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. 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