contributions of Drs Kelvin Lynn, Grant Pidgeon, and Mark Marshall. The work of Dr Stephen McDonald and Phil Clayton at ANZDATA is also acknowledged. 2 Data sources and collection The 2015 data report includes data from the ANZDATA Registry for the calendar year ending 31 December 2015. The audit data are shown in table and graphic formats in the following pages. ANZDATA collates demographic and clinical data about all adults and children who are treated with dialysis or a kidney transplant in Australia and New Zealand. This report only includes patients who are treated in New Zealand. may be minor changes in the data from previous years’ reports which result from corrections and updates to the central ANZDATA database and minor changes resulting from updating of the NZ population from the 2013 census. The National Renal Advisory Board welcomes feedback on this report. Comments can be sent to Dr Ian Dittmer, Chair of the National Renal Advisory Board () or Dr Suetonia Palmer () who drafted the report. New Zealand nephrology services are represented on the ANZDATA steering committee by Dr Tonya Kara (). Peritoneal dialysis peritonitis rates are provided from the New Zealand Peritoneal Dialysis Registry () by Dr Gerald Waters (). Catheter-associated bacterial infections are provided by staff at individual dialysis units. Census data about treatment of people with end-stage kidney disease who do not receive treatment with dialysis or transplantation are not collected nationally and therefore are not includable in this report. Data for ABO incompatible kidney transplants and transplants conducted within kidney exchange chains are derived from the National Renal Transplant Service (NRTS) courtesy of the Service lead, Dr Nick Cross and Dale Gommans (data manager) (). The number of patients on the waiting list for a kidney transplant are provided by Dr Jonathan Downing at the New Zealand Blood Service. Patient summaries, editable figures (PowerPoint), and raw data (in Excel format) of this report are available on request from Dr Suetonia Palmer (suetonia.palmer@otago.ac.nz) .
Starting treatment: Ethnicity The incidence of renal replacement therapy remained substantially higher among Māori and Pacific patients than among NZ European patients. This inequity in entering end-stage kidney disease treatment remains persistent and marked (Figure 3.5). The incidence of renal replacement therapy has been stable (62-76 pmp) among New Zealand European and Asian New Zealand patients, whereas the incidence is 216 pmp among Māori patients (3.5-fold higher) and 272 pmp among Pacific patients higher). In 2013, the ratios were 4.4 among Māori and 5.5 among Pacific patients (Figure 3.5). There is considerable disparity in the opportunity to commence treatment with a kidney transplant (pre-emptive transplantation) based on ethnicity. Of the 24 patients who received a kidney transplant, none in 2015 identified as Māori, 1 was Asian (2.2%) and 2 (1.9%) identified as Pacific ethnicity (Figure 3.6).
Modality 4320 adult patients were treated with dialysis (582 pmp) and 1589 (369 pmp) were treated with transplantation at end of calendar year 2015. 6 children and adolescents were treated with dialysis and 42 were treated with kidney transplantation at end of calendar year 2015. Most DHBs treat proportionally more patients with dialysis than transplantation, with the exception of Starship, Capital and Coast, Canterbury, and Southern DHBs. Most patients treated with dialysis in NZ received facility-based haemodialysis within a hospital centre or satellite unit (Figure 4.3). The proportion of dialysis patients receiving facility haemodialysis treatment continued to increase year on year from 27.9% in 2006 to 32.1% in 2015 (Figure 4.4). PD treatment rates appeared to fall in proportion with increasing facility haemodialysis. The number and proportion of dialysis patients treated with peritoneal dialysis (either automated or continuous ambulatory) has fallen from 23.5% of RRT patients in 2006 to 18.1% in 2015. The proportion of patients on peritoneal dialysis is falling mainly due to falling rates of CAPD (from 11.4% of all RRT in 2011 to 8.6% in 2015). The rates of APD have remained at approximately 10% of all RRT. The proportion of dialysis patients treated with home haemodialysis has remained largely unchanged (16.1% of dialysis in 2006 to 18.0%) in 2015. The number of home haemodialysis patients as a proportion of all haemodialysis has remained unchanged at between 25-28% over the previous decade. The overall proportion of dialysis patients treated with any dialysis is decreasing (from 54.0% in 2005 to 48.6% in 2014) due to decreasing use of CAPD and increasing facility dialysis.
Patterns of the modality for dialysis treatment remains highly variable across treating DHBs (Figure 4.5). The prevalence of peritoneal dialysis ranged from 9.3% of all ESKD patients at Waitemata to 30.1% at Waikato. The proportion treated with automated PD ranged from 16.8% at Waikato and 22.3% at Taranaki to 5.6% at MidCentral and 5.8% at Auckland. The proportion of patients who did home haemodialysis was highest at Southern (27.5% of all patients) and lowest at Capital & Coast (5.7%) and Northland (6.9%) DHBs. The modalities of treatment at Starship show variation due to the relatively smaller numbers of children treated at this centre. Satellite dialysis was provided to a substantial number of patients at Northland, Waitemata, Auckland, Counties Manukau, and Waikato. The proportion on satellite dialysis at Counties Manukau continues to decrease, while the numbers treated with satellite dialysis at Capital Coast, Waitemata, and Northland appear to be increasing. Regional (Taranaki, MidCentral) and South Island (Canterbury and Southern) DHBs report no satellite facility dialysis treatment. As a proportion of the overall NZ population, Māori and Pacific patients are over-represented in the number of patients treated with dialysis each year, and under-represented in the number of patients who are treated with a kidney transplant.
Diabetes 54% of patients treated with dialysis in 2015 had a recorded diagnosis of diabetes (Figure 4.6). 22% of kidney transplant recipients had a diagnosis of diabetes. This proportion is increasing year on year (increased from 45% in 2006 in dialysis patients and 17% for transplant patients). The proportion of dialysis patients with a documented diagnosis of diabetes is markedly higher than among kidney transplant patients.
Peritoneal dialysis peritonitis rates The number of PD peritonitis episodes for every year of PD treatment per patient ranged from 0.26 at the Southern DHB to 0.74 at the Hawke’s Bay DHB (Figure 7.2). The current International Society for Peritoneal Dialysis guideline recommends a target of below 0.5 episodes per patient-year of treatment. The number of episodes per patient year of treatment in 2015 (by DHB) were (DHBs not reaching ISPD target in bold): Northland: 0.36 Waitemata: 0.36 Auckland: 0.34 Starship: 1.50 Counties Manukau: 0.55 Waikato: 0.55 Hawke’s Bay: 0.74 Taranaki: 0.50 MidCentral: -- Capital & Coast: 0.40 Canterbury: 0.45 Southern: 0.26 The PD peritonitis rate appears to be increasing at Northland, Waitemata, and Bay DHBs. The rate appears to be decreasing at Auckland, Counties Manukau, and Southern DHBs. Wide variation in PD peritonitis rates at some treating DHBs make interpretation of trends difficult. There does not appear to be a relationship between DHB unit size and trend in PD peritonitis rate.
9 Haemodialysis adequacy, frequency, and treatment duration Duration of haemodialysis The proportion of haemodialysis patients that were receiving <4.5 hours of haemodialysis at each treatment session is highly variable. continues to increase at most centres, although decreasing trends are observed at Counties Manukau, Hawkes Bay, and Taranaki (Figure 9.1). There does not appear to be a clear association between the proportion of patients treated with satellite or home haemodialysis and the length of treatment sessions. The DHBs in the Auckland region and Taranaki DHB appear to have more patients treated with shorter hours. The proportion of patients receiving <4.5 hours at each treatment session in 2015 was: Northland: 3.2% Waitemata: 33.1% Auckland: 47.1% Counties Manukau: 42.4% Waikato: 13.4% Hawke’s Bay: 27.4% Taranaki: 55.2% MidCentral: 17.5% Capital & Coast: 17.5% Canterbury: 8.3% Southern: 7.8%
Haemodialysis adequacy Various measures of the adequacy of the haemodialysis dose are used by dialysis services. These are commonly the amount of urea removed by dialysis at each dialysis session (measured using the urea reduction ratio (URR) or Kt/V). Many treating DHBs do not measure or report dialysis adequacy. Missing data represent differing practice patterns and the difficulty in measuring dialysis adequacy for home-based haemodialysis. It is unclear whether dialysis clearances are associated with patient outcomes. More recently, haemodiafiltration has been reported to be with improved. Future reports will include the use of haemodiafiltration and high-flux dialysis. The proportion of patients at each DHB who received a URR ≥65% was: Northland: 81.7% Waitemata: 60.8% Auckland: 53.3% Counties Manukau: 58.6% Waikato: 65.8% Hawke’s Bay: 74.6% Taranaki: 65.5% MidCentral: 80% Capital & Coast: 63.0% Canterbury: Not estimable Southern: Not estimable.
Access to home dialysis and transplantation based on gender and ethnicity Decreasing rates of peritoneal dialysis Persistent ESA prescribing among patients with haemoglobin >130 g/L Annual surveys of practice patterns not routinely collected within ANZDATA – e.g., transition-to-adult care, viral screening, immunisation practices.