Peritoneal dialysis in rural Australia

BMC Nephrology

Stephen P McDonald²  Blair S Grace¹  Nicholas A Gray³ 

[1] Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia;Department of Renal Medicine, Central and North Adelaide Renal Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia;Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia

关键词: Rural;    Remoteness;    Peritoneal dialysis;    Outcomes;    Mortality;    Dialysis;    Australia;    ANZDATA;   

Others  :  1082761
DOI  :  10.1186/1471-2369-14-278

 received in 2013-01-08, accepted in 2013-11-26,  发布年份 2013

【 摘 要 】

Background

Australians living in rural areas have lower incidence rates of renal replacement therapy and poorer dialysis survival compared with urban dwellers. This study compares peritoneal dialysis (PD) patient characteristics and outcomes in rural and urban Australia.

Methods

Non-indigenous Australian adults who commenced chronic dialysis between 1 January 2000 and 31 December 2010 according to the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) were investigated. Each patient’s residence was classified according to the Australian Bureau of Statistics remote area index as major city (MC), inner regional (IR), outer regional (OR), or remote/very remote (REM).

Results

A total of 7657 patients underwent PD treatment during the study period. Patient distribution was 69.0% MC, 19.6% IR, 9.5% OR, and 1.8% REM. PD uptake increased with increasing remoteness. Compared with MC, sub-hazard ratios [95% confidence intervals] for commencing PD were 1.70 [1.61-1.79] IR, 2.01 [1.87-2.16] OR, and 2.60 [2.21-3.06] REM. During the first 6 months of PD, technique failure was less likely outside MC (sub-hazard ratio 0.47 [95% CI: 0.35-0.62], P < 0.001), but no difference was seen after 6 months (sub-hazard ratio 1.05 [95% CI: 0.84-1.32], P = 0.6). Technique failure due to technical (sub-hazard ratio 0.57 [95% CI: 0.38-0.84], P = 0.005) and non-medical causes (sub-hazard ratio 0.52 [95% CI: 0.31-0.87], P = 0.01) was less likely outside MC. Time to first peritonitis episode was not associated with remoteness (P = 0.8). Patient survival while on PD or within 90 days of stopping PD did not differ by region (P = 0.2).

Conclusions

PD uptake increases with increasing remoteness. In rural areas, PD technique failure is less likely during the first 6 months and time to first peritonitis is comparable to urban areas. Mortality while on PD does not differ by region. PD is therefore a good dialysis modality choice for rural patients in Australia.

【 授权许可】

   
2013 Gray et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Gray NA, Dent H, McDonald SP: Renal replacement therapy in rural and urban Australia. Nephrol Dial Transplant 2012, 27(5):2069-2076.
• [2]McDonald S, Excell L: Stock and flow. In ANZDATA Registry Report 2005. Edited by McDonald S, Excell L. Adelaide, South Australia: Australia and New Zealand Dialysis and Transplant Registry; 2005:28-32.
• [3]Grace B, Excell L, McDonald S: Stock and flow. In ANZDATA Registry Report 2010. Edited by McDonald S, Excell L, Livingston B. Adelaide, South Australia: Australia and New Zealand Dialysis and Transplant Registry; 2010:1.1-1.7.
• [4]O’Hare AM, Johansen KL, Rodriguez RA: Dialysis and kidney transplantation among patients living in rural areas of the United States. Kidney Int 2006, 69:343-349.
• [5]Maripuri S, Arbogast P, Ikizler TA, Cavanaugh KL: Rural and micropolitan residence and mortality in patients on dialysis. Clin J Am Soc Nephrol 2012, 7:1121-1129.
• [6]Tonelli M, Hemmelgarn B, Culleton B, Klarenbach S, Gill GS, Wiebe N, Manns B: Mortality of Canadians treated by peritoneal dialysis in remote locations. Kidney Int 2007, 72:1023-1028.
• [7]Chidambaram M, Bargman JM, Quinn RR, Austin PC, Hux JE, Laupacis A: Patient and physician predictors of peritoneal dialysis technique failure: a population based, retrospective cohort study. Perit Dial Int 2011, 31(5):565-573.
• [8]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, 26:3366-3372.
• [9]Cho Y, Badve SV, Hawley CM, McDonald SP, Brown FG, Boudville N, Wiggins KJ, Bannister KM, Clayton P, Johnson DW: The effects of living distantly from peritoneal dialysis units on peritonitis risk, microbiology, treatment and outcomes: a multi-centre registry study. BMC Nephrol 2012, 13:41. BioMed Central Full Text
• [10]Australian Institute of Health and Welfare: Rural, regional and remote health: a study on mortality (2nd edition). Rural health series no. 8. Cat. no. PHE 95. 2nd edition. Canberra: AIHW; 2007.
• [11]Lim WH, Johnson DW, McDonald SP: Higher rate and earlier peritonitis in aboriginal patients compared to non-aboriginal patients with end-stage renal failure maintained on peritoneal dialysis in Australia: analysis of ANZDATA. Nephrol 2005, 10:192-197.
• [12]Australian Bureau of Statistics: Australian standard geographical classification. Canberra: ABS Catalogue No. 1216.0; 2010.
• [13]Fine J, Gray R: A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 1999, 94:496-509.
• [14]Moist LM, Bragg-Gresham JL, Pisoni RL, Saran R, Akiba T, Jacobson SH, Fukuhara S, Mapes DL, Rayner HC, Saito A, Port FK: Travel time to dialysis as a predictor of health-related quality of life, adherence, and mortality: the dialysis outcomes and practice patterns study (DOPPS). Am J Kidney Dis 2008, 51:641-650.
• [15]Xu G, Tu W, Xu C: Mupirocin for preventing exit-site infection and peritonitis in patients udergoing peritoneal dialysis. Nephrol Dial Transplant 2010, 25:587-592.
• [16]Australian Institute of Health and Welfare: Medical labour force 2003. cat. No. HWL 32 (national health labour series no. 32). Canberra: AIHW; 2005.
• [17]Lane C: Australian nephrology workforce survey. 2007. http://www.nephrology.edu.au/workforce/documents/AustralianNephrologyWorkforceReportforANZSN.pdf webcite (7 June 2011, date last accessed)
• [18]Xu R, Han Q-F, Zhu T-Y, Ren Y-P, Chen J-H, Zhao H-P, Chen M-H, Dong J, Wang Y, Hao C-M, Zhang R, Zhang X-H, Wang M, Tian M, Wang H-Y: Impact of individual and environmental socioeconomic status on peritoneal dialysis outcomes: a retrospective multicenter cohort study. PLoS One 2012, 7(11):e50766.
• [19]Tang W, Grace B, McDonald SP, Hawley CM, Badve SV, Boudville NC, Brown FG, Clayton PA, Johnson DW: Socio-economic status and peritonitis in Australian non-indigenous peritoneal dialysis patients. Perit Dial Int 2013. doi:10.3747/pdi.2013.00004. in press
• [20]Australian Institute of Health and Welfare: End-stage kidney disease in Australia: total incidence, 2003–2007. Cat. no. PHE 143. Canberra: AIHW; 2011.
• [21]Gray NA, Mahadevan K, Campbell VK, Noble EP, Anstey CM: Data quality of the Australia and New Zealand dialysis and transplant registry (ANZDATA): a pilot audit. Nephrol 2013, 18:665-670.