%)
1161 (100%)
80 (100%)
347 (100%)
3 (100%)
>=400
* Number of patients having C.V.V. HD not included. NR** - Not Reported
Figure 5.12
Figure 5.13
Distribution of Blood Flow Rates
Prevalent Haemodialysis
Australia
Distribution of Blood Flow Rates
Prevalent Haemodialysis
New Zealand
57.5 58.1 58.4
60
57.1
60
49.5
45.9
40
19.7 20.1
20
21.1
At 31 Dec
14.6 14.3 14.0
4.0 3.7 3.1
3.6 3.4 3.1
0
5-6
Percent
Percent
40
200-249
250-299
300-349
350-399
>=400
24.9 25.3
20.8
20.3
16.7
20
2011 (8844)
2010 (8581)
2009 (8250)
At 31 Dec
14.0
6.4 6.2 6.7
2.3 2.1
1.2
0
200-249
250-299
300-349
350-399
>=400
2011 (1588)
2010 (1553)
2009 (1480)
ANZDATA Registry 2012 Report
HAEMODIALYSIS
_____________________________________________________________________________________
Figure 5.14
Duration and Number of Sessions Per Week
December 2011
Sessions
Per
week
Hours of Each Treatment
<4
4
4.5
5
5.5
>5.5
Total
Not Reported
Australia
3.1-4.9
42 (7.6%)
78 (14.1%)
46 (8.3%)
126 (22.7%)
17 (3.1%)
245 (44.2%)
<=3
361 (4.4%)
3264 (40.2%)
1807 (22.2%)
2369 (29.1%)
129 (1.6%)
195 (2.4%)
>=5
70 (42.4%)
43 (26.1%)
3 (1.8%)
5 (3%)
1 (.6%)
43 (26.1%)
Not reported
1 (1.2%)
Total
473 (5.3%)
554 (100%)
2 (0%)
8127 (100%)
165 (100%)
82 (98.8%)
83 (100%)
84 (.9%)
8929 (100%)
3385 (37.9%)
1856 (20.8%)
2501 (28%)
147 (1.6%)
483 (5.4%)
43 (25.4%)
169 (100%)
1395 (100%)
New Zealand
3.1-4.9
8 (4.7%)
31 (18.3%)
18 (10.7%)
59 (34.9%)
10 (5.9%)
<=3
20 (1.4%)
455 (32.6%)
346 (24.8%)
473 (33.9%)
34 (2.4%)
67 (4.8%)
>=5
9 (37.5%)
7 (29.2%)
2 (8.3%)
2 (8.3%)
1 (4.2%)
3 (12.5%)
Not reported
1 (33.3%)
Total
37 (2.3%)
493 (31%)
366 (23%)
535 (33.6%)
45 (2.8%)
113 (7.1%)
24 (100%)
2 (66.7%)
3 (100%)
2 (.1%)
1591 (100%)
* Intermediate durations are rounded up, e.g. 4.25 is included in 4.5
Figure 5.15
FREQUENT AND LONG HAEMODIALYSIS
Haemodialysis Frequency (per Week)
December 2009 - 2011
2
7
2
6
2
6
2
9
2
9
2
11
91
92
91
89
89
88
100
(Figures 5.14 - 5.23)
The proportions of those dialysing > 3 times per week
in Australia has plateaued, with no change from 2009.
In New Zealand the proportion dialysing more than
three times per week continues to increase. The proportions dialysing ≥ 4.5 hours per session has slowly
increased. As a result, the proportions dialysing more
than the “standard” 12 hours per week continue to rise.
Percent
80
60
40
In 2011, 57% and 70% of HD patients were dialysing ≥
13.5 hours per week in Australia and New Zealand
respectively. Figures 5.16-5.20 show these from
several perspectives.
Frequency/Week
5
3.1-4.9
3
20
0
Dec 09 Dec 10 Dec 11
Dec 09 Dec 10 Dec 11
Australia
New Zealand
Figure 5.16
Figure 5.17
Haemodialysis Session Length (Hours)
December 2009 - 2011
Percent
80
60
6
2
5
2
5
2
6
2
7
3
7
3
27
28
28
31
33
34
19
20
21
19
19
Length(Hours)
40
20
0
40
5
40
5
38
5
38
3
36
3
23
31
2
Dec 09 Dec 10 Dec 11
Dec 09 Dec 10 Dec 11
Australia
New Zealand
>5.5
5.5
5
4.5
4
<4
Percent
100
Haemodialysis Duration (Hours per Week)
December 2009 - 2011
100
6
5
5
6
7
7
80
31
31
32
36
38
40
19
19
20
18
19
23
60
40
20
0
39
38
37
5
5
5
36
34
29
3
2
2
Dec 09 Dec 10 Dec 11
Dec 09 Dec 10 Dec 11
Australia
New Zealand
Hours/Week
 20
15-19.9
13.5-14.9
12-13.4
<12
5-7
HAEMODIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Figure 5.18
Percentage of Patients
Dialysing Five or More Days per Week
Australia
New Zealand
3.5
3
Percent
2.5
2
1.5
1
.5
0
Dec 04
Dec 06
Dec 08
Dec 10
Dec 04
Dec 06
Dec 08
Dec 10
Dec 05
Dec 07
Dec 09
Dec 11
Dec 05
Dec 07
Dec 09
Dec 11
Survey Period
Figure 5.19
Percentage of Patients - Dialysing 3 Days per Week
Dialysing 4.5 Hours per Session or Longer
Australia
New Zealand
Percent
65
60
55
50
45
Dec 04
Dec 06
Dec 08
Dec 10
Dec 04
Dec 06
Dec 08
Dec 10
Dec 05
Dec 07
Dec 09
Dec 11
Dec 05
Dec 07
Dec 09
Dec 11
Survey Period
Figure 5.20
Percentage of Patients
Dialysing >12 Hours per Week
Australia
New Zealand
Percent
65
60
55
50
45
Dec 04
Dec 06
Dec 08
Dec 10
Dec 04
Dec 06
Dec 08
Dec 10
Dec 05
Dec 07
Dec 09
Dec 11
Dec 05
Dec 07
Dec 09
Dec 11
Survey Period
5-8
ANZDATA Registry 2012 Report
HAEMODIALYSIS
_____________________________________________________________________________________
Dialysis frequency and session length vary among the Australian jurisdictions. Patients in Queensland and Victoria are more likely to dialyse more
frequently, while patients in New South Wales/ACT and the Northern Territory tend to dialyse longer per session on average (Figures 5.21 - 5.23).
Figure 5.21
Haemodialysis Percentage ≥ 5 Sessions per Week
By Australian State and Country
Australia
Qld
NSW/ACT
Vic
Tas
SA
NT
WA
New
Zealand
Dec-11
61 (3.7%)
24 (.8%)
50 (2.2%)
2 (1.3%)
7 (1.2%)
3 (.7%)
18 (2.1%)
24 (1.5%)
Dec-10
52 (3.2%)
25 (.9%)
48 (2.2%)
3 (2.1%)
8 (1.4%)
5 (1.2%)
15 (1.9%)
28 (1.8%)
Dec-09
41 (2.6%)
28 (1%)
40 (1.9%)
2 (1.4%)
7 (1.3%)
-
10 (1.3%)
28 (1.9%)
Dec-08
51 (3.5%)
25 (1%)
46 (2.2%)
2 (1.5%)
10 (2%)
1 (.3%)
12 (1.6%)
34 (2.5%)
Figure 5.22
Haemodialysis Percentage ≥ 4.5 Hours Per Session
Three Sessions per Week
By Australian State and Country
Australia
WA
New
Zealand
133 (22.2%) 318 (72.6%)
213 (24.3%)
916 (57.6%)
79 (54.1%)
138 (24.5%) 300 (74.8%)
201 (25%)
827 (53.4%)
663 (31.2%)
81 (54.7%)
132 (24.4%) 305 (79.6%)
192 (24.7%)
753 (50.9%)
642 (30.9%)
55 (41%)
105 (21.4%) 278 (76.8%)
176 (22.9%)
651 (48.5%)
Qld
NSW/ACT
Vic
Tas
Dec-11
840 (51.2%)
1917 (65.9%)
889 (38.6%)
100
(63.3%)
Dec-10
829 (51.1%)
1857 (65.9%)
757 (34%)
Dec-09
788 (50.3%)
1746 (64.5%)
Dec-08
727 (49.3%)
1734 (66.1%)
SA
NT
Figure 5.23
Haemodialysis Percentage >12 Hours per Week
By Australian State and Country
Australia
Qld
NSW/ACT
Vic
Tas
SA
NT
WA
New
Zealand
Dec-11
1006
(61.3%)
2176 (74.8%)
1087
(47.1%)
112 (70.9%)
160 (26.8%)
328 (74.9%)
272 (31%)
1105 (69.5%)
Dec-10
996 (61.4%)
2080 (73.8%)
959 (43%)
92 (63%)
167 (29.6%)
310 (77.3%)
255 (31.7%)
993 (64.1%)
Dec-09
964 (61.5%)
1988 (73.4%)
873 (41.1%)
92 (62.2%)
161 (29.8%)
308 (80.4%)
238 (30.7%)
905 (61.1%)
Dec-08
893 (60.5%)
1950 (74.4%)
841 (40.5%)
64 (47.8%)
131 (26.7%)
285 (78.7%)
215 (28%)
781 (58.2%)
5-9
HAEMODIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
OUTCOMES AMONG HAEMODIALYSIS PATIENTS
In Australia, there has been little change in haemodialysis patient survival over
time, after adjusting for age, diabetes status, sex, race and comorbidities.
In New Zealand, recent cohorts have slightly better survival. Unadjusted survivals are shown in Figures 5.24-5.26.
In both countries, diabetes status and age have marked effects on haemodialysis patient survival. (Figures 5.24 - 5.34).
Note: For all tables and graphs the times indicated are from the 90th day
and not the first treatment.
Figure 5.24
Haemodialysis at 90 Days Patient Survival
Censored for Transplant
2000 - 2011
% [95% Confidence Interval]
Survival
No. of
Patients
6 months
1 year
3 years
5 years
2000-2002
3144
96 [96, 97]
90 [89, 91]
68 [67, 70]
50 [48, 52]
2003-2005
3783
96 [95, 97]
90 [88, 90]
67 [66, 69]
48 [47, 50]
2006-2008
4454
96 [95, 96]
90 [89, 91]
69 [67, 70]
52 [50, 53]
2009-2011
4137
96 [96, 97]
91 [90, 92]
-
-
2000-2002
567
97 [95, 98]
93 [90, 95]
71 [67, 75]
47 [42, 51]
2003-2005
655
97 [95, 98]
90 [88, 93]
70 [66, 73]
48 [44, 52]
2006-2008
693
97 [95, 98]
92 [89, 93]
69 [65, 72]
50 [45, 55]
2009-2011
735
97 [96, 98]
94 [92, 95]
-
-
Australia
New Zealand
Figure 5.25
Figure 5.26
Patient Survival - Haemodialysis at 90 Days
2000 - 2011
Censored for Transplant - New Zealand
1.00
1.00
0.75
0.75
Patient Survival
Patient Survival
Patient Survival - Haemodialysis at 90 Days
2000 - 2011
Censored for Transplant - Australia
0.50
2000-2002 (3144)
2003-2005 (3783)
2006-2008 (4454)
2009-2011 (4137)
0.25
0.00
0
1
2000-2002 (567)
2003-2005 (655)
2006-2008 (693)
2009-2011 (735)
0.25
0.00
2
3
Years
5-10
0.50
4
5
0
1
2
3
Years
4
5
ANZDATA Registry 2012 Report
HAEMODIALYSIS
_____________________________________________________________________________________
Figures 5.27- 5.28
These figures show survival curves for patients treated with haemodialysis at day 90, adjusted to a
median age of 63.1 years for Australia and 57.2 years for New Zealand; non-diabetic primary renal
disease; caucasoid race; female gender and no comorbid conditions (lung disease, coronary artery
disease, peripheral vascular disease or cerebrovascular disease).
Note: x axis scale refers to time after day 90. PRD = Primary renal disease.
Figure 5.33-5.35 show survival stratified by age at the start of treatment.
Figure 5.27
Patient Survival - Haemodialysis at 90 Days
2000 - 2011
Censored for Transplant - Australia
Adjusted for Age,Race,Diabetic PRD,Comorbidity and Gender
Patient Survival
1.00
0.75
0.50
2000-2002 (3144)
2003-2005 (3783)
2006-2008 (4454)
2009-2011 (4137)
0.25
0.00
0
1
2
3
4
5
Years
Figure 5.28
Patient Survival - Haemodialysis at 90 Days
2000 - 2011
Censored for Transplant - New Zealand
Adjusted for Age,Race,Diabetic PRD , Comorbidity and Gender
Patient Survival
1.00
0.75
0.50
2000-2002 (567)
2003-2005 (655)
2006-2008 (693)
2009-2011 (735)
0.25
0.00
0
1
2
3
4
5
Years
5-11
HAEMODIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Figure 5.29
Haemodialysis at 90 Days
Patient Survival - Diabetic / Non Diabetic
Censored for Transplant
2000 - 2011
% [95% Confidence Interval]
Survival
No. of
Patients
6 months
1 year
3 years
5 years
Australia
Non Diabetic
10549
96 [96, 96]
90 [89, 90]
70 [69, 71]
52 [51, 53]
Diabetic
4969
97 [96, 97]
90 [89, 91]
67 [65, 68]
46 [44, 48]
Non Diabetic
1414
97 [96, 98]
92 [90, 93]
74 [71, 76]
54 [51, 58]
Diabetic
1236
97 [96, 98]
92 [90, 94]
68 [65, 70]
43 [40, 47]
New Zealand
Figure 5.30
Patient Survival - Haemodialysis at 90 Days
2000 - 2011
Censored for Transplant - Australia
Patient Survival
1.00
0.75
0.50
0.25
Non-diabetic (10549)
Diabetic (4969)
0.00
0
1
2
3
4
5
Years
Figure 5.31
Patient Survival - Haemodialysis at 90 Days
2000 - 2011
Censored for Transplant - New Zealand
Patient Survival
1.00
0.75
0.50
0.25
Non-diabetic (1414)
Diabetic (1236)
0.00
0
1
2
3
Years
5-12
4
5
ANZDATA Registry 2012 Report
HAEMODIALYSIS
_____________________________________________________________________________________
Figure 5.32
Haemodialysis at 90 Days
Patient Survival - By Age Group
Censored for Transplant
2000 - 2011
% [95% Confidence Interval]
Survival
No. of
Patients
6 months
1 year
3 years
5 years
0-39 years
1599
99 [99, 100]
97 [96, 98]
88 [86, 90]
81 [78, 84]
40-59 years
4910
98 [97, 98]
94 [93, 95]
80 [78, 81]
66 [64, 68]
60-74 years
5531
96 [95, 96]
89 [88, 89]
66 [64, 67]
46 [45, 48]
>=75 years
3478
94 [93, 94]
84 [83, 85]
52 [50, 54]
28 [27, 30]
0-39 years
361
100 [98, 100]
97 [95, 99]
83 [77, 87]
71 [64, 78]
40-59 years
1130
97 [96, 98]
94 [93, 95]
79 [76, 82]
57 [53, 60]
60-74 years
931
96 [95, 97]
90 [88, 92]
64 [60, 67]
40 [36, 44]
>=75 years
228
95 [91, 97]
81 [76, 86]
43 [35, 50]
18 [12, 25]
Age Groups
Australia
New Zealand
Figure 5.33
Patient Survival - Haemodialysis at 90 Days
2000 - 2011
Censored for Transplant - Australia
Patient Survival
1.00
0.75
0.50
Age
<40 (1599)
40-59 (4910)
60-74 (5531)
>=75 (3478)
0.25
0.00
0
1
2
3
4
5
Years
Figure 5.34
Patient Survival - Haemodialysis at 90 Days
2000 - 2011
Censored for Transplant - New Zealand
Patient Survival
1.00
0.75
0.50
Age
<40 (361)
40-59 (1130)
60-74 (931)
>=75 (228)
0.25
0.00
0
1
2
3
4
5
Years
5-13
HAEMODIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
MEMBRANE TYPE AND SURFACE
AREAS
AUSTRALIA
Figure 5.35
Haemodialyser Membrane Types
by Surface Area 31-DEC-2011
Figures 5.35 - 5.38.
Usage of low flux polysulfone dialysers was 1% in
2011, (2% in December 2010, 5% in 2009 and
2008).While the use of high flux polysulphone continues to decrease (1% in 2011, 2010 and 2009,
1.5% in 2008, 7% in both 2007 and 2006, 9% in
2005 and 39% in 2004.
Dialyser Membrane
Type
Flux
Square Metres
<1.0
1.0-1.4 1.5-1.7 1.8-1.9
Total
>1.9
Australia
High flux Polysulphone-Helixone increased to 63%
in December 2011 from 57% in 2010, 53% in
2009, 49% in 2008 and 39% in 2007. High flux
Polyamix increased to 33% this year from 32% last
year and 29% in 2009.
There were 99% of patients receiving dialysis with
high flux dialysers in 2011 (96% in 2010, 88% in
2009, 81% in 2008 and 72% in 2007).
NEW ZEALAND Figures 5.36 and 5.39.
Cellulose Triacetate
High
.
.
2
11
41
54
Diacetate
Low
.
.
.
.
1
1
Polyamix
High
5
37
665
.
2205
2912
Polyamix
Low
.
6
25
.
23
54
Polyethersulfone
High
.
.
3
6
91
100
Polynephron
High
.
.
.
.
77
77
Polysulphone
High
1
6
.
7
2
16
Polysulphone
Low
1
3
.
22
43
69
Polysulphone-Helixone
High
2
591
.
3290
1680
5563
Polysynthane
Low
Total
Low flux polysulphone decreased to 11% in December 2011, from 13% and 19% in December
2010 and 2009 respectively.
.
.
.
.
1
1
9
643
695
3336
4164
8847
New Zealand
There were 77% (1217 patients) reported as receiving dialysis with high flux dialysers in December 2011, an increase from 72% (1104 patients) in
2010 and 62%(911 patients) in 2009.
Polyamix
High
.
3
49
.
440
492
Polyamix
Low
.
3
57
.
130
190
Polysulphone
Low
.
1
.
79
102
182
Polysulphone-Helixone
High
.
363
.
267
95
725
.
370
106
346
767
1589
Total
Figure 5.36
Number of Patients at end of 2011 by HD Modality
NT
NSW/ACT
VIC
QLD
SA
WA
TAS
NZ
Total
426
2499
2287
1380
459
680
123
1243
9097
HAEMOFILTRATION
0
0
0
0
0
4
4
3
11
HAEMODIAFILTRATION
9
379
19
262
139
125
31
342
1306
435
2898
2306
1642
598
809
158
1588
10434
HAEMODIALYSIS-HOLLOW FIBRE
DIALYSERS
Total
Figure 5.37
Figure 5.38
Haemodialysis Surface Area
New Zealand
40
20
33.7
35.9
18.8
21.8
19
Percent
30
20
0
5-14
<=1.2 1.25
1.3
1.7
1.8
1.9
2.1
2.2
2.4
2.5
0
7.4
6.4
4.5
6
6.7
8.3
<=1.2 1.25
.4
.2
.1
.1
.6
.9
.5
1.3
1.3
1.4
.2
9.3
10
.3
.1
.1
0
.1
.1
10
7.9
8.9
7.1
12.7
Percent
30
Dec 2010 (1550)
Dec 2011 (1589)
26.8
27.8
26.7
Dec 2010 (8581)
Dec 2011 (8847)
23
40
37.7
37.5
Haemodialysis Surface Area
Australia
1.3
1.4
1.7
1.8
1.9
2.1
2.2
2.4
2.5
ANZDATA Registry 2012 Report
HAEMODIALYSIS
_____________________________________________________________________________________
ANAEMIA
In Australia, mean haemoglobin and erythropoietic agent use has gradually reduced. Haemodialysis patients had a higher erythropoietic agent usage despite a similar mean haemoglobin compared to peritoneal dialysis patients (Figures 5.39 - 5.40).
In New Zealand, mean haemoglobin has stabilised at 114 g/L. The increase in erythropoietic agent usage
seen over 2004-2011 has reached a plateau.
Figure 5.39
Mean Haemoglobin Among Dialysis Patients
By Survey Period
Australia
New Zealand
Mean Hb(g/L)
120
115
110
105
100
Dec 04 Dec 06 Dec 08 Dec 10 Dec 04 Dec 06 Dec 08 Dec 10
Dec 05 Dec 07 Dec 09 Dec 11 Dec 05 Dec 07 Dec 09 Dec 11
Survey Period
PD
HD
Figure 5.40
Use of Erythropoietic Agents
By Survey Period
Australia
New Zealand
100
90
Percent
80
70
60
50
40
30
Dec 04 Dec 06 Dec 08 Dec 10 Dec 04 Dec 06 Dec 08 Dec 10
Dec 05 Dec 07 Dec 09 Dec 11 Dec 05 Dec 07 Dec 09 Dec 11
Survey Period
PD
HD
5-15
HAEMODIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
HAEMOGLOBIN
In Australia, among patients dialysing at 31 December 2011, haemoglobin is <110 g/L in 41%
and >140g/L in 3% of haemodialysis patients, which is the same as the previous two years.
In New Zealand, the corresponding percentages are 44% and 4% respectively. Figure 5.42
shows the proportion of patients with proven or likely cardiovascular disease reported as a
comorbidity to the Registry, achieving the clinical target of haemoglobin ≤ 120 g/L.
Figure 5.41
Haemoglobin - Haemodialysis
December 2009-2011
Percent
Hb(g/L)
<110
110-119
4
10
3
8
3
8
22
21
19
30
30
39
Dec 10
30
35
Dec 09
120-129
130-139
140
5
10
4
8
4
9
22
21
18
25
26
25
41
38
41
44
Dec 11
Dec 09
Dec 10
Dec 11
Australia
New Zealand
Figure 5.42
Haemoglobin - Haemodialysis
By Coronary Artery Disease Status
Australia - December 2009-2011
Percent
33
32
34
Dec 09
Hb(g/L)
110-120
120
33
29
26
32
33
34
29
27
32
32
39
41
35
38
Dec 10
Dec 11
Dec 09
Dec 10
No CAD
5-16
<110
CAD
<110
32
29
26
27
28
28
40
41
43
46
Dec 11
Dec 09
Dec 10
Dec 11
Percent
Hb(g/L)
Haemoglobin - Haemodialysis
By Coronary Artery Disease Status
New Zealand - December 2009-2011
No CAD
110-120
120
36
32
30
28
29
28
36
39
42
Dec 09
Dec 10
Dec 11
CAD
ANZDATA Registry 2012 Report
HAEMODIALYSIS
_____________________________________________________________________________________
HAEMOGLOBIN
BY
TREATING CENTRE
Figures 5.43- 5.46
The first 2 figures show the median haemoglobin (with inter-quartile range) for individual centres, arranged from lowest to highest. Also shown are the proportion of patients in each centre with a haemoglobin of 110-129 g/L.
In Australia, median haemoglobin for each centre ranged from 105 to 125 g/L for haemodialysis patients
and in New Zealand 107-118 g/L.
The proportion of patients in Australia with a haemoglobin of 110-129 g/L in each centre ranged from
30% to 76% for haemodialysis patients and for New Zealand 28% to 55%. For Figures 5.45 and 5.46
the error bars show the 95% confidence intervals.
Figure 5.43
Figure 5.44
Haemoglobin in Haemodialysis Patients
Haemoglobin in Haemodialysis Patients
New Zealand 31 December 2011
140
130
130
Median Hb (g/L)
Median Hb (g/L)
Australia 31 December 2011
140
120
110
120
110
100
100
90
90
Excludes hospitals with <10 patients
0
5
10
15
20
25
30
35
40
45
50
55
60
65
Excludes hospitals with <10 patients
0
70
1
2
3
4
Figure 5.45
6
7
8
9
10
Figure 5.46
% Haemodialysis Patients with Hb 110-129 g/L
% Haemodialysis Patients with Hb 110-129 g/L
Australia 31 December 2011
New Zealand 31 December 2011
100
100
90
90
80
80
70
70
60
60
Percent
Percent
5
Caring Hospital
Caring Hospital
50
40
50
40
30
30
20
20
10
10
0
0
Excludes hospitals with <10 patients
0
5
10
15
20
25
30
35
40
Caring Hospital
45
50
55
60
65
70
Excludes hospitals with <10 patients
0
1
2
3
4
5
6
7
8
9
10
Caring Hospital
5-17
HAEMODIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
FERRITIN
AND
TRANSFERRIN SATURATION
Figures 5.47 - 5.48
In Australia and New Zealand the proportions of haemodialysis patients with ferritin <200 mcg/L
and those with ferritin ≥ 500 mcg/L have been relatively stable.
In both Australia distributions of transferrin saturation have been unchanged for the past three
years, while in New Zealand the proportion with a transferrin saturation <20 has increased.
Figure 5.47
Percent
Ferritin - Haemodialysis
December 2009-2011
g/L
<100
17
19
17
17
15
15
24
23
22
23
23
20
37
37
39
35
34
35
12
10
12
10
11
11
11
13
14
13
13
18
Dec 09
Dec 10
Dec 11
Dec 09
Dec 10
Dec 11
100-199
200-499
500-799
Australia
800
New Zealand
Figure 5.48
Transferrin Saturation - Haemodialysis
December 2009-2011
T/Sat(%)
Percent
14
13
13
20-29
30-39
40
19
19
19
18
37
37
37
37
39
30
31
31
30
31
Dec 10
Dec 11
Dec 09
Australia
8
12
14
19
Dec 09
5-18
<20
Dec 10
17
37
38
Dec 11
New Zealand
ANZDATA Registry 2012 Report
HAEMODIALYSIS
_____________________________________________________________________________________
FERRITIN
BY
TREATING CENTRE
Figures 5.49 - 5.52
These figures show the proportions of patients in each centre with ferritin of 200-500 mcg/L and transferrin saturation of
>20% respectively, as recommended by the CARI guidelines.
In Australia, the proportions of patients with ferritin within this range in each centre varied widely between 2-72% for haemodialysis patients. Similarly large variations between centres were seen for transferrin saturation, between 26-95%.
Again, this large variation probably reflects differences in practices, protocols and patient case-mix among centres.
In New Zealand, the corresponding figures for ferritin were between 21-50% for haemodialysis patients and the corresponding figures for transferrin saturation were between 32-72%. In both countries, significant proportions of patients did
not have ferritin and transferrin saturation within the recommended ranges, even in the “best performing” centres.
Figure 5.50
Figure 5.49
% Haemodialysis Patients
with Ferritin 200-500 g/L
% Haemodialysis Patients
with Ferritin 200-500 g/L
New Zealand 31 December 2011
Percent
Percent
Australia 31 December 2011
100
90
80
70
60
50
40
30
20
10
0
Excludes hospitals with <10 patients
0
5
10
15
20
25
30
35
40
45
50
55
60
65
100
90
80
70
60
50
40
30
20
10
0
Excludes hospitals with <10 patients
0
70
1
2
3
Figure 5.51
5
6
7
8
9
10
Figure 5.52
% Haemodialysis Patients with TSat >20%
% Haemodialysis Patients with TSat >20%
Australia 31 December 2011
New Zealand 31 December 2011
100
100
90
90
80
80
70
70
60
60
Percent
Percent
4
Caring Hospital
Caring Hospital
50
40
50
40
30
30
20
20
10
10
0
Excludes hospitals with <10 patients
0
5
10
15
20
25
30
35
40
Caring Hospital
0
45
50
55
60
65
70
Excludes hospitals with <10 patients
0
1
2
3
4
5
6
7
8
9
10
Caring Hospital
5-19
HAEMODIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
SERUM CALCIUM
Figure 5.53
In Australia the proportions of patients with serum calcium ≥ 2.4 mmol/L has stabilised, while, in New
Zealand it has increased marginally. Those with < 2.2 mmol/L have increased slightly in Australia,
but remained fairly stable in New Zealand.
Figure 5.53
Serum Calcium - Haemodialysis
December 2009-2011
Calcium
(mmol/L)
4
18
5
20
Percent
<2.0
2.2-2.3
4
18
12
11
12
28
28
30
38
37
36
18
6
17
6
Dec 10
Dec 11
27
27
28
8
8
9
17
5
Dec 10
Dec 11
Dec 09
Dec 09
2.6
2.4-2.5
42
42
41
2.0-2.1
Australia
New Zealand
SERUM CALCIUM BY TREATING CENTRE
Figures 5.54 and 5.55 show the proportions of patients at each centre with serum calcium 2.1
-2.4 mmol/L, as recommended by the CARI guidelines. Note: however, that the values in the
guidelines are for corrected total calcium, while those in this report are for uncorrected total
calcium.
In Australia, the proportions ranged widely between 25-94% for haemodialysis patients, while
in New Zealand the corresponding proportions were 32-70%.
Figure 5.55
Figure 5.54
% Haemodialysis Patients
with Calcium 2.1-2.4 mmol/L
% Haemodialysis Patients with
Calcium 2.1-2.4 mmol/L
Excludes hospitals with <10 patients
0
5
10
15
20
25
30
35
40
Caring Hospital
5-20
New Zealand 31 December 2011
Percent
Percent
Australia 31 December 2011
100
90
80
70
60
50
40
30
20
10
0
45
50
55
60
65
70
100
90
80
70
60
50
40
30
20
10
0
Excludes hospitals with <10 patients
0
1
2
3
4
5
6
Caring Hospital
7
8
9
10
ANZDATA Registry 2012 Report
HAEMODIALYSIS
_____________________________________________________________________________________
SERUM PHOSPHATE
Figure 5.56
In Australia, the control of serum phosphate has stabilised after a period of steady
improvements. In New Zealand, the proportion with serum phosphate > 1.8 mmol/L
has largely remained stable.
Figure 5.56
Serum Phosphate - Haemodialysis
December 2009-2011
Percent
Phosphate (mmol/L)
<1.4
33
32
33
14
14
13
16
16
17
36
38
36
Dec 10
Dec 11
Dec 09
1.4-1.5
1.6-1.7
47
46
47
16
15
13
13
15
15
25
24
25
Dec 10
Dec 11
Dec 09
Australia
1.8
New Zealand
SERUM PHOSPHATE
BY
TREATING CENTRE
Figures 5.57 - 5.58 show the proportions of patients at each centre with serum phosphate 0.8-1.6
mmol/L, as recommended by the CARI guidelines.
In Australia, the proportions ranged widely between 30-72% for haemodialysis patients and in
New Zealand, the corresponding proportions were 29-65%.
Figure 5.57
Figure 5.58
% Haemodialysis Patients with
Phosphate 0.8-1.6 mmol/L
% Haemodialysis Patients with
Phosphate 0.8-1.6 mmol/L
New Zealand 31 December 2011
Percent
Percent
Australia 31 December 2011
100
90
80
70
60
50
40
30
20
10
0
Excludes hospitals with <10 patients
0
5
10
15
20
25
30
35
40
Caring Hospital
45
50
55
60
65
70
100
90
80
70
60
50
40
30
20
10
0
Excludes hospitals with <10 patients
0
1
2
3
4
5
6
7
8
9
10
Caring Hospital
5-21
HAEMODIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
CALCIUM-PHOSPHATE PRODUCT
Figure 5.59
In both Australia and New Zealand, improvements in the calcium-phosphate product seen over the
last few years have plateaued.
Overall, the proportion of people with high calcium-phosphate product was substantially higher in
New Zealand than Australia.
Figure 5.59
Calcium Phosphate Product - Haemodialysis
December 2009-2011
2
2
Percent
Ca X PO4 (mmol /L )
<3.5
14
9
12
13
8
12
14
9
11
16
16
15
51
50
Dec 09
51
Dec 10
Dec 11
3.5-3.9
4.0-4.4
4.5-4.9
5.0
26
24
26
11
12
12
15
15
13
14
17
15
34
32
34
Dec 10
Dec 11
Dec 09
Australia
New Zealand
CALCIUM-PHOSPHATE PRODUCT
BY
TREATING CENTRE
Figures 5.60 - 5.61 show the proportions of patients at each centre with calcium-phosphate
product <4.0 mmol2/L2, as recommended by the CARI guidelines.
In Australia, the proportions ranged widely between 45-80% for haemodialysis patients while
in New Zealand, the corresponding proportions were 35-65%.
Figure 5.61
Figure 5.60
% Haemodialysis Patients
with
2 2
Ca X PO4 < 4.0 mmol /L
% Haemodialysis Patients
with
2 2
Ca X PO4 < 4.0 mmol /L
Excludes hospitals with <10 patients
0
5
10
15
20
25
30
35
40
Caring Hospital
5-22
New Zealand 31 December 2011
Percent
Percent
Australia 31 December 2011
100
90
80
70
60
50
40
30
20
10
0
45
50
55
60
65
70
100
90
80
70
60
50
40
30
20
10
0
Excludes hospitals with <10 patients
0
1
2
3
4
5
6
Caring Hospital
7
8
9
10
ANZDATA Registry 2012 Report
HAEMODIALYSIS
_____________________________________________________________________________________
UREA REDUCTION RATIO
Figures 5.62 and 5.64
Distributions of URR values have shown an increase in those in higher URR groups the past three years. About
8% and 25% of patients on haemodialysis three times a week have URR <65% in Australia and New Zealand
respectively.
URR is highest in patients dialysing with an AV graft and lowest in those using catheters Figure 5.63.Of those
with URR < 65%, 14% in Australia and 36% in New Zealand had CVC access.
Figure 5.62
Figure 5.63
Urea Reduction Ratio
Urea Reduction Ratio
Related to Type of Access
HD Three Sessions per Week
URR (%)
<60
60-64
65-69
70-74
75-79
12
14
15
15
HD Three Sessions per Week - December 2011
80-100
URR (%)
26
25
28
30
28
22
26
24
24
14
6
3
11
5
3
11
5
3
Dec 09
Dec 10
Dec 11
15
22
21
19
16
15
22
19
15
15
13
12
Dec 09
Dec 10
Dec 11
Australia
30
Percent
Percent
26
<60
60-64
65-69
70-74
75-79
80-100
22
20
17
21
15
22
23
24
21
19
19
14
13
10
13
5
22
AVG
CVC
19
27
24
11
4
3
AVF
New Zealand
41
24
25
20
8
3
4
16
9
7
AVG
CVC
Australia
AVF
12
13
18
New Zealand
Figure 5.64
Urea Reduction Ratio - Prevalent Patients
Three Sessions per Week - December 2011
Urea Reduction Ratio %
Hours per Session
< 65
>=65
Total
Australia
<4 hours
41 (13.4%) 265 (86.6%) 306 4 hours
266 (8.9%) 2725 (91.1%) 2991 >4-5 hours
282 (7.3%) 3575 (92.7%) 3857 >5 hours
23 (9.6%) 217 (90.4%) 240 Total
612 (8.3%) 6782 (91.7%) 7394 New Zealand
<4 hours
8 (44.4%) 10 (55.6%) 18 4 hours
104 (26.0%) 296 (74.0%) 400 >4-5 hours
174 (24.0%) 550 (76.0%) 724 >5 hours
17 (20.7%) 65 (79.3%) 82 Total
303 (24.8%) 921 (75.2%) 1224 5-23
HAEMODIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
UREA REDUCTION RATIO
BY
TREATING CENTRE
Figures 5.65 and 5.66 show the median URR in each hospital and Figures 5.67 and 5.68 show the proportions of haemodialysis patients dialysing three times per week in each hospital with URR > 70%, the target recommended by the CARI guidelines.
Median URR values in the respective countries did not vary greatly: 70-82% in Australia and 67-85% in New Zealand. However, the proportions with URR >70% in each unit varied widely, from 55-97% in Australia and 35-95% in New Zealand.
Figure 5.65
Figure 5.66
Median URR in Haemodialysis Patients
(Three Sessions per Week)
Median URR in Haemodialysis Patients
(Three Sessions per Week)
Australia 31 December 2011
New Zealand 31 December 2011
90
90
Median URR(%)
100
Median URR(%)
100
80
70
60
50
Excludes hospitals with <10 patients
0
5
10
15
20
25
30
35
40
80
70
60
50
45
50
55
60
65
70
Excludes hospitals with <10 patients
0
1
2
Caring Hospital
Percent
Percent
7
8
New Zealand 31 December 2011
Excludes hospitals with <10 patients
10
15
20
25
30
35
40
Caring Hospital
5-24
6
% Haemodialysis Patients with URR>70%
(Three Sessions per Week)
Australia 31 December 2011
5
5
Figure 5.68
% Haemodialysis Patients with URR>70%
(Three Sessions per Week)
0
4
Caring Hospital
Figure 5.67
100
90
80
70
60
50
40
30
20
10
0
3
45
50
55
60
65
70
100
90
80
70
60
50
40
30
20
10
0
Excludes hospitals with <10 patients
0
1
2
3
4
Caring Hospital
5
6
7
8
ANZDATA Registry 2012 Report
HAEMODIALYSIS
_____________________________________________________________________________________
VASCULAR ACCESS
AT
FIRST TREATMENT
Figures 5.69 to 5.78
The proportion of patients starting haemodialysis with an AVF has continued to rise in both Australia and New Zealand
although the majority of patients still commence with a catheter.
In Australia, tunnelled catheters were more common than non-tunnelled, but the reverse was true in New Zealand.
Female, young (age <25years) patients and those patients who were first seen by nephrologists < 3 months before starting
haemodialysis (“late referrals”) were less likely to start with an AVF or AVG.
In both Australian and New Zealand indigenous peoples had similar or decreased rates of AVF or AVG at the commencement of dialysis.
ANZDATA does not collect information about indication for HD catheter usage, hence the reason less than half of non-late
referred patients commence with a central venous catheter is not known.
Figure 5.69
Figure 5.70
Vascular Access - Initial RRT
Haemodialysis at Initial Modality
AVG
18
22
Tunnel Catheter
Non-Tunnel Catheter
12
17
Percent
44
39
2
38
42
2
2
37
41
2008
2009
AVF
41
45
42
2
38
44
2010
2011
33
29
2
30
2
29
1
50
1
22
29
23
29
2
20
2008
2009
2010
2011
<25
Australia
37
2008
42
1
2
50
41
38
27
29
1
1
26
31
32
0
21
53
47
2
45
50
40
25-54 55-74 >=75
0
<25
25-54 55-74 >=75
New Zealand
Vascular Access - Initial RRT
By Diabetic Status - New Zealand
AVG
19
Tunnel Catheter
16
12
AVF
Non-Tunnel Catheter
23
18
18
37
2
43
2009
43
2
38
42
2
44
2010 2011
Non Diabetic
43
39
42
3
3
2
36
40
38
43
2010
2011
39
2008 2009
Diabetic
AVG
Tunnel Catheter
Non-Tunnel Catheter
12
2
Percent
Percent
2
11
Figure 5.72
44
39
39
Non-Tunnel Catheter
Australia
Vascular Access - Initial RRT
By Diabetic Status - Australia
21
Tunnel Catheter
12
47
New Zealand
Figure 5.71
AVF
AVG
13
27
41
Percent
AVF
Vascular Access - Initial RRT
By Age Group 2011
39
45
45
45
41
29
26
29
30
1
1
0
1
30
25
28
26
28
2009
2010
2011
2008
2009
27
38
2
16
2008
3
Non Diabetic
45
31
3
21
2010
38
32
1
29
2011
Diabetic
5-25
HAEMODIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
VASCULAR ACCESS
Figure 5.73
AT
FIRST TREATMENT
Figure 5.74
Vascular Access - Initial RRT
By Gender - Australia
AVG
18
41
42
3
4
19
43
3
11
Non-Tunnel Catheter
47
37
2
17
19
22
42
2
1
40
1
33
38
34
40
39
44
40
2008
2009
2010
2011
2008
2009
2010
2011
32
1
2008
Tunnel Catheter
32
37
3
3
51
49
2009
2010
35
32
40
34
2
54
2009
2011
0
10
0
12
0
8
2008
2009
2010
2009
Tunnel Catheter
0
3
0
2010
2011
30
2011
2008
67
67
70
38
29
29
30
2009
1
3
0
4
2011
2008
2009
59
25
1
3
36
1
14
Non-Tunnel Catheter
35
30
3
1
30
2010
Early
38
0
3
0
2010
2011
Late
Figure 5.78
Vascular Access - Initial RRT
By BMI - 2011
Asian
Caucasian
Maori Pacific People
New Zealand
Australia
27
2
34
37
id
ly
O
be
se
23
0
se
27
0
28
ei
gh
t
ht
ei
g
0
15
al
0
44
or
b
33
33
44
O
be
39
er
w
43
67
m
51
39
46
O
ve
rw
49
1
Non-Tunnel Catheter
N
or
3
U
nd
1
22
1
se
34
37
se
30
29
43
38
O
be
0
8
O
be
1
0
29
12
id
ly
25
13
2
al
39
29
Tunnel Catheter
M
ATSI
Australia
2
46
52
O
ve
rw
44
47
ht
1
47
m
40
13
19
42
AVG
or
b
11
N
or
15
AVF
Non-Tunnel Catheter
ei
g
12
Tunnel Catheter
Percent
AVG
er
w
AVF
U
nd
Percent
0
4
2008
38
29
34
Late
40
5-26
1
3
2011
38
Late
32
Vascular Access - Initial RRT
By Racial Origin - 2011
Caucasian
30
AVG
35
58
Figure 5.77
45
2010
AVF
21
64
55
50
Early
2
29
30
Vascular Access - Initial RRT
By Referral Time - New Zealand
Non-Tunnel Catheter
9
12
14
42
29
1
M
Percent
2008
38
59
25
Early
Percent
AVG
47
70
Figure 5.76
AVF
3
67
3
36
30
67
30
3
Vascular Access - Initial RRT
By Referral Time - Australia
35
Non-Tunnel Catheter
35
38
29
34
Male
Figure 5.75
15
Tunnel Catheter
13
46
Female
AVG
35
36
1
AVF
ei
gh
t
Percent
21
Tunnel Catheter
Percent
AVF
Vascular Access - Initial RRT
By Referral Time - New Zealand
New Zealand
ANZDATA Registry 2012 Report
HAEMODIALYSIS
_____________________________________________________________________________________
VASCULAR ACCESS
AT
FIRST TREATMENT
Figure 5.79
Vascular Access at First Treatment
Haemodialysis as Initial Modality 1-Jan-2008 to 31-Dec-2011
2008
2009
2010
2011
AVF or AVG
CVC
AVF or AVG
CVC
AVF or AVG
CVC
AVF or AVG
CVC
QLD
139 (36%) 250 (64%) 152 (41%) 219 (59%) 138 (40%) 207 (60%) 131 (40%) 197 (60%) NSW/ACT
189 (34%) 374 (66%) 185 (37%) 316 (63%) 200 (37%) 339 (63%) 223 (39%) 347 (61%) Vic
185 (47%) 212 (53%) 214 (50%) 216 (50%) 200 (45%) 246 (55%) 230 (51%) 223 (49%) Tas
12 (35%) 22 (65%) 16 (43%) 21 (57%) 19 (61%) 12 (39%) 19 (61%) 12 (39%) SA
70 (53%) 61 (47%) 89 (61%) 58 (39%) 55 (40%) 82 (60%) 91 (68%) 42 (32%) NT
39 (49%) 41 (51%) 27 (46%) 32 (54%) 25 (45%) 30 (55%) 38 (49%) 40 (51%) WA
67 (34%) 131 (66%) 66 (38%) 106 (62%) 52 (31%) 114 (69%) 86 (41%) 124 (59%) 73 (23%) 247 (77%) 111 (31%) 249 (69%) 83 (25%) 250 (75%) 93 (30%) 220 (70%) Australia
New Zealand
Figures 5.80 and 5.81 show the proportion of patients of each hospital starting haemodialysis with AVF/AVG, arranged
from the lowest to the highest. In Australia, this ranged widely from 0-80%. The corresponding range in New Zealand was
9-45%. This wide variation reflects differences in practices, protocols, resources and patient case-mix among centres.
Figure 5.80
Figure 5.81
% New HD Patients Starting with AVF/AVG
New Zealand 1 Jan 2011 - 31 Dec 2011
100
100
90
90
80
80
70
70
60
60
Percent
Percent
% New HD Patients Starting with AVF/AVG
Australia 1 Jan 2011 - 31 Dec 2011
50
40
50
40
30
30
20
20
10
10
0
Excludes hospitals with <10 patients
0
5
10
15
20
25
30
Caring Hospital
0
35
40
45
50
Excludes hospitals with <10 patients
0
1
2
3
4
5
6
7
8
9
10
Caring Hospital
5-27
HAEMODIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
PREVALENT HAEMODIALYSIS ACCESS
Figures 5.82 - 5.88
In both Australia and New Zealand, the proportions of patients dialysing with an AV graft at 31 December
2011 are declining, while those dialysing with an AV fistulas are stable. The proportions dialysing with catheters have also stabilised.
Female patients in both countries, young (age < 25 years) in Australia or old (age ≥75 years) patients in
New Zealand were less likely to be dialysing with an AVF or AVG.
Figure 5.82
Prevalent Haemodialysis Access
Percent
AVF
AVG
Tunnel Catheter
0
14
0
14
0
13
10
9
9
77
76
78
0
13
8
79
Non-Tunnel Catheter
2
1
1
25
23
21
21
6
5
5
5
67
70
73
73
1
Dec 08 Dec 09 Dec 10 Dec 11
Dec 08 Dec 09 Dec 10 Dec 11
Australia
New Zealand
Figure 5.83
Prevalent Haemodialysis Access
By Age Group - December 2011
AVF
1
22
AVG
0
12
6
Percent
5
72
<25
Tunnel Catheter
0
13
8
2
24
5
81
79
77
25-54 55-74 >=75
Australia
5-28
0
13
9
Non-Tunnel Catheter
68
<25
1
21
1
18
4
5
1
31
7
74
75
61
25-54 55-74 >=75
New Zealand
ANZDATA Registry 2012 Report
HAEMODIALYSIS
_____________________________________________________________________________________
PREVALENT HAEMODIALYSIS ACCESS
Figure 5.85
Figure 5.84
Prevalent Haemodialysis Access
By Diabetic Status - New Zealand
Prevalent Haemodialysis Access
By Diabetic Status - Australia
Percent
0
13
11
AVG
0
13
10
77
76
Tunnel Catheter
0
12
8
0
12
9
80
79
AVF
Non-Tunnel Catheter
0
16
0
15
0
16
9
9
8
75
76
0
14
7
78
76
AVG
1
1
25
24
6
6
68
69
Percent
AVF
Tunnel Catheter
0
20
1
19
5
5
75
75
Non-Tunnel Catheter
2
3
2
25
22
23
1
22
5
5
5
5
67
71
71
71
Dec 08 Dec 09 Dec 10 Dec 11
Dec 08 Dec 09 Dec 10 Dec 11
Dec 08 Dec 09 Dec 10 Dec 11
Dec 08 Dec 09 Dec 10 Dec 11
Non Diabetic
Diabetic
Non Diabetic
Diabetic
Figure 5.86
Figure 5.87
Prevalent Haemodialysis Access
By Gender - Australia
AVG
Tunnel Catheter
0
17
0
16
0
16
14
13
13
11
Percent
0
18
68
69
71
73
Non-Tunnel Catheter
0
12
7
0
12
7
81
81
0
12
6
AVF
0
11
6
Percent
AVF
Prevalent Haemodialysis Access
By Gender - New Zealand
83
82
AVG
Tunnel Catheter
2
2
1
1
31
28
28
25
8
8
8
7
59
63
63
68
Non-Tunnel Catheter
1
22
2
20
4
4
73
74
0
17
3
1
18
4
79
77
Dec 08 Dec 09 Dec 10 Dec 11
Dec 08 Dec 09 Dec 10 Dec 11
Dec 08 Dec 09 Dec 10 Dec 11
Dec 08 Dec 09 Dec 10 Dec 11
Female
Male
Female
Male
Figure 5.88
Prevalent Haemodialysis Access
By BMI - 2011
AVG
1
19
10
0
14
7
70
79
0
12
8
80
Tunnel Catheter
0
12
8
79
0
12
8
79
0
48
2
27
7
1
21
3
1
17
5
1
15
5
64
76
77
79
U
nd
er
w
ei
gh
t
N
or
m
al
O
ve
rw
ei
gh
t
O
M
b
es
or
bi
e
dl
y
O
be
se
O
M
be
or
se
bi
dl
y
O
be
se
Australia
Non-Tunnel Catheter
4
48
U
nd
er
w
ei
gh
t
N
or
m
al
O
ve
rw
ei
gh
t
Percent
AVF
New Zealand
5-29
HAEMODIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
PREVALENT HAEMODIALYSIS ACCESS
Figures 5.89- 5.90. These show dialysis access among prevalent (rather than incident) patients (those receiving haemodialysis at 31 December 2011).
In Australia indigenous people were more likely to dialyse with an AVF. In New Zealand, Maori
and Pacific people were more likely to dialyse with an AVF.
Patients on home haemodialysis have the highest rate of AVF use in both Australia and New
Zealand.
Figure 5.89
Prevalent Haemodialysis Access
By Racial Origin - December 2011
AVF
AVG
0
13
9
1
12
3
Tunnel Catheter
1
12
7
Non-Tunnel Catheter
0
18
2
23
Percent
7
78
Caucasian
84
81
ATSI
Asian
69
Caucasian
Australia
7
0
21
2
74
76
Maori Pacific People
New Zealand
Figure 5.90
Prevalent Haemodialysis Access
By Facility - December 2011
AVF
AVG
1
22
0
11
8
Tunnel Catheter
0
3
8
2
33
6
0
12
4
0
5
8
84
86
Sat HD
Home HD
Percent
4
71
Hosp HD
81
90
61
Sat HD
Australia
5-30
Non-Tunnel Catheter
Home HD
Hosp HD
New Zealand
ANZDATA Registry 2012 Report
HAEMODIALYSIS
_____________________________________________________________________________________
PREVALENT HAEMODIALYSIS ACCESS
Figures 5.91 - 5.93 show the proportion of haemodialysis patients at each state or hospital dialysing
with an AVF/AVG on 31st December, 2011, arranged from the lowest to the highest.
In Australia, the hospital proportions varied widely from 72-100%. The corresponding range in New
Zealand was 59-90%. The error bars displayed show the 95% confidence intervals.
Figure 5.91
Prevalent Vascular Access at 31-Dec-2011
Dec 2008
Dec 2009
Dec 2010
Dec 2011
AVF or AVG
CVC
AVF or AVG
CVC
AVF or AVG
CVC
AVF or AVG
CVC
QLD
1283 (87%) 192 (13%) 1372 (88%) 196 (13%) 1426 (88%) 196 (12%) 1429 (87%) 212 (13%) NSW/ACT
2200 (84%) 421 (16%) 2259 (83%) 449 (17%) 2387 (85%) 430 (15%) 2479 (86%) 415 (14%) Vic
1860 (90%) 215 (10%) 1899 (89%) 227 (11%) 1972 (88%) 257 (12%) 2049 (89%) 256 (11%) Tas
110 (82%) 24 (18%) 118 (80%) 30 (20%) 128 (88%) 18 (12%) 134 (85%) 24 (15%) SA
429 (88%) 61 (12%) 484 (90%) 56 (10%) 504 (89%) 60 (11%) 556 (93%) 42 (7%) NT
328 (91%) 34 (9%) 366 (96%) 17 (4%) 367 (92%) 34 (8%) 394 (90%) 42 (10%) WA
562 (73%) 205 (27%) 593 (76%) 183 (24%) 619 (78%) 179 (22%) 634 (78%) 174 (22%) 983 (73%) 360 (27%) 1111 (75%) 369 (25%) 1204 (78%) 345 (22%) 1241 (78%) 347 (22%) Australia
New Zealand
Figure 5.92
Figure 5.93
% Prevalent HD Patients Dialysing with AVF/AVG
New Zealand 31 December 2011
100
100
90
90
80
80
70
70
60
60
Percent
Percent
% Prevalent HD Patients Dialysing with AVF/AVG
Australia 31 December 2011
50
40
50
40
30
30
20
20
10
10
0
0
Excludes hospitals with <10 patients
0
5
10
15
20
25
30
35
40
Caring Hospital
45
50
55
60
65
70
Excludes hospitals with <10 patients
0
1
2
3
4
5
6
7
8
9
10
Caring Hospital
5-31
HAEMODIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
OBESITY
AMONG INCIDENT
HAEMODIALYSIS PATIENTS
Figures 5.94 - 5.99 show the proportions of incident haemodialysis patients with obesity and morbid
obesity. In both Australia and New Zealand obesity rates have been increasing over the last ten years.
The proportion of morbidly obese patients starting haemodialysis has doubled from 2002 to 2011 in
Australia and increased 20% in New Zealand.
As might be expected, patients with diabetes are more likely to be obese or morbidly obese compared
to those without diabetes (Figures 5.99 - 5.100).
Obesity for these analysis is defined as a BMI>30kg/m². Morbid obesity is defined as ≥35kg/m²
Figure 5.94
Obesity in Incident Haemodialysis Patients
By Year
50
Percentage Obese
40
40
30
24
22
25
28 29
31
33
31
34
36
44 43 44
44
42
42
47 48
37
20
10
0
Figure 5.95
02 03 04 05 06 07 08 09 10 11
02 03 04 05 06 07 08 09 10 11
Australia
New Zealand
Obesity in Incident Haemodialysis Patients
By State and Country - 2011
50
Percentage Obese
40
35
36
36
48
46
45
36
35
32
30
25
20
10
0
Figure 5.96
QLD
NSW
ACT
VIC
TAS
SA
NT
WA
AUS
Morbid Obesity in Incident Haemodialysis Patients
By Year
28
Percentage Morbidly Obese
30
23 23
20
20
10
0
5-32
NZ
9 9
10
11 11
13
14 14
15
19 19
20
25
24
21
16
02 03 04 05 06 07 08 09 10 11
02 03 04 05 06 07 08 09 10 11
Australia
New Zealand
ANZDATA Registry 2012 Report
HAEMODIALYSIS
_____________________________________________________________________________________
Figure 5.97
Morbid Obesity in Incident Haemodialysis Patients
By State and Country - 2011
24
Percentage Morbidly Obese
25
20
20
17
15
16
15
13
15
14
13
11
10
5
0
QLD
NSW
ACT
VIC
TAS
SA
NT
WA
AUS
NZ
Figure 5.98
Obesity in Incident Haemodialysis Patients
By Diabetes - 2011
60
Percentage Obese
58
60
48
46
37
40
27
20
pa
t
D
D
ia
be
t
ia
be
ic
te
s
C
ne
ph
ro
om
D
on
N
hy
or
bi
d
ic
ia
be
t
hy
pa
t
ne
ph
ro
ic
D
D
ia
be
t
ia
be
N
te
s
C
on
-
D
om
ia
be
t
ic
or
bi
d
0
Australia
New Zealand
Figure 5.99
40
33
30
22
36
23
15
20
10
10
Australia
ne
ph
ro
pa
th
y
or
bi
d
om
C
D
ia
be
tic
D
ia
be
te
s
N
on
-D
ia
be
tic
ne
ph
ro
pa
th
y
C
ia
be
te
s
D
D
ia
be
tic
om
or
bi
d
0
N
on
-D
ia
be
tic
Percentage Morbidly Obese
Morbid Obesity in Incident Haemodialysis Patients
By Diabetes - 2011
New Zealand
5-33
HAEMODIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
OBESITY
AMONG
PREVALENT HAEMODIALYSIS PATIENTS
Figures 5.100 - 5.105 show the proportion of prevalent haemodialysis patients with obesity
and morbid obesity. In both Australia and New Zealand prevalent obesity rates have been
increasing over the last ten years. The proportion of morbidly obese patients treated with
haemodialysis has nearly doubled from 2002 to 2011 in both countries.
Patients with diabetes are more like to be obese or morbidly obese compared to those without diabetes (Figures 5.104 and 5.105).
Figure 5.100
Obesity in Prevalent Haemodialysis Patients
By Year
Percentage Obese
50
42 43
40
30
25
29
27 28
31
49 50
46 46 47
34 34
21 21
20
16 17
10
0
02 03 04 05 07 08 09 10 11
02 03 04 05 07 08 09 10 11
Australia
New Zealand
Figure 5.101
Morbid Obesity in Prevalent Haemodialysis Patients
By Year
Percentage Morbidly Obese
30
21
20
10
0
5-34
7
6
8
9
10
11 11
12
13
14
23
24 24
25
26
27
16
02 03 04 05 07 08 09 10 11
02 03 04 05 07 08 09 10 11
Australia
New Zealand
ANZDATA Registry 2012 Report
HAEMODIALYSIS
_____________________________________________________________________________________
Figure 5.102
Obesity in Prevalent Haemodialysis Patients
By State and Country - 2011
50
50
37
Percentage Obese
40
32
32
34
29
30
31
30
23
22
20
10
0
QLD
NSW
ACT
VIC
TAS
SA
NT
WA
AUS
NZ
Figure 5.103
Morbid Obesity in Prevalent Haemodialysis Patients
By State and Country - 2011
Percentage Morbidly Obese
30
27
20
17
16
14
13
14
10
8
10
0
QLD
NSW
ACT
VIC
TAS
SA
Obesity in Prevalent Haemodialysis Patients
By Diabetes - 2011
Australia
10
17
Australia
ne
ph
ro
pa
th
y
or
bi
d
D
ia
be
tic
C
o-
m
ia
be
tic
on
-D
D
ia
be
te
s
N
ne
ph
ro
pa
th
y
0
or
bi
d
ph
ro
p
ne
et
ic
ia
b
D
New Zealand
19
8
C
om
at
h
y
d
om
or
bi
C
tic
be
te
s
-D
ia
be
D
ia
N
on
ph
ro
p
D
ia
b
et
ic
be
te
s
ne
C
om
or
bi
at
h
y
d
0
18
20
D
ia
be
tic
20
35
30
ia
be
tic
36
21
tic
NZ
34
ia
be
te
s
40
40
-D
ia
be
AUS
40
D
42
Percentage Morbidly Obese
60
D
ia
WA
Morbid Obesity in Prevalent Haemodialysis Patients
By Diabetes - 2011
N
on
-D
62
60
Percentage Obese
NT
Figure 5.105
Figure 5.104
N
on
13
12
New Zealand
5-35
HAEMODIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Home Haemodialysis
The proportion of all prevalent dialysis patients who were using home HD in each State was 13% for New South Wales / ACT, 9%
Queensland, 7% Victoria, 6% the Northern Territory, 5% Tasmania, 5% Western Australia and 3% for South Australia.
The distribution of numbers of patients receiving home haemodialysis by state is shown in Figure 5.106. As can be appreciated,
numbers are greatest in New South Wales and in New Zealand, with substantial numbers also in Victoria and Queensland.
These proportions were lower among older people (Figure 5.108).
Considerable further discussion is contained in chapter 4 .
Figure 5.106
Home HD numbers by state
at end 2011
489
500
433
Percent
400
300
191
200
100
0
27
NT
18
NSW/ACT
Vic
ANZDATA prevalent dialysis patients
5-36
184
Qld
SA
52
11
WA
Tas
NZ
ANZDATA Registry 2012 Report
HAEMODIALYSIS
_____________________________________________________________________________________
The distribution of prevalent home dialysis patients by age group is shown in Figure 5.107.
Figure 5.107
Home HD numbers by age group
at end 2011
100
Percent
80
60
40
025456575-
20
0
NT NSW/ACT Vic
Qld
SA
WA
Tas
NZ
ANZDATA prevalent dialysis patients
Figure 5.108
Proportion (%) of Prevalent Patients aged ≥ 65 years
Treated with Home Haemodialysis 2007 - 2011
State
2007
2008
2009
2010
2011
Queensland
5.40%
5.50%
5.40%
5.10%
4.90%
New South Wales/ACT
9.00%
8.30%
8.10%
7.70%
7.40%
Victoria
4.90%
4.70%
4.40%
4.00%
3.80%
Tasmania
2.10%
2.50%
2.80%
3.30%
2.60%
South Australia
0.50%
0.60%
0.70%
0.90%
1.10%
Northern Territory
3.70%
4.30%
5.60%
5.30%
5.00%
Western Australia
1.50%
1.50%
1.90%
2.50%
2.60%
New Zealand
9.60%
9.50%
10.30%
11.10%
11.20%
Australia
5-37
HAEMODIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
The trend in numbers treated with home HD is for different age groups are illustrated for Australia and New
Zealand in the Figure 5.109 and 5.110. The Y axes for individual graphs vary – the absolute numbers in the
age groups 25 to 64 years are substantially greater than among older patients. However, there has been
strong growth in the older age groups in the last few years .
Figure 5.109
Home HD numbers at end year
Australia - by age group
Number
0-
25-
110
100
90
80
70
45-
350
500
300
400
250
300
200
200
1990 1995 2000 2005 2010
65-
75-
100
15
80
10
60
5
40
0
1990 1995 2000 2005 2010
1990 1995 2000 2005 2010
Year
Age at 31 Dec each year
Figure 5.110
Home HD numbers at end year
NZ - by age group
080
140
120
100
80
60
60
40
Number
25-
20
200
150
100
50
1990 1995 2000 2005 2010
6540
30
20
10
758
6
4
2
0
1990 1995 2000 2005 2010
1990 1995 2000 2005 2010
Year
Age at 31 Dec each year
5-38
45-
ANZDATA Registry 2012 Report
HAEMODIALYSIS
_____________________________________________________________________________________
Technique failure
The following 3 figures explore the concept of technique failure as applied to home haemodialysis. Each
treatment episode can end in a variety of ways. Changes to another dialysis modality (either institutional
haemodialysis or peritoneal dialysis) are considered a “failure”, as is death. Follow-up is censored at transplantation, or 31 Dec 2011.
Figure 5.111
Technique failure
Home haemodialysis 2001-10
1.00
0.75
0.50
0.25
Australia
New Zealand
0.00
0
2
4
6
8
10
Years
Censored at transplantation
Figure 5.112
Technique failure
Home haemodialysis 2001-11
1.00
0.75
Age at RRT start
0.50
<25
25-44
45-64
65-74
75+
0.25
0.00
0
2
4
6
8
10
Years
Censored at transplantation
Australia and NZ combined
5-39
HAEMODIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
When death of patient is counted as a censoring event (rather than “failure”), the differences between the
age groups become less apparent (Figure 5.113). It can be seen that (among those alive and not transplanted) over 75% of home haemodialysis patients continue in this therapy after 2 years. However, as time passes there is a progressive difference which emerges with higher technique failure rates among the older patients.
Figure 5.113
Death censored technique failure
Home HD 2001-11
Australia
New Zealand
1.00
1.00
0.75
0.75
0.50
0.50
0.25
0.25
0.00
0.00
0
1
2
3
4
5
Years
Censored at transplantation and death
ANZDATA Registry
5-40
Age at RRT start
<25
25-44
45-64
65-74
75+
0
1
2
3
Years
4
5
ANZDATA Registry 2012 Report
HAEMODIALYSIS
_____________________________________________________________________________________
Definitions in use
CARI guidelines
Caring for Australasians with Renal Impairment guidelines
Quotidian HD
> 3 sessions/week and/or > 5.5 hours/session
Long Hour HD
≥ 6.5 hours per HD session
High Flux Dialyser
Ultrafiltration coefficient (kuf) >20 ml/hr/mmHg as specified by the
manufacturer)
AVF
AVG
Native vein arteriovenous fistula
Synthetic arteriovenous bridge graft
CVC
Central venous HD catheter (Includes both tunnelled and non-tunnelled
unless otherwise stated)
Obese
BMI ≥ 30
Morbid Obesity
BMI ≥ 35
5-41
HAEMODIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
This page is intentionally left blank
5-42
CHAPTER 6
PERITONEAL DIALYSIS
Fiona Brown
Aarti Gulyani
Stephen McDonald
Kylie Hurst
2012 Annual Report - 35th Edition
PERITONEAL DIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
STOCK
AND
FLOW
AUSTRALIA
Peritoneal dialysis was used to treat 19% of all dialysis
patients in 2011 (APD-1283,CAPD-786,total 10998). PD
accounted for 68% of all home dialysis, a figure which has
remained stable for several years (Figure 6.1).Of the 26,970
patients who have ever received peritoneal dialysis, 5% had
experienced at least five years of continuous peritoneal
dialysis (Figure 6.2).
The proportion of all home dialysis patients on peritoneal
dialysis in each State ranged from 38% (Australian Capital
Territory) to 86% (South Australia) (Figure 6.1).
The annual stock and flow of patients during the period 2007
-2011 is shown in Figures 6.3 and 6.4.
There were 820 new peritoneal dialysis patients in the
calendar year 2011; of these 543 patients (66%) started renal replacement therapy with peritoneal dialysis and 277
(34%) had previously been treated with haemodialysis or a
transplant (Figure 6.3).
Numbers of new patients over the age of 65 years increased
8%, from 292 to 316 in 2011, following a decrease of 7% in
2010 (Figure 6.8). Most age groups increased with the ex-
ception of the 25-34 and 65-74 year age groups which decreased slightly.
The proportion of people with diabetic nephropathy has been
stable over the last 5 years.
The proportion of patients in each age group treated with
peritoneal dialysis ranged from 2% (≥ 85 years) to 22% (5674 years).
There were 257 deaths in 2011 compared with 265 in 2010.
For more detail see Appendix II at
(www.anzdata.org.au/v1/report_2011.html).
our
website
The prevalence of automated peritoneal dialysis is stable
(62%) (Figure 6.11)
There were 205 peritoneal dialysis patients who received a
transplant in 2011 compared with 186 in 2010; this was 10%
of all patients treated (Figure 6.3).
Permanent transfers to haemodialysis fell substantially in
2011 (to 331 patients (16%) from 403 patients (20%) in 2010.
(Figure 6.3).
Figure 6.1
Proportion (%) Peritoneal Dialysis of all
Home Dialysis Patients 2007 - 2011
State
2007
2008
2009
2010
2011
Queensland
70%
68%
66%
67%
66%
New South Wales
63%
67%
66%
66%
66%
Australian Capital
Territory
60%
49%
46%
40%
38%
Victoria
66%
67%
66%
66%
67%
Tasmania
87%
83%
82%
78%
81%
South Australia
95%
95%
93%
88%
86%
Northern Territory
67%
63%
57%
59%
51%
Western Australia
89%
89%
87%
83%
81%
Australia
69%
70%
69%
68%
68%
New Zealand
69%
70%
68%
66%
64%
Figure 6.2
Continuous Period of Peritoneal Dialysis 1963 - 2011
Months
36-41 42-47 48-59 60-71
0-<6
6-11
12-17
18-23 24-29
30-35
1st treatment (n=22,285)
6530
3956
2858
2209
1756
1227
942
728
932
All Treatments (n=26,970)
8216
4890
3457
2651
2029
1423
1103
841
1072
72-83
84-95
96-107
≥108
558
268
146
87
88
631
297
161
93
106
Australia
New Zealand
6-2
1st Treatment (n=6,107)
1106
915
788
706
575
462
368
282
415
213
122
69
41
45
All Treatments (n=7,271)
1425
1113
958
826
670
527
419
313
464
240
139
76
45
56
PERITONEAL DIALYSIS
_____________________________________________________________________________________
ANZDATA Registry 2012 Report
Figure 6.3
Stock and Flow of Peritoneal Dialysis Patients
2007 - 2011
State
2007
2008
2009
2010
2011
897
997
892
751
820
Australia
Patients new to PD
First Dialysis Treatment
588
657
587
496
543
Previous Dialysis (HD)
288
308
282
234
258
21
32
23
21
19
Transplanted
Failed Transplant
142
175
154
186
205
Deaths
296
293
312
265
257
Never Transplanted
292
279
302
261
250
Previous Transplant
4
14
10
4
7
Transfer to Haemodialysis
422
482
506
471
331
Patients Dialysing (PD) at 31 December
2137
2242
2200
2082
2069
Patients Dialysing (PD) at Home at 31 December
2111
2206
2177
2067
2043
New Zealand
241
274
283
275
239
First Dialysis Treatment
131
153
199
163
149
Previous Dialysis (HD)
104
115
80
111
87
Patients new to PD
6
6
4
1
3
Transplanted
Failed Transplant
37
28
35
46
40
Deaths
120
124
126
114
139
Never Transplanted
113
117
124
109
133
Previous Transplant
7
7
2
5
6
Transfer to Haemodialysis
124
124
116
113
99
Patients Dialysing (PD) at 31 December
746
763
799
833
790
Patients Dialysing (PD) at Home at 31 December
742
758
795
828
783
Figure 6.5
Figure 6.4
Stock and Flow of Peritoneal Dialysis Patients
Australia 2007-2011
Stock and Flow of Peritoneal Dialysis Patients
New Zealand 2007-2011
2500
1000
2069 Patients
790 Patients
2000
800
1500
600
1000
New Patients
Transplants
Perm. Transfer
Deaths
No. Dialysing
500
0
2007
2008
2009
2010
2011
400
New Patients
Transplants
Perm. Transfer
Deaths
No. Dialysing
200
0
2007
2008
2009
2010
2011
6-3
PERITONEAL DIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Figure 6.7
Figure 6.6
Age (%) of New Peritoneal Dialysis Patients 2011
Australia
Number of Patients = 820
25
22
18
20
15
11
10
5
0
0-14
15-24
25-34
22
19
15
15
9
10
5
3.4
2.6
25
Number of Patients = 2069
20
15
Percent
Percent
22
Age (%) of Current Peritoneal Dialysis Patients
Australia 31-Dec-2011
4.6
35-44
45-54
55-64
65-74
75-84
1.6
5
>=85
0
0-14
2.4
2.1
1.2
15-24
25-34
35-44
55-64
65-74
75-84
Australia
Figure 6.8
Stock and Flow of Peritoneal Dialysis by Age Groups
Age Groups
45-54
2007 - 2011
2007
2008
2009
2010
2011
00-14 years
22 (2%)
14 (1%)
25 (3%)
20 (3%)
21 (3%)
15-24 years
18 (2%)
32 (3%)
26 (3%)
17 (2%)
28 (3%)
25-34 years
43 (5%)
51 (5%)
54 (6%)
42 (6%)
41 (5%)
35-44 years
93 (10%)
99 (10%)
75 (8%)
79 (11%)
86 (10%)
45-54 years
161 (18%)
175 (18%)
128 (14%)
133 (18%)
150 (18%)
55-64 years
199 (22%)
217 (22%)
197 (22%)
168 (22%)
178 (22%)
65-74 years
203 (23%)
229 (23%)
226 (25%)
179 (24%)
178 (22%)
75-84 years
150 (17%)
168 (17%)
143 (16%)
105 (14%)
125 (15%)
>=85 years
8 (1%)
12 (1%)
18 (2%)
8 (1%)
13 (2%)
897 (100%)
997 (100%)
892 (100%)
751 (100%)
820 (100%)
00-14 years
34 (2%)
28 (1%)
32 (1%)
29 (1%)
24 (1%)
15-24 years
25 (1%)
47 (2%)
52 (2%)
39 (2%)
44 (2%)
25-34 years
76 (4%)
84 (4%)
97 (4%)
90 (4%)
96 (5%)
35-44 years
199 (9%)
183 (8%)
171 (8%)
180 (9%)
187 (9%)
45-54 years
339 (16%)
371 (17%)
338 (15%)
301 (14%)
304 (15%)
55-64 years
480 (22%)
507 (23%)
480 (22%)
458 (22%)
453 (22%)
65-74 years
549 (26%)
553 (25%)
579 (26%)
557 (27%)
515 (25%)
75-84 years
403 (19%)
422 (19%)
398 (18%)
376 (18%)
396 (19%)
>=85 years
32 (1%)
47 (2%)
53 (2%)
52 (2%)
50 (2%)
2137 (100%)
2242 (100%)
2200 (100%)
2082 (100%)
2069 (100%)
231 (26%)
260 (26%)
252 (28%)
199 (26%)
220 (27%)
17 (2%)
28 (3%)
13 (1%)
14 (2%)
9 (1%)
131 (15%)
118 (12%)
148 (17%)
96 (13%)
112 (14%)
New Patients *
Total
Patients Dialysing
Total
Primary Renal Disease *
Glomerulonephritis
Analgesic Nephropathy
Hypertension
Polycystic Disease
50 (6%)
67 (7%)
54 (6%)
53 (7%)
45 (5%)
Reflux Nephropathy
29 (3%)
40 (4%)
39 (4%)
22 (3%)
23 (3%)
Diabetic Nephropathy
285 (32%)
328 (33%)
266 (30%)
247 (33%)
271 (33%)
Miscellaneous
96 (11%)
80 (8%)
81 (9%)
82 (11%)
89 (11%)
Uncertain
58 (6%)
76 (8%)
39 (4%)
38 (5%)
51 (6%)
897 (100%)
997 (100%)
892 (100%)
751 (100%)
820 (100%)
Total
* New patients receiving first peritoneal dialysis treatment
6-4
>=85
PERITONEAL DIALYSIS
_____________________________________________________________________________________
ANZDATA Registry 2012 Report
Figure 6.9
PD Patients (%) of all Prevalent Dialysis
Australia 2011
80
67
Number of PD Patients = 2069
Percent
60
40
29
25
21
19
19
19
20
17
11
0
0-14
15-24
25-34
35-44
45-54
55-64
65-74
75-84
>=85
Figure 6.10
Number (Per Million) Prevalent PD Patients
Australia 2007 - 2011
Non Diabetic
Diabetic
100.8
105
100.8
94.5
92.4
2007
2008
2009
2010
2011
29%
30%
28%
29%
30%
% Diab
Figure 6.11
Number of Prevalent APD/CAPD Patients
Australia 2007 - 2011
CAPD
APD
2137
% APD
2242
2200
2082
2069
2007
2008
2009
2010
2011
54%
57%
60%
61%
62%
6-5
PERITONEAL DIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
NEW ZEALAND
Peritoneal dialysis accounted for 33% of all dialysis
patients and 64% of all patients dialysing at home.
Figure 6.12
A substantially lower proportion of patients used automated PD than in Australia. Forty four percent of all peritoneal
dialysis in 2011 was APD compared with 43% in 2010 and
42% in 2009.
PD Patients (%) of all Prevalent Dialysis
New Zealand 2011
100
90
Percent
80
60
Number of PD Patients = 790
37
40
35
22
26
40
38
27
17
20
0
0-14
15-24
25-34
35-44
45-54
55-64
65-74
75-84
>=85
Primary renal disease of new peritoneal dialysis patients is
shown in Figure 6.13, and the age distribution of prevalent
peritoneal dialysis patients is shown in Figures 6.16 and
6.17.
The most common primary renal disease of new patients
to peritoneal dialysis was diabetic nephropathy (47%), a
decrease of 6% from 2010, followed by glomerulonephritis
(23%) and hypertension (12%).
Figure 6.13
Number (Per Million) Prevalent PD Patients
New Zealand 2007 - 2011
The proportion of patients in each age group treated with
peritoneal dialysis ranged from 35% (55-64 years) and
17%
(≥85 years) (Figure 6.12).
Non Diabetic
Diabetic
178.5
176.4
The annual stock and flow of patients during the period
2007 to 2011 is shown in Figures 6.3 and 6.5. Of the 7,271
patients treated since 1963, 790 (11%) were alive at 31st
December, 2011 and 556 (8%) had more than five years
continuous treatment (Figure 6.2).
184.8
191.1
178.5
There were 139 deaths amongst prevalent peritoneal
dialysis patients in 2011 compared with 114 in 2010.
(Figure 6.3).
For more detail see Appendix III at our website
(www.anzdata.org.au/v1/report_2011.html).
% Diab
2007
2008
39%
38%
2009
2010
2011
39%
43%
44%
Figure 6.14
Number of Prevalent APD/CAPD Patients
New Zealand 2007 - 2011
CAPD
APD
% APD
6-6
746
763
799
832
790
2007
2008
2009
2010
2011
33%
38%
42%
43%
44%
There were 40 patients transplanted in 2011 (46 in 2010).
PERITONEAL DIALYSIS
_____________________________________________________________________________________
ANZDATA Registry 2012 Report
Figure 6.16
Figure 6.15
Age (%) of Current Peritoneal Dialysis Patients
New Zealand 31-Dec-2011
Age (%) of New Peritoneal Dialysis Patients 2011
New Zealand
31
30
30
30
Number of Patients = 790
20
20
Percent
Percent
Number of Patients = 239
16
8.8
10
15
11
10
7.5
7.5
5.4
2.1
0
28
28
1.7
.4
0
0-14
15-24
25-34
35-44
45-54
55-64
Figure 6.17
65-74
75-84
>=85
0-14
3.3
2.9
1.1
.5
15-24
25-34
45-54
55-64
65-74
75-84
>=85
New Zealand
Stock and Flow of Peritoneal Dialysis by Age Groups
Age Groups
35-44
2007 - 2011
2007
2008
2009
2010
2011
00-14 years
5 (2%)
10 (4%)
3 (1%)
3 (1%)
5 (2%)
15-24 years
5 (2%)
13 (5%)
4 (1%)
8 (3%)
4 (2%)
25-34 years
18 (7%)
11 (4%)
10 (4%)
9 (3%)
13 (5%)
New Patients *
35-44 years
21 (9%)
21 (8%)
31 (11%)
22 (8%)
21 (9%)
45-54 years
43 (18%)
55 (20%)
59 (21%)
43 (16%)
37 (15%)
55-64 years
73 (30%)
78 (28%)
62 (22%)
88 (32%)
74 (31%)
65-74 years
55 (23%)
69 (25%)
86 (30%)
70 (25%)
66 (28%)
75-84 years
18 (7%)
17 (6%)
27 (10%)
32 (12%)
18 (8%)
>=85 years
3 (1%)
Total
1 (0%)
1 (0%)
241 (100%)
274 (100%)
283 (100%)
275 (100%)
239 (100%)
00-14 years
8 (1%)
13 (2%)
10 (1%)
7 (1%)
9 (1%)
15-24 years
23 (3%)
28 (4%)
27 (3%)
22 (3%)
23 (3%)
25-34 years
36 (5%)
30 (4%)
33 (4%)
30 (4%)
26 (3%)
35-44 years
63 (8%)
62 (8%)
62 (8%)
67 (8%)
59 (7%)
45-54 years
121 (16%)
141 (18%)
157 (20%)
140 (17%)
120 (15%)
55-64 years
195 (26%)
209 (27%)
212 (27%)
235 (28%)
236 (30%)
65-74 years
186 (25%)
186 (24%)
216 (27%)
231 (28%)
224 (28%)
75-84 years
100 (13%)
81 (11%)
72 (9%)
98 (12%)
89 (11%)
>=85 years
14 (2%)
13 (2%)
10 (1%)
3 (0%)
4 (1%)
746 (100%)
763 (100%)
799 (100%)
833 (100%)
790 (100%)
55 (23%)
65 (24%)
57 (20%)
65 (24%)
55 (23%)
Patients Dialysing
Total
Primary Renal Disease *
Glomerulonephritis
Analgesic Nephropathy
2 (1%)
3 (1%)
3 (1%)
36 (13%)
28 (12%)
10 (4%)
Hypertension
26 (11%)
35 (13%)
33 (12%)
Polycystic Disease
11 (5%)
12 (4%)
18 (6%)
7 (3%)
Reflux Nephropathy
9 (4%)
4 (1%)
5 (2%)
3 (1%)
4 (2%)
Diabetic Nephropathy
105 (44%)
115 (42%)
127 (45%)
134 (49%)
103 (43%)
Miscellaneous
27 (11%)
27 (10%)
31 (11%)
20 (7%)
24 (10%)
8 (3%)
14 (5%)
12 (4%)
7 (3%)
12 (5%)
241 (100%)
274 (100%)
283 (100%)
275 (100%)
239 (100%)
Uncertain
Total
* New patients receiving first peritoneal dialysis treatment
6-7
PERITONEAL DIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
PERITONEAL DIALYSIS FLUIDS
At the end of 2011, 33% of CAPD and 45% of APD patients were receiving Icodextrin in
Australia (Figures 6.18 and 6.19) These proportions were lower for CAPD (27%) and higher
for APD (69%) in New Zealand (Figure 6.20). There was also considerable variation between States in Icodextrin usage rates, with the highest rates seen in the South Australia for
CAPD and Tasmania for APD (Figure 6.18, 6.21). Low GDP fluids (whether lactate or bicarbonate based fluids) were used infrequently in 2011, consistent with previous years (Figure
6.22 - 6.27).
Figure 6.18
Icodextrin Usage by Modality Type - December 2011
Australia
Modality
Type
CAPD
APD
Total
No
Yes
New Zealand
NR*
Total
No
Yes
NR*
Total
439
n
512
261
15
788
321
116
2
%
64.97%
33.12%
1.90%
.
73.12%
26.42%
0.46%
n
701
576
4
1281
108
243
351
%
54.72%
44.96%
0.31%
.
30.77%
69.23%
.
.
n
1213
837
19
2069
429
359
2
790
%
58.63%
40.45%
0.92%
.
54.30%
45.44%
0.25%
.
NR* - Not Reported
Figure 6.19
Figure 6.20
Icodextrin Usage by Modality
Icodextrin Usage by Modality
Prevalent Patients December 2009-2011
Australia
Prevalent Patients December 2009-2011
New Zealand
34
18
43
45
72
70
66
57
24
27
45
Percent
30
Percent
28
55
55
82
76
66
69
39
34
31
73
Icodextrin
Yes
No
Dec 09Dec 10Dec 11
Dec 09Dec 10Dec 11
Dec 09Dec 10Dec 11
Dec 09Dec 10Dec 11
CAPD
APD
CAPD
APD
Figure 6.21
Icodextrin Usage by State and New Zealand
Prevalent Patients December 2011
44
36
26
24
39
27
50
Percent
64
74
76
61
73
50
65
69
60 67
59 61
35
19
31
NT
NSW/ACT
VIC
QLD
SA
WA
TAS
NZ
42
81
NT
NSW/ACT
VIC
QLD
SA
WA
TAS
NZ
31
40 33
41 39
58
69
56
6-8
61
CAPD
APD
Icodextrin
Yes
No
Icodextrin
Yes
No
PERITONEAL DIALYSIS
_____________________________________________________________________________________
ANZDATA Registry 2012 Report
PERITONEAL DIALYSIS FLUIDS
Figure 6.22
Low GDP - Lactate Usage by Modality Type - December 2011
Australia
Modality
Type
CAPD
APD
Total
No
Yes
New Zealand
NR*
Total
No
Yes
NR*
Total
n
756
16
16
788
436
1
2
439
%
95.94%
2.03%
2.03%
.
99.32%
0.23%
0.46%
.
n
1243
34
4
1281
339
11
1
351
%
97.03%
2.65%
0.31%
.
96.58%
3.13%
0.28%
.
n
1999
50
20
2069
775
12
3
790
%
96.62%
2.42%
0.97%
.
98.10%
1.52%
0.38%
.
NR* - Not Reported
Figure 6.23
Low GDP - Lactate Usage by Modality
Percent
Prevalent Patients December 2009-2011
Australia
5
4
2
4
3
3
95
96
98
96
97
97
Lactate
Yes
No
Dec 09 Dec 10 Dec 11
CAPD
APD
Low GDP - Lactate Usage by Modality
Prevalent Patients December 2009-2011
New Zealand
Percent
Figure 6.24
Dec 09 Dec 10 Dec 11
0
0
0
4
3
3
100
100
100
96
97
97
Lactate
Yes
No
Dec 09 Dec 10 Dec 11
Dec 09 Dec 10 Dec 11
CAPD
APD
6-9
PERITONEAL DIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
PERITONEAL DIALYSIS FLUIDS
Figure 6.25
Low GDP - Bicarb Usage by Modality Type - December 2011
Australia
Modality
Type
CAPD
APD
Total
No
Yes
New Zealand
NR*
Total
No
Yes
Total
439
n
728
44
16
788
432
5
2
%
92.39%
5.58%
2.03%
.
98.41%
1.14%
0.46%
.
n
1244
33
4
1281
345
5
1
351
%
97.11%
2.58%
0.31%
.
98.29%
1.42%
0.28%
.
n
1972
77
20
2069
777
10
3
790
%
95.31%
3.72%
0.97%
.
98.35%
1.27%
0.38%
.
NR* - Not Reported
Figure 6.26
Low GDP - Bicarb Usage by Modality
Percent
Prevalent Patients December 2009-2011
Australia
2
1
6
2
2
3
98
99
94
98
98
97
Bicarb
Yes
No
Dec 09 Dec 10 Dec 11
Dec 09 Dec 10 Dec 11
CAPD
APD
Figure 6.27
Low GDP - Bicarb Usage by Modality
Percent
Prevalent Patients December 2009-2011
New Zealand
1
2
1
2
2
1
99
98
99
98
98
99
Bicarb
Yes
No
6-10
NR*
Dec 09 Dec 10 Dec 11
Dec 09 Dec 10 Dec 11
CAPD
APD
PERITONEAL DIALYSIS
_____________________________________________________________________________________
ANZDATA Registry 2012 Report
OUTCOMES AMONG PERITONEAL DIALYSIS PATIENTS
Figure 6.28
Patient Survival
On univariate analyses, there has been
some slight improvement in PD patient
survival in Australia at six months and one,
three and five years from 2000.
Peritoneal Dialysis at 90 Days Patient Survival
2000-2011, Censored for Transplant
% [95% Confidence Interval]
Year of
Starting
No. of
Patients
In New Zealand PD patient survival has
been unchanged up to 2005, but has improved for the 2006-2011 cohort
Survival
6 months
1 year
3 years
5 years
(Figures 6.28 - 6.30).
Australia
2000-2002
1267
98 [97, 99]
92 [90, 93]
63 [60, 66]
42 [39, 45]
2003-2005
1285
97 [96, 98]
92 [91, 94]
69 [66, 71]
47 [44, 50]
2006-2008
1660
99 [98, 99]
94 [93, 95]
73 [71, 75]
54 [50, 57]
2009-2011
1303
98 [97, 99]
94 [92, 95]
-
-
2000-2002
455
98 [96, 99]
91 [88, 93]
62 [57, 67]
40 [35, 44]
2003-2005
435
98 [96, 99]
91 [87, 93]
63 [58, 68]
41 [36, 46]
2006-2008
412
98 [96, 99]
94 [91, 96]
77 [72, 81]
50 [43, 56]
2009-2011
454
100 [98, 100]
95 [92, 97]
-
-
Diabetic PD patients had lower patient
survival at later time points in both Australia and New Zealand (Figures 6.31 - 6.33).
As expected PD patient survival is closely
related to age (Figures 6.34 -6.36).
New Zealand
Figure 6.29
Patient Survival - Peritoneal Dialysis at 90 Days
2000 - 2011
Censored for Transplant - Australia
Patient Survival
1.00
0.75
0.50
2000-2002 (1267)
2003-2005 (1285)
2006-2008 (1660)
2009-2011 (1303)
0.25
0.00
0
1
2
3
4
5
Years
Figure 6.30
Patient Survival - Peritoneal Dialysis at 90 Days
2000 - 2011
Censored for Transplant - New Zealand
Patient Survival
1.00
0.75
0.50
2000-2002 (455)
2003-2005 (435)
2006-2008 (412)
2009-2011 (454)
0.25
0.00
0
1
2
3
4
5
Years
6-11
PERITONEAL DIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Figure 6.31
Peritoneal Dialysis at 90 Days
Patient Survival - Diabetic / Non Diabetic
Censored for Transplant Commenced 2000 - 2011
% [95% Confidence Interval]
Survival
No. of
Patients
6 months
1 year
3 years
5 years
Non Diabetic
3857
98 [98, 99]
94 [93, 95]
73 [71, 74]
54 [52, 56]
Diabetic
1658
97 [96, 98]
91 [89, 92]
62 [59, 64]
36 [33, 39]
Australia
New Zealand
Non Diabetic
1033
98 [97, 99]
94 [92, 95]
71 [67, 74]
51 [47, 55]
Diabetic
723
99 [98, 99]
91 [89, 93]
63 [59, 67]
34 [30, 39]
Figure 6.32
Patient Survival - Peritoneal Dialysis at 90 Days
2000 - 2011
Censored for Transplant - Australia
Patient Survival
1.00
0.75
0.50
0.25
Non-diabetic (3857)
Diabetic (1658)
0.00
0
1
2
3
4
5
Years
Figure 6.33
Patient Survival - Peritoneal Dialysis at 90 Days
2000 - 2011
Censored for Transplant - New Zealand
Patient Survival
1.00
0.75
0.50
0.25
Non-diabetic (1033)
Diabetic (723)
0.00
0
1
2
3
Years
6-12
4
5
PERITONEAL DIALYSIS
_____________________________________________________________________________________
ANZDATA Registry 2012 Report
Figure 6.34
Peritoneal Dialysis at 90 Days
Patient Survival - By Age Group
Censored for Transplant 2000 - 2011
% [95% Confidence Interval]
Survival
No. of
Patients
6 months
0-39 years
766
99 [99, 100]
99 [97, 99]
90 [86, 93]
80 [74, 85]
40-59 years
1662
98 [98, 99]
96 [95, 97]
81 [79, 83]
66 [63, 69]
Age Groups
1 year
3 years
5 years
Australia
60-74 years
2066
98 [97, 98]
92 [90, 93]
66 [63, 68]
42 [39, 45]
>=75 years
1021
96 [95, 97]
87 [85, 89]
51 [47, 54]
27 [24, 30]
New Zealand
0-39 years
199
99 [96, 100]
98 [95, 99]
89 [81, 94]
78 [66, 85]
40-59 years
589
99 [98, 100]
95 [93, 97]
74 [70, 78]
54 [48, 59]
60-74 years
745
98 [97, 99]
91 [89, 93]
64 [60, 68]
37 [32, 41]
>=75 years
223
95 [91, 97]
85 [79, 89]
49 [42, 56]
24 [18, 30]
Figure 6.35
Patient Survival - Peritoneal Dialysis at 90 Days
2000 - 2011
Censored for Transplant - Australia
Patient Survival
1.00
0.75
0.50
Age
<40 (766)
40-59 (1662)
60-74 (2066)
75 (1021)
0.25
0.00
0
1
2
3
4
5
Years
Figure 6.36
Patient Survival - Peritoneal Dialysis at 90 Days
2000 - 2011
Censored for Transplant - New Zealand
Patient Survival
1.00
0.75
0.50
Age
<40 (199)
40-59 (589)
60-74 (745)
75 (223)
0.25
0.00
0
1
2
3
4
5
Years
6-13
PERITONEAL DIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Figures 6.37 - 6.38 show survival curves for patients treated with peritoneal dialysis at day 90, adjusted to a median age of 62.6 years for Australia and 60.4 years for New Zealand; non diabetic primary
renal disease; Caucasian race; female sex and no comorbid conditions (lung disease, coronary heart
disease, peripheral vascular disease or cerebrovascular disease).
In Australia the patient survival has steadily improved since 2000 (Figure 6.37).
In New Zealand there has seen an improvement in the 2008-2011 time (Figure 6.38),although this
trend is most apparent after the second year. In both countries patient survival has improved over
time.
Figure 6.37
Patient Survival - Peritoneal Dialysis at 90 Days
2000 - 2011
Censored for Transplant - Australia
Adjusted for Age,Race,Sex,Diabetic PRD and Comorbidities
Patient Survival
1.00
0.75
0.50
2000-2002 (1267)
2003-2005 (1285)
2006-2008 (1660)
2009-2011 (1303)
0.25
0.00
0
1
2
3
4
5
Years
Figure 6.38
Patient Survival - Peritoneal Dialysis at 90 Days
2000 - 2011
Censored for Transplant - New Zealand
Adjusted for Age,Race,Sex,Diabetic PRD and Comorbidities
Patient Survival
1.00
0.75
0.50
2000-2002 (455)
2003-2005 (435)
2006-2008 (412)
2009-2011 (454)
0.25
0.00
0
1
2
3
Years
* PRD = primary renal disease
6-14
4
5
PERITONEAL DIALYSIS
_____________________________________________________________________________________
ANZDATA Registry 2012 Report
PERITONEAL DIALYSIS TECHNIQUE SURVIVAL
Figure 6.39
Methods
Survivals are calculated using the
Kaplan-Meier technique. Patients are
followed from the 90th day after first
treatment for those on peritoneal dialysis at that time point and not transplanted during those first 90 days.
For patient survival patients are censored at first transplant and at most
recent follow up regardless of dialysis
modality changes.
Peritoneal Dialysis at 90 Days
Technique Survival - Diabetic / Non Diabetic
Censored for Transplant Commenced 2000- 2011
% [95% Confidence Interval]
No. of
Patients
Survival
6 months
1 year
3 years
5 years
Australia
For technique survival, failure is defined as a change from peritoneal dialysis to haemodialysis or death.
Non Diabetic
3857
95 [94, 96]
85 [83, 86]
55 [53, 57]
37 [34, 39]
Diabetic
1658
94 [93, 95]
85 [83, 87]
54 [51, 57]
36 [32, 40]
Figures 6.39-6.44 show Technical survival for patients receiving peritoneal
dialysis. In those analysed, patients
are censored at the time of transplantation.
New Zealand
Figure 6.40
Non Diabetic
1033
96 [95, 97]
90 [88, 92]
66 [62, 70]
46 [41, 51]
Diabetic
723
98 [97, 99]
92 [90, 94]
67 [63, 71]
43 [36, 49]
Technique Survival - Peritoneal Dialysis at 90 Days
2000 - 2011
Censored for Transplant - Australia
Technique Survival
1.00
0.75
0.50
0.25
Non-diabetic (3857)
Diabetic (1658)
0.00
0
1
2
3
4
5
Years
Figure 6.41
Technique Survival - Peritoneal Dialysis at 90 Days
2000 - 2011
Censored for Transplant - New Zealand
Technique Survival
1.00
0.75
0.50
0.25
Non-diabetic (1033)
Diabetic (723)
0.00
0
1
2
3
4
5
Years
6-15
PERITONEAL DIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Figure 6.42
Peritoneal Dialysis at 90 Days
Technique Survival - By Age Group
Censored for Transplant 2000 - 2011
% [95% Confidence Interval]
Age Groups
No. of
Patients
Survival
6 months
1 year
3 years
5 years
Australia
0-39 years
766
94 [92, 96]
82 [79, 85]
48 [43, 53]
28 [22, 35]
40-59 years
1662
93 [91, 94]
80 [78, 82]
41 [38, 44]
22 [20, 25]
60-74 years
2066
93 [92, 94]
80 [78, 81]
38 [36, 41]
16 [14, 19]
>=75 years
1021
91 [90, 93]
74 [71, 77]
31 [28, 34]
10 [8, 12]
New Zealand
0-39 years
199
95 [91, 97]
87 [81, 91]
51 [41, 60]
28 [18, 39]
40-59 years
589
97 [95, 98]
88 [85, 90]
48 [43, 53]
24 [19, 29]
60-74 years
745
96 [94, 97]
82 [79, 85]
46 [42, 50]
17 [13, 20]
>=75 years
223
92 [87, 95]
79 [73, 84]
36 [29, 43]
10 [6, 15]
Figure 6.43
Technique Survival - Peritoneal Dialysis at 90 Days
2000 - 2011
Censored for Transplant - Australia
Technique Survival
1.00
0.75
0.50
Age
<40 (766)
40-59 (1662)
60-74 (2066)
75 (1021)
0.25
0.00
0
1
2
3
4
5
Years
Figure 6.44
Technique Survival - Peritoneal Dialysis at 90 Days
2000 - 2011
Censored for Transplant - New Zealand
Technique Survival
1.00
0.75
0.50
Age
<40 (199)
40-59 (589)
60-74 (745)
75 (223)
0.25
0.00
0
1
2
3
Years
6-16
4
5
PERITONEAL DIALYSIS
_____________________________________________________________________________________
ANZDATA Registry 2012 Report
TECHNIQUE FAILURE
(EXCLUDING DEATH
OR
TRANSPLANTATION)
In Australia, the most common primary cause of technique failure was a social reason (generally patient preference),
rather than a technical cause.
This accounted for 44% of transfers during 2010/2011 (Figure 6.45).
Infections (primarily peritonitis) were the second commonest cause, followed by inadequate dialysis and mechanical/
technical complications.
In New Zealand, the most common primary cause of technique failure was also a “social reason”, which accounted for
36% of transfers during 2010/2011 and infections 22% (Figure 6.45). It is recognised that these are broad categories,
and there are likely to be multiple contributors (medical and social) in many individual cases.
Figure 6.45
Causes of Technique Failure 1-Jan-2010 to 31-Dec-2011
Excluding Death, Transplantation, Recovery of Renal Function
Causes of Technique Failure
Australia
New Zealand
Recurrent/persistent peritonitis
138
80
Acute peritonitis
230
50
Tunnel/exit site infection
38
7
Total Infective Causes
406 (21%)
137 (22%)
Inadequate solute clearance
231
86
Inadequate fluid ultrafiltration
104
53
Excessive fluid ultrafiltration
5
3
Total Dialysis Failure
340 (17%)
142 (23%)
Dialysate leak
46
30
Hydrothorax
2
Scrotal oedema
16
3
Catheter block
40
13
Catheter fell out
5
2
Hernia
55
22
Abdominal pain
18
2
Abdominal surgery
39
13
Other surgery
29
4
Haemoperitoneum
1
Sclerosing peritonitis
1
2
Miscellaneous
88
18
Multiple adhesions
5
5
344 (18%)
115 (19%)
Total Technical Failure
Unable to manage self care
97
30
Patient preference
750
186
6
3
853 (44%)
219 (36%)
Transfer outside Australia/NZ
Total Social Reasons
6-17
PERITONEAL DIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
PERITONITIS
Australian median time to first peritonitis was 22 months, with 34% of patients completely free of peritonitis at
three years. In New Zealand the time was 19.4 months (31% of patients free of peritonitis at three years),
(Figure 6.46). As noted in previous reports there is a strong association between ethnicity and peritonitis free
survival (Figure 6.49).
The median peritonitis-free survival for home automated peritoneal dialysis patients was 21 months in Australia, and 12.8 months in New Zealand.
Figure 6.46
First PD Treatment to First Episode of Peritonitis
Related to Age at Entry 01-Jan-2007 to 31-Dec-2011
Age Groups
Survival
Australia
All
00-14
15-34
35-54
55-64
65-74
>=75
(n=102)
(n=352)
(n=1179)
(n=959)
(n=1015)
(n=750)
(n=4357)
3 months
80 [71,87]
87 [83,90]
86 [84,88]
88 [86,90]
88 [86,90]
86 [84,89]
87 [86,88]
6 months
70 [59,78]
80 [76,84]
79 [77,82]
80 [77,82]
81 [79,84]
79 [76,82]
80 [78,81]
9 months
59 [48,69]
73 [67,78]
73 [70,75]
71 [68,74]
75 [72,78]
71 [68,75]
72 [71,74]
1 year
54 [42,65]
69 [63,75]
67 [63,70]
66 [62,69]
69 [66,72]
64 [60,68]
66 [65,68]
2 years
31 [16,47]
52 [45,59]
47 [43,51]
46 [41,50]
49 [45,53]
46 [41,51]
47 [45,49]
3 years
12 [1,37]
41 [32,50]
32 [27,36]
35 [30,40]
32 [27,37]
38 [33,43]
34 [32,36]
New Zealand
(n=26)
(n=95)
(n=353)
(n=375)
(n=346)
(n=117)
(n=1312)
3 months
76 [54,88]
87 [78,93]
90 [86,92]
83 [79,87]
86 [82,89]
85 [77,91]
86 [84,88]
6 months
50 [29,68]
79 [68,87]
79 [74,83]
74 [69,78]
77 [72,81]
79 [70,86]
76 [74,79]
9 months
44 [23,63]
67 [55,76]
70 [64,74]
67 [62,72]
68 [63,73]
69 [59,77]
68 [65,70]
1 year
35 [14,57]
63 [51,73]
63 [57,68]
60 [54,65]
61 [55,67]
62 [51,71]
61 [58,64]
2 years
35 [14,57]
40 [26,54]
45 [38,51]
43 [36,49]
43 [37,50]
43 [31,55]
43 [40,46]
3 years
-
19 [7,35]
31 [23,39]
37 [30,44]
31 [24,39]
27 [13,42]
31 [27,35]
% Survival [95% Confidence Interval]
Figure 6.47
Figure 6.48
First PD Treatment to First Peritonitis
Related to Age at First PD
2007- 2011 Australia
First PD Treatment to First Peritonitis
Related to Age at First PD
2007 - 2011 New Zealand
1.00
1.00
0.75
0.75
00-14 (102)
15-34 (352)
35-54 (1179)
55-64 (959)
65-74 (1015)
75 (750)
0.50
0.25
0.00
0m
3m
6m
9m 12m/1yr 15m
Analysis Time
6-18
18m
21m 2yr
00-14 (26)
15-34 (95)
35-54 (353)
55-64 (375)
65-74 (346)
75 (117)
0.50
0.25
0.00
0m
3m
6m
9m 12m/1yr 15m
Analysis Time
18m
21m 2yr
PERITONEAL DIALYSIS
_____________________________________________________________________________________
ANZDATA Registry 2012 Report
Figure 6.49
First PD Treatment to First Peritonitis
Related to Race and Age at First PD
2002 - 2006 Australia
1.00
0.75
Asian 35-54 (102)
Caucasian 35-54 (715)
Indigenous 35-54 (166)
Asian 55-64 (55)
Caucasian 55-64 (662)
Indigenous 55-64 (95)
0.50
0.25
0.00
0m
3m
6m
9m 12m/1yr 15m 18m
21m 2yr
Analysis Time
First PD Treatment to First Peritonitis
Related to Race and Age at First PD
2007 - 2011 Australia
1.00
0.75
Asian 35-54 (117)
Caucasian 35-54 (773)
Indigenous 35-54 (170)
Asian 55-64 (90)
Caucasian 55-64 (678)
Indigenous 55-64 (97)
0.50
0.25
0.00
0m
3m
6m
9m 12m/1yr 15m 18m
21m 2yr
Analysis Time
Figure 6.50
First PD Treatment to First Peritonitis
Related to Race and Age at First PD
2002 - 2006 New Zealand
1.00
0.75
Asian 35-54 (10)
Caucasian 35-54 (148)
Indigenous 35-54 (198)
Asian 55-64 (16)
Caucasian 55-64 (129)
Indigenous 55-64 (195)
0.50
0.25
0.00
0m
3m
6m
9m 12m/1yr 15m 18m
21m 2yr
Analysis Time
First PD Treatment to First Peritonitis
Related to Race and Age at First PD
2007 - 2011 New Zealand
1.00
0.75
Asian 35-54 (10)
Caucasian 35-54 (138)
Indigenous 35-54 (182)
Asian 55-64 (19)
Caucasian 55-64 (134)
Indigenous 55-64 (200)
0.50
0.25
0.00
0m
3m
6m
9m 12m/1yr 15m 18m
21m 2yr
Analysis Time
6-19
PERITONEAL DIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Figure 6.51
First Home APD Treatment to First Episode of Peritonitis
Related to Age at Entry 01-Jan-2007 to 31-Dec-2011
Survival
Australia
Age Groups
00-14
15-34
35-54
55-64
65-74
>=75
(n=88)
(n=267)
(n=761)
(n=575)
(n=596)
(n=415)
(n=2702)
3 months
84 [74, 91]
90 [85, 93]
88 [85, 90]
91 [88, 93]
90 [87, 92]
90 [87, 93]
89 [88, 90]
6 months
74 [63, 82]
84 [79, 88]
80 [77, 83]
83 [79, 86]
82 [78, 85]
83 [79, 87]
82 [80, 83]
9 months
63 [51, 74]
77 [70, 82]
73 [70, 77]
76 [72, 80]
75 [71, 79]
74 [69, 78]
74 [73, 76]
1 year
59 [46, 70]
72 [65, 78]
67 [63, 71]
69 [64, 73]
71 [66, 75]
69 [63, 74]
69 [67, 71]
2 years
34 [17, 51]
53 [44, 62]
50 [45, 55]
51 [46, 56]
52 [46, 57]
48 [42, 55]
50 [48, 53]
3 years
14 [1, 40]
40 [30, 51]
32 [26, 38]
39 [32, 46]
35 [29, 42]
45 [38, 52]
36 [33, 40]
New Zealand
3 months
(n=24)
(n=67)
(n=175)
(n=144)
(n=109)
(n=43)
(n=562)
83 [60, 93]
82 [70, 90]
87 [81, 91]
91 [85, 95]
86 [77, 91]
90 [75, 96]
87 [84, 90]
6 months
54 [32, 72]
79 [66, 87]
79 [72, 84]
82 [74, 88]
70 [59, 78]
78 [61, 89]
77 [73, 80]
9 months
48 [26, 68]
59 [45, 71]
70 [62, 77]
74 [64, 81]
61 [50, 70]
63 [44, 76]
66 [62, 70]
1 year
39 [16, 61]
57 [43, 69]
61 [52, 69]
62 [52, 70]
52 [41, 63]
56 [38, 71]
58 [53, 62]
2 years
39 [16, 61]
29 [15, 45]
46 [36, 56]
50 [39, 60]
36 [23, 48]
-
40 [35, 46]
3 years
-
18 [6, 36]
32 [20, 45]
36 [23, 49]
21 [8, 38]
-
27 [20, 34]
% Survival [95% Confidence Interval]
Figure 6.52
First Home APD Treatment to First Peritonitis
Related to Age at First Home APD
2007 - 2011 Australia
1.00
0.75
00-14 (88)
15-34 (267)
35-54 (761)
55-64 (575)
65-74 (596)
75 (415)
0.50
0.25
0.00
0m
3m
6m
9m 12m/1yr 15m
18m
21m
2yr
Analysis Time
First Home APD Treatment to First Peritonitis
Related to Age at First Home APD
2007 - 2011 New Zealand
1.00
0.75
00-14 (24)
15-34 (67)
35-54 (175)
55-64 (144)
65-74 (109)
75 (43)
0.50
0.25
0.00
0m
3m
6m
9m 12m/1yr 15m
Analysis Time
6-20
All
18m
21m
2yr
PERITONEAL DIALYSIS
_____________________________________________________________________________________
ANZDATA Registry 2012 Report
AUSTRALIAN PERITONITIS REGISTRY
1-OCT-2003
TO
31-DEC-2011
This section contains details of the organism and treatment for episodes of peritonitis within Australia
collected by ANZDATA. A more detailed collection of data about peritonitis was started in late 2003.
Similar information for patients in New Zealand is collected separately by the New Zealand Peritonitis
Registry (reported separately).
During 2011, the number of episodes of peritonitis remained similar to previous years (shown in Figure
6.53), although there was a slight decrease in overall rates per person-year (figure 6.54).
Rates of peritonitis have fluctuated, with a trend to lower rates over the past two years (2003-2011)
(Figure 6.54).
Figure 6.53
Number of Peritonitis Episodes
Year
Freq.
Percent
Cum.
2003
250
2.59
2.59
2004
1,196
12.4
14.99
2005
1,072
11.11
26.1
2006
1,116
11.57
37.67
2007
1,254
13
50.67
2008
1,369
14.19
64.86
2009
1,345
13.94
78.8
2010
1,138
11.8
90.6
2011
907
9.4
100
Total
9,647
100
Figure 6.54
Number of Episodes per Patient Year and
Patient Months per Episode 2004 – 2011
Figure 6.55
0.70
18
0.60
20
0.58
0.58
0.57
0.53
0.50
24
Number of PD episodes per person
Australia, 2003-2011
.8
.6
Proportion
0.60
0.62
Patient-months per episode
Episodes per patient-year
0.63
.4
.2
0.43
0
2003/4 2005
2006
2007
2008
2009
2010
2011
0
2
4
6
8
Number of PD episodes per person
6-21
PERITONEAL DIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
There has been a gradual trend over this time towards a lower proportion of episodes attributable to
gram negative organisms and non-MRSA S. aureus, with a greater proportion of culture negative
episodes (Figure 6.56). The Registry does not collect data on use of prior antibiotics or laboratory
techniques that might influence the rate of culture negative peritonitis.
Figure 6.56
Distribution of organisms causing peritonitis
Percent of peritonitis episodes
100
Culture negative
Coag neg Staph
MRSA
Staph aureus, non MRSA
Other Gram Pos
Gram negative org
Anaerobes
Fungi
Mycobacteria
Other
80
60
40
20
0
2003/4 2005 2006 2007 2008 2009 2010 2011
There remains quite widespread variation in the major organisms reported between the different
states in Australia (Figure 6.57). We do not collect data about variation in prophylaxis, patient
selection processes, PD training or other factors that might account for part or all of this variation.
Figure 6.57
Peritonitis in Australia
Episodes during 2011
100
Culture negative
Coag neg Staph
MRSA
Staph aureus, non MRSA
Other Gram Pos
Gram negative org
Anaerobes
Fungi
Mycobacteria
Other
No culture taken
Percent
80
60
40
20
Tas
WA
SA
Qld
Vic
NSW/ACT
6-22
NT
0
PERITONEAL DIALYSIS
_____________________________________________________________________________________
ANZDATA Registry 2012 Report
ANTIBIOTIC TREATMENT
The proportion of episodes which were treated with an aminoglycoside-containing initial regimen has
increased slightly over the period 2006-2009 but declined in 2010-2011, as has the proportion treated
with a regimen containing vancomycin is slowly increasing, but declined in 2010 (Figure 6.58).
Figure 6.58
Proportion of initial antibiotic regimens
.8
.6
.4
.2
Initial antibiotic regimen
Vancomycin
Aminoglycoside
0
2003/42005 2006 2007 2008 2009 2010 2011
Among episodes of peritonitis treated during 2011, the proportion of those who received vancomycin in
the initial or second antibiotic regimen is shown in Figure 6.59.
Figure 6.59
First regimen
Second regimen
Third regimen
4%
6%
17%
40%
41%
30%
49%
37%
32%
11%
17%
18%
Vanc / gent
Vanc / gent
Vanc / gent
No No
No Yes
No No
No Yes
No No
No Yes
Yes No
Yes Yes
Yes No
Yes Yes
Yes No
Yes Yes
6-23
PERITONEAL DIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
OUTCOMES
There is a strong relationship between the type of organism and the proportion of transfer to permanent
haemodialysis. After fungal, mycobacterial or gram negative peritonitis, there is a considerably higher
proportion of permanent transfers to HD than with other, more common, causes of peritonitis.
Figure 6.60
Proportion of Episodes Resulting in
Permanent Haemodialysis Transfer
Primary organism
No culture taken
Treating state
7
Other
Tas
22
37
Mycobacteria
2
Fungi
28
Anaerobes
135
Staph aureus, non MRSA
MRSA
178
Vic
75
13
Coag neg Staph
32
Qld
192
Other Gram Pos
144
SA
2
Gram negative org
WA
151
NSW/ACT
328
191
Culture negative
NT
189
0
.2
.4
.6
.8
1
26
0
.1
Proportion
.2
.3
.4
.5
Proportion
Values are total number of peritonitis episodes reported 1/1/11-31/12/11
RATES
OF
PERITONITIS ACROSS INDIVIDUAL UNITS
Figure 6.61 shows the peritonitis rates for all units in Australia over the period 1st
October, 2003 to 31st December 2011. Only units who averaged at least ten
patient-years of peritonitis treatment per year over that period are included.
There is substantial variation in the rates between units.
Figure 6.61
Peritonitis rates by treating unit
All peritonitiis episodes 2003-11
4
2.5
2
6
1.5
1
12
.5
24
Confidence intervals not shown where upper limit >3
Units with <10 person-years PD over 2003-11 not shown
6-24
Patient-months per episode
Episodes per patient-year
3
PERITONEAL DIALYSIS
_____________________________________________________________________________________
ANZDATA Registry 2012 Report
As demonstrated in Figure 6.62 there remains over a threefold variation in peritonitis rates between units.
There are a number of individual characteristics which predict the occurrence of peritonitis, including older
age, diabetes, cigarette smoking (but not centre size) and Aboriginal racial origin. These are covered in
greater detail in a manuscript in Peritoneal Dialysis International (Ghali et al Perit Dial Inter 2011: 31
(6):651-62). Similarly, there remains considerable variation between units (Figure 6.62), and between
States (Figure 6.63).
Figure 6.62
Peritonitis rates by treating unit
2011 only
4
2.5
2
6
1.5
1
12
.5
24
Patient-months per episode
Episodes per patient-year
3
Confidence intervals not shown where upper limit >3
Units with <5 person-years PD over 2011 not shown
Figure 6.63
Rates of peritonitis by state
8
1.05
1.00
12
0.77
0.60
0.57
0.54
0.50
0.52
0.33
24
0.47
NT
NSW/ACT
Vic
Qld
SA
All episodes of peritonitis 1/10/03 to 31/12/11
Patient-months per episode
Episodes per patient-year
1.50
WA
Tas
36
6-25
PERITONEAL DIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
HAEMOGLOBIN
In Australia, at the end of 2011, haemoglobin was <110 g/L in 43% between 110-119 g/L in 28% of
PD patients, , higher than in previous years, and >140 g/L in 4%, which is similar to previous years.
In New Zealand, the corresponding percentages were very similar - 26%, 44% and 3% respectively.
Figure 6.65 shows the Hb levels in PD patients with proven or likely coronary artery disease .
Figure 6.64
Haemoglobin - Peritoneal Dialysis
December 2009-2011
Percent
Hb(g/L)
<110
110-119
120-129
130-139
140
4
10
5
9
4
7
4
10
4
9
3
8
21
19
17
20
20
19
28
29
28
29
26
37
38
43
38
39
44
Dec 10
Dec 11
Dec 09
Dec 10
Dec 11
Dec 09
28
Australia
New Zealand
Figure 6.65
Haemoglobin - Peritoneal Dialysis
By Coronary Artery Disease Status
Australia - December 2009-2011
26
110-120
120
33
31
30
33
32
31
31
29
37
39
44
37
36
Dec 10
Dec 11
Dec 09
Dec 10
Dec 09
No CAD
6-26
<110
30
CAD
Hb(g/L)
27
<110
110-120
120
33
28
28
28
30
27
30
35
29
32
28
28
42
37
36
43
40
42
44
Dec 11
Dec 09
Dec 10
Dec 11
Dec 09
Dec 10
Dec 11
31
Percent
Percent
Hb(g/L)
Haemoglobin - Peritoneal Dialysis
By Coronary Artery Disease Status
New Zealand - December 2009-2011
No CAD
CAD
PERITONEAL DIALYSIS
_____________________________________________________________________________________
ANZDATA Registry 2012 Report
HAEMOGLOBIN IN PERITONEAL DIALYSIS PATIENTS
BY TREATING CENTRE
Figures 6.66 - 6.69:
These figures show the median haemoglobin (with inter-quartile range) for individual centres, arranged from lowest to highest (Figures 6.66 and 6.67). Also shown are the proportion of patients in each centre with a haemoglobin of 110-129 g/L
(Figures 6.68 and 6.69).
In Australia, median haemoglobin for each centre ranged from 104 to 125 g/L for peritoneal dialysis patients and in New
Zealand 107-122 g/L.
The proportion of patients in Australia with a haemoglobin of 110-129 g/L in each centre ranged from 25% to 65% for peritoneal dialysis patients and for New Zealand 32% to 72%. This large variation is likely to reflect differences in practices,
protocols and patient case-mix among centres.
Figure 6.67
Figure 6.66
Haemoglobin in Peritoneal Dialysis Patients
Haemoglobin in Peritoneal Dialysis Patients
New Zealand 31 December 2011
Australia 31 December 2011
140
140
130
Median Hb (g/L)
Median Hb (g/L)
130
120
110
100
90
120
110
100
90
80
80
70
70
Excludes hospitals with <10 patients
0
5
10
15
20
25
30
35
Excludes hospitals with <10 patients
0
40
1
2
3
4
Figure 6.68
8
9
10
11
New Zealand 31 December 2011
Percent
Percent
7
% Peritoneal Dialysis Patients
with Hb 110-129 g/L
Australia 31 December 2011
Excludes hospitals with <10 patients
0
6
Figure 6.69
% Peritoneal Dialysis Patients
with Hb 110-129 g/L
100
90
80
70
60
50
40
30
20
10
0
5
Caring Hospital
Caring Hospital
5
10
15
20
25
Caring Hospital
30
35
40
100
90
80
70
60
50
40
30
20
10
0
Excludes hospitals with <10 patients
0
1
2
3
4
5
6
7
8
9
10
11
Caring Hospital
6-27
PERITONEAL DIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
FERRITIN
AND
TRANSFERRIN SATURATION
Overall there are no remarkable trends in this area.
In both Australia and New Zealand, distributions of ferritin, transferrin saturation have been unchanged for the past
three years.
Figure 6.70
Percent
Ferritin - Peritoneal Dialysis
December 2009-2011
g/L
<100
10
11
15
100-199
200-499
500-799
800
9
12
10
15
10
14
16
15
17
37
36
38
42
42
39
20
20
19
19
18
22
18
18
18
15
13
12
Dec 10
Dec 11
Dec 09
Dec 10
Dec 11
Dec 09
Australia
New Zealand
Figure 6.71
Transferrin Saturation - Peritoneal Dialysis
December 2009-2011
Percent
T/Sat(%)
12
9
10
18
19
17
40
39
30
Dec 09
20-29
30-39
40
13
11
10
20
19
19
43
38
42
41
33
30
29
28
30
Dec 10
Dec 11
Dec 09
Dec 10
Dec 11
Australia
6-28
<20
New Zealand
PERITONEAL DIALYSIS
_____________________________________________________________________________________
ANZDATA Registry 2012 Report
FERRITIN
BY
TREATING CENTRE
The proportions of patients in each centre with ferritin between 200-500 mcg/L and transferrin saturation of >20% respectively, as recommended by the CARI guidelines, are shown in Figures 6.72-6.75.
In Australia, the proportions of patients with ferritin within this range in each centre varied widely between 12-65% for peritoneal dialysis patients. Similarly large variations between centres were seen for transferrin saturation, between 30-95%. Again,
this large variation may reflect differences in practices, protocols and patient case-mix among centres.
In New Zealand, the corresponding figures for ferritin were between 28-60% for peritoneal dialysis patients and for transferrin
saturation between 52-90%. In both countries, significant proportions of patients did not have ferritin and transferrin saturation
within the recommended ranges.
Figure 6.72
Figure 6.73
% Peritoneal Dialysis Patients
with Ferritin 200-500 g/L
% Peritoneal Dialysis Patients
with Ferritin 200-500 g/L
New Zealand 31 December 2011
Percent
Percent
Australia 31 December 2011
100
90
80
70
60
50
40
30
20
10
0
Excludes hospitals with <10 patients
0
5
10
15
20
25
30
35
100
90
80
70
60
50
40
30
20
10
0
40
Excludes hospitals with <10 patients
0
1
2
3
4
Caring Hospital
6
7
8
9
10
11
Figure 6.75
Figure 6.74
% Peritoneal Dialysis Patients with TSat >20%
% Peritoneal Dialysis Patients with TSat >20%
New Zealand 31 December 2011
Australia 31 December2011
100
100
90
90
80
80
70
70
60
60
Percent
Percent
5
Caring Hospital
50
40
50
40
30
30
20
20
10
10
0
0
Excludes hospitals with <10 patients
0
5
10
15
20
Caring Hospital
25
30
35
40
Excludes hospitals with <10 patients
0
1
2
3
4
5
6
7
8
9
10
11
Caring Hospital
6-29
PERITONEAL DIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
SERUM CALCIUM
In both Australia and New Zealand the proportions of patients with proportions with serum calcium ≥2.4 mmol/L
and < 2.2 mmol/L have remained fairly stable (Figure 6.76)
Figure 6.76
Serum Calcium - Peritoneal Dialysis
December 2009-2011
Percent
Calcium
(mmol/L)
<2.0
2.0-2.1
5
17
4
17
5
16
40
40
38
2.2-2.3
11
9
7
25
25
24
41
38
43
22
6
21
5
Dec 10
Dec 11
28
28
31
11
11
11
19
6
Dec 10
Dec 11
Dec 09
Dec 09
 2.6
2.4-2.5
Australia
New Zealand
SERUM CALCIUM
BY
TREATING CENTRE
Figures 6.77 and 6.78 show the proportions of patients at each centre with serum calcium 2.1-2.4 mmol/L, as recommended by the CARI guidelines. Note however that the values in the guidelines were for corrected total calcium, while those in this report are for uncorrected total calcium.
In Australia, the proportions ranged widely between 42-80% for peritoneal dialysis patients, while in New Zealand
the corresponding proportions were 55-79%.
Figure 6.77
Figure 6.78
% Peritoneal Dialysis Patients
with Calcium 2.1-2.4 mmol/L
% Peritoneal Dialysis Patients with
Calcium 2.1-2.4 mmol/L
Excludes hospitals with <10 patients
0
5
10
15
20
25
Caring Hospital
6-30
New Zealand 31 December 2011
Percent
Percent
Australia 31 December 2011
100
90
80
70
60
50
40
30
20
10
0
30
35
40
100
90
80
70
60
50
40
30
20
10
0
Excludes hospitals with <10 patients
0
1
2
3
4
5
6
Caring Hospital
7
8
9
10
11
PERITONEAL DIALYSIS
_____________________________________________________________________________________
ANZDATA Registry 2012 Report
SERUM PHOSPHATE
In Australia, serum phosphate has stabilized over the last three years (reflected in the size of the ≥ 1.8 mmol/
L group) (Figure 6.79)
In New Zealand, the proportions with serum phosphate ≥ 1.8 mmol/L have remained stable.
Figure 6.79
Serum Phosphate - Peritoneal Dialysis
December 2009-2011
Percent
Phosphate (mmol/L)
<1.4
1.4-1.5
1.6-1.7
1.8
36
38
37
41
43
42
16
16
18
16
15
18
18
17
17
18
15
16
29
29
28
26
26
24
Dec 10
Dec 11
Dec 09
Dec 10
Dec 11
Dec 09
Australia
New Zealand
SERUM PHOSPHATE
BY
TREATING CENTRE
Figures 6.80 - 6.81 show the proportions of patients at each centre with serum phosphate 0.8-1.6 mmol/L,
as recommended by the CARI guidelines.
In Australia, the proportions ranged widely between 18-80% for peritoneal dialysis patients and in New
Zealand, the corresponding proportions were 35-66%.
Figure 6.80
Figure 6.81
% Peritoneal Dialysis Patients with
Phosphate 0.8-1.6 mmol/L
% Peritoneal Dialysis Patients with
Phosphate 0.8-1.6 mmol/L
New Zealand 31 December 2011
Percent
Percent
Australia 31 December 2011
100
90
80
70
60
50
40
30
20
10
0
Excludes hospitals with <10 patients
0
5
10
15
20
25
Caring Hospital
30
35
40
100
90
80
70
60
50
40
30
20
10
0
Excludes hospitals with <10 patients
0
1
2
3
4
5
6
7
8
9
10
11
Caring Hospital
6-31
PERITONEAL DIALYSIS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
CALCIUM-PHOSPHATE PRODUCT
In both Australia and New Zealand, calcium-phosphate product has remained steady, with smaller
proportions of patients with a product ≥ 3.5 mmol2/L2. (Figure 6.82).
Overall, the proportion of people with high calcium-phosphate product was higher in New Zealand
than Australia.
Figure 6.82
Calcium Phosphate Product
Peritoneal Dialysis
December 2009-2011
2
2
Percent
Ca X PO4 (mmol /L )
<3.5
14
9
14
15
10
15
15
9
13
18
18
19
45
43
Dec 10
Dec 09
3.5-3.9
4.0-4.4
4.5-4.9
5.0
21
20
18
10
14
10
16
10
17
16
16
18
44
39
39
37
Dec 11
Dec 09
Dec 10
Dec 11
Australia
New Zealand
CALCIUM-PHOSPHATE PRODUCT
BY
TREATING CENTRE
Figures 6.83 - 6.84 show the proportions of patients at each centre with calcium-phosphate product
<4.0 mmol2/L2, as recommended by the CARI guidelines.
In Australia, the proportions ranged widely between 45-82% for peritoneal dialysis patients while in
New Zealand, the corresponding proportions were 29-70%.
Figure 6.84
Figure 6.83
% Peritoneal Dialysis Patients
with
2 2
Ca X PO4 < 4.0 mmol /L
% Peritoneal Dialysis Patients
with
2 2
Ca X PO4 < 4.0 mmol /L
New Zealand 31 December 2011
Percent
Percent
Australia 31 December 2011
100
90
80
70
60
50
40
30
20
10
0
Excludes hospitals with <10 patients
0
5
10
15
20
25
Caring Hospital
6-32
30
35
40
100
90
80
70
60
50
40
30
20
10
0
Excludes hospitals with <10 patients
0
1
2
3
4
5
6
Caring Hospital
7
8
9
10
11
CHAPTER 7
TRANSPLANT
WAITING LIST
Stephen McDonald
Philip Clayton
Blair Grace
Jeremy Chapman
Jenni Wright
Data from ANZDATA and the Na onal Organ Matching System of Australia (NOMS) 2012 Annual Report - 35th Edition
TRANSPLANT WAITING LIST
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
The waiting list data in this year’s report is an entirely new analysis, and is the early output from a project foreshadowed in
last year’s report to link data from the Australian National Organ Matching System (NOMS) with ANZDATA. This allows
the incorporation of demographic and clinical data, providing the opportunity to explore the dynamics of the waiting list
with more granularity than has previously been possible. A variety of further analyses are planned; in this year's report we
focus on simple waiting list stock and flow, overall and categorised by race and age. A variety of further analyses are
planned. We are working with the New Zealand Blood Service to undertake similar analyses for NZ patients.
Figure 7.1 shows the basic stock and flow tables for Australia for each year. For these tables, the numbers of people
moving on and off the waiting list for any reasons are shown. Reasons for de-listing are not systematically collected by
NOMS; a number of these patients may return to the list in subsequent years. This is one area for further analysis.
Waiting list data refers to waiting for deceased donor (DD) kidney transplants only. Recipients of living donor (LD) transplants may or may not be on the waiting list prior to transplantation. For this reason, LD transplants to recipients not on
the waiting list are also included. Recipients of kidney-pancreas (and other multiple-organ transplants) are not included in
these tables.
In the tables below, the columns describe (from left to right) :
Numbers on the active list at the beginning of the year
Numbers added during the year
Numbers removed from the active list during the year
Number of DD transplants to people on the waiting list
Number of LD transplants to people on the waiting list
Number of transplants performed out of Australia / New Zealand to people on the waiting list
Numbers who died while on the waiting list
Numbers on the waiting list at the end of the year
Numbers of LD transplants to recipients not on the waiting list.
Figure 7.1
Australian Deceased Donor Kidney Waiting List - Stock and flow Totals
Year
Active
1 Jan
Made
Active
during
year
Off list
DD Tx
LD on
active list
OS Tx
Died
Active
31 Dec
LD not on
active list
2007
1386
623
173
338
96
8
14
1380
175
2008
1380
686
196
441
123
1
16
1289
231
2009
1289
710
189
434
63
4
10
1299
264
2010
1299
651
160
533
59
1
7
1190
237
Figure 7.2
Australian Deceased Donor Kidney Waiting List - Stock and flow
(non-indigenous patients)
7-2
Year
Active
1 Jan
Made
Active
during
year
Off list
DD tx
LD on
active list
Os Tx
Died
Active
31 Dec
LD not on
active list
2007
1332
603
168
324
94
8
14
1327
173
2008
1327
650
188
417
119
1
13
1239
228
2009
1239
679
177
414
62
4
10
1251
261
2010
1251
613
152
505
59
1
6
1141
237
ANZDATA Registry 2012 Report
TRANSPLANT WAITING LIST
_____________________________________________________________________________________
Figure 7.3
Australian Deceased Donor Kidney Waiting List - Stock and flow
(indigenous patients)
Year
Active
1 Jan
Made
Active
during
year
Off
list
DD tx
LD on
active list
Os Tx
Died
Active
31 Dec
LD not on
active list
2007
54
20
5
14
2
0
0
53
2
2008
53
36
8
24
4
0
3
50
3
2009
50
31
12
20
1
0
0
48
3
2010
48
38
8
28
0
0
1
49
0
The numbers of both dialysis patients and transplants vary with age; in Figure 7.4 the stock and flow for the years
2007-10 by broad age groups is shown. As expected, numbers listed 65 years or older are much lower than for
younger age groups, and the proportion removed from the list is higher.
Figure 7.4
Australian Deceased Donor Kidney Waiting List
Stock and flow for each year by age
Year
Age
group
Active
1 Jan
Made
Active
during
year
Off list
DD tx
LD on
active list
OS Tx
Died
Active
31 Dec
LD not on
active list
2007
<25
23
29
2
10
7
0
0
33
15
2008
<25
33
34
3
16
9
0
0
39
31
2009
<25
39
29
4
19
2
1
0
42
37
2010
<25
42
34
3
22
4
0
1
46
44
2007
25-44
338
166
32
91
28
1
2
350
72
2008
25-44
350
160
54
124
40
0
3
289
67
2009
25-44
289
213
35
108
21
2
2
334
82
2010
25-44
334
193
43
129
24
0
0
331
77
2007
45-64
810
344
99
197
48
6
11
793
73
2008
45-64
793
386
96
243
60
1
11
768
102
2009
45-64
768
385
110
244
38
1
7
753
123
2010
45-64
753
352
84
310
22
1
5
683
107
2007
65+
215
84
40
40
13
1
1
204
15
2008
65+
204
106
43
58
14
0
2
193
31
2009
65+
193
83
40
63
2
0
1
170
22
2010
65+
170
72
30
72
9
0
1
130
9
7-3
TRANSPLANT WAITING LIST
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
This page is intentionally left blank
7-4
CHAPTER 8
TRANSPLANTATION
Philip Clayton
Scott Campbell
Steven Chadban
Stephen McDonald
Kylie Hurst
2012 Annual Report - 35th Edition
TRANSPLANTATION
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
TRANSPLANTS PERFORMED
IN
2011
Figure 8.1
Number of Kidney Transplant Operations
AUSTRALIA
Total (Living Donors)
Australia
New Zealand
Year
8-2
1st
2nd
3rd
4th
5th
Total
1st
2nd
3rd
4th
Total
1963
5
1
0
0
0
6 (0)
0
0
0
0
0
1964
2
0
0
0
0
2 (0)
0
0
0
0
0
1965
12
1
1
0
0
14 (3)
1
0
0
0
1 (1)
1966
18
2
0
0
0
20 (5)
10
3
0
0
13 (0)
1967
69
2
0
0
0
71 (2)
18
4
1
0
23 (1)
1968
97
10
0
0
0
107 (0)
17
4
0
0
21 (2)
1969
149
12
0
0
0
161 (0)
39
5
0
0
44 (0)
1970
168
12
2
0
0
182 (1)
21
3
1
0
25 (0)
1971
207
22
1
0
0
230 (1)
26
6
0
0
32 (1)
1972
183
16
0
0
0
199 (2)
43
8
0
0
51 (1)
1973
213
30
1
0
0
244 (7)
50
10
2
0
62 (0)
1974
224
35
4
0
0
263 (6)
35
5
1
0
41 (3)
1975
271
29
3
1
0
304 (7)
61
13
0
0
74 (2)
1976
223
41
4
0
0
268 (10)
38
13
1
0
52 (1)
1977
265
57
4
0
0
326 (16)
46
10
2
0
58 (4)
1978
269
43
2
0
0
314 (17)
43
11
3
0
57 (11)
1979
293
35
5
0
0
333 (34)
61
13
3
2
79 (16)
57
13
4
0
74 (18)
51
8
1
0
60 (10)
1980
287
63
9
0
0
359 (36)
1981
306
58
9
1
0
374 (35)
1982
321
72
6
0
0
399 (53)
48
17
0
0
65 (8)
1983
272
63
10
2
0
347 (48)
69
25
4
0
98 (11)
1984
362
72
10
1
0
445 (48)
63
11
0
0
74 (16)
1985
318
79
17
1
0
415 (36)
60
25
3
0
88 (6)
1986
366
63
7
2
0
438 (32)
79
19
6
1
105 (13)
1987
310
58
21
3
0
392 (40)
57
17
4
1
79 (20)
1988
391
62
10
2
1
466 (46)
61
11
6
0
78 (8)
1989
433
46
10
2
0
491 (48)
71
11
1
0
83 (12)
1990
387
45
9
2
0
443 (59)
86
14
2
0
102 (23)
1991
386
70
11
3
0
470 (78)
62
10
4
1
77 (13)
1992
404
57
13
3
0
477 (70)
105
5
5
0
115 (17)
1993
385
63
6
4
1
459 (66)
68
13
2
0
83 (20)
1994
384
41
12
2
1
440 (103)
70
11
1
1
83 (20)
1995
371
60
11
0
0
442 (94)
84
7
3
0
94 (24)
1996
416
50
9
0
0
475 (115)
88
7
1
0
96 (26)
1997
447
51
6
1
0
505 (147)
101
10
1
0
112 (31)
1998
443
62
11
2
0
518 (161)
95
10
1
0
106 (31)
1999
403
43
9
0
0
455 (168)
97
11
4
0
112 (42)
2000
476
47
7
1
0
531 (181)
91
13
2
0
106 (31)
2001
488
45
6
2
0
541 (213)
101
9
0
0
110 (43)
2002
537
60
5
2
0
604 (230)
103
12
2
0
117 (48)
2003
472
60
10
1
0
543 (218)
94
13
4
0
111 (44)
2004
583
53
11
3
0
650 (244)
98
7
0
0
105 (48)
2005
539
67
15
2
0
623 (246)
87
5
0
1
93 (46)
2006
549
70
17
5
0
641 (273)
80
8
2
0
90 (49)
2007
527
75
11
0
2
615 (271)
112
9
2
0
123 (58)
2008
708
84
16
5
0
813 (354)
111
10
1
0
122 (69)
2009
673
88
11
0
0
773 (327)
109
12
0
0
121 (67)
2010
744
83
18
1
0
846 (296)
104
5
1
0
110 (60)
2011
744
68
10
3
0
825 (255)
110
7
1
0
118 (57)
The 825 transplant operations performed in
2011 represent a decrease over 2010. This
was primarily driven by a 14% decrease in the
number of live donor transplants performed
compared with 2011, and a 28% decrease
compared with 2008.
The 2011 numbers represents a transplant
rate of 37 per million population per year,
compared with 38 per million in 2010. There
has been a progressive increase in the number of kidney transplants from non-heart beating donors; in 2011 such kidneys accounted
for 26% of deceased donor kidney transplants.
The number of kidney transplants from heart
beating donors has remained constant (Figure
8.4).
For more up to date figures on the deceased
organ donor rate, see www.anzdata.org.au/
anzod/updates/anzodupdate.htm
Living donor transplants accounted for 31%
(255 grafts) in 2011, down from 35% in 2010
(296 grafts) and 42% in 2009 (327 grafts).
Primary recipients (those receiving a first
transplant) received 90% of all kidneys transplanted in 2011, similar to recent years.
NEW ZEALAND
The number of transplant operations (118)
performed in 2011 represents a transplant
rate of 27 per million population per year compared with 25 in 2010 (Figure 8.1).
The percentage of living donors remained
steady at 48% of all operations in 2011
(Figure 8.3). There were no transplants from
non-heart beating donors in 2011.
Of the grafts performed in 2011, 93% were to
primary recipients, reflecting a reduced number of subsequent grafts in 2011.
ANZDATA Registry 2012 Report
TRANSPLANTATION
_____________________________________________________________________________________
Figure 8.2
Deceased and Living Donor Transplants
Australia 2007-2011
570
550
600
Number of transplants
459
344 354
400
446
327
271
296
255
200
Living donor
Deceased donor
0
2007
2008
2009
2010
2011
Figure 8.3
Deceased and Living Donor Transplants
New Zealand 2007-2011
80
Number of transplants
65
69
67
60
58
53
60
54
57
61
50
40
20
Living donor
Deceased donor
0
2007
2008
2009
2010
2011
Figure 8.4
Transplants from Non-Heart Beating Donors
Australia 2007-2011
Transplants from Heart Beating Donors
Australia 2007-2011
416
151
150
Number of transplants
Number of transplants
100
75
50
0
43
27
2007
2008
2009
2010
2011
419
371
400
117
433
317
300
200
100
0
2007
2008
2009
2010
2011
8-3
TRANSPLANTATION
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
TRANSPLANT RATE
OF
PATIENTS DIALYSED
In Australia transplantation was performed in 6% of patients who received dialysis in 2011.
Of all patients in the 15-64 year age group who received dialysis treatment during 2011, 10% were transplanted in 2011,
compared with 11% in 2010 (Figure 8.6).
The ratio of transplantation to numbers dialysing in Australia was the highest in the age groups 5-14 years (49%) and 04 years of age (32%) and declined with increasing age (Figure 8.7).
In New Zealand transplantation was performed for 4% of patients, the same percentage as 2010 (Figure 8.5).
As in Australia, the rate of transplantation for New Zealand patients was highest among those less than 14 years old
(Figure 8.8).
Figure 8.5
Figure 8.6
Ratio of Transplantation 2011
Ratio of Transplantation 2011
Related to patients dialysed
Related to patients dialysed, ages 15-64
9
8
% transplanted
20
8
16
8
7
7
6
6
6
5
4
4
2
% transplanted
10
15
10
QLD NSW
ACT
Vic
Tas
SA
NT
WA
Aust
49
Living
Deceased
QLDNSW ACT Vic Tas SA NT WA
Aust NZ
Related to patients dialysed
60
60
32
% transplanted
% transplanted
2
Ratio of Transplantation 2011 - New Zealand
Related to patients dialysed
50
30
17
20
19
12
10
10
8
3
0-4
5-14
0
15-24 25-34 35-44 45-54 55-64 65-74 75-84
40
20
9
9
11
6
5
0
85+
0
0-4
5-14
* Pre-emptive transplant patients included
4
1
0
15-24 25-34 35-44 45-54 55-64 65-74 75-84
Age
Age
8-4
10
10
Figure 8.8
Ratio of Transplantation 2011 - Australia
0
10
9
6
0
NZ
Figure 8.7
40
9
14
5
2
0
14
0
85+
ANZDATA Registry 2012 Report
TRANSPLANTATION
_____________________________________________________________________________________
AGE
OF
RECIPIENTS TRANSPLANTED
The median age of transplant recipients
in 2011 was 50 years, the same as in
2010. The age range was 1 to 76 years
(Figures 8.9 and 8.10).
Graft Number and Age of Patients Transplanted
2011
Graft
No.
Age Groups
Total
00-04
05-14
15-24
25-34
35-44
45-54
55-64
65-74
75-84
1
4
13
12
48
79
136
152
66
1
511
2
0
1
2
8
7
15
11
6
0
50
3
0
0
1
0
2
3
1
0
0
7
4
0
0
0
0
2
0
0
0
0
2
1
4
12
17
33
44
41
59
22
1
233
2
0
0
3
5
5
1
4
0
0
18
3
0
0
1
0
0
2
0
0
0
3
4
0
0
0
0
0
0
1
0
0
1
8
26
36
94
139
198
228
94
2
825
1
2
1
2
9
5
14
18
7
0
58
2
0
0
0
0
0
2
0
0
0
2
3
0
0
0
0
1
0
0
0
0
1
1
1
0
5
6
7
17
13
3
0
52
2
0
0
0
0
1
2
2
0
0
5
3
1
7
15
14
35
33
10
0
118
The transplantation rate per million for
each age group and as a percentage of
dialysed patients for each age group
are shown in Figures 8.7 and 8.10.
Australia
Deceased
Living Donor
Total
NEW ZEALAND
The 2011 median age of transplant
recipients in 2011 was 50 years. The
age range was 1 to 73 years (Figures
8.8 and 8.11).
New Zealand
Deceased
Living Donor
Total
Figure 8.10
80
New Zealand
89
65
56
60
44
40
0
Transplant Operations (per million) 2011
29
0-4
9
12
2
5-14
15-24
25-34
35-44
Age
45-54
55-64
65-74
75-84
Transplants per million population
Transplants per million population
Australia
5
Recipients aged between 35 and 54
years comprised 42% of the total. Thirty
-six percent of recipients were over 54
years of age in 2011.
Figure 8.11
Transplant Operations (per million) 2011
20
2011
AUSTRALIA
Figure 8.9
Donor
Source
IN
80
67
57
60
40
20
31
26
23
11
10
2
0
0-4
5-14
15-24
25-34
35-44
45-54
55-64
65-74
Age
8-5
TRANSPLANTATION
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
ETHNICITY
OF
Transplantation Rate - Age Group 15-64 years
2002 - 2011
Figure 8.12.
For the 15-64 year age group in
2011, 12.4% of dialysed Caucasian
patients were transplanted. For Australian Aboriginals and Torres Strait
Islanders (ATSI), the numbers receiving transplants remains low.
Tx
Dialysed
Rate
Tx
Dialysed
Rate
Tx
Dialysed
Rate
2002
479
3724
12.9%
17
729
2.3%
549
5088
10.8%
2003
414
3789
10.9&
12
783
1.5%
478
5250
9.1%
2004
491
3873
12.7%
25
856
2.9%
581
5436
10.7%
2005
460
4040
11.4%
20
930
2.2%
548
5714
9.6%
2006
480
4241
11.3%
27
989
2.7%
578
6037
9.6%
2007
471
4381
10.8%
17
1065
1.6%
557
6330
8.8%
2008
602
4487
13.4%
29
1175
2.5%
724
6628
10.9%
2009
574
4493
12.8%
23
1198
1.9%
687
6709
10.2%
2010
607
4432
13.7%
27
1212
2.2%
734
6711
10.9%
2011
551
4460
12.4%
25
1264
2.0%
695
6840
10.2%
New Zealand
Transplantation Rate - Age Group 15-64 years
Caucasian
Year
In New Zealand, 16.9% of
transplant recipients were
Maoris and 7.6% were Pacific
People.
Pacific People
All Patients
Dialysed
Rate
Tx
Dialysed
Rate
Tx
Dialysed
Rate
Tx
Dialysed
Rate
2002
70
541
12.9%
12
494
2.4%
15
267
5.6%
102
1397
7.3%
2003
64
545
11.7%
16
531
3.0%
13
271
4.8%
101
1442
7.0%
2004
65
542
12.0%
10
558
1.8%
12
285
4.2%
96
1483
6.5%
2005
73
568
12.9%
3
563
0.5%
3
303
1.0%
82
1523
5.4%
2006
59
567
10.4%
9
606
1.5%
5
322
1.6%
80
1599
5.0%
2007
82
576
14.2%
15
616
2.4%
6
344
1.7%
111
1648
6.7%
2008
84
586
14.3%
12
620
1.9%
9
376
2.4%
112
1699
6.6%
2009
77
599
12.9%
13
636
2.0%
6
405
1.5%
101
1782
5.7%
2010
62
591
10.5%
17
661
2.6%
8
444
1.8%
95
1856
5.1%
2011
67
601
11.1%
18
648
2.8%
7
466
1.5%
104
1877
5.5%
Figure 8.14
New Transplanted Patients 2007 - 2011
Related to Ethnicity
Race
2007
2008
2009
2010
2011
Australia
615 (100.0%)
813 (100.0%)
773 (100.0%)
846 (100.0%)
825 (100.0%)
Caucasian
524 (85.2%)
675 (83.0%)
651 (84.2%)
706 (83.5%)
658 (79.8%)
Aboriginal/Torres St. Islanders
18 (2.9%)
31 (3.8%)
24 (3.1%)
28 (3.3%)
28 (3.4%)
Asian
56 (9.1%)
83 (10.2%)
75 (9.7%)
83 (9.8%)
97 (11.8%)
Other
17 (2.8%)
24 (3.0%)
23 (3.0%)
29 (3.4%)
42 (5.1%)
123 (100.0%)
122 (100.0%)
121 (100.0%)
110 (100.0%)
118 (100.0%)
91 (74.0%)
93 (76.2%)
91 (75.2%)
71 (64.5%)
77 (65.3%)
Asian
9 (7.3%)
7 (5.7%)
5 (4.1%)
8 (7.3%)
11 (9.3%)
Maori
17 (13.8%)
12 (9.8%)
19 (15.7%)
20 (18.2%)
20 (16.9%)
Pacific
6 (4.9%)
10 (8.2%)
6 (5.0%)
9 (8.2%)
9 (7.6%)
Other
-
-
-
2 (1.8%)
1 (0.8%)
New Zealand
Caucasian
8-6
Maori
2002 - 2011
Tx
Figure 8.14 shows these data
in another format.
In Australia in 2011, 3.4% of
transplant recipients were of
Aboriginal/TSI ethnicity.
All Patients
Figure 8.13
Figure 8.13.
AUSTRALIA AND NEW
ZEALAND
Aboriginal and
Torres St. Islanders
Caucasian
Year
In contrast, the number of ATSI patients dialysed continues to increase
each year.
Amongst the 15-64 year age
group, the proportion of Maori
and Pacific People who received a renal transplant in
2011 was substantially lower
than other groups.
Australia
Figure 8.12
AUSTRALIA
NEW ZEALAND
TRANSPLANT RECIPIENTS
ANZDATA Registry 2012 Report
TRANSPLANTATION
_____________________________________________________________________________________
AUSTRALIAN REGIONAL TRANSPLANTATION ACTIVITY
Figure 8.15
Transplants in each Region 2007 - 2011
Number of Operations
(per Million Population per year)
State
2007
2008
2009
2010
2011
Queensland
114 (27)
136 (32)
140 (32)
137 (31)
155 (35)
New South Wales / ACT *
187 (26)
243 (33)
238 (32)
265 (35)
232 (31)
Victoria / Tasmania *
183 (32)
246 (42)
233 (39)
285 (48)
278 (46)
South Australia / NT *
78 (43)
110 (60)
83 (45)
82 (44)
74 (40)
Western Australia
53 (25)
78 (36)
79 (35)
77 (34)
86 (37)
Australia
615 (29)
813 (38)
773 (35)
846 (38)
825 (37)
* For calculation of population related totals,
the populations of these States were summed
Figure 8.16
Transplant Operations 2007-2011
80
60
60
40
40
20
20
0
0
2007
2008
2009
2010
Transplants per million population
Transplants per million population
Australian transplant regions
80
The rate of transplantation for each transplant
region is shown in Figures 8.15 and 8.16.
QLD
NSW/ACT
Vic/Tas
SA/NT
WA
2011
Transplants performed for people resident in Tasmania and the Northern Territory patients are
included in figures for Victoria and South Australia regions. These regions share common waiting
lists and allocation protocols.
The transplant rates for residents of each State
and New Zealand are shown in Figure 8.17.
The highest rate (52 per million) occurred in
Northern Territory followed by Victoria (46 per
million) and Tasmania (45 per million). The lowest rate (31 per million) was in New South Wales.
Year
Figure 8.17
Rate of Transplantation 2011
Related to population (per million)
52
46 45
Rate of transplantation
50
40
33
31
34
42
37
37
27
30
20
10
0
Deceased
Living
QLDNSW ACT Vic Tas SA NT WA
Aust NZ
NSW population excludes residents of the Southern Area Health Service
ACT population includes residents of the Southern Area Health Service
Medical services in the ACT service the Southern Area Region
8-7
TRANSPLANTATION
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
FUNCTIONING TRANSPLANTS
AT
31ST DECEMBER 2011
AUSTRALIA
Figure 8.18
There have been 19,859 transplant operations performed on 17,135
patients since 1963. Of these, 8,753 grafts were functioning at 31st
December 2011.
Fourteen percent of transplanted kidneys and 11% of functioning
grafts were regrafts. Living donor transplants accounted for 24% of
operations and 37% of functioning grafts (Figure 8.18). The number
of kidney transplant operations performed by each hospital during this
period is shown in Appendix I, available on the Web.
The number of functioning grafts at the end of 2011 represents a
4.8% increase over the previous year. The annual rate of increase
has remained steady (Figure 8.20 and 8.21).
The prevalence of functioning grafts in each State is shown in Figures
8.20 and 8.21. South Australia/Northern Territory has the highest
prevalence of functioning renal transplants (546 per million). The lowest prevalence was in Western Australia (349 per million).
The age distribution of functioning transplants as a proportion of patients on renal replacement therapy is shown in Figure 8.23. The proportion depending on living donor grafts is greater in the younger age
groups (Figures 8.23 and 8.24).
Summary of Kidney
Transplantation
Australia 1963 - 2011
Deceased
Donor
Living
Donor
Performed
Functioning*
First
Second
Third
12853
1936
315
4818
582
96
Fourth
48
15
Fifth
4
1
Total
15156
5512
First
4248
2951
Second
390
243
Third
Fourth
55
9
41
6
Fifth
1
0
Total
4703
3241
19859
8753
Total
* Lost to follow up not included
The details of age are shown Figure 8.25, and details of age, gender
and ethnicity are shown in figure 8.28.
The majority of recipients with functioning grafts were male (61%).
The ethnic origin of recipients was Caucasian 87%, Asian 8%, Aboriginal and Torres Strait Islanders 2% and Others 3% (Figure 8.28).
The 8,753 grafts functioning at the end of 2011 represent 44% of all
kidneys transplanted since 1963. Thirty-four percent of grafts were
functioning ten or more years and 9% for 20 or more years. There
were 171 recipients with grafts functioning 30 years or longer (Figure
8.29). The longest graft had functioned for 43 years at 31st December,
2011.
NEW ZEALAND
Figure 8.19
Summary of Kidney
Transplantation
New Zealand 1965 - 2011
There have been 3,746 operations performed on 3,188 patients since
1965 with 1,481 grafts still functioning at 31st December 2011 (Figure
8.19). Fifteen percent of operations and 9.6% of functioning grafts
were regrafts. Kidneys from living donors accounted for 28% of operations and 44% of functioning grafts.
The number of operations performed by individual hospitals is shown
in Appendix I at the end of this Report.
The age relationship and donor source are shown in Figure 8.25. The
majority were male (58%) and the racial distribution was Caucasian
76%, Maori 10%, Pacific People 6% and Asian 7% (Figure 8.28).
The majority (69%) of functioning grafts were in the 35-64 year age
group and the mean and median ages were 51 and 52 years respectively. The modal age group was 55-64 years (Figure 8.25).
The 1,481 grafts functioning at the end of 2011 represent 40% of all
kidneys transplanted since 1965. The longest surviving graft had
functioned for 41 years at 31st December 2011. There were 138
grafts functioning for 20 or more years and 23 for 30 or more years
(Figure 8.30).
8-8
Performed
Functioning*
First
2232
734
Second
396
77
76
17
Fourth
7
0
Total
2711
828
First
949
605
Second
77
44
Third
6
4
Total
1032
653
3743
1481
Deceased Third
Donor
Living
Donor
Total
* Lost to follow up not included
ANZDATA Registry 2012 Report
TRANSPLANTATION
_____________________________________________________________________________________
Figure 8.20
Functioning Transplants 2002 - 2011
Transplanting Region, Australia and New Zealand
(Number Per Million Population)
QLD
NSW/ACT *
VIC/Tas *
SA/NT *
WA
Australia
NZ
2002
1109 (299)
1907 (274)
1538 (288)
702 (408)
528 (274)
5784 (294)
1116 (283)
2003
1150 (302)
2008 (287)
1581 (293)
737 (426)
530 (271)
6006 (302)
1168 (290)
2004
1185 (304)
2106 (299)
1651 (302)
791 (454)
562 (283)
6295 (313)
1221 (299)
2005
1220 (305)
2179 (307)
1721 (311)
811 (461)
617 (306)
6548 (321)
1239 (300)
2006
1257 (307)
2271 (318)
1830 (326)
847 (476)
657 (319)
6862 (332)
1247 (298)
2007
1313 (314)
2317 (321)
1925 (338)
882 (491)
678 (321)
7115 (339)
1283 (303)
2008
1372 (321)
2422 (331)
2057 (355)
934 (514)
716 (329)
7501 (351)
1348 (316)
2009
1447 (331)
2530 (341)
2203 (373)
963 (523)
748 (333)
7891 (362)
1399 (324)
2010
1517 (343)
2676 (357)
2374 (397)
1006 (541)
777 (338)
8350 (378)
1437 (329)
2011
1597 (357)
2773 (366)
2542 (420)
1021 (546)
820 (349)
8753 (392)
1481 (336)
Year
* For calculation of population related totals, the population of these States were combined
Patients lost to follow up are not included
Figure 8.22
Functioning Transplants by Region
Prevalence of Functioning Transplants 31 Dec 2011
Australia 2002-2011
Per million population
700
700
600
600
500
500
400
400
300
300
200
200
100
QLD
NSW/ACT
Vic/Tas
SA/NT
WA
100
2002
2004
2006
2008
2010
2012
Transplants per million population
Per million population
Figure 8.21
380
400
Figure 8.23
420 430
352 369
393
364
330
298
200
0
Year
QLD NSW ACT
Vic
Tas
SA
NT
WA
Aust
Prevalence of Functioning Transplants
Prevalence of Functioning Transplants
As mode of RRT, Australia 2011
As mode of RRT, New Zealand 2011
45
0-4
5-14
65
63
62
15-24
25-34
35-44
Age
34
20
40
46
45-54
37
27
65-74
Living donor
Deceased donor
1
0
35-44
55-64
10
85+
52
50
25-34
50
65-74
47
15-24
57
45-54
55-64
71
71
0-4
87
75-84
NZ
Figure 8.24
5-14
Age
567
600
60
Percentage of patients
80
100
13
12
75-84
85+
0
20
Living donor
Deceased donor
40
60
80
100
Percentage of patients
8-9
TRANSPLANTATION
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Figure 8.25
Age of All Functioning Transplant Patients
Resident Country at Transplant 31-Dec-2011
Donor
Source
Graft
No.
Age Groups
05-14
15-24
25-34
35-44
45-54
55-64
65-74
75-84
85-94
14
132
280
655
1515
2152
2353
1369
277
6
8753
1
6
39
83
216
702
1186
1447
930
204
5
4818
2
-
4
6
43
104
181
155
73
15
1
582
3
4
-
-
1
-
7
-
27
6
34
7
17
2
10
-
-
-
96
15
Australia
Deceased
Donor
Total
00-04
5
-
-
-
-
-
-
1
-
-
-
1
Total
6
43
90
266
839
1408
1622
1013
219
6
5512
1
2
3
8
86
175
360
593
673
660
343
53
-
2951
4
-
3
-
13
2
-
28
1
69
12
2
54
16
1
61
8
2
10
3
-
5
-
-
243
41
6
Total
8
89
190
389
676
744
731
356
58
-
3241
Living Donor
New Zealand
Deceased
Donor
5
20
56
129
230
380
408
214
36
3
1481
1
2
3
13
44
83
179
228
147
33
2
734
2
-
-
1
2
17
29
22
6
-
-
77
3
-
-
-
-
6
4
5
2
-
-
17
Total
2
3
14
46
106
212
255
155
33
2
828
1
2
3
17
41
76
110
150
145
59
3
1
605
3
-
-
1
-
7
-
13
1
15
3
8
-
-
-
-
44
4
Total
3
17
42
83
124
168
153
59
3
1
653
Living Donor
Figure 8.26
Age Distribution of Functioning Transplants
Australia 2011 (n=8753)
Per million population, Australia 2011
Number of transplants
2,500
2152
2353
2,000
1515
1,500
1,000
655
500
14
0
1369
0-4
132
5-14
280
277
6
15-24 25-34 35-44 45-54 55-64 65-74 75-84
Transplants per million population
Age Distribution of Functioning Transplants
915
1,000
819
707
800
600
480
400
277
205
200
0
85+
10
0-4
48
5-14
91
15
15-24 25-34 35-44 45-54 55-64 65-74 75-84
85+
Age
Age
Figure 8.27
Age Distribution of Functioning Transplants
New Zealand 2011 (n=1481)
408
380
Number of transplants
400
300
230
200
129
56
100
5
0
0-4
36
20
5-14
15-24 25-34 35-44 45-54 55-64 65-74 75-84
Age
8-10
214
3
85+
Transplants per million population
Age Distribution of Functioning Transplants
Per million population, New Zealand 2011
825
800
615
658
600
381
400
228
200
0
16
34
0-4
5-14
191
87
41
15-24 25-34 35-44 45-54 55-64 65-74 75-84
Age
85+
ANZDATA Registry 2012 Report
TRANSPLANTATION
_____________________________________________________________________________________
Figure 8.28
Functioning Transplant Patients - Resident Country at Transplant
Related to Ethnicity and Age Group 31-Dec-2011
Gender
Racial Origin
05-14
15-24
25-34
35-44
45-54
55-64
65-74
75-84
85-94
14
132
280
655
1515
2152
2353
1369
277
6
8753
Aboriginal/TSI
2
-
37
1
100
2
215
8
498
16
673
26
741
19
492
3
126
-
3
-
2887
75
Asian
Other
1
1
4
5
9
7
22
14
70
21
99
24
115
17
34
9
5
1
-
359
99
Caucasian
Female
Total
4
47
118
259
605
822
892
538
132
3
3420
Caucasian
7
69
138
343
809
1171
1264
767
136
3
4707
Aboriginal/TSI
-
3
6
9
18
36
30
11
1
-
114
Asian
-
9
10
30
62
96
126
42
6
-
381
Other
3
4
8
14
21
27
41
11
2
-
131
Total
10
85
162
396
910
1330
1461
831
145
3
5333
5
20
56
129
230
380
408
214
36
3
1481
-
6
4
22
3
5
35
7
7
75
2
13
111
19
16
130
11
8
69
2
7
19
3
1
-
468
44
63
Pacific
-
1
-
9
8
12
7
2
1
-
40
Other
-
-
-
1
-
-
-
-
-
-
1
Total
-
11
30
59
98
158
156
80
23
1
616
Caucasian
5
7
20
49
109
175
191
94
9
2
661
Asian
Maori
-
1
1
5
8
9
5
7
10
26
19
21
12
18
2
1
-
57
88
Pacific
-
1
-
3
8
11
17
10
1
-
51
Other
-
-
-
1
3
-
4
-
-
-
8
Total
5
9
26
70
132
222
252
134
13
2
865
Male
New Zealand
Caucasian
Asian
Maori
Male
Figure 8.30
Number and Duration of Functioning Grafts
Australia 2011 (n=8753)
New Zealand 2011 (n=1481)
Deceased
Living
600
400
200
Duration (years)
Deceased
Living
100
50
0
<1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
800
Number of functioning grafts
Number and Duration of Functioning Grafts
<1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Number of functioning grafts
Figure 8.29
0
Total
00-04
Australia
Female
Prevalent Age Groups
Duration (years)
8-11
TRANSPLANTATION
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
RATES
OF
GRAFT LOSS
The rates of loss of graft function and death with a functioning graft in Australia in 2011 were 2.3% and 2.2% per
patient year respectively; in total 4.5% of grafts at risk were lost. The rate of loss of graft function (but not deaths
with functioning graft) was the same as 2010 (Figure 8.31).
In 2011, the rate of loss of graft function in New Zealand was 2.0% and death with functioning graft was 2.6%; in
total 4.6% of grafts at risk were lost (Figure 8.31).
The causes of graft failure from 2002 to 2011 are shown in Figure 8.32.
Chronic allograft nephropathy and death with function remain the key impediments to long term graft survival.
The importance of death with function, chronic allograft nephropathy and other causes of graft loss after one year is
evident in Figure 8.33.
Among the causes of death with functioning graft, cardiovascular disease and malignancy were predominant. (Figure 8.33)
Figure 8.31
Graft Loss Rate
2002 - 2011
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Australia
6113
6327
6656
6918
7189
7477
7928
8274
8737
9175
Death with Function
Loss of Graft Function
2.3%
2.9%
2.3%
2.7%
2.2%
3.1%
2.4%
2.8%
2.0%
2.5%
2.2%
2.5%
2.2%
2.9%
1.8%
2.8%
2.0%
2.3%
2.2%
2.3%
All Losses
5.2%
4.9%
5.3%
5.1%
4.5%
4.7%
5.1%
4.5%
4.3%
4.5%
New Zealand
1180
1227
1273
1314
1329
1370
1405
1469
1509
1555
Death with Function
Loss of Graft Function
2.7%
2.7%
2.2%
2.5%
2.2%
1.8%
2.3%
3.3%
2.6%
3.5%
3.2%
2.9%
1.9%
2.1%
2.3%
2.4%
2.3%
2.1%
2.6%
2.0%
All Losses
5.4%
4.7%
4.0%
5.6%
6.0%
6.1%
3.9%
4.7%
4.4%
4.6%
Figure 8.32
Year of Graft Loss Due to Death or Failure
Loss
Cause of Failure
2002 - 2011
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Total
138
144
144
163
144
162
172
146
171
201
1585
8
3
5
3
7
11
10
16
8
10
81
Chronic Allograft (CAN)
108
113
143
134
105
131
172
151
145
144
1346
Rejection - Hyperacute
Vascular
Technical Problems
Glomerulonephritis
16
3
15
15
3
12
18
2
13
13
4
16
1
14
5
23
8
2
15
2
14
4
9
17
3
15
11
3
14
6
3
15
3
132
32
147
Non Compliance
Other
11
16
10
13
8
19
6
15
3
19
8
15
6
16
12
14
6
18
6
31
76
176
315
313
352
354
321
352
405
374
376
416
3578
330
Australia
Death with Function
Rejection - Acute
Failed
Total
New Zealand
Failed
Total
8-12
Death with Function
32
27
28
30
34
44
26
34
34
41
Rejection - Acute
1
1
-
2
2
1
1
1
-
3
12
Chronic Allograft (CAN)
22
16
15
24
31
21
20
29
17
14
209
Rejection - Hyperacute
Vascular
Technical Problems
Glomerulonephritis
1
1
1
1
2
4
1
2
4
2
3
3
6
3
1
4
1
5
2
-
3
5
2
4
1
17
9
34
Non Compliance
Other
3
3
3
4
1
4
1
8
1
4
6
4
1
1
1
2
5
2
3
5
25
37
64
58
51
74
81
84
55
69
66
72
674
ANZDATA Registry 2012 Report
TRANSPLANTATION
_____________________________________________________________________________________
Figure 8.33
Graft Losses
Cause of Loss
2007 - 2011
Australia
New Zealand
Graft Function
Graft Function
<1 year
>= 1 year
Any Time
<1 year
>= 1 year
Any Time
Cardiac
21 (30%)
191 (24%)
212 (25%)
4 (36%)
47 (28%)
51 (28%)
Vascular
5 (7%)
70 (9%)
75 (9%)
1 (9%)
7 (4%)
8 (4%)
Infection
29 (42%)
130 (17%)
159 (19%)
1 (9%)
27 (16%)
28 (16%)
Death with functioning Graft
Social
3 (4%)
53 (7%)
56 (7%)
1 (9%)
8 (5%)
9 (5%)
Malignancy
5 (7%)
262 (33%)
267 (31%)
3 (27%)
60 (36%)
63 (35%)
Miscellaneous
6 (9%)
77 (10%)
83 (10%)
1 (9%)
19 (11%)
20 (11%)
69 (100%)
783 (100%)
852 (100%)
11 (100%)
168 (100%)
179 (100%)
30 (23%)
25 (3%)
55 (5%)
-
6 (4%)
6 (4%)
Rejection - Chronic Allograft (CAN)
9 (7%)
734 (78%)
743 (69%)
1 (6%)
100 (67%)
101 (60%)
Rejection - Hyperacute
2 (2%)
-
2 (<1%)
-
-
-
Vascular
41 (31%)
15 (2%)
56 (5%)
8 (44%)
3 (2%)
11 (7%)
Technical Problems
10 (8%)
5 (1%)
15 (1%)
1 (6%)
-
1 (1%)
Glomerulonephritis
9 (7%)
59 (6%)
68 (6%)
3 (17%)
15 (10%)
18 (11%)
Non Compliance
1 (1%)
37 (4%)
38 (4%)
1 (6%)
15 (10%)
16 (10%)
Other
30 (23%)
64 (7%)
94 (9%)
4 (22%)
10 (7%)
14 (8%)
Total
132 (100%)
939 (100%)
1071 (100%)
18 (100%)
149 (100%)
167 (100%)
Total
Graft Failure
Rejection - Acute
8-13
TRANSPLANTATION
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
IMMUNOSUPPRESSION
AUSTRALIA
In Australia in 2011 Tacrolimus was used initially in 87% and Cyclosporine in 10% of primary
deceased donor grafts. The proportion of patients initially using Tacrolimus has increased
since 2004, as shown in Figure 8.34. The number of patients still taking Prednisolone two
years after transplantation has increased since 2004 and is now 94%, for patients transplanted in 2009.
Caution is necessary in the interpretation of small changes in clinical practice with immunosuppressive therapy. A number of large research trials are undertaken in Australia. The drug
protocol used in those studies can potentially skew the number of patients taking specific
drugs in any given year.
Australia
Figure 8.34
Immunosuppressive Therapy - Primary Deceased Donor Graft 2004 - 2011
Initial
treatment
Treatment
at
12 months
Treatment
at
24 months
Year
Aza
CyA
Tacrol
MMF
MPA
Sirol
Everolimus
Pred
Number of
Deceased
Donor Grafts
2004
6 (2%)
212 (59%)
136 (38%)
309 (85%)
25 (7%)
10 (3%)
1 (<1%)
360 (99%)
362
2005
9 (3%)
131 (41%)
172 (54%)
299 (94%)
4 (1%)
17 (5%)
-
308 (97%)
319
2006
-
155 (51%)
139 (45%)
260 (85%)
24 (8%)
3 (1%)
19 (6%)
296 (97%)
306
2007
2 (1%)
139 (48%)
140 (49%)
244 (85%)
36 (13%)
-
5 (2%)
285 (99%)
287
2008
2 (1%)
137 (35%)
240 (61%)
364 (93%)
22 (6%)
-
-
389 (99%)
391
2009
4 (1%)
62 (16%)
310 (82%)
356 (95%)
13 (3%)
-
3 (1%)
375 (100%)
376
2010
-
66 (14%)
409 (86%)
426 (89%)
37 (8%)
1 (<1%)
3 (1%)
477 (100%)
478
2011
1 (<1%)
51 (10%)
443 (87%)
309 (60%)
189 (37%)
-
-
498 (97%)
511
2004
23 (7%)
129 (39%)
162 (49%)
236 (72%)
46 (14%)
31 (9%)
1 (<1%)
304 (93%)
328
2005
23 (8%)
83 (29%)
172 (59%)
229 (79%)
21 (7%)
29 (10%)
3 (1%)
262 (90%)
291
2006
12 (4%)
94 (34%)
145 (52%)
216 (78%)
27 (10%)
21 (8%)
20 (7%)
259 (93%)
278
2007
13 (5%)
86 (32%)
149 (56%)
189 (71%)
51 (19%)
12 (5%)
14 (5%)
252 (95%)
265
2008
17 (5%)
84 (23%)
251 (70%)
288 (80%)
37 (10%)
12 (3%)
9 (2%)
345 (96%)
361
2009
18 (5%)
40 (11%)
283 (80%)
282 (80%)
39 (11%)
18 (5%)
9 (3%)
341 (96%)
354
2010
24 (5%)
51 (11%)
364 (81%)
332 (73%)
65 (14%)
16 (4%)
10 (2%)
430 (95%)
452
2004
30 (9%)
116 (36%)
154 (48%)
219 (68%)
45 (14%)
41 (13%)
5 (2%)
283 (88%)
320
2005
23 (8%)
76 (27%)
156 (55%)
220 (78%)
23 (8%)
45 (16%)
5 (2%)
238 (84%)
282
2006
15 (6%)
81 (30%)
144 (53%)
207 (76%)
31 (11%)
23 (8%)
25 (9%)
248 (92%)
271
2007
12 (5%)
79 (31%)
152 (59%)
181 (70%)
54 (21%)
14 (5%)
13 (5%)
243 (94%)
259
2008
20 (6%)
80 (23%)
238 (68%)
275 (79%)
39 (11%)
12 (3%)
9 (3%)
324 (93%)
350
2009
22 (6%)
36 (10%)
268 (78%)
257 (75%)
43 (13%)
18 (5%)
11 (3%)
322 (94%)
343
Aza
CyA
Tacrol
MMF
MPA
Sirol
Pred
8-14
=
=
=
=
=
=
=
Azathioprine
Cyclosporine
Tacrolimus
Mycophenolate Mofetil
Mycophenolic Acid (Enteric Coated)
Sirolimus
Prednisolone
ANZDATA Registry 2012 Report
TRANSPLANTATION
_____________________________________________________________________________________
IMMUNOSUPPRESSION
NEW ZEALAND
In New Zealand in 2011, 71% of new primary deceased donor transplant recipients received
Cyclosporine and 29% received Tacrolimus (Figure 8.35). No transplant recipients commenced
Azathioprine at the time of transplantation.
There are very few patients in New Zealand receiving TOR-inhibitors (Sirolimus or Everolimus).
Whereas only 67% of the 2004 cohort remained on Mycophenolate two years post transplant,
96% of the 2009 cohort were still taking Mycophenolate preparations two years later.
Caution is necessary in the interpretation of differences in practice between Australia and New
Zealand. The funding of different pharmaceutical agents is quite different in the two countries.
New Zealand
Figure 8.35
Immunosuppressive Therapy - Primary Deceased Donor Graft 2004 - 2011
Initial
treatment
Treatment
at
12 months
Treatment
at
24 months
Year
Aza
CyA
Tacrol
MMF
MPA
Sirol
Everolimus
Pred
Number of
Deceased
Donor Grafts
2004
-
47 (94%)
3 (6%)
49 (98%)
-
-
-
50 (100%)
50
2005
-
32 (76%)
8 (19%)
41 (98%)
-
-
-
41 (98%)
42
2006
-
26 (68%)
11 (30%)
34 (92%)
-
-
3 (8%)
37 (100%)
37
2007
-
43 (74%)
15 (26%)
57 (98%)
-
-
1 (2%)
58 (100%)
58
2008
-
30 (67%)
15 (33%)
42 (93%)
3 (7%)
-
-
45 (100%)
45
2009
-
39 (78%)
10 (20%)
49 (98%)
-
-
-
49 (98%)
50
2010
-
32 (71%)
13 (29%)
45 (100%)
-
-
-
45 (100%)
45
2011
-
41 (71%)
17 (29%)
58 (100%)
-
-
-
58 (100%)
58
2004
9 (19%)
30 (64%)
17 (36%)
37 (79%)
-
-
-
45 (96%)
47
2005
2 (5%)
21 (55%)
16 (42%)
33 (87%)
1 (3%)
2 (5%)
1 (3%)
35 (92%)
38
2006
-
18 (53%)
15 (45%)
29 (88%)
-
-
3 (9%)
32 (97%)
33
2007
3 (6%)
31 (60%)
20 (38%)
43 (83%)
-
2 (4%)
1 (2%)
48 (92%)
52
2008
2 (5%)
21 (48%)
23 (52%)
39 (89%)
1 (2%)
-
-
41 (93%)
44
2009
-
24 (50%)
23 (48%)
48 (100%)
-
1 (2%)
-
45 (94%)
48
2010
2 (5%)
16 (37%)
26 (60%)
40 (93%)
-
-
-
41 (95%)
43
2004
12 (27%)
27 (60%)
18 (40%)
30 (67%)
-
-
-
41 (91%)
45
2005
2 (6%)
18 (50%)
17 (47%)
30 (83%)
1 (3%)
2 (6%)
1 (3%)
29 (81%)
36
2006
-
16 (50%)
16 (50%)
28 (88%)
-
-
2 (6%)
30 (94%)
32
2007
3 (6%)
29 (58%)
20 (40%)
41 (82%)
-
2 (4%)
1 (2%)
45 (90%)
50
2008
2 (5%)
20 (48%)
22 (52%)
37 (88%)
-
1 (2%)
-
40 (95%)
42
2009
-
20 (43%)
24 (52%)
44 (96%)
-
1 (2%)
-
41 (89%)
46
Aza
CyA
Tacrol
MMF
MPA
Sirol
Pred
= Azathioprine
= Cyclosporine
= Tacrolimus
= Mycophenolate Mofetil
= Mycophenolic Acid (Enteric Coated)
= Sirolimus
= Prednisolone
8-15
TRANSPLANTATION
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
USE
OF
ANTIBODY THERAPY
FOR INDUCTION IMMUNOSUPPRESSION
AUSTRALIA
NEW ZEALAND
AND
The use of mono and polyclonal antibody agents for induction immunosuppression has changed through time
and use and differs among centres and between Australia and New Zealand. The changes in use of these
agents in recent years are reported here. Readers should note that differences between Australia and New
Zealand are likely to reflect case mix and also drug availability. For this Report induction therapy is defined as
treatment given pre-transplant or up to two weeks post transplant in the absence of rejection.
Figure 8.36 shows the use of induction agents over the last five years.
In Australia in 2011 8% of recipients received an alternative agent either in addition to, or instead of Basiliximab and Daclizumab. There has been a small recent increase in the use of Intravenous Immunoglobulin and
T cell depleting polyclonal Ab, probably reflecting an increase in desensitisation regimens and ABO incompatible transplants.
In New Zealand, agents other than the interleukin 2 receptor antagonists Basiliximab and Daclizumab are
very uncommon.
Figure 8.36
Antibody Use for Induction Immunosuppression
Australia and New Zealand 2007 - 2011
Number of Kidney Transplant Recipients
Receiving Each Agent by Year
(% Total New Transplants)
2007
2008
2009
2010
2011
Australia
Muromonab-CD3
2 (0.3%)
-
1 (0.1%)
-
-
Intravenous immunoglobulin
14 (2.3%)
25 (3.1%)
28 (3.6%)
39 (4.6%)
40 (4.8%)
Anti-CD25
532 (86.5%)
740 (91.0%)
715 (92.5%)
798 (94.3%)
748 (90.7%)
Rituximab
7 (1.1%)
21 (2.6%)
17 (2.2%)
9 (1.1%)
9 (1.1%)
T cell depleting polyclonal Ab
17 (2.8%)
22 (2.7%)
40 (5.2%)
52 (6.1%)
33 (4.0%)
615
813
773
846
825
-
-
-
1 (0.9%)
1 (0.8%)
47 (38.2%)
74 (60.7%)
63 (52.1%)
65 (59.1%)
110 (93.2%)
Rituximab
-
1 (0.8%)
2 (1.7%)
1 (0.9%)
3 (2.5%)
Intravenous Immunoglobulin
-
-
-
-
-
Total new transplants
New Zealand
T cell depleting polyclonal Ab
Anti-CD25
Muromonab-CD3
Total new transplants
8-16
-
-
-
-
-
123
122
121
110
118
ANZDATA Registry 2012 Report
TRANSPLANTATION
_____________________________________________________________________________________
USE
OF
ANTIBODY THERAPY
AUSTRALIA
FOR
AND
TREATMENT
OF
REJECTION
NEW ZEALAND
Figure 8.37 shows the number of people who received antibody agents for treating acute rejection by calendar
year. The number is also reported as a proportion of new transplant recipients in each calendar year, but readers should be aware that although the large majority of people experiencing acute rejection do so within the
first six months of transplantation, some experience rejection after this time (when they would not necessarily
be counted as a new transplant). For this reason the total number of transplant recipients treated during the
year is also reported.
Muromonab-CD3 has now been withdrawn from sale and was unavailable in 2011. The use of T cell depleting
polyclonal Ab and Intravenous Immunoglobulin has increased recently.
Figure 8.37
Antibody Use as Treatment for Acute Rejection
Australia and New Zealand 2007 - 2011
Number of Kidney Transplant Recipients
Receiving Each Agent by Year
(% Total New Transplants)
2007
2008
2009
2010
2011
9 (1.5%)
10 (1.2%)
12 (1.6%)
2 (0.2%)
-
Australia
Muromonab-CD3
Intravenous immunoglobulin
70 (11.4%)
89 (10.9%)
105 (13.6%)
92 (10.9%)
104 (12.6%)
Anti-CD25
-
1 (0.1%)
1 (0.1%)
-
-
Rituximab
16 (2.6%)
24 (3.0%)
26 (3.4%)
15 (1.8%)
11 (1.3%)
T cell depleting polyclonal Ab
14 (2.3%)
19 (2.3%)
27 (3.5%)
41 (4.8%)
42 (5.1%)
Total new transplants
615
813
773
846
825
Total transplants at risk
7477
7928
8274
8737
9175
Muromonab-CD3
10 (8.1%)
10 (8.2%)
8 (6.6%)
4 (3.6%)
-
Intravenous immunoglobulin
3 (2.4%)
2 (1.6%)
7 (5.8%)
3 (2.7%)
3 (2.5%)
Anti-CD25
1 (0.8%)
1 (0.8%)
-
-
1 (0.8%)
Rituximab
-
-
3 (2.5%)
-
-
New Zealand
T cell depleting polyclonal Ab
3 (2.4%)
3 (2.5%)
2 (1.7%)
12 (10.9%)
11 (9.3%)
Total new transplants
123
122
121
110
118
Total transplants at risk
1370
1405
1469
1509
1555
8-17
TRANSPLANTATION
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
REJECTION RATES
AUSTRALIA AND NEW ZEALAND
Figure 8.38 shows the proportion of patients experiencing rejection in the first six
months after transplant. For both living and deceased donor primary grafts, the
six month incidence of rejection has fallen over the last decade.
Rejection rates in subsequent grafts are more variable due to the lower number
of recipients, but have not clearly fallen in either living or deceased donors.
Figure 8.38
Australia and New Zealand
Rejection Rates at Six Months Post Transplant
Donor Source
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
First graft
27.5%
27.7%
21.6%
19.6% 19.6%
21.1%
17.0%
16.8%
17.8%
16.1%
Second and subsequent
13.0%
33.3%
34.8%
18.5% 33.3%
34.3%
30.0%
24.3%
12.9%
18.5%
First graft
22.9%
26.8%
22.8%
18.6% 16.3%
17.7%
22.0%
20.9%
18.7%
17.9%
Second and subsequent
24.1%
25.0%
27.5%
31.7% 36.4%
32.8%
32.9%
36.5%
27.3%
16.1%
Living Donor
Deceased Donor
8-18
ANZDATA Registry 2012 Report
TRANSPLANTATION
_____________________________________________________________________________________
SHORT TERM SURVIVAL - PRIMARY DECEASED DONOR GRAFTS
AUSTRALIA
Graft and patient survival for primary deceased donor grafts performed in Australia, calculated by the
Kaplan-Meier method, is shown in Figure 8.39. The figures include graft losses or deaths on the day of
transplant, and graft survival is not censored for death. Unadjusted one year patient and graft survival for
primary deceased donor grafts in Australia have stabilised in the past ten years. Kaplan-Meier graphs
illustrating this are shown in Figure 8.40.
Figure 8.39
Primary Deceased Donor - Australia
Recipient and Graft Survival 1992 - 2011
% [95% Confidence Interval]
Survival
Year of
Transplant
1 month
6 months
1 year
5 years
Recipient Survival
1992-1993 (n=665)
99 (98, 99)
95 (94, 97)
94 (92, 96)
85 (82, 87)
1994-1995 (n=576)
99 (98, 100)
96 (94, 97)
96 (94, 97)
86 (83, 88)
1996-1997 (n=624)
99 (97, 99)
96 (94, 97)
95 (93, 97)
86 (83, 89)
1998-1999 (n=541)
99 (98, 100)
97 (95, 98)
95 (93, 96)
86 (83, 89)
2000-2001 (n=600)
99 (98, 100)
97 (96, 98)
95 (93, 97)
89 (87, 92)
2002-2003 (n=600)
100 (99, 100)
98 (96, 99)
97 (95, 98)
89 (87, 92)
2004-2005 (n=681)
99 (98, 100)
98 (96, 99)
96 (94, 97)
89 (86, 91)
2006-2007 (n=593)
99 (97, 99)
96 (94, 98)
96 (94, 97)
90 (87, 92)
2008-2009 (n=767)
99 (99, 100)
98 (97, 99)
98 (96, 98)
-
2010-2011 (n=989)
99 (99, 100)
98 (97, 99)
97 (96, 98)
-
1992-1993 (n=665)
91 (89, 93)
87 (85, 90)
86 (83, 88)
73 (69, 76)
1994-1995 (n=576)
95 (93, 97)
91 (89, 93)
90 (87, 92)
74 (70, 78)
1996-1997 (n=624)
94 (91, 95)
90 (87, 92)
89 (86, 91)
78 (74, 81)
1998-1999 (n=541)
96 (94, 97)
93 (90, 95)
91 (88, 93)
77 (73, 80)
2000-2001 (n=600)
97 (95, 98)
94 (92, 96)
92 (90, 94)
82 (79, 85)
2002-2003 (n=600)
95 (93, 97)
94 (91, 95)
93 (90, 94)
81 (77, 84)
2004-2005 (n=681)
95 (93, 97)
93 (91, 95)
91 (88, 93)
80 (77, 83)
2006-2007 (n=593)
96 (94, 97)
93 (91, 95)
92 (89, 94)
81 (77, 84)
2008-2009 (n=767)
97 (95, 98)
95 (93, 96)
93 (91, 95)
-
2010-2011 (n=989)
98 (97, 99)
96 (95, 97)
95 (93, 96)
-
Graft Survival
Figure 8.40
Primary Deceased Donor Grafts
Primary Deceased Donor Grafts
Graft survival - Australia
1.00
1.00
0.95
0.95
0.90
0.90
0.85
0.80
2004-2005 (681)
2006-2007 (593)
2008-2009 (767)
2010-2011 (989)
0.75
0.70
0.65
0
1
2
3
Years
4
5
Graft survival
Recipient survival
Recipient survival - Australia
0.85
0.80
2004-2005 (681)
2006-2007 (593)
2008-2009 (767)
2010-2011 (989)
0.75
0.70
0.65
0
1
2
3
4
5
Years
8-19
TRANSPLANTATION
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
SHORT TERM SURVIVAL - PRIMARY DECEASED DONOR GRAFTS
NEW ZEALAND
Graft and patient survival for primary deceased donor grafts performed in New Zealand, calculated by the
Kaplan-Meier method, is shown in Figure 8.41. Like Australia, the improvement in unadjusted one year
patient and graft survival have stabilised in the past ten years, although there is greater random variation
due to smaller overall numbers. Figure 8.42 presents these data as Kaplan-Meier curves.
Figure 8.41
Primary Deceased Donor - New Zealand
Recipient and Graft Survival 1992 - 2011
% [95% Confidence Interval]
Survival
Year of
Transplant
1 month
6 months
1 year
5 years
79 (71, 85)
Recipient Survival
1992-1993 (n=142)
98 (94, 99)
93 (87, 96)
89 (82, 93)
1994-1995 (n=114)
97 (92, 99)
92 (85, 96)
91 (84, 95)
88 (80, 93)
1996-1997 (n=135)
99 (94, 100)
95 (89, 97)
94 (89, 97)
84 (76, 89)
1998-1999 (n=126)
96 (91, 98)
91 (85, 95)
90 (83, 94)
79 (71, 85)
2000-2001 (n=125)
100
96 (91, 98)
96 (91, 98)
86 (79, 91)
2002-2003 (n=113)
98 (93, 100)
94 (87, 97)
94 (87, 97)
87 (79, 92)
2004-2005 (n=92)
99 (93, 100)
97 (90, 99)
97 (90, 99)
91 (83, 96)
2006-2007 (n=95)
99 (93, 100)
97 (91, 99)
96 (89, 98)
86 (77, 92)
2008-2009 (n=95)
100
99 (93, 100)
99 (93, 100)
-
2010-2011 (n=103)
99 (93, 100)
99 (93, 100)
98 (90, 99)
-
Graft Survival
1992-1993 (n=142)
89 (82, 93)
82 (74, 87)
77 (70, 83)
67 (59, 74)
1994-1995 (n=114)
88 (80, 93)
84 (76, 90)
80 (71, 86)
69 (60, 77)
1996-1997 (n=135)
90 (83, 94)
87 (80, 91)
84 (77, 90)
72 (63, 79)
1998-1999 (n=126)
91 (85, 95)
86 (78, 91)
83 (75, 88)
69 (60, 76)
2000-2001 (n=125)
94 (89, 97)
90 (84, 94)
90 (84, 94)
78 (70, 85)
2002-2003 (n=113)
90 (83, 94)
88 (80, 92)
88 (80, 92)
75 (66, 82)
2004-2005 (n=92)
98 (92, 99)
92 (85, 96)
92 (85, 96)
87 (78, 92)
2006-2007 (n=95)
93 (85, 96)
91 (83, 95)
89 (81, 94)
76 (66, 84)
2008-2009 (n=95)
99 (93, 100)
98 (92, 99)
97 (91, 99)
-
2010-2011 (n=103)
96 (90, 99)
95 (88, 98)
93 (85, 97)
-
Figure 8.42
Primary Deceased Donor Grafts
Primary Deceased Donor Grafts
Graft Survival - New Zealand
1.00
0.95
0.95
0.90
0.90
0.85
0.80
2004-2005 (92)
2006-2007 (95)
2008-2009 (95)
2010-2011 (103)
0.75
0.70
0.65
0
1
2
3
Years
8-20
4
5
Graft survival
Recipient survival
Recipient Survival - New Zealand
1.00
0.85
0.80
2004-2005 (92)
2006-2007 (95)
2008-2009 (95)
2010-2011 (103)
0.75
0.70
0.65
0
1
2
3
Years
4
5
ANZDATA Registry 2012 Report
TRANSPLANTATION
_____________________________________________________________________________________
LONG TERM SURVIVAL - PRIMARY DECEASED DONOR GRAFTS
AUSTRALIA
AND
NEW ZEALAND
The aim of this section is to summarise the longer term outcomes of kidney transplants
in a survival metric rather than as rates - that is, to describe the proportion of grafts
surviving at particular time points.
As can be seen from the tables and figures, the graft survival advantage of living over
deceased donor recipients and first over subsequent grafts is consistent over time. The
considerable jump in survival from the 1980-84 cohort to 1985-89 coincides with the
introduction of Cyclosporin into routine clinical practice in Australia. Since that time
there have been lesser but consistent improvements in graft survival.
Figure 8.43
Graft and Patient Survival of Primary Grafts
Deceased Donors - Australia and New Zealand
Graft Survival
Time Period
Patient Survival
1 year
5 yrs
10 yrs
15 yrs
20 yrs
1 year
5 yrs
10 yrs
15 yrs
20 yrs
1970-1974 (n=1149)
58.2%
41.9%
30.3%
22.8%
14.6%
77.0%
57.4%
44.4%
34.2%
25.1%
1975-1979 (n=1463)
51.7%
36.0%
25.6%
17.7%
12.6%
81.0%
63.6%
49.4%
35.5%
26.2%
1980-1984 (n=1595)
63.3%
45.4%
32.1%
23.0%
16.2%
91.4%
75.1%
59.4%
45.9%
34.7%
1985-1989 (n=1916)
80.8%
65.8%
47.2%
32.9%
21.4%
92.1%
80.3%
64.5%
51.2%
39.6%
1990-1994 (n=1906)
85.0%
70.9%
50.7%
34.7%
24.1%
93.4%
83.9%
67.7%
53.2%
41.1%
1995-1999 (n=1779)
88.6%
76.2%
58.6%
41.3%
-
94.7%
86.1%
72.4%
57.1%
-
2000-2004 (n=1850)
91.6%
80.9%
64.3%
-
-
96.0%
89.1%
76.9%
-
-
2005-2009 (n=1911)
92.3%
81.0%
-
-
-
96.7%
89.6%
-
-
-
2010-2014 (n=1092)
94.8%
-
-
-
-
97.4%
-
-
-
-
Figure 8.44
Primary Deceased Donor Grafts
Graft survival - Australia and New Zealand
1.00
Graft survival
0.75
0.50
2010-2011
2005-2009
2000-2004
1995-1999
1990-1994
1985-1989
0.25
0.00
0
10
20
30
Years
8-21
TRANSPLANTATION
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
SHORT TERM SURVIVAL - SECOND AND SUBSEQUENT
DECEASED DONOR GRAFTS
AUSTRALIA
AND
NEW ZEALAND
Patient and graft survival for second or subsequent deceased donor grafts in Australia,
calculated by the Kaplan-Meier method, is shown in Figures 8.45 and 8.46.
Figure 8.45
Second and Subsequent Deceased Donor - Australia
Recipient and Graft Survival 1992 - 2011
% [95% Confidence Interval]
Survival
Year of
Transplant
1 month
6 months
1 year
5 years
1992-1993 (n=135)
99 (95, 100)
96 (91, 98)
95 (89, 97)
84 (76, 89)
1994-1995 (n=109)
98 (93, 100)
97 (92, 99)
95 (89, 98)
87 (79, 92)
1996-1997 (n=94)
100
98 (92, 99)
98 (92, 99)
86 (77, 92)
1998-1999 (n=102)
100
97 (91, 99)
94 (87, 97)
84 (76, 90)
Recipient Survival
2000-2001 (n=78)
97 (90, 99)
95 (87, 98)
95 (87, 98)
90 (81, 95)
2002-2003 (n=99)
99 (93, 100)
95 (88, 98)
90 (82, 94)
85 (76, 91)
2004-2005 (n=102)
100
100
97 (91, 99)
85 (77, 91)
2006-2007 (n=119)
99 (94, 100)
97 (92, 99)
97 (91, 99)
89 (82, 93)
2008-2009 (n=138)
100
99 (95, 100)
98 (93, 99)
-
2010-2011 (n=131)
99 (95, 100)
96 (90, 98)
94 (87, 97)
-
1992-1993 (n=135)
83 (75, 88)
79 (71, 85)
78 (70, 84)
65 (57, 73)
1994-1995 (n=109)
86 (78, 91)
83 (74, 89)
81 (72, 87)
67 (57, 75)
1996-1997 (n=94)
90 (82, 95)
87 (79, 93)
86 (77, 92)
69 (59, 77)
1998-1999 (n=102)
93 (86, 97)
88 (80, 93)
83 (75, 89)
69 (59, 77)
2000-2001 (n=78)
90 (81, 95)
83 (73, 90)
82 (72, 89)
67 (55, 76)
2002-2003 (n=99)
93 (86, 97)
90 (82, 94)
85 (76, 91)
71 (61, 79)
2004-2005 (n=102)
97 (91, 99)
95 (89, 98)
89 (81, 94)
71 (61, 78)
2006-2007 (n=119)
95 (89, 98)
92 (85, 95)
90 (83, 94)
73 (64, 80)
2008-2009 (n=138)
97 (92, 99)
95 (90, 98)
93 (87, 96)
-
2010-2011 (n=131)
95 (89, 97)
93 (87, 96)
92 (85, 95)
-
Graft Survival
Figure 8.46
Second and Subsequent Deceased Donor Grafts
Second and Subsequent Deceased Donor Grafts
1.00
0.95
0.95
0.90
0.90
0.85
0.80
2004-2005 (102)
2006-2007 (119)
2008-2009 (138)
2010-2011 (131)
0.75
0.70
0.65
0
1
2
3
Years
8-22
Graft survival - Australia
1.00
4
5
Graft survival
Recipient survival
Recipient survival - Australia
0.85
0.80
2004-2005 (102)
2006-2007 (119)
2008-2009 (138)
2010-2011 (131)
0.75
0.70
0.65
0
1
2
3
Years
4
5
ANZDATA Registry 2012 Report
TRANSPLANTATION
_____________________________________________________________________________________
LONG TERM SURVIVAL - SECOND AND SUBSEQUENT
DECEASED DONOR GRAFTS
AUSTRALIA
AND
NEW ZEALAND
The long-term graft and patient survival of second and subsequent grafts is shown in
Figures 8.47 and 8.48. There has been a steady improvement in both graft and patient
survival, such that survival of subsequent grafts is now similar to primary grafts (Figures
8.43 and 8.44).
Figure 8.47
Graft and Patient Survival of Second and Subsequent Grafts
Deceased Donors
Australia and New Zealand
Graft Survival
Patient Survival
Time Period
1 year
5 yrs
10 yrs
15 yrs
20 yrs
1 year
5 yrs
10 yrs
15 yrs
20 yrs
1970-1974 (n=158)
58.9%
37.3%
27.2%
21.5%
14.6%
79.1%
55.7%
42.4%
33.5%
26.6%
1975-1979 (n=284)
44.0%
28.2%
20.4%
15.0%
8.1%
78.2%
57.4%
44.7%
31.3%
20.0%
1980-1984 (n=417)
48.9%
36.0%
25.6%
20.3%
14.2%
90.6%
74.8%
59.0%
46.8%
37.1%
1985-1989 (n=458)
70.1%
51.7%
34.4%
23.2%
13.9%
93.7%
79.2%
62.8%
47.3%
35.1%
1990-1994 (n=374)
78.3%
64.2%
44.1%
31.2%
20.8%
93.0%
82.6%
67.9%
54.0%
40.2%
1995-1999 (n=296)
81.8%
66.6%
44.3%
29.0%
-
95.9%
86.1%
73.3%
59.1%
-
2000-2004 (n=268)
86.6%
70.1%
49.3%
-
-
93.7%
86.2%
74.8%
-
-
2005-2009 (n=343)
89.5%
73.7%
-
-
-
96.2%
88.7%
-
-
-
2010-2011 (n=139)
92.2%
-
-
-
-
94.0%
-
-
-
-
Figure 8.48
Second and Subsequent Deceased Donor Grafts
Graft survival - Australia and New Zealand
1.00
Graft survival
0.75
0.50
2010-2011
2005-2009
2000-2004
1995-1999
1990-1994
1985-1989
0.25
0.00
0
10
20
30
Years
8-23
TRANSPLANTATION
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
SHORT TERM SURVIVAL - PRIMARY LIVING DONOR GRAFTS
AUSTRALIA
NEW ZEALAND
AND
Australia
Figure 8.49
For primary living donor graft recipients,
excellent patient and graft survival rates
have been maintained despite the increased
rates of living donor transplantation and
corresponding increase in performing less
ideal living donor transplants, particularly
from older donors and unrelated donor
transplants.
Current patient and graft survival for primary
living donor recipients in Australia and New
Zealand are similar.
Primary Living Donor Grafts 1992 - 2011
Recipient and Graft Survival
Year of
Transplant
% [95% Confidence Interval]
1 month
6 months
1 year
5 years
1992-1993 (n=124)
100
99 (94, 100)
98 (94, 100)
92 (85, 96)
1994-1995 (n=179)
100
98 (94, 99)
97 (93, 98)
94 (89, 97)
1996-1997 (n=239)
100
99 (97, 100)
99 (96, 100)
96 (92, 98)
1998-1999 (n=305)
100
99 (97, 100)
99 (97, 100)
96 (93, 97)
2000-2001 (n=364)
99 (98, 100)
99 (97, 99)
99 (97, 99)
95 (92, 97)
2002-2003 (n=409)
100 (98, 100)
99 (97, 99)
98 (96, 99)
93 (90, 95)
2004-2005 (n=441)
100 (98, 100)
100 (98, 100)
99 (98, 100)
97 (94, 98)
2006-2007 (n=483)
100 (99, 100)
99 (98, 100)
99 (97, 99)
95 (92, 96)
2008-2009 (n=615)
100 (98, 100)
99 (97, 99)
98 (97, 99)
-
2010-2011 (n=499)
100
100 (98, 100)
99 (97, 100)
-
1992-1993 (n=124)
97 (92, 99)
96 (91, 98)
94 (88, 97)
83 (75, 88)
1994-1995 (n=179)
94 (90, 97)
92 (86, 95)
90 (85, 94)
83 (76, 87)
1996-1997 (n=239)
96 (92, 98)
95 (91, 97)
94 (90, 96)
86 (81, 90)
1998-1999 (n=305)
98 (96, 99)
97 (94, 98)
96 (94, 98)
87 (82, 90)
2000-2001 (n=364)
98 (95, 99)
96 (93, 97)
95 (93, 97)
88 (84, 91)
2002-2003 (n=409)
98 (96, 99)
96 (94, 98)
95 (93, 97)
88 (84, 91)
2004-2005 (n=441)
100 (98, 100)
98 (96, 99)
98 (96, 99)
89 (86, 92)
2006-2007 (n=483)
99 (97, 99)
98 (96, 99)
97 (95, 98)
89 (86, 92)
2008-2009 (n=615)
98 (96, 99)
96 (95, 98)
96 (94, 97)
-
2010-2011 (n=499)
99 (98, 100)
99 (98, 100)
98 (96, 99)
-
Recipient Survival
Graft Survival
New Zealand
Figure 8.50
Year of
Transplant
Primary Living Donor Grafts 1992 - 2011
Recipient and Graft Survival
% [95% Confidence Interval]
1 month
6 months
1 year
5 years
1992-1993 (n=31)
100
97 (79, 100)
97 (79, 100)
94 (77, 98)
1994-1995 (n=40)
1996-1997 (n=54)
100
100
100
100
98 (84, 100)
100
92 (78, 97)
87 (75, 94)
1998-1999 (n=66)
100
100
100
92 (83, 97)
2000-2001 (n=67)
100
100
100
95 (87, 99)
2002-2003 (n=84)
100
99 (92, 100)
99 (92, 100)
95 (88, 98)
2004-2005 (n=93)
2006-2007 (n=97)
99 (93, 100)
100
98 (92, 99)
99 (93, 100)
96 (89, 98)
99 (93, 100)
89 (81, 94)
96 (89, 99)
2008-2009 (n=125)
2010-2011 (n=111)
99 (94, 100)
100
98 (94, 100)
99 (93, 100)
97 (92, 99)
99 (93, 100)
-
1992-1993 (n=31)
100
97 (79, 100)
97 (79, 100)
84 (66, 93)
1994-1995 (n=40)
93 (79, 98)
90 (76, 96)
90 (76, 96)
75 (58, 86)
1996-1997 (n=54)
96 (86, 99)
96 (86, 99)
96 (86, 99)
74 (60, 84)
1998-1999 (n=66)
97 (88, 99)
95 (87, 99)
94 (85, 98)
74 (62, 83)
2000-2001 (n=67)
97 (89, 99)
97 (89, 99)
97 (89, 99)
83 (72, 90)
2002-2003 (n=84)
100
99 (92, 100)
99 (92, 100)
90 (82, 95)
2004-2005 (n=93)
96 (89, 98)
94 (86, 97)
92 (85, 96)
86 (77, 92)
Recipient Survival
Graft Survival
8-24
2006-2007 (n=97)
100
98 (92, 99)
98 (92, 99)
93 (85, 97)
2008-2009 (n=125)
98 (94, 100)
98 (93, 99)
96 (91, 98)
-
2010-2011 (n=111)
97 (92, 99)
96 (91, 99)
96 (91, 99)
-
ANZDATA Registry 2012 Report
TRANSPLANTATION
_____________________________________________________________________________________
Figure 8.52
Figure 8.51
Primary Living Donor Grafts
Primary Living Donor Grafts
Graft Survival - Australia
1.00
0.95
0.95
0.90
0.90
0.85
0.80
2004-2005 (441)
2006-2007 (483)
2008-2009 (615)
2010-2011 (499)
0.75
0.70
0.65
0
1
2
3
4
Graft survival
Recipient survival
Recipient Survival - Australia
1.00
0.85
0.80
2004-2005 (441)
2006-2007 (483)
2008-2009 (615)
2010-2011 (499)
0.75
0.70
0.65
5
0
Years
1
5
Primary Living Donor Grafts
Graft survival - New Zealand
Recipient survival - New Zealand
1.00
1.00
0.95
0.95
0.90
0.90
0.85
0.80
2004-2005 (93)
2006-2007 (97)
2008-2009 (125)
2010-2011 (111)
0.75
0.70
0.65
2
3
Years
4
5
Graft survival
Recipient survival
4
Figure 8.54
Primary Living Donor Grafts
1
3
Years
Figure 8.53
0
2
0.85
0.80
2004-2005 (93)
2006-2007 (97)
2008-2009 (125)
2010-2011 (111)
0.75
0.70
0.65
0
1
2
3
4
5
Years
8-25
TRANSPLANTATION
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
LONG TERM SURVIVAL - PRIMARY LIVING DONOR GRAFTS
AUSTRALIA
AND
NEW ZEALAND
Figure 8.55
Graft and Patient Survival of Primary Grafts
Living Donors - Australia and New Zealand
Graft Survival
Patient Survival
Time Period
1 year
5 yrs
10 yrs
15 yrs
20 yrs
1 year
5 yrs
10 yrs
15 yrs
20 yrs
1970-1974 (n=21)
85.7%
76.2%
61.5%
46.2%
20.5%
90.5%
81.0%
61.9%
52.4%
42.9%
1975-1979 (n=107)
81.2%
63.3%
49.9%
41.2%
31.1%
90.7%
78.5%
71.0%
61.7%
52.2%
1980-1984 (n=241)
82.8%
71.2%
59.3%
46.5%
35.9%
96.3%
85.4%
74.9%
64.8%
55.4%
1985-1989 (n=230)
90.8%
74.8%
60.5%
45.1%
35.1%
95.2%
87.8%
79.9%
71.1%
62.9%
1990-1994 (n=431)
91.8%
79.6%
65.3%
48.8%
32.6%
97.2%
89.2%
84.0%
74.5%
69.0%
1995-1999 (n=766)
94.5%
84.0%
68.8%
51.9%
-
98.6%
94.7%
86.6%
76.4%
-
2000-2004 (n=1193)
95.9%
87.7%
72.4%
-
-
98.5%
94.3%
87.2%
-
-
2005-2009 (n=1585)
96.7%
89.4%
-
-
-
98.5%
95.1%
-
-
-
2010-2011 (n=610)
97.6%
-
-
-
-
98.9%
-
-
-
-
Figure 8.56
Primary Living Donor Grafts
Graft survival - Australia and New Zealand
1.00
Graft survival
0.75
0.50
2010-2011
2005-2009
2000-2004
1995-1999
1990-1994
1985-1989
0.25
0.00
0
10
20
Years
8-26
30
ANZDATA Registry 2012 Report
TRANSPLANTATION
_____________________________________________________________________________________
LONG TERM SURVIVAL - SECOND AND SUBSEQUENT
LIVING DONOR GRAFTS
AUSTRALIA
AND
NEW ZEALAND
Figure 8.57
Graft and Patient Survival of Second and Subsequent Grafts
Living Donors - Australia and New Zealand
Graft Survival
Time Period
1 year
5 yrs
10 yrs
Patient Survival
15 yrs
20 yrs
1 year
5 yrs
10 yrs
15 yrs
20 yrs
1970-1974 (n=1)
100.0%
100.0%
-
-
-
100.0%
100.0%
-
-
-
1975-1979 (n=11)
72.7%
45.5%
36.4%
36.4%
27.3%
100.0%
100.0%
81.8%
72.7%
63.6%
1980-1984 (n=42)
78.6%
64.3%
59.5%
50.0%
40.5%
97.6%
81.0%
78.6%
71.4%
51.9%
1985-1989 (n=31)
87.1%
74.2%
58.1%
45.2%
29.0%
96.8%
83.9%
71.0%
64.5%
47.5%
1990-1994 (n=38)
100.0%
86.8%
41.2%
35.7%
23.5%
100.0%
94.7%
73.3%
67.9%
50.2%
1995-1999 (n=74)
93.2%
82.4%
68.9%
58.9%
-
98.6%
98.6%
89.2%
81.0%
-
2000-2004 (n=107)
93.5%
86.0%
65.3%
-
-
98.1%
95.3%
85.1%
-
-
2005-2009 (n=175)
95.4%
80.4%
-
-
-
98.3%
92.0%
-
-
-
2010-2011 (n=58)
92.6%
-
-
-
-
97.8%
-
-
-
-
Figure 8.58
Second and Subsequent Living Donor Grafts
Graft survival - Australia and New Zealand
1.00
Graft survival
0.75
0.50
2010-2011
2005-2009
2000-2004
1995-1999
1990-1994
1985-1989
0.25
0.00
0
5
10
15
20
25
Years
8-27
TRANSPLANTATION
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
This page is intentionally left blank
8-28
CHAPTER 9
KIDNEY DONATION
Philip Clayton
2012 Annual Report - 35th Edition
KIDNEY DONATION
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
The format of this chapter has been substantially revised this year. It includes new data for deceased donors, with a focus
on trends in donor demographics, and now also includes the living donor data that was previously included in chapter 8.
DECEASED KIDNEY DONORS
The data for this section comes from the Australia and New Zealand Organ Donor (ANZOD) Registry. Much more information about deceased organ donors in Australia and New Zealand can be found on the ANZOD website,
http://www.anzdata.org.au/anzod/v1/indexanzod.html.
Figures 9.1 and 9.2 show the different types of deceased kidney donors in each country over 2002-2011. In Australia there
has been a large increase in the number of donors since 2008, driven by an increase in expanded criteria (ECD) and in
particular cardiac death (DCD) donors. In New Zealand the donor numbers are steady and the proportion of ECD and DCD
donors are much lower than in Australia.
Figure 9.2
Figure 9.1
Deceased Kidney Donor Type
Deceased Kidney Donor Type
New Zealand 2002-2011
Australia 2002-2011
40
200
100
DCD
DBD ECD
DBD SCD
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Number of donors
Number of donors
300
30
20
DCD
DBD ECD
DBD SCD
10
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
DCD, donor after cardiac death
DBD ECD, expanded critera donor after brain death
DCD SCD, standard criteria donor after brain death
DCD, donor after cardiac death
DBD ECD, expanded critera donor after brain death
DCD SCD, standard criteria donor after brain death
The causes of death of deceased donors are shown in Figures 9.3 and 9.4. Stroke remains the most common cause of
kidney donor death in both Australia and New Zealand. In Australia there has been a slight reduction in the proportion of
deaths due to road trauma, with a corresponding increase in the proportion due to hypoxia/anoxia.
Figure 9.4
Figure 9.3
Cause of donor death
Cause of donor death
Australia 2002-2011
New Zealand 2002-2011
60
60
40
40
%
%
Stroke
Hypoxia/anoxia
Road trauma
Other trauma
Other
Cerebral tumour
20
0
2002
9-2
2004
2006
2008
2010
2012
Stroke
Hypoxia/anoxia
Road trauma
Other trauma
Other
Cerebral tumour
20
0
2002
2004
2006
2008
2010
2012
ANZDATA Registry 2012 Report
KIDNEY DONATION
_____________________________________________________________________________________
Figures 9.5 and 9.6 show the mean age of deceased kidney donors in Australia and New Zealand over the last 20 years.
In Australia the mean age has increased steadily from 36 years in 1992 to 47 years in 2011. In New Zealand there is no
clear trend, and donors are younger than in Australia; the mean donor age in 2011 was 36 years.
Figure 9.5
Figure 9.6
Deceased kidney donor age
Deceased kidney donor age
New Zealand 1992-2011
50
40
30
20
10
0
1990
1995
2000
2005
2010
Donor age (years), mean and 95% CI
Donor age (years), mean and 95% CI
Australia 1992-2011
50
40
30
20
10
0
1990
1995
2000
Year
2005
2010
Year
Figures 9.7 and 9.8 show the discard rate of retrieved kidneys – the proportion of kidneys that were retrieved for the purpose of transplantation, but not ultimately transplanted into a recipient. Despite the increasing age and complexity of donors in Australia the discard rate has remained steady at around 3% over the last 10 years. In New Zealand discard rates
are slightly higher than in Australia (note the different y-axis scales).
Figure 9.7
Figure 9.8
Discard rate of retrieved kidneys
Discard rate of retrieved kidneys
New Zealand 2002-2011
% kidneys retrieved but not transplanted
% kidneys retrieved but not transplanted
Australia 2002-2011
10
8
6
4
2
0
2002
2004
2006
2008
2010
2012
40
30
20
10
0
2002
2004
2006
2008
2010
2012
9-3
KIDNEY DONATION
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
LIVING KIDNEY DONORS
Figure 9.9
AUSTRALIA
Living Donor Operations as a Proportion
(%) of Annual Transplantation
Australia 2006 - 2011
There were 255 living donor kidney transplants performed in
2011 in Australia, representing 31% of all transplant operations (Figure 9.9).
Year of Transplantation
Recipient
Age Groups
2006
2007
2008
2009
2010
2011
00-04 years
100%
89%
75%
55%
60%
50%
05-14 years
55%
56%
59%
71%
60%
46%
15-24 years
71%
65%
67%
73%
76%
58%
25-34 years
48%
57%
53%
54%
44%
40%
35-44 years
37%
38%
36%
41%
41%
35%
45-54 years
37%
43%
41%
39%
26%
22%
55-64 years
40%
35%
39%
37%
31%
28%
65-74 years
41%
45%
44%
33%
18%
23%
75-84 years
0%
0%
0%
0%
67%
50%
All Recipients
43%
44%
44%
42%
35%
31%
Figure 9.10
Figure 9.12 shows the age-related proportion of living donor
transplants for the years 2002 and 2011. The overall proportion of living donors decreased in most age groups.
The proportion of living donor transplants for each State and
New Zealand for recipients aged 25-44 years is shown for
the years 2004-2007 and 2008-2011 in Figure 9.10. Overall
there has been an increase in this age group for both countries from 2004-2007 to 2008-2011, the highest in New Zealand in 2011 (60%).
The proportion of genetically unrelated donors was 50% (127
donors) in 2011 compared with 40% (119 donors) in 2010,
shown in Figure 9.16. Fifty-seven percent of living unrelated
donors were spouses or partners. The age distribution of
living donors is shown in Figure 9.12.
The first paired kidney exchange transplants were performed
in 2007 in Western Australia and there were a further five in
2008, followed by another two in 2009, eight in 2010 and
twenty-five in 2011. There were five non-directed donors in
2011. Thirty five of the living donors in 2011 were blood
group incompatible with the recipient, down from 40 in 2010
(Figure 9.15).
Percentage Living Donor Grafts - Australia
NEW ZEALAND
Stratified by age, 2007 vs 2011
100
The number of living donor transplants decreased by 5% (57
donors) in New Zealand in 2011, as shown in Figure 9.14.
89
80
% 60
50
56
46
65
58 57
40
22
35
28
Forty-eight percent of grafts were from a living donor.
23
20
0
There were 33 genetically unrelated kidney donors in 2011,
compared with 23 in 2010.
45
43
40 38
35
2007 (44%)
2011 (31%)
0-4
5-14 15-24 25-34 35-44 45-54 55-64 65-74
Age
Unrelated donors represented 58% of all living donors in
2011, shown in Figure 9.16. Eighteen of these were from a
spouse or partner.
There were three non-directed donors in 2011 (compared
with four in 2010).
Figure 9.11
Percentage Living Donor Grafts
Age 25-44, 2004-2007 vs 2008-2011
60
55
51
51
47
4342
4142 43 40 42
60
40
3433
%
20
2004-2007
2008-2011
9-4
N
Z
Au
st
W
A
Q
LD
N
SW
/A
C
T
Vi
c/
Ta
s
SA
/N
T
0
ANZDATA Registry 2012 Report
KIDNEY DONATION
_____________________________________________________________________________________
Figure 9.12
Number of transplants
Age of Living Donors in Australia 2002-2011
150
150
100
100
50
18-24
25-34
35-44
45-54
55-64
65-74
75+
50
0
0
2002
2004
2006
2008
2010
2012
Year of transplant
Figure 9.13
Figure 9.14
Source of Living Kidney Donor
Source of Living Kidney Donor
New Zealand 2002-2011
Australia 2002-2011
354
230 218
244 246
273 271
255
200
100
58
60
48
44
48 46
60
57
49
40
20
Unrelated
Related
Unrelated
Related
0
69 67
327
Number of transplants
300
80
296
0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Figure 9.15
ABO Incompatible Living Donor Transplants
Australia 2007-2011
40
36
40
Number of ABOi transplants
Number of transplants
400
35
30
30
22
20
10
0
2007
2008
2009
2010
2011
9-5
KIDNEY DONATION
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Figure 9.16
Source of Living Donor Kidneys
2007 - 2011
(x = identical twin) (+ = non identical twin)
Australia
Source
2008
2009
2010
2011
2007
2008
2009
2010
2011
271
354
327
296
255
58
69
67
60
57
Total Living Donors
Related
New Zealand
2007
(167)
(175)
(186)
(177)
(128)
36
38
41
37
24
Mother
60
46
53
48
38
5
6
5
3
0
Father
37
41
27
37
33
5
9
6
5
3
Sister
28
30
41
35
22
11
9
8
6
9
Brother
20
33
32
26
18
5
5
11
10
5
Identical twin sister
0
0
0
1
0
0
0
0
0
0
Identical twin brother
0
0
0
0
1
0
0
0
0
1
Non-identical twin sister
1
1
2
0
1
0
0
0
0
0
Non-identical twin brother
0
0
0
2
0
0
0
0
0
0
Daughter
3
6
4
4
5
3
1
4
2
2
Son
7
3
4
7
1
4
2
3
3
2
Grandmother
0
2
5
3
0
0
0
0
0
0
Grandfather
0
0
0
1
1
0
0
0
0
0
Cousin
7
5
5
4
2
2
2
0
3
1
Niece
1
0
1
1
1
0
1
2
1
0
Nephew
0
0
3
0
0
1
0
0
0
0
Aunt
1
7
6
7
3
0
1
2
2
0
Uncle
2
1
3
1
2
0
2
0
2
1
Unrelated
(104)
(179)
(141)
(119)
(127)
22
31
26
23
33
Wife
40
64
63
47
47
8
5
2
5
10
Husband
14
35
33
21
20
5
5
1
2
4
Mother-in-law
1
0
1
1
0
0
0
0
0
0
Father-in-law
0
1
0
1
0
0
0
0
0
0
Stepmother
0
1
0
0
0
0
0
0
0
0
Stepfather
1
2
0
0
0
1
1
0
1
0
Stepsister
0
1
0
0
0
0
0
1
0
0
Sister-in-law
2
4
4
0
2
0
1
0
0
0
Brother-in-law
3
1
3
1
0
0
1
0
1
1
Daughter-in-law
0
0
0
1
0
0
0
0
0
0
Son-in-law
0
1
1
0
0
0
0
1
0
1
Stepdaughter
0
1
0
0
0
0
0
0
0
0
Stepson
0
0
0
1
1
0
0
0
0
0
Partner
6
10
6
6
6
1
0
1
2
4
Friend
15
27
18
16
12
6
10
13
7
4
Non-directed
1
6
4
1
5
1
8
6
4
3
Pathological
16
13
6
11
9
0
0
0
0
0
Paired kidney exchange
2
5
2
8
25
0
0
0
0
2
Other
3
7
0
4
0
0
0
1
1
4
Figure 9.17
Gender of Living Donor Kidneys
Source and State/
Country of Transplant
2007
2008
Male
Female
Total
Male
Related
NSW/ACT
VIC/TAS
QLD
SA/NT
WA
41%
39%
41%
42%
57%
59%
61%
59%
58%
43%
58
61
22
19
7
57%
39%
35%
45%
41%
43%
61%
65%
55%
59%
AUSTRALIA
NEW ZEALAND
41%
42%
59%
58%
167
36
46%
47%
Unrelated
NSW/ACT
VIC/TAS
QLD
SA/NT
WA
AUSTRALIA
44%
34%
45%
14%
36%
56%
66%
55%
86%
64%
32
29
22
7
14
38%
62%
NEW ZEALAND
45%
55%
9-6
2007 - 2011
2009
Female Total
2010
2011
Male
Female
Total
Male
Female
Total
Male
Female
Total
63
56
17
22
17
48%
26%
31%
44%
55%
52%
74%
69%
56%
45%
66
58
26
16
20
37%
42%
57%
40%
42%
63%
58%
43%
60%
58%
46
66
21
20
24
41%
50%
45%
30%
50%
59%
50%
55%
70%
50%
46
44
20
10
8
54%
53%
175
38
39%
49%
61%
51%
186
41
42%
57%
58%
43%
177
37
45%
50%
55%
50%
128
24
31%
52%
33%
37%
32%
69%
48%
67%
63%
68%
51
60
27
19
22
37%
35%
41%
86%
38%
63%
65%
59%
14%
63%
41
40
29
7
24
41%
41%
36%
38%
23%
59%
59%
64%
63%
77%
37
39
22
8
13
43%
43%
25%
50%
43%
57%
58%
75%
50%
52%
42
40
16
6
23
104
39%
61%
179
40%
60%
141
38%
62%
119
41%
58%
127
22
39%
61%
31
42%
58%
26
43%
57%
23
42%
58%
33
ANZDATA Registry 2012 Report
KIDNEY DONATION
_____________________________________________________________________________________
TIMING
OF
LIVING DONOR TRANSPLANTS
The timing of living donor transplants relative to the start of dialysis is shown in Figure 9.18.
The proportion of all primary living donor transplants performed “pre-emptively” in Australia
was 37%, compared with 35% in 2010. This continues a broader trend of increasing use of
pre-emptive transplantation (Figure 9.19). Thirty-one percent had received dialysis treatment for twelve months or longer prior to a first living donor graft.
The proportion of pre-emptive primary living donor transplants in New Zealand was 23% in
2011, compared with 25% in 2010 (Figure 9.18). Fifty-four percent received dialysis for
twelve months or longer prior to being transplanted.
Figure 9.18
Timing of Living Donor Transplantation
for Primary Grafts in Relation to Date of Dialysis Start
by Year of Transplant 2007 - 2011
Pre-emptive
NZ
2008
2009
2010
2011
62 (26%)
94 (30%)
108 (36%)
92 (35%)
87 (37%)
7 (3%)
5 (2%)
10 (3%)
6 (2%)
7 (3%)
1 month to <1 year post dialysis
55 (23%)
77 (24%)
81 (27%)
62 (23%)
66 (28%)
>=1 year post dialysis
116 (48%)
141 (44%)
99 (33%)
106 (40%)
73 (31%)
Pre-emptive
23 (43%)
20 (30%)
18 (31%)
15 (25%)
12 (23%)
<1 month post dialysis
1 (2%)
2 (3%)
1 (2%)
1 (2%)
1 (2%)
1 month to <1 year post dialysis
9 (17%)
14 (21%)
8 (14%)
10 (17%)
11 (21%)
>=1 year post dialysis
21 (39%)
30 (45%)
32 (54%)
33 (56%)
28 (54%)
Figure 9.19
Pre-emptive Transplants - Australia
2002-2011
108
94
100
Number of transplants
Aust
<1 month post dialysis
2007
72
80
60
54
50
52
2003
2004
65
92
87
62
40
20
0
2002
2005
2006
2007
2008
2009
2010
2011
9-7
KIDNEY DONATION
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
This page is intentionally left blank
9-8
CHAPTER 10
CANCER
Angela C. Webster
Alex Peng
Patrick J. Kelly
2012 Annual Report - 35th Edition
ANZDATA Registry 2012 Report
CANCER REPORT
_____________________________________________________________________________________
Overview
This year the cancer report has three components. Firstly, we revise the site-specific cancer risk for people undergoing dialysis or after their first kidney transplant. Secondly, we update the cumulative incidence of cancers in the dialysis and posttransplant populations compared to the general population. Thirdly we examine change in cancer risk over time.
Cancer risk for different cancer sites whilst on
dialysis or after transplantation
This report summarises the relative cancer risk of patients
treated for end stage kidney disease in Australia and New
Zealand.
To compare the risk of a cancer at different sites we compared the observed number of incident cancer diagnoses notified to ANZDATA with the expected number of cancer diagnoses in the general population. We accounted for differences in
age and sex distribution by using indirect standardisation,
standardising for differences in age, sex, calendar year, and
country (either Australia or New Zealand).
For ANZDATA registrants living in Australia we used the Australian general population data for comparison, and for
ANZDATA registrants living in New Zealand, we used the
New Zealand general population data for comparison. We
have not included basal cell or squamous cell carcinomas of
the skin, as these are not registrable cancers, and no population based data for these cancers exists.
For Australia, general population data about cancer incidence
and general population distribution were obtained from the
Australian Institute of Health and Welfare and the National
Cancer Statistics Clearing House. For New Zealand, general
population data about cancer incidence and general population distribution were obtained from New Zealand Health Information Service, the Ministry of Health and Statistics New Zealand. Although ANZDATA holds records from 1963, the general population comparison data was only available from 1980
- 2009 for New Zealand, and from 1982-2009 for Australia.
For this reason, we limited these ANZDATA analyses to people receiving renal replacement therapy between 1982-2009,
so that we reduced potential for bias in results. In practical
terms this means that the analyses take into account change
in risk that may occur through differences in the age and sex
distribution between the ESKD population and that of the referent general population, and also differences that may have
occurred over time, and so the final calculation is adjusted for
these differences.
This is the first ANZDATA report that has used New Zealand
general population data to compare with New Zealand
ANZDATA registrants, thus any inter-country differences in
cancer risk should be accounted for. There remain some potential sources of confounding. Cancer risk in Australian Indigenous and Torres Strait Island populations are different compared to the Australian general population, and similarly New
Zealand Maori and Pacific Island populations have different
cancer risks compared to other New Zealanders. All of these
populations are over-represented in the ESKD population of
Australia and New Zealand. We were not able to account for
these potential differences, as general population cancer data
for these groups are not available.
10-2
Results of the cancer risk analyses are presented as standardised incidence ratios (SIR) with 95% confidence intervals
(CI), which can be interpreted like risk ratios or relative risk;
a value of SIR = 1 is equivalent risk, SIR = 0.5 is half the
risk, SIR = 2 is double the risk etc. The breadth of the 95%
CI reflects the precision of the SIR estimates, and those with
95% CI which do not cross 1 can be regarded as statistically
significant.
We examined cancer risk for people treated with dialysis
and for kidney transplant recipients separately. Once people
had received a transplant, all subsequent cancers were
counted in the post transplant group even if there was a
subsequent return to dialysis. All site cancer risk included
the first cancer experienced by an ANZDATA registrant during either dialysis or after transplantation, but not any subsequent cancers. Site specific cancer risk included the first
cancer at that cancer site experienced by an ANZDATA
registrant, regardless of whether they had experienced an
earlier cancer at a different site.
ANZDATA Registry 2012 Report
CANCER REPORT
_____________________________________________________________________________________
Risk of Cancer for People Undergoing Dialysis
Shows the risk of cancer experienced by the 50,635 people undergoing dialysis in Australia and New Zealand between 1982
and 2009, representing 145,043 years of observation. During this time 2,568 people on dialysis (5.1 %) had at least one cancer. The period of risk for a dialysis patient was calculated from the day of first dialysis treatment and ended at transplantation,
death or last known follow-up, which ever occurred soonest. Time spent on dialysis after a failed transplant was not considered here. Incident cancers diagnosed at any time after the first month of dialysis are summed in the observed totals. Site
specific cancers are reported according to International Classification of Diseases Oncology codes, and grouped to match the
categories available for the available general population data.
Table 10.1
Standardised incidence ratio of cancer overall, and at different sites, for people
on dialysis in Australia and New Zealand, 1982-2009
ICD-O code*
Cancer site
All sites
C00
lip
Observed cases
Expected cases
SIR (95%CI)
2586
1794.66
1.44 (1.39 - 1.50)
2
15.91
0.13 (0.03 - 0.50)
C01-C14
head and neck
44
34.71
1.27 (0.94 - 1.70)
C15
oesophagus
41
25.5
1.61 (1.18 - 2.18)
C16
stomach
67
43.17
1.55 (1.22 - 1.97)
C17
small intestine
15
5.76
2.60 (1.57 - 4.32)
C18-C21
colorectal
281
272.61
1.03 (0.92 - 1.16)
C22
liver
47
19.51
2.41 (1.81 - 3.21)
C23-C24
gallbladder
17
12.1
1.40 (0.87 - 2.26)
C25
pancreas
48
42.25
1.14 (0.86 - 1.51)
C30-31
nasal cavity
6
2.65
2.26 (1.02 - 5.03)
C32
larynx
12
14.54
0.83 (0.47 - 1.45)
C33-C34
trachea, bronchus, lung
363
213.48
1.70 (1.53 - 1.88)
C37-C38
other thoracic
4
1.57
2.55 (0.96 - 6.78)
C40-C41
bone & articular cartilage
5
2.29
2.18 (0.91 - 5.24)
C43
melanoma
162
157.22
1.03 (0.88 - 1.2)
C45
mesothelioma
15
13.3
1.13 (0.68 - 1.87)
C46
kaposis sarcoma
9
1.01
8.88 (4.62 - 17.07)
C47-C49
connective & soft tissues
11
9.86
1.12 (0.62 - 2.01)
C50
breast
196
153.48
1.28 (1.11 - 1.47)
C53
cervix
26
9.26
2.81 (1.91 - 4.13)
C54-C55
uterus
35
25.74
1.36 (0.98 - 1.89)
C56
ovary
17
17.65
0.96 (0.60 - 1.55)
C51-C52, C57-C58
other female genital
14
5.16
2.71 (1.61 - 4.58)
C61
prostate
211
366.96
0.58 (0.5 - 0.66)
C62
testis
3
3.61
0.83 (0.27 - 2.58)
C60, C63
penis & male genital
3
2.14
1.40 (0.45 - 4.35)
C67
bladder
186
55.79
3.33 (2.89 - 3.85)
C64-C66, C68
kidney, ureter, urethra
300
50.12
5.99 (5.35 - 6.70)
C69
eye
0
4.36
Not calculable
C70-C72
brain & CNS
31
23.14
1.34 (0.94 - 1.91)
C73
thyroid
56
12.95
4.32 (3.33 - 5.62)
C74-75
other endocrine
10
0.9
11.06 (5.95 - 20.56)
C81-C85, C96
all lymphoma
82
72.57
1.13 (0.91 - 1.40)
C90
multiple myeloma
176
24.81
7.09 (6.12 - 8.22)
C91-C95
leukaemia
53
48.57
1.09 (0.83 - 1.43)
Not specified or unknown primary
142
62.76
2.26 (1.92 - 2.67)
*International classification of diseases for oncology topography codes. See http://www.who.int/classifications/icd/adaptations/oncology/en/
10-3
ANZDATA Registry 2012 Report
CANCER REPORT
_____________________________________________________________________________________
Risk of Cancer in Recipients after First Kidney Transplant
Shows the risk of cancer experienced by the 17,150 people who underwent at least one kidney transplant in Australia and
New Zealand between 1982 and 2009, representing 159,413 years of observation. During this time 2180 transplant recipients (12.7 %) had at least one cancer. For these calculations the period of risk for each patient started on the day of transplantation and continued until death or last known follow-up. People have not been removed from the analysis at the time of
graft failure. Observed cancers are all those reported from 30 days after the date of 1st transplantation, and include those
occurring after graft failure, and those that occurred after a subsequent transplant.
Table 10.2
Standardised incidence ratio of cancer overall, and at different sites, for people
after first transplant in Australia and New Zealand, 1982-2009
ICD-O code
Cancer site
All site
Observed cases
Expected cases
SIR (95%CI)
2180
867.78
2.51 (2.41 - 2.62)
C00
lip
16
10.38
1.54 (0.94 - 2.52)
C01-C14
head and neck
82
22.97
3.57 (2.88 - 4.43)
C15
oesophagus
43
10.95
3.93 (2.91 - 5.29)
C16
stomach
27
18.8
1.44 (0.99 - 2.09)
C17
small intestine
7
3.04
2.30 (1.10 - 4.83)
C18-C21
colorectal
240
125.02
1.92 (1.69 - 2.18)
C22
liver
26
9.28
2.80 (1.91 - 4.12)
C23-C24
gallbladder
11
5.05
2.18 (1.21 - 3.93)
C25
pancreas
22
17.3
1.27 (0.84 - 1.93)
C30-31
nasal cavity
12
1.51
7.93 (4.50 - 13.96)
C32
larynx
12
8.01
1.50 (0.85 - 2.64)
C33-C34
trachea, bronchus, lung
158
89.64
1.76 (1.51 - 2.06)
C37-C38
other thoracic
7
1.01
6.91 (3.30 - 14.50)
C40-C41
bone & articular cartilage
7
1.88
3.72 (1.77 - 7.80)
C43
melanoma
276
100.66
2.74 (2.44 - 3.09)
C45
mesothelioma
11
5.12
2.15 (1.19 - 3.88)
C46
kaposis sarcoma
25
1.12
22.29 (15.06 - 32.98)
C47-C49
connective & soft tissues
22
5.92
3.72 (2.45 - 5.65)
C50
breast
139
113.96
1.22 (1.03 - 1.44)
C53
cervix
44
9.14
4.81 (3.58 - 6.47)
C54-C55
uterus
28
16.54
1.69 (1.17 - 2.45)
C56
ovary
14
11.44
1.22 (0.73 - 2.070)
C51-C52, C57-C58
other female genital
50
2.86
17.49 (13.26 - 23.08)
C61
prostate
120
146.8
0.82 (0.68 - 0.98)
C62
testis
11
7.1
1.55 (0.86 - 2.80)
C60, C63
penis & male genital
11
1.01
10.94 (6.06 - 19.75)
C67
bladder
113
20.38
5.54 (4.61 - 6.67)
C64-C66, C68
kidney, ureter, urethra
223
25.99
8.58 (7.52 - 9.78)
C69
eye
6
2.59
2.32 (1.04 - 5.16)
C70-C72
brain & CNS
24
15.41
1.56 (1.04 - 2.32)
C73
thyroid
50
12.13
4.12 (3.13 - 5.44)
C74-75
other endocrine
7
0.72
9.77 (4.66 - 20.50)
C81-C85, C96
all lymphoma
384
39.82
9.64 (8.73 - 10.66)
C90
multiple myeloma
24
10.78
2.23 (1.49 - 3.32)
C91-C95
leukaemia
41
22.6
1.81 (1.34 - 2.46)
Not specified or unknown primary
89
25.04
3.56 (2.89 - 4.38)
*International classification of diseases for oncology topography codes. See http://www.who.int/classifications/icd/adaptations/oncology/en/
10-4
ANZDATA Registry 2012 Report
CANCER REPORT
_____________________________________________________________________________________
Cumulative Risk (of cancer on dialysis or after transplantation)
The second section of this report examines the cumulative risk of a cancer over time for people in Australia and New Zealand
on dialysis or after receiving a kidney transplant. Although the relative risk of cancer after receiving a kidney transplant is
much greater than whilst on dialysis, in absolute terms the cumulative incidence is similar overall. This is because the dialysis
population is older than the transplanted population, and cancer risk increases with age.
Figure 10.1 shows the cumulative risk of at least 1 cancer for those on dialysis. The numbers tabulated below the graph
shows the number of patients remaining at risk as time progresses. Dialysis patients cease to be at risk from the day of 1st
transplant, death or last known follow-up, whichever occurs first. After 5 years on dialysis 8.0% of people will have developed
a cancer, 16.1% at 10 years, 23.1% at 15 years, and long term dialysis survivors 27.9% by 20 years.
Figure 10.1 Cumulative risk of at least 1 cancer after starting dialysis, for people in Australian and New Zealand
1982-2009
Figure 10.1
0.30
Dialysis population
General population
Proportion with cancer
0.25
0.20
0.15
0.10
0.05
0.00
0
5
10
15
20
Time since start of dialysis (years)
At risk
50635
8961
1311
178
29
10-5
ANZDATA Registry 2012 Report
CANCER REPORT
_____________________________________________________________________________________
Similarly figure 10.2 shows the cumulative risk of at least 1 cancer following kidney transplantation. Risk of cancer increase
more steeply over time than for people on dialysis, and continues to diverge from the general population risk.
After 5 years post transplantation 5.0% of people will have developed a cancer, 11.8% at 10 years, 19.1% at 15 years, and for
long term transplant survivors 26.3% by 20 years.
Figure 10.2 Cumulative risk of at least 1 cancer after receiving first kidney transplant, for people in
Australian and New Zealand 1982-2009
Figure 10.2
0.30
transplant recipients
general population
Proportion with cancer
0.25
0.20
0.15
0.10
0.05
0.00
0
5
10
15
20
Time since first transplant (years)
At risk
17150
10-6
11143
6659
3689
1836
ANZDATA Registry 2012 Report
CANCER REPORT
_____________________________________________________________________________________
Figure 10.2 shows cumulative risk of at least 1 cancer for transplant recipients whilst their 1st graft continues to function.
Cancer risk while a kidney transplant continues to function is slightly higher than for those people who have lost their transplant and have returned to dialysis (figure 10.2), but the difference is not striking.
For these calculation patients cease to be at risk at graft failure, death or last known follow-up, whichever occurs first.
Figure 10.3 Cumulative risk of at least 1 cancer during kidney transplant function, for people in
Australian and New Zealand 1982-2009
Figure 10.3
0.30
transplant recipients
general population
Proportion with cancer
0.25
0.20
0.15
0.10
0.05
0.00
0
5
10
15
20
Time since first transplant (years)
At risk
17,150
9,052
4,702
2,168
921
10-7
ANZDATA Registry 2012 Report
CANCER REPORT
_____________________________________________________________________________________
Cumulative Incidence by Cancer Site
Shows the cumulative incidence of cancers of the renal tract – kidney, ureter and urethra for people during dialysis or after
kidney transplantation. Although the relative risk of cancers at these sites is higher for transplant recipients (SIR 8.58, 95%
CI 7.52 - 9.78) than for people on dialysis (SIR 5.99, 95%CI 5.35 - 6.70), in absolute terms, the cumulative incidence of
these cancers is higher for people on dialysis. This is because of the differences in age and sex between the dialysis population and those with a transplant.
For figures 10.1-10.4, the curve for the expected number of cancers is calculated using general population data, for people
of the same age and sex, over the same time period.
Figure 10.4 Cumulative risk of cancer of the renal tract (C64-C66, C68; kidney, ureter, urethra), for people in
Australian and New Zealand 1982-2009
Figure 10.4 - A: during dialysis
0.06
dialysis population
general population
Proportion with cancer
0.05
0.04
0.03
0.02
0.01
0.00
0
5
10
15
20
Time since start of dialysis (years)
At risk
50,635
9,353
1,418
201
32
Figure 10.4 - B: after receiving first transplant
0.06
transplant recipients
general population
Proportion with cancer
0.05
0.04
0.03
0.02
0.01
0.00
0
5
10
15
20
Time since first transplant (years)
At risk
17,150
10-8
9,332
5,015
2,416
1,059
ANZDATA Registry 2012 Report
CANCER REPORT
_____________________________________________________________________________________
Change in Risk of Cancer Over Time
The third part of this year’s cancer report describes changes in risk of cancer over time.
Figure 10.5 shows the relative risk of cancer for people on dialysis and after kidney transplantation for different eras,
compared to the general population. Relative risk of cancer compared to the general population is now lower than it
was in the 1980s.
Differences in the age and sex distribution of the ESKD population has changed over time, but the estimates in figure 10.5 compare the ESKD population with the general population of the same age and sex. The reason for the
observation of decreased relative risk of cancer may be that the overall general health of the ESKD population has
changed over the years, and people with a greater burden of co-morbidity now receive dialysis or kidney transplants
compared to 30 years ago, where the overall burden of co-morbidity in the general population has not changed, or
changed at a slower pace.
Thus, overall the greater co-morbidity of the ESKD population might cause people to die of other causes, such as
cardiovascular disease rather than to survive and develop cancer. The cancer working group plan on investigating
this finding more thoroughly over the coming year.
Figure 10.5 Change in cancer risk over time, all cancers
Standardised Incidence Ratio
4
Dialysis
Transplant
3
2
1
1982-1984
1985-1989
1990-1994
1995-1999
2000-2004
2005-2009
10-9
ANZDATA Registry 2012 Report
CANCER REPORT
_____________________________________________________________________________________
This page is intentionally left blank
10-10
CHAPTER 11
PAEDIATRIC
Sean Kennedy
Nancy Briggs
Hannah Dent
Stephen McDonald
Kylie Hurst
2012 Annual Report - 35th Edition
PAEDIATRIC REPORT
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
This year, as well as providing a summary of current trends in the frequency
and causes of ESKD, the paediatric report will focus on current trends in the epidemiology and outcomes of
paediatric transplantation.
INCIDENCE AND PREVALENCE OF ESKD IN
CHILDREN AND ADOLESCENTS 1991 - 2011
GENERAL OVERVIEW
As shown in Figure 11.1, there is no clear long term trend in the incidence of children and adolescents developing ESKD and being treated with renal replacement therapy, although there are fluctuations from year to year.
Prevalent numbers of treated ESKD have gradually increased across all age groups reflecting improved survival
through increased duration of ESKD (Figure 11.2).
Figure 11.1
Incidence of RRT - Age 0-17 Years
Australia
Incidence of RRT - Age 0-17 Years
New Zealand
40
15
10
Age (years)
0-4
5-9
10-14
15-17
5
30
20
Age (years)
0-4
5-9
10-14
15-17
10
0
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0
RRT incidence (per million)
RRT incidence (per million)
20
Figure 11.2
Prevalence of RRT - Age 0-17 Years
New Zealand
Prevalence of RRT - Age 0-17 Years
Australia
Age (years)
0-4
5-9
10-14
15-17
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0
11-2
100
Age (years)
50
0-4
5-9
10-14
15-17
0
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
50
RRT prevalence (per million)
RRT prevalence (per million)
150
100
PAEDIATRIC REPORT
_____________________________________________________________________________________
ANZDATA Registry 2012 Report
CAUSES
OF
ESKD
IN
CHILDREN
AND
ADOLESCENTS 2006 - 2011
Overall, glomerulonephritis remains the most common cause of ESKD in children and adolescents (30%) but
causes vary significantly with age. In young children renal hypoplasia/dysplasia is the most common cause while
reflux nephropathy is a common cause of ESKD in adolescents.
Figure 11.3
Causes of End Stage Kidney Disease
In Children and Adolescents 2006 - 2011
Australia and New Zealand
Age Groups (Years)
Primary Renal Disease
Glomerulonephritis
Total
0-4
5-9
10-14
15-17
13 (16%)
17 (29%)
23 (32%)
38 (39%)
91 (30%)
1 (1%)
3 (3%)
4 (1%)
Familial Glomerulonephritis
Reflux Nephropathy
3 (4%)
3 (5%)
5 (7%)
11 (11%)
22 (7%)
Polycystic Kidney Disease
8 (10%)
3 (5%)
1 (1%)
1 (1%)
13 (4%)
1 (2%)
3 (4%)
4 (4%)
8 (3%)
Medullary Cystic Disease
Posterior Urethral Valve
7 (9%)
2 (3%)
9 (13%)
3 (3%)
21 (7%)
Haemolytic Uraemic Syndrome
7 (9%)
1 (2%)
2 (3%)
2 (2%)
12 (4%)
24 (30%)
13 (22%)
12 (17%)
15 (15%)
64 (21%)
3 (5%)
2 (3%)
3 (3%)
10 (3%)
Interstitial Nephritis
1 (2%)
1 (1%)
2 (1%)
Cystinosis
1 (2%)
1 (1%)
2 (1%)
Hypoplasia / Dysplasia
Diabetes
2 (3%)
Cortical Necrosis
2 (3%)
Uncertain
Miscellaneous / Other
Total
1 (1%)
1 (1%)
3 (1%)
6 (6%)
7 (2%)
13 (16%)
14 (24%)
10 (14%)
12 (12%)
49 (16%)
80
59
71
98
308
11-3
PAEDIATRIC REPORT
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
MODALITY
OF
TREATMENT
2006 - 2011
The modality of the first renal replacement treatment is shown in Figure 11.4. Although numbers are small and
therefore fluctuate from year to year, around 20% of children and adolescents receive pre-emptive kidney transplants. Of the remainder, 37% commence renal replacement therapy with haemodialysis compared with 43% starting with peritoneal dialysis.
Figure 11.4
Modality of Initial Renal Replacement Therapy
By Year of First Treatment - Australia and New Zealand < 18 Years of
Age at First Treatment
Year
Current
2006
2007
2008
2009
2010
2011
Total
Haemodialysis
17 (41%)
16 (31%)
28 (46%)
16 (30%)
18 (38%)
20 (37%)
115 (37%)
Peritoneal Dialysis
16 (39%)
26 (51%)
23 (38%)
29 (54%)
19 (40%)
23 (43%)
136 (44%)
Transplant
8 (20%)
9 (18%)
10 (16%)
9 (17%)
10 (21%)
11 (20%)
57 (19%)
41
51
61
54
47
54
308
Treatment
Total
For prevalent patients (Figure 11.5), a very different pattern is seen, with the great majority of children and
adolescents with a functioning transplant. This reflects the relatively high rate of transplantation among
children.
Figure 11.5
Modality of Treatment for all Patients in Australia and New Zealand
< 18 Years of Age at 31st December
Current
Treatment
2006
2007
2008
2009
2010
2011
Total
Haemodialysis
23 (8%)
24 (8%)
35 (11%)
29 (9%)
30 (9%)
Peritoneal Dialysis
35 (12%)
55 (18%)
54 (17%)
57 (18%)
50 (15%)
81 (24%)
332 (18%)
Transplant
236 (80%)
230 (74%)
225 (72%)
229 (73%)
245 (75%)
253 (76%)
1418 (75%)
294
309
314
315
325
334
1891
Total
11-4
Year
141 (7%)
PAEDIATRIC REPORT
_____________________________________________________________________________________
ANZDATA Registry 2012 Report
TRANSPLANT DEMOGRAPHICS
Figures 11.6-11.9 show the trends in paediatric transplantation over the 12- year period from 2000-2011. Live donor kidneys
(living related and unrelated) mostly come from donors in the 35-44 year age group. In contrast, the proportion of deceased
donors aged < 25 is higher than in living donors. There are no significant trends in the type of donor according to recipient
age. The use of donor after cardiac death (DCD) kidneys in children and adolescents remains uncommon (~6%).
The time to first kidney transplant (Fig 11.8) has remained largely unchanged over this period.
Figure 11.6
Figure 11.7
Recipient Age by Donor Source 2000-2011
Donor Age by Donor Source 2000-2011
7
11
11
28
22
22
25
39
46
19
27
11
7
Age (years)
13
17
18
39
27
1
Brain dead
n=161
Live related
n=279
11
2
35
4
35
34
4
10
15
Brain dead
n=161
38
38
35
18
20
2002-03
2004-05
31
2006-07
13
15
52
45
46
Percent
9
Percent
2000-01
11
Live unrelated
n=18
40
15-17
10-14
5-9
0-4
7
DCD
n=15
Number of HLA Mismatches 2000-2011
39
25
Age (years)
25
Figure 11.9
28
27
17
25
Time to First Kidney Transplant 2000-2011
37
27
32
28
DCD
n=15
Figure 11.8
10
27
23
55
45-54
35-44
25-34
<25
11
Live related Live unrelated
n=279
n=18
27
28
44
Percent
Percent
27
56
11
25
24
41
41
32
34
44
25
23
25
2008-09
2010-11
3 years
1-3 years
0-1 year
Pre-emptive
33
2
2000-01
29
36
41
5
5
3
2
2002-03
2004-05
2006-07
2008-09
1
5-6
3-4
1-2
0
2010-11
11-5
PAEDIATRIC REPORT
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Figure 11.10
Graft numbers 2002 - 2011
Australia and New Zealand Recipients <18 Years of Age
Year
Graft
numbers
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
1
34
45
35
47
26
28
45
36
40
44
2
3
1
4
1
4
3
4
3
3
2
Figure 11.11
Donor Source by Year 2002 - 2011
Australia and New Zealand
Number (%) of Total Transplants in Recipients <18 Years of Age
Year
Donor Source
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
LD pre-emptive
5 (14%)
7 (15%)
5 (13%)
10 (21%)
7 (23%)
8 (26%)
9 (18%)
9 (23%)
10
(23%)
10
(22%)
LD not pre-emptive
16 (43%) 23 (50%) 19 (49%)
20 (42%)
15
(50%)
13 (42%)
24 (49%) 16 (41%)
19
(44%)
10
(22%)
DBD
16 (43%) 16 (35%) 15 (38%)
17 (35%)
8 (27%)
9 (29%)
13 (27%) 12 (31%)
11
(26%)
21
(46%)
DCD
0 (0%)
0 (0%)
0 (0%)
1 (2%)
0 (0%)
1 (3%)
3 (6%)
2 (5%)
3 (7%)
5 (11%)
Total
37
46
39
48
30
31
49
39
43
46
Figure 11.12
Antibody Use for Induction Immunosuppression
Australia and New Zealand 2002 - 2011 Number of Transplant Recipients
Age <18 Years Receiving Each Agent By Year (% Total New Transplants)
Year
Agent
Muromonab-CD3
Intravenous immunoglobulin
Anti-CD25
Rituximab
T cell depleting polyclonal Ab
Total new transplants
11-6
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
1 (3%)
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
1 (3%)
-
2 (4%)
17 (46%)
26
26
43
33
36 (84%)
41 (89%)
32 (67%) 20 (67%) 19 (61%)
-
-
-
-
-
-
1 (2%)
-
1 (2%)
-
3 (8%)
2 (4%)
-
1 (2%)
-
-
-
1 (3%)
2 (5%)
2 (4%)
37
46
39
48
30
31
49
39
43
46
PAEDIATRIC REPORT
_____________________________________________________________________________________
ANZDATA Registry 2012 Report
IMMUNOSUPPRESSION
Tacrolimus continues to be the most commonly used calcineurin inhibitor (CNI) at induction and one year posttransplant. The proportion of patients on cyclosporin is higher in the five and ten year cohorts and reflects historical
use of this agent. Within the 2005 cohort, 50% of patients were commenced on tacrolimus compared with 64% on
tacrolimus at five years.
Mycophenolate is the most commonly used antimetabolite at induction and long term use has increased over time,
with only a small proportion of patients treated with azathioprine aside from the five and ten year cohorts.
The proportion of prednisolone-free patients at induction has returned to zero, reflecting a trend since 2005 for virtually universal use of prednisolone at induction. Similarly, there are appears to be a trend since 2005 for a decreasing proportion of steroid-free use in longer term transplants.
Figure 11.13
Figure 11.14
Calcineurin and mTOR Inhibitors at Induction
Transplant Cohorts 2000 - 2011
Neither
Cyclosporine
mTOR Inhibitor
Neither
3
18
26
37
46
41
50
68
84
79
71
61
51
59
48
95
98 100
3
3
2
0
2
0
16
0
5
0
2
0
0
Figure 11.15
25
21
52
61
18
14
4
62
11
63
mTOR Inhibitor
2
5
91
84
7
0
8
3
2
98
21
26
3
0
25
5
16
0
5
22
4
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Figure 11.16
Calcineurin and mTOR Inhibitors at Five Years
Transplant Cohorts 2000 - 2006
10
8
54
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Neither
74
Tacrolimus
67
43
3
0
30
76
32
3
Cyclosporine
0
30
53
Percent
Percent
Tacrolimus
Calcineurin and mTOR Inhibitors at One Year
Transplant Cohorts 2000 - 2010
Cyclosporine
17
17
Tacrolimus
27
23
Calcineurin and mTOR Inhibitors at Ten Years
Transplant Cohorts 2000 - 2001
Neither
mTOR Inhibitor
15
Cyclosporine
21
21
Tacrolimus
mTOR Inhibitor
30
65
77
51
65
45
0
2000
17
0
2001
16
3
3
5
10
3
2002
2003
2004
64
75
9
12
2005
Percent
Percent
45
39
45
36
20
0
4
4
5
2006
2000
2001
11-7
PAEDIATRIC REPORT
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
IMMUNOSUPPRESSION
Figure 11.17
Figure 11.18
Antimetabolites at Induction
Transplant Cohorts 2000 - 2011
79 77
Azathioprine
Mycophenolate
None
61
92 91 90 98
100 97 96 97 100 100
Percent
Percent
None
Antimetabolites at One Year
Transplant Cohorts 2000 - 2010
86
77
33
21 23
0 0
4
4
5
3
8
3
2
0
0
3
0
4
0
3
0
0
6
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Figure 11.19
86
5
8
7
7
23
0
15
15
0
4
7
89
87
88
5
7
8
5
7
5
Azathioprine
Antimetabolites at Ten Years
Transplant Cohorts 2000 - 2001
Mycophenolate
None
Azathioprine
56
68
73
87
94
87
45
30
10
22
13
20
10
13
7
11
3
10
2000
2001
2002
2003
2004
6
0
2005
4
8
15
20
2006
2000
2001
Steroid-free Fraction
Transplant Cohorts 2000 - 2011
Percent steroid-free
40
30
Mycophenolate
70
Figure 11.21
Induction
6 months
1 year
3 years
5 years
20
10
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
11-8
78
96
12
7
7
Percent
Percent
86
Figure 11.20
45
74
73
Mycophenolate
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Antimetabolites at Five Years
Transplant Cohorts 2000 - 2006
None
Azathioprine
PAEDIATRIC REPORT
_____________________________________________________________________________________
ANZDATA Registry 2012 Report
TRANSPLANT OUTCOMES
Graft and patient survival for grafts performed in Australia and New Zealand on recipients aged < 18 years, calculated
by the Kaplan-Meier method, is shown in Figure 11.22. Unadjusted one, three and five year survival have remained
stable over the past ten years.
Figure 11.22
Recipient and Graft Survival
Recipients Aged <18 Years 2002 - 2011
% [95% Confidence Interval]
Survival
Year
6 months
1 year
3 years
5 years
92 [83-96]
Recipient Survival
2002-03 (n=83)
93 [85-97]
93 [85-97]
92 [83-96]
2004-05 (n=87)
100
99 [92-100]
98 [91-99]
96 [89-99]
2006-07 (n=61)
100
100
98 [89-100]
98 [89-100]
2008-09 (n=88)
100
100
100
-
2010-11 (n=89)
100
98 [87-100]
-
-
2002-03 (n=83)
92 [83-96]
90 [82-95]
88 [79-93]
81 [70-88]
2004-05 (n=87)
97 [90-99]
95 [88-98]
88 [79-94]
76 [66-84]
2006-07 (n=61)
93 [83-97]
90 [79-95]
82 [70-90]
80 [68-88]
2008-09 (n=88)
94 [87-98]
94 [87-98]
86 [76-92]
-
2010-11 (n=89)
100
96 [86-99]
-
-
Graft Survival
Figure 11.23
Causes of Graft Failure 2002 - 2011
By Age at Transplant
Age Groups (Years)
Reason for
Failure
5-9
Rejection - Acute
1 (11%)
2 (15%)
2 (9%)
5 (15%)
10 (13%)
Rejection - CAN
1 (11%)
4 (31%)
12 (52%)
11 (32%)
28 (35%)
Vascular rejection
-
3 (23%)
-
2 (6%)
5 (6%)
Technical reasons
3 (33%)
-
4 (17%)
4 (12%)
11 (14%)
Recurrent disease
10-14
15-17
Total
0-4
-
3 (23%)
3 (13%)
1 (3%)
7 (9%)
Non-compliance
1 (11%)
-
-
5 (15%)
6 (8%)
Death with function
2 (22%)
1 (8%)
-
3 (9%)
6 (8%)
Other
1 (11%)
-
2 (9%)
3 (9%)
6 (8%)
Total
9
13
23
34
79
Figure 11.24
Causes of Graft Failure 2002 - 2011
By Age at Failure
Reason for
Failure
Age Groups (Years)
10-14
15-17
Total
0-4
5-9
Rejection - Acute
-
3 (21%)
-
-
3 (4%)
Rejection - CAN
-
4 (29%)
13 (43%)
18 (56%)
35 (44%)
Vascular rejection
-
2 (14%)
2 (7%)
2 (6%)
6 (8%)
Technical reasons
3 (75%)
-
4 (13%)
4 (13%)
11 (14%)
Recurrent disease
-
1 (7%)
5 (17%)
-
6 (8%)
Non-compliance
-
1 (7%)
1 (3%)
3 (9%)
5 (6%)
Death with function
1 (25%)
2 (14%)
2 (7%)
2 (6%)
7 (9%)
Other
-
1 (7%)
3 (10%)
3 (9%)
7 (9%)
Total
4
14
30
32
80
11-9
PAEDIATRIC REPORT
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
REJECTION
The proportions of patients experiencing at least one episode of acute rejection (biopsy proven or clinically
diagnosed) in the first six months post-transplant, and between 6-24 months post transplant, have remained
largely unchanged over the past five years (Figures 11.25 and 11.26). The majority of rejection episodes are
either cellular or not biopsied (Figure 11.27).
Figure 11.25
Figure 11.26
Rejection 6-24 Months Post Transplant
Transplant Cohorts 2003 -2009
Rejection <6 Months Post Transplant
Transplant Cohorts 2002 - 2010
40
2003 cohort includes those from 01 October 2003
30
30
% with rejection
% with rejection
40
24
20
17
15
17
13
13
14
10
8
20
18
16
13
10
10
9
8
7
5
0
0
2002
2003
2004
2005
2006
2007
2008
2009
2010
2002
2011
2003
2004
2005
2006
2007
2008
2009
Figure 11.27
Type of Rejection 2002 - 2010
Rejection <6 months
Post Transplant
Year
2002
2003
2004
2005
2006
2007
2008
2009
2010
No biopsy
1
1
3
5
6
2
.
1
3
Cellular
8
9
5
6
2
4
6
2
3
ABMR
1
.
.
.
.
.
.
.
1
Cellular + ABMR
.
.
.
1
.
.
1
.
.
Rejection 6-24 months
Post Transplant
*
*
No biopsy
-
-
2
3
1
.
1
.
-
Cellular
-
-
2
5
1
4
12
3
-
ABMR
-
-
.
.
.
1
.
.
-
Cellular + ABMR
-
-
.
.
.
.
1
.
-
* NOTE: Not collected until Oct 2003.
11-10
ABMR - antibody-mediated rejection
2010
ANZDATA Registry 2012 Report
INDIGENOUS
_____________________________________________________________________________________
CHAPTER 12
END-STAGE KIDNEY
DISEASE AMONG
INDIGENOUS PEOPLES
OF AUSTRALIA
AND NEW ZEALAND
Stephen McDonald
Matthew Jose
Kylie Hurst
2012 Annual Report - 35th Edition
12-1
INDIGENOUS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
INTRODUCTION
In this chapter, rates of end-stage kidney disease among the Indigenous Peoples of Australia and New Zealand are
presented. For Australia, these are Aboriginal and Torres Strait Islanders; for New Zealand, analyses include Maori
and Pacific Peoples. In all cases, indigenous origin is reported by the renal unit on the basis of self-description.
Maori and Pacific Peoples resident in Australia and Aboriginal and Torres Strait islanders resident in New Zealand
are not considered “indigenous” unless otherwise specified. For some tables, we have also included data on Maori
and Pacific Peoples living in Australia. While not indigenous to Australia, these have been included as useful comparators with the NZ experience of this group.
This chapter contains a number of specific analyses of treated ESKD among indigenous people, and also draws
together tables from elsewhere in the report .
NEW PATIENTS
Figure 12.1
New Patients 2006 - 2011
Figures 12.1 - 12.7
Australia
Mode of
Treatment
2006
2007
2008
2009
2010
2011
NonIndigenous
ATSI
New Zealand
Total
NonIndigenous
Maori
Australia
Pacific
People
Total
PD
552
31
583
95
47
17
159
HD
1,588
190
1,778
143
122
62
327
Graft
73
0
73
13
0
0
13
PD
532
56
588
83
35
13
131
HD
1,546
183
1,729
139
108
64
311
Graft
65
0
65
23
3
0
26
PD
606
51
657
96
35
22
153
HD
1,593
199
1,792
136
119
65
320
Graft
100
0
100
21
3
0
24
PD
552
35
587
124
53
22
199
HD
1,558
159
1,717
158
121
81
360
Graft
115
2
117
22
2
0
24
PD
460
36
496
88
47
28
163
HD
1,554
168
1,722
147
106
80
333
Graft
101
0
101
14
2
0
16
New Zealand
PD
513
30
543
90
37
22
149
HD
1,591
220
1,811
152
89
72
313
Graft
99
0
99
15
0
0
15
Total
13,198
1,360
14,558
1,559
929
548
3,036
37 (23% of total) Maori patients commenced on PD in 2011 while the number of Pacific Peoples starting with PD
increased to 23%.
Percentage of New Patients - New Zealand
Commencing on Haemodialysis
Percentage of New Patients - Australia
Commencing on Haemodialysis
ATSI
Maori
Non Indigenous
Pacific People
Non Indigenous
100
100
80
80
60
60
40
40
20
20
12-2
The number of Maori and Pacific
People starting dialysis decreased in
2011 (126 patients and 94 patients)
respectively.
Figure 12.3
Figure 12.2
0
A total of 250 Aboriginal and Torres
Strait Islander People commenced
dialysis in Australia during 2011. The
majority (88%) were treated with haemodialysis as their initial RRT modality; in 2011 the number of people commencing PD (30 patients). No preemptive transplants were performed
among Aboriginal Australians in 2011.
0
2007
2008
2009
2010
2011
2007
2008
2009
2010
2011
ANZDATA Registry 2012 Report
INDIGENOUS
_____________________________________________________________________________________
INCIDENCE RATES
Overall, the incidence rates (per million population) of indigenous peoples in Australia and NZ are considerably higher
than that for non-indigenous people. Direct comparisons are confounded by the different age distributions - the indigenous population is considerably younger than the non-indigenous population. However, there does appear to have
been a stabilisation of incident rates among Aboriginal Australians. Rates among Pacific Peoples in New Zealand have
increased in the last few years prior to a fall in 2011. This must be viewed with caution, as is it single year. In contrast,
there is a clear trend to lower rates among Maori. The relative rate differs with age and also (for Aboriginal Australians)
with gender - this is illustrated in Figure 12.5.
Figure 12.4
Unadjusted incident RRT rate
Aboriginal & TSI, Australia
Maori and Pacific Peoples, treated in New Zealand
400
500
Per million per year
Per million per year
400
300
200
300
200
100
100
0
0
1985
1990
1995
Year
2000
2005
2010
1985
1990
Aboriginal and TSI
1995
Maori
Year
2000
2005
2010
Pacific Peoples
ANZDATA
Note X and Y scales differ
Figure 12.5
Relative incidence rate Aboriginal vs non Aboriginal
Australia, 2008-11
25
Among Aboriginal Australians,
there is a marked excess relative
rate among those aged 35-64
years. The relative rate is higher
among females than males.
Relative rate
20
15
10
5
0
0-14
15-24
25-34
35-44
45-54
Age (years)
Female
55-64
65-74
75+
Male
Relative incidence rate
Mäori & Pacific Peoples vs non-Mäori
Figure 12.6
New Zealand, 2008-11
20
15
Relative rate
Among Maori and Pacific People
the excess rate is concentrated
among older groups, and there is
no gender difference.
10
5
1
0-14
15-24
25-34
Mäori
35-44
45-54
Age (years)
55-64
65-74
75+
Pacific Peoples
The relative rates for male and female are similar at all ages for Mäori and Pacific Peoples
12-3
INDIGENOUS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
There is also considerable variation between Australian jurisdictions in the Aboriginal/TSI RRT incident rates. The
incidence rates for each State/Territory can be seen in Figure 12.7.
While rates for the very young (<15 years) and older (>65 years) groups are similar in each State/Territory, the rates
for people 25-65 years of age show a clear trend of progressively higher rates from NSW/Victoria to Queensland then
South Australia, Western Australia and the Northern Territory. Data is shown for a three year period given the small
numbers in some locations.
Age-specific incidence rates of treated RRT
Figure 12.7
among Aboriginal & TSI people, by state and age at RRT start
per million per year
per million per year
2000
0
NT
4000
WA
6000
SA
65-74 years
75+ years
4000
2000
0
NT
WA
SA
Qld
Vic
NSW
NT
WA
SA
Qld
Vic
NSW
NT
WA
SA
Qld
Vic
NSW
Rate
6000
NT
WA
0
SA
2000
Qld
4000
Vic
55-64 years
Qld
per million per year
0
Vic
per million per year
500
45-54 years
5000
4000
3000
2000
1000
0
NSW
8000
1000
NSW
per million per year
25-44 years
1500
NT
WA
SA
Qld
Vic
6000
NSW
per million per year
0-24 years
100
80
60
40
20
0
95% CI
ANZDATA and ABS data, 2009-11
The overall stabilisation of rates among Aboriginal Australians is seen consistently across each age group. In some age
groups (such as 25-34 & 65-74 years) there is a suggestion of a downwards trend. There are a number of factors which
contribute to incident numbers of RRT (among both indigenous and non-indigenous people). It is not clear whether this
stabilisation reflects the underlying rates of diabetes, rates of disease progression, referral patterns or other diseases.
Figure 12.8
Age-specific incident RRT rate
Aboriginal & TSI, Australia
0-14
50
0
Per million per year
15-24
25-34
200
150
100
50
0
500
0
35-44
1500
1000
500
0
45-54
55-64
2500
2000
1500
1000
500
4000
3000
2000
1000
0
1990 19952000 2005 2010
65-74
4000
3000
2000
1000
0
75+
3000
2000
1000
0
1990 1995 2000 2005 2010
1990 1995 20002005 2010
Year
Rate
note: Y axis scales differ
12-4
95% CI
ANZDATA Registry 2012 Report
INDIGENOUS
_____________________________________________________________________________________
Age specific trends for Maori and Pacific Peoples are shown in Figures 12.9 and 12.10.
Note that the Y axis scale varies.
Figure 12.9
Age-specific incident RRT rate
Maori, New Zealand
0-14
15-24
50
0
Per million per year
25-34
300
200
100
0
150
100
50
0
35-44
45-54
55-64
1500
1000
500
0
400
300
200
100
0
2500
2000
1500
1000
500
1990 19952000 2005 2010
65-74
75+
3000
2000
1000
0
3000
2000
1000
0
1990 1995 2000 2005 2010
1990 1995 20002005 2010
Year
Rate
95% CI
note: Y axis scales differ
Figure 12.10
Age-specific incident RRT rate
Pacific Peoples, New Zealand
0-14
Per million per year
15-24
25-34
300
200
100
0
80
60
40
20
0
400
300
200
100
0
35-44
45-54
55-64
4000
3000
2000
1000
0
1500
1000
500
0
600
400
200
0
1990 19952000 2005 2010
65-74
75+
4000
3000
2000
1000
0
4000
3000
2000
1000
0
1990 1995 2000 2005 2010
1990 1995 20002005 2010
Year
Rate
95% CI
note: Y axis scales differ
12-5
INDIGENOUS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
NEW TRANSPLANTS
Figure 12.11
New Transplants 2001 - 2011
Australia
In both Australia and New
Zealand numbers of transplants to indigenous recipients were low.
Year
Donor
Source
NonIndigenous
2001
Australia
Over the period 2001-11
there has been an increase in
the number of transplants
from deceased donors. Numbers from living donors remain extremely low. The table also contains transplants
to Maori and Pacific people
resident in Australia; the
numbers of these have increased over 2010-11.
2002
2003
2004
2005
New Zealand
The number of transplants to
Maori and Pacific Peoples
recipients remains stable. In
contrast to the situation in
Australia,, there is a higher
proportion of transplants from
living donors.
2006
2007
2008
2009
2010
2011
New Zealand
ATSI
Maori
Pacific
People
NonIndigenous
ATSI
LD
206
3
1
3
37
5
1
304
510
18
21
3
4
3
6
52
89
10
15
5
6
LD
226
0
1
3
43
3
2
DD
353
17
1
3
46
10
13
Total
579
17
2
6
89
13
15
LD
DD
Total
214
314
528
3
10
13
0
1
1
1
1
33
48
81
8
8
16
3
11
14
LD
DD
Total
239
377
616
4
22
26
0
1
1
1
6
7
39
42
81
5
7
12
4
8
12
LD
DD
Total
239
357
596
3
19
22
0
0
0
4
1
5
44
42
86
3
3
2
2
4
LD
265
3
0
5
42
4
3
DD
Total
337
602
24
27
5
5
2
7
31
73
6
10
4
7
LD
DD
Total
261
327
588
4
14
18
1
1
2
5
2
7
45
55
100
9
8
17
4
2
6
LD
341
7
2
4
58
7
4
DD
Total
430
771
24
31
0
2
5
9
42
100
5
12
6
10
LD
320
4
2
1
58
8
1
DD
Total
418
738
20
24
3
5
5
6
38
96
11
19
5
6
LD
DD
Total
292
512
804
0
28
28
1
1
2
3
9
12
49
32
81
7
13
20
4
5
9
LD
249
2
1
3
49
6
2
DD
521
26
10
13
40
14
7
Total
770
28
11
16
89
20
9
New Zealand
30
30
count of patient
Figure 12.12
2011
2010
2009
2008
Live related
2007
2006
2005
2004
2003
2002
Indigenous transplants numbers
ATSI in Australia, Maori and PP in New Zealand
2001
2011
2010
2009
2008
2007
2006
0
2005
0
2004
10
2003
10
2002
20
2001
20
Deceased
Live unrelated
12-6
Pacific
People
DD
Total
Australia
Indigenous Transplant
Numbers. Australian figures include ATSI
only.
Maori
ANZDATA Registry 2012 Report
INDIGENOUS
_____________________________________________________________________________________
Cumulative incidence curves (utilising competing risk techniques to account for the effects of both components of graft
failure) are shown for indigenous transplant outcomes in Figure 12.13. It can be seen that for Aboriginal and TSI, there
are higher rates of loss of graft function, and substantially higher rates of death with graft function compared with nonindigenous. Both of these differences are progressive over time. Lesser differences are seen for Maori / PP. In particular,
the excess death rate among Maori/PP stabilises after the initial months.
Figure 12.13
Transplant outcomes
Cumulative incidence
Loss graft function
Death with graft function
.2
.1
0
0
1
2
3
4
5
0
1
2
3
4
5
Years
ATSI
NZ non-indig
non-ATSI
Maori/PP
ANZDATA, all grafts 1/1/01 to 31/12/11
DD1, cumulative incidence competing risks
Information on donor source is shown in Figure 12.14. There are substantially lower rates of living donation among
indigenous groups in Australia, with a lesser difference in New Zealand. Australian figures include ATSI only.
Figure 12.14
Donor source
by indigenous status
Australia Non-indigenous
7%
6%
16%
24%
Australia Aboriginal/TSI
60%
87%
New Zealand Non-indigenous
New Zealand Maori /Islander
12%
20%
24%
48%
64%
31%
Deceased
Live unrelated
Live related
ANZDATA, Donor source, grafts 1/1/01 to 31/12/11
12-7
INDIGENOUS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
TREATMENT
OF
PREVALENT PATIENTS
Australia
The number of prevalent Aboriginal and Torres Strait Islander People with treated end-stage kidney disease
increased by only 8% in 2011 after a slight increase in 2010. The percentage of ATSI on home haemodialysis
was 6% in 2011 (this includes patients who perform independent self-care dialysis in other community settings).
The percentage of ATSI treated with peritoneal dialysis was steady in 2011.
New Zealand
The number of prevalent Maori with treated end-stage kidney disease decreased in 2011, whilst Pacific People
increased. The percentage of Maori (26%) treated with home haemodialysis remains similar to past years, whilst
in Pacific People this percentage (11%) has decreased since 2006.
The use of peritoneal dialysis in the Maori population decreased slightly whilst in Pacific Islanders population
increased slightly in 2011.
Figure 12.15
Prevalent Patients 2006 - 2011
Australia
Year
2006
2007
2008
2009
2010
2011
Mode of
Treatment
Non-Indigenous
Aboriginal/TSI
ATSI
New Zealand
Maori
Pacific
People
Non-Indigenous
ATSI
Maori
Pacific
People
APD
CAPD
Hospital HD
912
937
2,119
55
95
186
7
2
18
16
23
42
108
323
252
92
155
204
18
70
106
Satellite HD
Home HD
3,263
820
603
51
20
9
70
14
85
174
124
109
138
39
Graft
6,762
148
26
53
1,074
106
75
APD
CAPD
1,058
862
65
92
9
5
18
28
120
306
101
130
25
64
Hospital HD
Satellite HD
Home HD
Graft
2,050
3,548
864
7,022
205
679
53
148
14
22
11
28
33
93
21
55
273
95
179
1,114
216
130
111
108
126
158
37
76
APD
1,165
79
12
15
149
105
34
CAPD
Hospital HD
Satellite HD
Home HD
Graft
850
2,054
3,784
868
7,409
87
215
728
53
159
11
17
28
8
27
23
40
107
22
61
284
276
97
177
1,156
117
222
135
110
112
74
124
158
44
82
APD
CAPD
Hospital HD
Satellite HD
Home HD
Graft
1,212
68
10
23
783
74
9
21
2,063
224
19
37
4,039
747
35
110
869
70
11
27
7,798
160
31
65
175
278
310
97
198
1,200
125
111
221
147
128
120
36
74
159
169
52
84
APD
CAPD
Hospital HD
Satellite HD
Home HD
Graft
1,177
695
2,041
4,356
858
8,241
62
80
216
779
74
177
16
10
23
42
13
31
24
18
41
123
29
73
188
269
307
97
222
1,225
138
115
235
141
131
130
32
90
189
160
71
86
APD
CAPD
Hospital HD
Satellite HD
Home HD
1,180
682
2,109
4,518
847
63
73
261
832
73
12
11
20
45
14
26
22
37
135
38
185
242
328
87
230
137
107
246
122
130
29
90
216
159
73
Graft
8,621
190
40
84
1,257
143
88
* By Resident Country at 31st December
12-8
ANZDATA Registry 2012 Report
INDIGENOUS
_____________________________________________________________________________________
DIALYSIS MODALITY
The distribution of dialysis modality is shown graphically in Figures 12.16 below. Among indigenous Australians, the principal differences are a substantially lower rate of home HD and APD; this figure also includes
the experience for Maori and Pacific Peoples treated in Australia at the end of 2011. Similar data is shown
for New Zealand in Figure 12.17. Again, rates of home treatments (HD and PD) are lower among the indigenous groups.
Figure 12.16
Dialysis modality end 2011
Australia, by indigenous origin
Non-indigenous
Aboriginal/TSI
6%
5%
6%
9% 13%
7%
48%
20%
23%
64%
Maori
Pacific islander
15% 10%
9%
14% 12%
11%
44%
14%
20%
52%
APD
Hospital HD
Home HD
CAPD
Satellite HD
Patients at end 2011 dialysing and resident in Australia
Figure 12.17
Dialysis modality end 2011
NZ, by indigenous origin
Non-indigenous
21%
8%
17%
Maori
18% 18%
16%
23%
31%
14%
33%
Pacific islander
13%5%
16%
28%
38%
APD
Hospital HD
Home HD
CAPD
Satellite HD
Patients at end 2011 dialysing and resident in New Zealand
12-9
INDIGENOUS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
ESTIMATED
GLOMERULAR FILTRATION RATE AT TREATMENT START
In both Australia and New Zealand, there has been a gradual trend towards lower eGFR at the time
of dialysis start, over 2010/11 among all groups. However, there is also a consistent difference (in
both countries ) between indigenous and non-indigenous, with higher eGFR values among the nonindigenous groups.
Figure 12.18
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Maori
Pacific People
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
10
8
6
4
2
0
Aboriginal/TSI
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
10
8
6
4
2
0
Non - Indigenous
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Median eGFR (mL/min/1.73m
2
eGFR at Dialysis Start
Australia
Excluding pre-emptive transplants
Figure 12.19
Maori
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
10
8
6
4
2
0
Non - Indigenous
Pacific People
10
8
6
4
2
0
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Median eGFR (mL/min/1.73m
2
eGFR at Dialysis Start
New Zealand
Excluding pre-emptive transplants
12-10
ANZDATA Registry 2012 Report
INDIGENOUS
_____________________________________________________________________________________
The tables on this page (Figures ) show the actual numbers for ATSI people in various states over
the last 5 years. Clearly the number of patients receiving dialysis vary considerably. There is also
considerable variation between states, and over time, in he number referred for transplantation.
Figure 12.20
Referring State before Transplantation
2007 - 2011
Tx Year
NT
NSW/ACT
VIC
QLD
SA
WA
TAS
Total
2007
3
1
-
3
5
5
1
18
2008
1
4
1
5
5
15
-
31
2009
2
5
1
1
5
10
-
24
2010
2
6
2
4
5
9
-
28
2011
5
4
2
3
4
9
1
28
Total
13
20
6
16
24
48
2
129
Figure 12.21
Numbers of patients on 31 December 2011
Modality - State
Modality
NT
NSW/ACT
VIC
QLD
SA
WA
TAS
Total
PD
22
21
3
56
2
32
0
136
Centre HD
375
127
42
242
76
225
6
1,093
Home HD
22
14
0
22
0
15
0
73
Tx
32
29
11
31
36
50
1
190
Total
451
191
56
351
114
322
7
1,492
WA
TAS
Total
Figure 12.22
Number of new patients - Initial State
2007 - 2011
Tx Year
NT
NSW/ACT
VIC
QLD
SA
2007
67
34
8
66
9
55
0
239
2008
76
32
4
56
19
63
0
250
2009
59
21
9
49
16
41
1
196
2010
52
30
9
62
17
32
2
204
2011
67
35
10
60
16
59
3
250
Total
321
152
40
293
77
250
6
1,139
12-11
INDIGENOUS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
INCIDENCE
AND
PREVALENCE
BY
STATE/TERRITORY
The next four pages show a variety of figures which summarise various key rates (incidence, prevalence, transplant rates)
among indigenous people in Australia and New Zealand. In large part they show information from previous pages, in a series of
differing formats.
State Incidence
The Northern Territory has the highest national incidence among indigenous people of treated end-stage kidney disease in Australia at 743pmp, the next highest is in South Australia (527 pmp).
Dialysis by Resident State
Treatment patterns for Aboriginal and Torres Strait Islander People vary by State. The highest rates are in the Northern Territory,
Western Australia and South Australia.
Transplant by Referring State
Rates of prevalent transplants vary substantially between States with highest rates in South and Western Australia. These rates
are per population, not per dialysis patient, and they reflect both background rates of kidney disease and transplant rates.
Figure 12.23
Incidence of New ATSI Patients
Per million ATSI population
1,200
1,000
800
Year
2008
2009
2010
2011
600
400
200
0
Figure 12.24
QLD
NSW/ACT VIC/TAS
SA
NT
WA
Australia
Incidence of New Transplants ATSI Patients
By referring State
Per million ATSI population
200
150
Year
2008
2009
2010
2011
100
50
0
12-12
QLD
NSW/ACT VIC/TAS
SA
NT
WA
Australia
ANZDATA Registry 2012 Report
INDIGENOUS
_____________________________________________________________________________________
Figure 12.25
Figure 12.26
Prevalence of Peritoneal Dialysis
ATSI Patients
6,000
700
5,000
600
4,000
Year
2008
2009
2010
2011
3,000
2,000
1,000
Per million ATSI population
Per million ATSI population
Prevalence of Haemodialysis
ATSI Patients
Year
2008
2009
2010
2011
400
300
200
100
0
QLD NSW/ACTVIC/TAS
SA
NT
WA
0
Australia
Figure 12.27
SA
NT
WA
Australia
Deaths ATSI Patients
1,000
1,200
800
Year
2008
2009
2010
2011
600
400
200
Per million ATSI population
900
1,000
0
QLD NSW/ACTVIC/TAS
Figure 12.28
Functioning Transplants
ATSI Patients
Per million ATSI population
500
800
700
Year
2008
2009
2010
2011
600
500
400
300
200
100
QLD NSW/ACT
VIC/TAS SA
NT
WA Australia
0
QLD NSW/ACT
VIC/TAS SA
NT
WA Australia
12-13
INDIGENOUS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Incidence of New Patients - New Zealand
Maori and Pacific People
Figure 12.29
Per Million Population
400
Maori
Pacific People
300
200
100
0
2007
2008
2009
2010
2011
Incidence of New Transplants - New Zealand
Maori and Pacific People
Figure 12.30
Per Million Population
40
Maori
Pacific People
30
20
10
0
2007
Figure 12.31
2008
2009
2010
2011
Prevalence of Haemodialysis- New Zealand
Maori and Pacific People
Maori
Pacific People
Per Million Population
1,500
1,250
1,000
750
500
250
0
12-14
2007
2008
2009
2010
2011
ANZDATA Registry 2012 Report
INDIGENOUS
_____________________________________________________________________________________
Prevalence of Peritoneal Dialysis- New Zealand
Maori and Pacific People
Figure 12.32
Maori
Pacific People
Per Million Population
600
500
400
300
200
100
0
2007
2008
2009
2010
2011
Functioning Transplant - New Zealand
Maori and Pacific People
Figure 12.33
Maori
Pacific People
Per Million Population
400
300
200
100
0
2007
2008
2009
2010
2011
Deaths - New Zealand
Maori and Pacific People
Figure 12.34
Maori
Pacific People
Per Million Population
300
200
100
0
2007
2008
2009
2010
2011
12-15
INDIGENOUS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
GEOGRAPHICAL
DISTRIBUTION
Figure 12.35 shows the number of incident ATSI (patients by postcode) The distribution of prevalent dialysis
patients are summarized in Figure 12.36 (by state) and 12.37 by statistical subdivision (obtained by mapping
postcodes to SSD). Note that some postcodes were distributed over more than one SSD
Figure 12.35
Incident indigenous patients 2006-2011
by postcode
Incident numbers, by postcode, 2007-2011
(50,100]
(20,50]
(10,20]
(5,10]
(2,5]
(1,2]
[0,1]
ANZDATA, indigenous patients only, based on postcode at first RRT
Figure 12.36
Prevalent indigenous patients, 31 Dec 2011
by state/territory
Percent indigenous RRT patients, Dec 31 2011
(75,100]
(50,75]
(20,50]
(10,20]
(5,10]
[0,5]
No data
12-16
ANZDATA Registry 2012 Report
INDIGENOUS
_____________________________________________________________________________________
Figure 12.37
Prevalent indigenous dialysis patients
31 Dec 2011
NSW
Vic
Qld
SA
WA
NT
Number of dialysis patients
100 - 200
50 - 100
20 - 50
10 - 20
5 - 10
2-5
1-2
0-1
ANZDATA, based on postcode of residence reported at at end 2011
mapped to SSD using ABS concordance files
12-17
INDIGENOUS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
LATE REFERRAL
Australia
The percentage of Aboriginal and Torres Strait Islander People referred late for treatment has been stable
for the last 3 years, and is very similar to the non-indigenous rate. Most (56%) commenced haemodialysis
using a catheter rather than permanent access in 2011 (Figure 12.39); again this is a similar situation to
the non-indigenous patients.
New Zealand
The proportion of Maori people referred late in 2011 decreased to 17% in 2010 from a peak in 2009. For
Pacific People referred late, the proportion increased to 26% . Most Maori (66%) and Pacific People (76%)
commenced haemodialysis with a catheter (Figure 12.39).
Figure 12.38
Late Referral 2007 - 2011
% Late Referral of (Total Number of Patients)
Australia
New Zealand
Year
ATSI
Maori
Pacific
People
NonIndigenous
Maori
Pacific
People
NonIndigenous
2007
32% (239)
36% (11)
27% (41)
23% (2091)
16% (146)
30% (77)
20% (245)
2008
24% (250)
24% (21)
32% (41)
21% (2237)
31% (157)
22% (87)
17% (253)
2009
22% (196)
32% (22)
37% (38)
20% (2165)
22% (176)
13% (103)
15% (304)
2010
25% (204)
19% (26)
26% (42)
22% (2047)
19% (155)
16% (108)
15% (249)
2011
30% (250)
20% (20)
17% (46)
22% (2137)
17% (126)
26% (94)
22% (257)
VASCULAR ACCESS
For all indigenous groups in Australia and New Zealand the vascular access rates (at first HD) are stable over
recent years. For both indigenous and non-indigenous groups these rates are higher in NZ than Australia.
Figure 12.39
Vascular Access Use at First ESRF Treatment
Where this is Haemodialysis 2007 - 2011
(% Using CVC)
Australia
Year
2007
2008
2009
2010
2011
12-18
New Zealand
Vascular
Access
ATSI
Maori
Pacific
People
NonIndigenous
Maori
Pacific
People
NonIndigenous
CVC
126 (69%)
5 (63%)
29 (78%)
869 (58%)
80 (74%)
52 (81%)
101 (73%)
AVF/AVG
57
3
8
632
28
12
38
CVC
121 (61%)
8 (57%)
22 (71%)
940 (61%)
90 (76%)
56 (86%)
101 (74%)
AVF/AVG
78
6
9
608
29
9
35
CVC
94 (59%)
12 (60%)
24 (75%)
838 (56%)
87 (72%)
51 (63%)
111 (70%)
AVF/AVG
65
8
8
668
34
30
47
CVC
105 (63%)
10 (59%)
22 (71%)
894 (59%)
82 (77%)
60 (75%)
108 (73%)
AVF/AVG
62
7
9
611
24
20
39
CVC
123 (56%)
8 (53%)
25 (71%)
829 (54%)
59 (66%)
55 (76%)
106 (70%)
AVF/AVG
96
7
10
705
30
17
46
ANZDATA Registry 2012 Report
INDIGENOUS
_____________________________________________________________________________________
Figure 12.40
Incidence and prevalence - Aboriginal And Torres Strait Islanders
2007- 2011 by Resident State (rate per million indigenous population)
Australia
Year
2007
Mode of
Treatment
NT
WA
Australia
66 (444)
34 (213)
8 (152)
9 (315)
67 (1028)
55 (761)
239 (453)
107 (669)
31 (590)
52 (1817)
315 (4835)
209 (2894)
937 (1778)
Prevalent PD
61 (410)
22 (138)
5 (95)
7 (245)
25 (384)
37 (512)
157 (298)
Functioning Transplant
27 (182)
22 (138)
8 (152)
26 (909)
39 (599)
26 (360)
148 (281)
3 (20)
1 (6)
1 (19)
5 (175)
3 (46)
5 (69)
18 (34)
35 (235)
14 (88)
6 (114)
12 (419)
32 (491)
36 (498)
135 (256)
New Patients
56 (367)
32 (196)
4 (75)
19 (651)
76 (1146)
63 (857)
250 (464)
Prevalent HD
242 (1587)
108 (662)
31 (578)
61 (2090)
335 (5054)
219 (2978)
996 (1850)
Prevalent PD
48 (315)
33 (202)
6 (112)
9 (308)
26 (392)
44 (598)
166 (308)
Functioning Transplant
30 (197)
21 (129)
7 (130)
29 (994)
35 (528)
37 (503)
159 (295)
5 (33)
4 (25)
1 (19)
5 (171)
1 (15)
15 (204)
31 (58)
45 (295)
18 (110)
3 (56)
6 (206)
55 (830)
37 (503)
164 (305)
Deaths
New Patients
49 (313)
21 (126)
10 (182)
16 (537)
59 (875)
41 (548)
196 (356)
Prevalent HD
246 (1572)
119 (715)
33 (601)
62 (2082)
361 (5353)
220 (2939)
1041 (1893)
Prevalent PD
50 (320)
22 (132)
5 (91)
7 (235)
22 (326)
36 (481)
142 (258)
Functioning Transplant
26 (166)
21 (126)
8 (146)
29 (974)
31 (460)
45 (601)
160 (291)
1 (6)
5 (30)
1 (18)
5 (168)
2 (30)
10 (134)
24 (44)
Deaths
50 (320)
22 (132)
9 (164)
14 (470)
42 (623)
40 (534)
177 (322)
New Patients
62 (386)
30 (177)
11 (196)
17 (560)
52 (758)
32 (420)
204 (363)
Prevalent HD
251 (1564)
120 (707)
40 (712)
68 (2238)
368 (5365)
222 (2913)
1069 (1903)
Prevalent PD
49 (305)
29 (171)
5 (89)
2 (66)
29 (423)
28 (367)
142 (253)
Functioning Transplant
30 (187)
26 (153)
10 (178)
33 (1086)
32 (466)
46 (604)
177 (315)
4 (25)
6 (35)
2 (36)
5 (165)
2 (29)
9 (118)
28 (50)
55 (343)
18 (106)
1 (18)
9 (296)
42 (612)
38 (499)
163 (290)
Transplant Ops
Transplant Ops
Deaths
2011
SA
223 (1500)
Transplant Ops
2010
VIC/TAS
New Patients
Deaths
2009
NSW/ACT
Prevalent HD
Transplant Ops
2008
QLD
New Patients
60 (364)
35 (202)
13 (226)
16 (516)
67 (960)
59 (760)
250 (436)
Prevalent HD
264 (1603)
141 (814)
48 (836)
76 (2451)
397 (5691)
240 (3093)
1166 (2032)
Prevalent PD
56 (340)
21 (121)
3 (52)
2 (65)
22 (315)
32 (412)
136 (237)
Functioning Transplant
31 (188)
29 (167)
12 (209)
36 (1161)
32 (459)
50 (644)
190 (331)
3 (18)
5 (29)
2 (35)
4 (129)
5 (72)
9 (116)
28 (49)
39 (237)
19 (110)
5 (87)
5 (161)
44 (631)
33 (425)
145 (253)
Transplant Ops
Deaths
12-19
INDIGENOUS
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
This page is intentionally left blank
12-20
ANZDATA Registry 2012 Report
Supplement
_____________________________________________________________________________________
2012
Report
Supplement
This year the appendices have been
replaced with this supplement report.
Please contact the Registry if you require
more detailed tabular data which was
previously supplied in the report
appendices.
Summary of data to
31st December 2011
S-1
Supplement
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
AUSTRALIA Summary
Dialysis Patients
At 31-Dec-2011
Hospital
Hosp
HD
Australia
2427
Home
CAPD
APD HD APD Hosp Home
9
972 1270
15
773
Functioning Transplants
At 31-Dec-2011
Total
Sat
HD
5530
PD
2
Patient Flow
1-Jan-2011 to 31-Dec-2011
Transplanting HospiNew Tx
tal
New
3+ Total
1
2 3+ Total Pts DD LD
Caring Hospital
Dialysis
Patients
1
2
Total
Deaths
Dx
Tx
Patient
Flow
f
• 50
X 22
J47
[1,035
10,998
7,793 829 159 8,781 7,769 825 159 8,753 2452 570 255 1,476 204 21,522
]
#141 #13 #2 #156 #141 #13 #2 #156
68
60
56
0
55
79
41
49
42
106
0
0
0
0
0
0
0
0
0
1
0
1
27
0
24
0
6
0
0
58
0
2
30
0
12
0
6
0
0
40
0
2
1
0
1
0
0
0
0
0
0
2
2
0
12
0
4
0
0
79
0
0
79
28
54
0
14
0
0
155
0
0
0
0
0
0
0
0
0
0
68
67
195
28
158
79
71
49
42
439
[3]
[3]
[12]
[2]
[20]
[6]
[2]
[3]
[56]
3
25
68
17
129
33
30
47
12
-
2
6
1
17
3
1
3
2
-
2
1
-
3
27
74
18
148
36
32
50
14
-
Qld Renal Tx Service +
-
-
-
-
-
-
-
-
0
-
620
70
12
702 1,439 143 15 1,597
4
Child & Adolescent R.S
Rockhampton
Royal Brisbane
St. Andrews - Diaverum
Sunshine Coast Health
Caloundra Private
Nambour General
Nambour Private
Toowoomba
Townsville
Wesley
3
60
73
21
0
0
0
0
0
5
28
0
8
14
44
0
0
0
0
0
0
3
23
0
0
7
53
0
0
0
0
0
11
89
221
21
[5]
[8]
[18]
[3]
47
47
106
-
3
5
-
1
-
47
50
112
-
-
-
-
-
10
17
52
3
-
11
30
18
79
26
44
0
0
0
0
0
0
0
16
0
11
8
0
0
7
0
39
2
0
0
0
0
2
0
0
0
2
0
10
16
0
0
52
0
71
24
0
0
0
0
1
0
0
11
107
18
213
76
44
[1]
[12]
[12]
[16]
[4]
116
74
66
95
11
3
13
6
1
1
-
127
78
80
101
-
-
-
-
1
23
4
15
38
13
-
921
1
184 204
6
153
537
1
Allamanda
Bundaberg
Cairns
Chermside
Goldcoast
Greenslopes Private
Hervey Bay
John Flynn
Mackay
Princess Alexandra
Queensland
-
-
-
K16
-
15
9
48
5
31
14
16
24
16
85
-
-
12
5
27
7
26
19
7
13
9
79
2
1
5
1
-
83
101
298
54
339
134
111
113
66
520
-
21
723
-
1
6
31
1
6
3
-
60
151
369
22
-
3
16
1
14
30
8
4
3
1
-
14
256
19
308
187
153
315
47
119 36
2,007 [186] 1,535 146 18 1,699 1,439 143 15 1,597 443 119 36
#20
#1
-
#21
#21
-
-
#21
J1
K1
J1 K1
J1
J2
J1 K1
4,081 J8 K5
35
31
0
0
3
1
4
8
0
0
2
9
0
4
0
0
44
53
[2]
[3]
35
31
4
1
-
39
32
-
-
-
-
10
19
-
-
7
9
1
1
91
95
Prince of Wales
St. George
St. Vincent’s
Sydney Children’s
Wollongong
Gosford
John Hunter
Lismore
Lismore Private Clinic
MacLeay
Manning Rural Referral
Mater
Mayo Private - Taree
Newcastle Nephrocare
42
111
66
1
7
43
48
30
0
0
20
0
15
0
0
2
1
0
0
1
0
0
0
0
0
0
0
0
8
48
16
0
16
13
47
18
0
0
4
0
0
0
17
55
13
0
20
25
53
13
0
0
6
0
0
0
2
0
1
0
0
1
0
0
0
0
0
0
0
0
3
3
2
0
28
7
6
5
0
0
1
0
0
0
39
30
10
0
126
77
127
56
13
13
13
29
0
23
0
0
0
0
1
0
0
0
0
0
0
0
0
0
111
249
109
1
198
167
281
122
13
13
44
29
15
[10]
[12]
[11]
[13]
[11]
[20]
[6]
[1]
[1]
[2]
[3]
[1]
141
134
64
25
116
87
195
64
4
45
3
13
12
6
1
8
7
21
5
8
-
5
3
7
3
-
159
146
73
26
131
94
219
69
4
53
3
289
82
64
51
247
3
-
31
3
7
2
20
-
11
4
1
-
331
85
75
53
268
3
-
24
49
34
3
35
36
53
25
5
7
1
2
26
3
12
-
10
1
1
13
-
12
35
15
33
24
50
17
3
2
2
5
4
4
4
2
7
3
7
1
2
-
286
434
201
27
371
288
559
209
16
15
50
89
22
Pt Macquarie Hospital
Pt Macquarie Private
Royal North Shore
23
18
40
0
0
0
8
0
35
9
0
24
0
0
0
1
0
5
0
0
103
0
0
0
23
41
18
207
[4]
[1]
[2]
[22]
27
151
1
16
6
28
173
170
14
9
193
2
15
3
47
6
3
1
2
2
20
1
7
24
73
20
409
Statewide Renal Serv. y
48
0
87
64
1
64
213
0
477
[50]
422
38
8
468
832
78
13
923
104
42
29
68
18
SW Sydney Renal Serv.*
Sydney Adventist
Tamworth
68
39
32
1
0
0
38
0
11
120
0
21
1
0
0
26
0
8
212
0
23
0
0
0
466
39
95
[19]
[1]
[8]
181
1
55
3
5
1
-
185
1
60
-
-
-
-
84
8
16
-
-
62
13
14
3
1
719
53
170
The Children’s Westmead
8
0
0
3
0
0
0
0
11
[4]
46
3
-
49
80
6
-
86
9
6
9
-
-
60
The Tweed
46
0
4
5
0
1
0
0
56
[4]
2
-
-
2
-
-
-
-
10
-
-
5
-
64
Western Renal Network
Westmead
Nepean
Orange
[Sydney Hospital] t
41
9
37
-
0
0
0
-
95
4
1
-
85
26
7
-
0
0
0
-
96
19
13
-
149
63
28
-
0
0
0
-
466
121
86
-
[48]
[7]
[9]
-
361
14
36
-
27
2
-
8
-
96
14
41
-
678
23
44
3
7
1
729
27
122
23
15
-
49
-
22
-
47
17
6
-
12
-
621
152
133
858
5
457 578
6
299
1351
1
3,555 [275] 2,243 180 42 2,465 2,519 208 46 2,773 761 144 88
475
74
6,590
J15
K6
Coffs Harbour
Dubbo
East Coast Renal Serv. v
New South Wales
0
#72
#7
-
#79
#74
#7
#1
#82
J2
J2
J2
K1
J1 K1
1,039 J7 K1
K3
J1
Canberra
30
0
32
8
0
12
182
0
264
[39]
182
31
2
215
-
-
-
-
53
-
-
27
8
516
J2
Australian Capital
30
0
32
8
0
12
182
0
264
[39]
182
31
2
215
-
-
-
-
53
-
-
27
8
516
J2
#2
#1
-
#3
-
-
-
-
Territory
Total Patient Flow = Total Dialysis Patients + Total Functioning Transplants (Caring Hospital)
+ Dialysis and Transplant Deaths + J and K patients
S-2
J1
K1
J1 K1
ANZDATA Registry 2012 Report
Supplement
_____________________________________________________________________________________
AUSTRALIA Summary
Dialysis Patients
At 31-Dec-2011
Hospital
Hosp
HD
Australia
Alfred
Austin Health *
Diaverum - Diamond Valley
Diaverum - North Melbourne
Eastern Area (EHRS)
Epworth
Forest Hill
Geelong
Kew Private
Malvern
Monash—Adult
Monash—Paediatric
NW Dialysis Service *
Royal Melbourne
Royal Children’s
St Vincent’s
Western Health
Victoria
2,427
Home
CAPD
APD HD APD Hosp Home
9
972 1270
Functioning Transplants
At 31-Dec-2011
15
773
Sat
HD
5,530
PD
2
Total
Dialysis
Patients
Caring Hospital
1
2
3+ Total
Patient Flow
1-Jan-2011 to 31-Dec-2011
Transplanting Hospital
1
2
New Tx
New
3+ Total Pts DD LD
Deaths
Dx
Tx
Total
Patient
Flow
f
• 50
X 22
10,998 [1,035] 7,793 829 159 8,781 7,769 825 159 8,753 2452 570 255 1,476 204 21,522
#140 #15 #1 #156 #141 #13 #2 #156
30
29
0
0
2
0
0
24
0
0
35
2
24
1
49
13
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
14
17
0
0
5
0
0
32
0
0
54
0
53
0
6
10
25
33
0
0
25
0
0
12
0
0
64
4
25
13
44
11
0
0
0
0
0
0
0
1
0
0
1
0
1
0
0
0
2
17
0
0
8
0
0
8
0
0
30
0
40
0
12
10
192
290
40
34
125
17
40
59
18
42
350
0
433
2
130
133
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
263
386
40
34
165
17
40
136
18
42
534
6
576
17
241
177
[15]
[42]
[4]
[5]
[7]
[3]
[3]
[21]
209
1
191 256
3
127
1905
0
2,692
[289]
[4]
[64]
[2]
[93]
[4]
[17]
[5]
131
252
6
86
526
12
787
40
175
1
11 1
30 7
1
12 1
61 20
2
118 21
5
15 6
-
143
289
7
99
607
14
926
45
196
1
125
271
565
22
944
68
204
-
7
1
133
30 8
309
69 20 654
2
24
149 23 1,116
8
1
77
20 5
229
-
2,016 255 56 2,327 2,199 285 58 2,542
#33 #4
#37
#31 #3
#34
57
85
2
1
44
1
5
35
6
112
3
118
10
9
60
47
13
24
65
71
1
20
-
J47
K16
13
27
41
3
-
37
45
3
2
9
3
2
25
3
4
68
78
29
30
4
6
2
12
7
2
-
452 J4 K1
729
J3
43
37
J1
181
20
42
263
J1
21
47
J1
1,223
J2
20
658 J3 K1
933
64
J2
468
209
J1
595 194 84
338
33
5,410 J18 K2
Launceston
6
0
4
26
0
2
64
0
Royal Hobart
77
0
7
16
0
2
0
0
102
102
[17]
[12]
83
102
14
17
1
3
98
122
-
-
-
-
21
31
-
-
10
13
1
-
211
239
J2
83
0
11
42
0
4
64
0
204
[29]
185
-
31
-
4
-
220
-
-
-
-
-
52
-
-
23
1
450
J2
53
0
13
66
0
11
401
0
544
[70]
644
87
16
747
848
987
139
56
16
85
19
1,397
J2
46
4
0
0
5
0
29
0
0
3
5
0
76
0
0
0
161
7
[16]
151
11
17
2
1
-
169
13
1
29
1
33
37
6
2
-
22
1
1
-
355
21
K2
103
0
18
98
0
16
477
0
712
[86]
806
#11
106 17
#2 #1
929
#14
878
#13
182
58
16
108
20
Alice Springs
Royal Darwin
17
36
0
0
8
19
3
9
1
1
0
16
194
164
0
0
223
245
[17]
[12]
16
45
3
5
-
19
50
-
-
-
-
39
44
-
-
27
18
2
1
271
315
J1
Northern Territory
53
0
27
12
2
16
358
0
468
[29]
61
-
8
-
-
69
-
-
-
-
-
83
-
-
45
3
586
J1
Fremantle
Hollywood Private
Princess Margaret
Royal Perth
Sir Charles Gairdner
St. John of God
40
30
53
75
-
0
0
0
2
-
10
4
28
14
-
17
0
24
27
-
0
0
0
0
-
30
0
43
72
-
170
0
333
152
-
0
0
0
0
-
267
7
481
342
-
[28]
[2]
[36]
[36]
-
178
15
282
290
-
10
29
33
-
2
11
7
-
190
15
322
330
-
4
32
333
351
14
2
30
30
4
12
8
-
4
34
375
389
18
65
2
121
95
-
3
27
25
-
1
12
18
-
49
66
31
-
2
10
7
-
508
22
879
713
-
J4
Western Australia
171
2
52
72
0
144
655
0
1,097
[102]
765
#2
72
-
20
-
857
#2
734
#2
66
-
20
-
820
#2
283
55
31
146
19
Tasmania
CN Adelaide Ren & Tx Serv.
¤
Flinders Medical
Women’s & Children’s
South Australia
119 20
4
-
123 20 1,021
#3 #1 #17
1,773 J2 K2
J2 K1
2,126 J6 K1
Explanation of Symbols used in Australian Summary
1035
f
Failed graft patients dialysing at 31-Dec-2011
22 X Australian transplanted patients (cared for in New Zealand)
50
•
New Zealand transplanted patients (cared for in Australia)
47 J Patients no longer dialysing - renal function recovered
16 K Number of patients transferred to dialysis outside Australia or lost to follow up
156 # Transplanted patients lost to follow up (not included in totals)
y Statewide Renal Services SWRS Tx 1 = 710 Tx2 = 65 Tx3 = 9 | RPAH Tx 1 = 102 Tx2 = 13 Tx3 = 4 CONC Tx 1 = 20
t
Patients with functioning graft, transplanted at Sydney Hospital 1967 to Jan-1983
v East Coast Renal Service - includes all transplant patients from units of the South Eastern Sydney Area Health Service
(Prince of Wales, St. George, St Vincent’s, Sydney Children’s) and Illawarra as the transplanting service
*
South West Sydney Renal Services (Amalgamation of Bankstown, Lidcombe, Liverpool)
*
Austin Health (Amalgamation of Austin, Fairfield, Heidelberg)
North West Dialysis Service - commenced 01-Jun-1998 with the amalgamation of Royal Melbourne, Western General and associated hospitals and satel*
lites to form a chronic dialysis program
+ From 2005 all transplants performed in Queensland are shown under QRTS (Queensland Renal Transplant Service)
From 2005 all functioning transplants cared for by Princess Alexandra are shown under QRTS
From 2005 paediatric patients from the Royal Children’s and Mater Children’s, previously shown under Princess Alexandra as the parent hospital are now
shown as CARS (Child and Adolescent Renal Service)
¤ Central Northern Adelaide Renal & Transplant Service commenced Jan-2010 with the amalgamation of Queen Elizabeth Hospital, Royal Adelaide Hospital
and associated hospitals and satellites
S-3
Supplement
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
AUSTRALIA
Location of Dialysis Treatment at end of Survey
Hospital Hospital/Location
Australia
Queensland
Home C.A.P.D Satellite HD APD HD APD Hosp Home HD PD Total 2,427
9
972
1,270
15
773
5,530
2
10,998
921
1
184
204
4
153
537
1
2,005
Allamanda Dialysis Unit (Fresenius)
68
0
0
0
0
0
0
0
68
Bundaberg Base Hospital
60
0
1
2
0
2
0
0
65
Cairns Base Hospital
56
0
27
30
1
2
0
0
116
Atherton Private Hospital
0
0
0
0
0
0
13
0
13
Cairns Private Hospital
0
0
0
0
0
0
38
0
38
Cairns Home Training
0
0
0
0
0
0
3
0
3
Cooktown Satellite
0
0
0
0
0
0
5
0
5
Innisfail Hospital
0
0
0
0
0
0
12
0
12
Mossman Satellite
0
0
0
0
0
0
8
0
8
Child and Adolescent Renal Service
3
0
0
8
0
0
0
0
11
Mater Children’s Hospital
0
0
0
4
0
0
0
0
4
Royal Children’s Hospital
3
0
0
4
0
0
0
0
7
Chermside Dialysis Unit (Fresenius)
Goldcoast Hospital
0
0
0
0
0
28
0
28
0
0
12
1
12
0
0
80
0
0
24
0
0
0
54
0
78
Greenslopes (Baxter)
79
0
0
0
0
0
0
0
79
Hervey Bay Hospital
41
0
6
6
0
4
0
0
57
Maryborough
0
0
0
0
0
0
14
0
14
John Flynn Hospital
49
0
0
0
0
0
0
0
49
Mackay Base Hospital
42
0
0
0
0
0
0
0
42
106
1
58
40
0
79
155
0
439
106
1
56
30
0
58
0
0
251
Ipswich Hospital
0
0
0
0
0
0
57
0
57
Redlands Hospital
0
0
0
0
0
0
37
0
37
St Vincent’s Robina Satellite
MetroSouth and Ipswich Nephrology Service
Princess Alexandra Hospital
Logan Satellite
Rockhampton Base Hospital
0
0
2
10
0
21
61
0
94
60
0
5
14
0
3
0
0
82
0
0
0
0
0
0
7
0
7
73
0
28
44
0
23
0
0
168
North Lakes Dialysis Unit
0
0
0
0
0
0
21
0
21
Redcliffe Hospital
0
0
0
0
0
0
32
0
32
East Street Self Care Dialysis Unit
Royal Brisbane Hospital
St. Andrew’s Dialysis Clinic (Diaverum)
21
0
0
0
0
0
5
0
26
Sunshine Coast Health District
59
0
16
7
0
2
52
0
136
0
0
0
0
0
0
11
0
0
0
0
17
0
17
Caloundra Private Hospital
11
Caloundra Public Hospital
0
0
0
0
0
0
0
0
20
0
20
Nambour General Hospital
30
0
16
7
0
2
0
0
55
Nambour Selangor Private Hospital
Gympie Satellite
18
0
0
0
0
0
0
0
18
Noosa Satellite
0
0
0
0
0
0
15
0
15
Toowoomba Hospital
26
0
8
2
0
16
7
0
59
0
0
0
0
0
0
12
0
12
Kingaroy Satellite
79
0
11
39
2
10
0
1
142
Home Hill Satellite
0
0
0
0
0
0
12
0
12
Mt Isa Satellite
0
0
0
0
0
0
15
0
15
North Ward Satellite
0
0
0
0
0
0
41
0
41
0
0
0
0
0
0
3
0
3
44
0
0
0
0
0
0
0
44
Townsville Hospital
Palm Island Satellite
Wesley Private Hospital
S-4
0
55
ANZDATA Registry 2012 Report
Supplement
_____________________________________________________________________________________
AUSTRALIA
Location of Dialysis Treatment at end of Survey
Hospital Hospital/Location
Australia
New South Wales
Home C.A.P.D Satellite HD APD HD APD Hosp Home HD PD Total 2,427
9
972
1,270
15
773
5,530
2
10,998
857
5
457
578
6
301
1,397
1
3,602
Bondi Satellite
0
0
0
0
0
0
10
0
10
Broken Hill Hospital
0
0
0
0
0
0
11
0
11
Brewarina Hospital
0
0
0
0
0
0
4
0
4
Coffs Harbour Base Hospital
35
0
3
4
0
2
0
0
44
Condobolin Hospital
0
0
0
0
0
0
1
0
1
Coonamble Hospital
0
0
0
0
0
0
3
0
3
Dubbo Base Hospital
31
0
3
23
0
14
5
0
76
Gilgandra Satellite
0
0
0
0
0
0
1
0
1
42
0
8
17
2
3
0
0
72
East Coast Renal Service
Prince of Wales Hospital
Eora Satellite
St. George Hospital
0
0
0
0
0
0
39
0
39
110
2
48
55
0
3
0
0
218
1
0
0
0
0
0
30
0
31
St. Vincent’s Hospital
66
1
16
13
1
2
0
0
99
Sydney Children’s Hospital
Sutherland Hospital
1
0
0
0
0
0
0
0
1
Forbes Hospital
0
0
0
0
0
0
11
0
11
Gosford Hospital
43
1
11
25
1
7
1
0
89
0
0
0
0
0
0
39
0
39
Gosford Satellite
0
0
0
0
0
0
37
0
37
John Hunter Hospital
48
0
47
53
0
6
0
0
154
Maitland Hospital
0
0
0
0
0
0
40
0
40
Muswellbrook Hospital
0
0
0
0
0
0
6
0
6
Singleton Satellite Centre
0
0
0
0
0
0
7
0
7
Wansey Satellite Centre
Lakehaven Satellite
0
0
0
0
0
0
74
0
74
Lindfield Dialysis Clinic (Diaverum)
0
0
0
0
0
0
41
0
41
Lismore Hospital
30
0
0
13
0
5
0
0
48
Ballina Hospital
0
0
18
0
0
0
27
0
45
Grafton Hospital
0
0
0
0
0
0
29
0
29
0
0
0
0
0
0
13
0
13
MacLeay Dialysis Centre—Kempsey
0
0
0
0
0
0
13
0
13
Manning Rural Hospital
20
0
4
6
0
1
0
0
31
0
0
0
0
0
0
13
0
13
Mater Hospital
0
0
0
0
0
0
28
0
28
Mayo Private Hospital - Taree
14
0
0
0
0
1
0
0
15
Newcastle Dialysis (Nephrocare)
0
0
0
0
0
0
23
0
23
Port Macquarie Hospital
23
0
8
9
0
1
0
0
41
Port Macquarie Private Hospital
18
0
0
0
0
0
0
0
18
Royal North Shore Hospital
40
0
35
24
0
5
0
0
104
Lanceley Cottage
0
0
0
0
0
0
41
0
41
Mona Vale Satellite
0
0
0
0
0
0
22
0
22
Bankstown Hospital
0
0
0
0
0
0
55
0
55
Campbelltown Dialysis Centre
0
0
0
0
0
0
39
0
39
Fairfield Satellite
0
0
0
0
0
0
62
0
62
Liverpool Community Centre
0
0
38
120
0
26
56
0
240
Liverpool Hospital
68
1
0
0
1
0
0
0
70
Lismore Private Dialysis Clinic
Taree Community Dialysis (ex Nita Reed)
South West Sydney Renal Service
S-5
Supplement
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Location of Dialysis Treatment at end of Survey
Hospital Hospital/Location
Australia
New South Wales (continued)
Home C.A.P.D Satellite HD APD HD APD Hosp Home HD PD Total 2427
9
972
1270
15
773
5530
2
10,998
857
5
457
578
6
301
1,397
1
3,602
0
0
0
0
0
0
10
0
10
77
Statewide Renal Services
Bega Satellite
31
0
45
0
1
0
0
0
Concord Repatriation Satellite Unit
0
0
0
0
0
0
20
0
20
Dame Eadith Walker
0
0
0
41
0
49
123
0
213
Goulburn Satellite (Fresenius)
0
0
0
0
0
1
15
0
16
Griffith Base Hospital
0
0
2
1
0
3
19
0
25
Moruya Dialysis Unit (Fresenius)
0
0
0
0
0
3
16
0
19
Norfolk Island Hospital
0
0
0
0
0
0
1
0
1
17
0
38
0
0
0
0
0
55
39
0
0
0
0
0
0
0
39
Concord Hospital
Royal Prince Alfred Hospital
Sydney Adventist Hospital
0
0
4
0
0
0
2
0
6
32
0
11
21
0
8
0
0
72
Armidale Hospital
0
0
0
0
0
0
12
0
12
Invarell Satellite
0
0
0
0
0
0
3
0
3
Moree Satellite
0
0
0
0
0
0
8
0
8
Sydney Dialysis Centre
Tamworth District Hospital
8
0
0
3
0
0
0
0
11
46
0
4
5
0
1
0
0
56
Wagga Wagga Base Hospital
0
0
0
7
0
4
31
0
42
Wellington Hospital - New South Wales
0
0
0
0
0
0
1
0
1
The Children’s Hospital at Westmead
The Tweed Hospital
Western Renal Network
41
0
95
85
0
96
0
0
317
Blacktown Regional Dialysis
0
0
0
0
0
0
81
0
81
Auburn Satellite
0
0
0
0
0
0
49
0
49
Norwest Private Dialysis Centre
0
0
0
0
0
0
19
0
19
Westmead Hospital
37
0
0
7
0
13
0
0
57
0
0
0
0
0
0
17
0
17
9
0
3
0
0
0
0
0
12
0
0
0
26
0
19
63
0
108
7
0
16
20
0
28
0
1
72
Shellharbour Satellite
0
0
0
0
0
0
33
0
33
Shoalhaven Satellite - Nowra
0
0
0
0
0
0
32
0
32
Wollongong Satellite
0
0
0
0
0
0
61
0
61
30
0
32
8
0
11
148
0
229
Orange Base Hospital
Bathurst Base Hospital
Nepean Hospital
Penrith Community Dialysis Centre
Wollongong Hospital
Australian Capital Territory
30
0
32
8
0
11
0
0
81
Canberra Community Satellite Centre
0
0
0
0
0
0
93
0
93
Northside Dialysis Centre (Fresenius)
0
0
0
0
0
0
55
0
55
209
1
191
256
3
127
1905
0
2,692
Canberra Hospital
Victoria
Alfred Hospital
30
0
14
25
0
2
0
0
71
Angliss Hospital
0
0
0
0
0
0
21
0
21
0
0
0
0
0
0
8
0
8
29
0
17
20
0
9
0
0
75
Austin Training Satellite
0
0
0
0
0
0
30
0
30
Heidelberg Hospital
0
0
0
0
0
0
63
0
63
North East Kidney Service
0
0
0
0
0
0
39
0
39
Ararat Hospital
Austin Health
S-6
ANZDATA Registry 2012 Report
Supplement
_____________________________________________________________________________________
Location of Dialysis Treatment at end of Survey
Hospital Hospital/Location
Home C.A.P.D Satellite HD APD HD APD Hosp Home HD PD Total 2427
9
972
1270
15
773
5530
2
10,998
209
1
191
256
3
127
1905
0
2,692
Bairnsdale Regional Health
0
0
0
0
0
0
28
0
28
Ballarat Health Service
0
0
0
0
0
0
39
0
39
Bendigo Hospital
0
0
0
13
0
8
43
0
64
Broadmeadows Satellite
0
0
0
0
0
0
46
0
46
Brunswick Satellite
0
0
0
0
0
0
35
0
35
Casey Hospital, Berwick
0
0
0
0
0
0
43
0
43
Australia
Victoria (continued)
Casterton Hospital
-
-
-
-
-
-
-
-
-
Caulfield General Medical Centre
0
0
0
0
0
0
44
0
44
Coburg Satellite
0
0
0
0
0
0
48
0
48
Cohuna Hospital
0
0
0
0
0
0
2
0
2
Colac Hospital
0
0
0
0
0
0
5
0
5
0
0
0
0
0
0
1
0
1
Craigieburn Satellite
0
0
0
0
0
0
12
0
12
Cranbourne Satellite
0
0
0
0
0
0
54
0
54
Dandenong Hospital
0
0
0
0
0
0
37
0
37
Daylesford Hospital
0
0
0
0
0
0
5
0
5
Diamond Valley Dialysis Clinic (Diaverum)
0
0
0
0
0
0
40
0
40
Donald Hospital
0
0
0
0
0
0
4
0
4
Echuca Hospital
0
0
0
0
0
0
11
0
11
Edenhope Hospital
0
0
0
0
0
0
2
0
2
Epping Dialysis Unit
0
0
0
0
0
0
51
0
51
Eastern Health Incentre Dialysis
2
0
0
0
0
0
0
0
2
Box Hill Satellite
Corryong Satellite Dialysis Centre
Eastern Health Integrated Renal Services
0
0
5
25
0
8
58
0
96
Epworth Hospital
0
0
0
0
0
0
17
0
17
Forest Hill Dialysis Centre (Fresenius)
0
0
0
0
0
0
42
0
42
Frankston Hospital
0
0
0
0
0
0
41
0
41
24
0
32
12
1
8
0
0
77
0
0
0
0
0
0
43
0
43
Goulburn Valley Hospital
0
0
0
0
0
0
25
0
25
Hamilton Hospital
0
0
0
0
0
0
7
0
7
Hastings Hospital
0
0
0
0
0
0
22
0
22
Horsham Hospital
0
0
0
0
0
0
9
0
9
Kew Private Dialysis Centre (Baxter)
0
0
0
0
0
0
19
0
19
Kyneton Hospital
0
0
0
0
0
0
8
0
8
Latrobe Regional Satellite Centre
0
0
0
0
0
0
37
0
37
Malvern Dialysis Centre (Fresenius)
0
0
0
0
0
0
44
0
44
Mansfield District Hospital
0
0
0
0
0
0
2
0
2
Maroondah Satellite
0
0
0
0
0
0
67
0
67
Maryborough Hospital
0
0
0
0
0
0
10
0
10
Melton Satellite
0
0
0
0
0
0
43
0
43
Mildura Hospital
0
0
0
0
0
0
29
0
29
Geelong Hospital
South Geelong Satellite
35
0
54
64
1
30
0
0
184
Monash Medical Centre - Paediatric
2
0
0
4
0
0
0
0
6
Moorabbin Satellite
0
0
0
0
0
0
69
0
69
Myrtleford Hospital
0
0
0
0
0
0
6
0
6
Monash Medical Centre - Adult
S-7
Supplement
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Location of Dialysis Treatment at end of Survey
Hospital Hospital/Location
Australia
Victoria (continued)
Home C.A.P.D Satellite HD APD HD APD Hosp Home HD PD Total 2427
9
972
1270
15
773
5530
2
10,998
209
1
191
256
3
127
1905
0
2,692
Newcomb Satellite
0
0
0
0
0
0
10
0
10
Nhill Hospital Satellite
0
0
0
0
0
0
3
0
3
North Melbourne Dialysis Clinic (Diaverum)
0
0
0
0
0
0
34
0
34
Orbost Hospital
0
0
0
0
0
0
8
0
8
Peter James Centre
0
0
0
0
0
0
75
0
75
Portland District Health
0
0
0
0
0
0
6
0
6
Robinvale Hospital
0
0
0
0
0
0
3
0
3
Rosebud Hospital
0
0
0
0
0
0
27
0
27
Royal Children’s Hospital
North West Dialysis Service
1
1
0
13
0
0
0
0
15
24
0
53
25
1
40
0
0
143
0
0
0
0
0
0
33
0
33
Sale Hospital
0
0
0
0
0
0
16
0
16
Sandringham Satellite
0
0
0
0
0
0
49
0
49
Seymour Hospital
0
0
0
0
0
0
5
0
5
St. George’s Hospital
0
0
0
0
0
0
29
0
29
St. Vincent’s Hospital
49
0
6
44
0
12
0
0
111
0
0
0
0
0
0
5
0
5
0
0
0
0
0
0
27
0
27
Swan Hill Hospital
0
0
0
0
0
0
13
0
13
Terang Hospital
0
0
0
0
0
0
1
0
1
Wangaratta Hospital
0
0
0
0
0
0
17
0
17
Warrnambool Hospital
0
0
0
0
0
0
14
0
14
Werribee Mercy Hospital
0
0
0
0
0
0
29
0
29
Western Gippsland Hospital
0
0
0
0
0
0
15
0
15
13
0
10
11
0
10
0
0
44
Northern Hospital Satellite
Kyabram Satellite Dialysis Centre
Sunbury Satellite Dialysis Centre
Western Health
Sunshine Satellite
0
0
0
0
0
0
74
0
74
Williamstown Satellite
0
0
0
0
0
0
50
0
50
Wodonga Regional Health Service
0
0
0
0
0
0
24
0
24
Wonthaggi Hospital
0
0
0
0
0
0
15
0
15
Yarawonga Hospital
0
0
0
0
0
0
11
0
11
Yarrum Hospital
0
0
0
0
0
0
3
0
3
83
0
11
42
0
4
64
0
204
6
0
1
5
0
1
0
0
13
Launceston Community Centre Satellite
0
0
0
8
0
0
41
0
49
North West Renal Unit (Burnie)
0
0
3
13
0
1
23
0
40
77
0
7
16
0
2
0
0
102
Tasmania
Launceston General Hospital
Royal Hobart Hospital
103
0
18
98
0
16
466
0
701
Berri Satellite
South Australia
0
0
0
0
0
0
6
0
6
Ceduna Hospital
0
0
0
0
0
0
4
0
4
Clare Satellite
0
0
0
0
0
0
4
0
4
46
0
4
29
0
5
0
0
84
Hampstead Rehabilitation Satellite
0
0
0
0
0
0
55
0
55
Hartley Private Hospital (Fresenius)
0
0
0
0
0
0
45
0
45
Lyell McEwin Satellite
0
0
0
0
0
0
55
0
55
Maitland Hospital
0
0
0
0
0
0
5
0
5
Flinders Medical Centre
S-8
ANZDATA Registry 2012 Report
Supplement
_____________________________________________________________________________________
AUSTRALIA
Location of Dialysis Treatment at end of Survey
Hospital Hospital/Location
Australia
South Australia
Home C.A.P.D Satellite HD APD HD APD Hosp Home HD PD Total 2427
9
972
1270
15
773
5530
2
10,998
103
0
18
98
0
16
466
0
701
Millicent Satellite
-
-
-
-
-
-
-
-
-
Modbury Satellite (Fresenius)
0
0
0
0
0
0
20
0
20
Mount Gambier Hospital
0
0
0
0
0
0
15
0
15
Murray Bridge Hospital
0
0
1
0
0
0
10
0
11
Noarlunga Satellite
0
0
0
0
0
0
31
0
31
Payneham Satellite (Baxter)
0
0
0
0
0
0
59
0
59
Port Pirie hospital
0
0
0
0
0
0
4
0
4
Port Augusta Hospital
0
0
0
0
0
0
32
0
32
Port Lincoln Satellite
0
0
0
0
0
0
7
0
7
0
0
8
22
0
4
39
0
73
Royal Adelaide Hospital
53
0
5
44
0
7
0
0
109
Victor Harbour Hospital
0
0
0
0
0
0
12
0
12
Wayville Satellite Centre
0
0
0
0
0
0
53
0
53
Whyalla Satellite
0
0
0
0
0
0
10
0
10
Women’s and Children’s Hospital
4
0
0
3
0
0
0
0
7
Northern Territory
53
0
27
12
2
16
358
0
468
Alice Springs Hospital
17
0
0
0
1
0
0
0
18
0
0
8
3
0
0
164
0
175
Queen Elizabeth Hospital
Flynn Drive Satellite
36
0
0
0
1
3
0
0
40
Katherine Dialysis Unit
0
0
0
0
0
0
23
0
23
Nightcliff Dialysis Centre
0
0
19
9
0
13
93
0
134
Palmerston Satellite
0
0
0
0
0
0
31
0
31
Tiwi Dialysis Centre
0
0
0
0
0
0
30
0
30
Tennant Creek Hospital
0
0
0
0
0
0
17
0
17
Western Australia
1,097
Royal Darwin Hospital
171
2
52
72
0
145
655
0
Albany - John Hortin Dialysis Unit
0
0
0
0
0
0
6
0
6
Armadale Satellite
0
0
0
0
0
0
49
0
49
Bunbury Satellite
0
0
0
0
0
0
21
0
21
Busselton Satellite
0
0
0
0
0
0
9
0
9
Fremantle Hospital
40
0
10
17
0
30
0
0
97
Geraldton Hospital
0
0
0
0
0
0
26
0
26
Joondalup Satellite
1
0
0
0
0
0
38
0
39
Kalgoorlie Hospital
0
0
0
0
0
2
29
0
31
Midland Private Dialysis Centre (Baxter)
0
0
0
0
0
0
107
0
107
Peel Health Campus (Mandurah)
0
0
0
0
0
0
31
0
31
Princess Margaret Hospital for Children
3
0
0
4
0
0
0
0
7
Rockingham Satellite
0
0
0
0
0
0
24
0
24
Royal Perth Hospital
53
0
28
23
0
41
0
0
145
Derby Satellite
0
0
0
0
0
0
7
0
7
Kimberley Dialysis Centre
0
0
0
1
0
0
42
0
43
Port Hedland Dialysis Unit, Pilbara
0
0
0
0
0
0
26
0
26
74
2
14
27
0
72
0
0
189
Cannington Dialysis Clinic (Diaverum)
0
0
0
0
0
0
83
0
83
Stirling Dialysis Clinic (Diaverum)
0
0
0
0
0
0
105
0
105
0
0
0
0
0
0
52
0
52
Sir Charles Gairdner Hospital
Spearwood Satellite
S-9
Supplement
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
NEW ZEALAND Summary
Hospital
Hosp
Home
Dialysis Patients
Functioning Transplants
Patient Flow
At 31-Dec-2011
At 31-Dec-2011
1-Jan-2011 to 31-Dec-2011
CAPD
HD APD HD APD Hosp
Hom
e
Total
Sat
HD
PD
Patients
1
2
3+ Total
Auckland City
2
433 349
5
434
368
0
1
2
New
New Tx
3+ Total Pts DD LD
X 22
f
New Zealand 790
Transplanting
Hospital
Caring Hospital
Dialysis
Deaths
Total
Patient
Dx
Tx
Flow
368
44 4,265
• 50
J15
2,381 [195] 1,315 117 21 1,453 1,339 121 21 1,481 477 61
#19
#2
-
#21
#19
#2
-
#21
57
K4
J1
K3
143
0
41
12
2
32
97
0
327
[33]
176
15
4
195
681
48
4
733
61
45
26
58
7
591
Starship
Children’s
1
0
0
10
0
0
0
0
11
[2]
25
-
-
25
-
-
-
-
5
-
-
-
1
37
Christchurch
28
0
43
9
3
40
0
0
123
[11]
225
19
4
248
293
30
8
331
40
7
13
23
7
402
Dunedin
11
0
44
10
0
29
0
0
94
[11]
82
11
4
97
-
-
-
-
24
-
-
13
3
207
Hawkes Bay
58
0
11
20
0
4
0
0
93
[10]
67
6
1
74
-
-
-
-
30
-
-
21
2
190
Middlemore
161
0
75
44
0
119
110
0
509
[26]
116
5
-
121
-
-
-
-
91
-
-
63
3
702
Palmerston
North
62
0
22
8
0
26
0
0
118
[9]
51
6
1
58
-
-
-
-
20
-
-
14
6
196
Taranaki Base
27
0
7
12
0
12
0
0
58
[7]
27
5
-
32
-
-
-
-
16
-
-
13
3
107
J1
Waikato
90
0
83
143
0
98
50
0
464
[30]
154
9
1
164
32
4
2
38
85
-
-
83
8
725
J5
K1
Wellington
71
0
35
32
0
42
40
0
220
[27]
212
25
6
243
333
39
7
379
60
9
18
43
1
508
J1
Whangarei
53
2
28
26
0
4
27
0
140
[9]
58
4
-
62
-
-
-
-
22
-
-
27
2
231
Waitemata
85
0
44
23
0
28
44
0
224
[20]
122
12
-
134
-
-
-
-
23
-
-
10
1
369
Total Patient Flow = Total Dialysis Patients + Total Functioning Transplants (Caring Hospital)
+ Dialysis and Transplant Deaths + J and K patients
S-10
195
f
Failed graft patients dialysing at 31-Dec-2011
50
X
Australian transplanted patients (cared for in New Zea-
22
•
New Zealand transplant patients (cared for in Australia)
11
J
Patients no longer dialysing - renal function recovered
2
K
Number of patients transferred to dialysis outside New Zealand
15
#
Transplanted patients lost to follow up (not included in totals)
J1
J6
ANZDATA Registry 2012 Report
Supplement
_____________________________________________________________________________________
NEW ZEALAND
Location of Dialysis Treatment at end of Survey
Hospital Hospital/Location
Home C.A.P.D Satellite Total HD APD HD APD Hosp Home HD PD 790
2
433
349
5
434
368
0
2,381
143
0
0
12
2
32
0
0
189
Auckland Home Training
0
0
41
0
0
0
4
0
45
Carrington Hospital
0
0
0
0
0
0
59
0
59
Greenlane Hospital
0
0
0
0
0
0
34
0
34
Christchurch Hospital
28
0
43
9
3
40
0
0
123
Dunedin Hospital
11
0
44
10
0
29
0
0
94
Hawkes Bay Hospital
58
0
11
20
0
4
0
0
93
Kaitaia Hospital
0
0
0
0
0
0
12
0
12
Kawakawa Hospital
0
0
0
0
0
0
1
0
1
Middlemore Hospital
161
0
75
44
0
119
0
0
399
0
0
0
0
0
0
110
0
110
Nelson Hospital
7
0
0
0
0
0
0
0
7
Palmerston North Hospital
62
0
22
8
0
26
0
0
118
Starship Children’s Hospital
1
0
0
10
0
0
0
0
11
Taranaki Base Hospital
27
0
7
12
0
12
0
0
58
Waikato Hospital
90
0
83
143
0
98
0
0
414
Rotorua Hospital
0
0
0
0
0
0
21
0
21
Tauranga Hospital
0
0
0
0
0
0
24
0
24
85
0
44
23
0
28
0
0
180
Waitakere Satellite
0
0
0
0
0
0
44
0
44
Whakatane Hospital
0
0
0
0
0
0
5
0
5
64
0
35
32
0
42
0
0
173
0
0
0
0
0
0
40
0
40
Whangarei Area Hospital
53
2
28
26
0
4
0
0
113
Bay of Islands Hospital
0
0
0
0
0
0
14
0
14
New Zealand
Auckland City Hospital
Manukau Satellite
Waitemata Renal Service
Wellington Hospital
Porirua Community Dialysis
S-11
Supplement
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
Primary Renal Disease of New Patients
1-Jan-2011 to 31-Dec-2011
AUSTRALIA
NEW ZEALAND
No.
Pts Per Mn
No.
Pts Per Mn
Glomerulonephritis
563
25
114
26
Analgesic Nephropathy
32
1
5
1
Polycystic Renal Disease
140
6
26
6
Reflux Nephropathy
54
2
9
2
Hypertension
358
16
51
12
Diabetes
870
39
200
Type 1 Insulin Dependent
Type 2 Non Insulin Requiring
Type 2 Insulin Requiring
(98)
45
4
(19)
(476)
21
(111)
25
(296)
13
(70)
16
4
Miscellaneous
298
13
49
Uncertain
138
6
23
5
2,453
110
477
108
TOTAL
11
Per Mn = Patients per million population
National and State Summary
1-Jan-2011 to 31-Dec-2011
New
Patients
Transplant Operations
Deaths
Transplant
Operations
Transplant
Operations
Deaths
Deaths
Functioning
Transplant
Resident
State
On
Dialysis
Total
Australia
2,453
825
825
1476
204
8,781
10,998
19,779
QLD
NSW
ACT
VIC
TAS
SA
NT
WA
443
761
53
595
52
182
83
284
155
232
278
74
86
146
215
20
253
23
68
12
88
314
475
27
338
23
108
45
146
46
74
8
33
1
20
3
19
1,699
2,465
215
2,327
220
929
69
857
2,005
3,555
264
2,693
204
712
468
1,097
3,704
6,020
479
5,020
424
1,641
537
1,954
477
118
118
368
44
1,453
2,381
3,834
New Zealand
Multi-Organ Kidney Transplants
1-Jan-2011 to 31-Dec-2011
AUSTRALIA
(3) Kidney / Liver Transplant
(2) VIC Resident
Trasnplanted in VIC
(1) QLD Resident
NEW ZEALAND
(1) Kidney / Liver Transplant
(1) NZ Resident
Transplanted in NZ
Transplanted in QLD
(1) Kidney / Split Liver Transplant
(1) VIC Resident
Transplanted in VIC
(1) Kidney / Lung Transplant
(1) VIC Resident
Transplanted in VIC
(26) Kidney / Pancreas Transplant
(10) NSW Resident Transplanted in NSW
(4) VIC Resident
Transplanted in VIC
(2) QLD Resident
Transplanted in NSW
(4) SA Resident
Transplanted in NSW
(2) WA Resident
Transplanted in NSW
(3) TAS Resident
Transplanted in VIC
(1) ACT Resident
Transplanted in NSW
(1) Kidney / Pancreas Islets Transplant
(1) QLD Resident
Transplanted in NSW
S-12
(3) Kidney / Pancreas Transplant
(3) NSW Resident Transplanted in NSW
ANZDATA Registry 2012 Report
Supplement
_____________________________________________________________________________________
New Patients, Dialysis and Functioning Transplants Per Million
Population
1-Jan-2011 to 31-Dec-2011
New Patients
Initial State
Transplant Op’s
(Resident State)
Functioning Tx
(Resident State)
Dialysis
Patients
Per Mn
% Diab.
Per Mn
% LD
Per Mn
% LD
Per Mn
% Home
Dx
110
35%
37
31%
393
37%
493
27%
NSW +
109
33%
31
39%
352
40%
508
38%
ACT *
91
21%
34
45%
369
41%
453
20%
VIC
108
34%
46
28%
420
39%
487
21%
TAS
102
40%
45
43%
430
53%
399
28%
SA
111
34%
42
22%
567
29%
435
19%
NT
359
65%
52
17%
298
35%
2023
12%
WA
121
40%
37
35%
364
43%
466
24%
108
42%
27
48%
330
44%
541
51%
AUSTRALIA
NEW ZEALAND
156 (92 living donors) patients transplanted in Australia and 21 (15 living donors) patients transplanted in New Zealand were lost to follow up during the survey period. These patients are not included in
totals.
+ NSW population excludes residents of the Southern Area Health Service
* ACT population includes residents of the Southern Area Health Service
Medical services in the ACT service the Southern Area Health Service
Population Data Sources:
for Australia - ABS 3101.0 Release 26-Jun-2012 and the South Eastern NSW population data is sourced from ABS 3235.0 NSW
population by age and sex
for New Zealand - Statistics NZ InfoShare downloaded on 20-Sep-2012
For Australian and State population data
ABS 3101.0 Demographic Statistics Mar 2012, Release 26-Jun-2012
Southern Area Health Service data
ABS 3235.0 NSW Population by Age and Sex, Regions of Australia, Release 31-Aug-2012
For New Zealand population data
Statistics NZ Infoshare Estimated Resident Population by Age and Sex (1991+) Release 14-May-2012
Number of Renal Transplant Operations
1-Jan-2011 to 31-Dec-2011
AUSTRALIA
NEW ZEALAND
1st
2nd
3rd
4th
Total
1st
2nd
3rd
4th
Total
744 (233)
68 (18)
10 (3)
3 (1)
825 (255)
110 (52)
7 (5)
1 (-)
- (-)
118
The number of living donor grafts for twelve months is shown in parenthesis.
S-13
Supplement
ANZDATA Registry 2012 Report
_____________________________________________________________________________________
This page is intentionally left blank
S-14