c05 peritoneal v0.3 20160421 - anzdata.org.au...ANZDATA Registry 5-4 Number of Patients=819 0 5 10...
Transcript of c05 peritoneal v0.3 20160421 - anzdata.org.au...ANZDATA Registry 5-4 Number of Patients=819 0 5 10...
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Peritoneal Dialysis
Chapter 5
ANZDATA gratefully acknowledges the contributions of the Peritoneal Dialysis Working Group
convened by Neil Boudville
Suggested Citation:
ANZDATA Registry. 38th Report, Chapter 5: Peritoneal Dialysis. Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia. 2016. Available at: http://www.anzdata.org.au
Contents:
Peritoneal Dialysis 5-1
Stock and Flow 5-2
Peritoneal Dialysis Fluids 5-8
Patient Survival 5-11
Technique Survival 5-14
Peritonitis 5-18
Australian Peritonitis Registry 5-22
Anaemia 5-27
Biochemistry 5-31
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ANZDATA Registry
5-2
State 2010 2011 2012 2013 2014
Queensland 67% 65% 63% 62% 63%
New South Wales 66% 66% 66% 66% 68%
Australian Capital Territory 40% 38% 45% 48% 52%
Victoria 66% 67% 69% 72% 73%
Tasmania 78% 78% 68% 69% 61%
South Australia 88% 86% 87% 80% 80%
Northern Territory 59% 50% 48% 47% 40%
Western Australia 83% 80% 78% 79% 78%
Australia 68% 67% 67% 67% 68%
New Zealand 66% 65% 62% 64% 63%
Proportion (%) PD of all Home Dialysis Patients
Table 5.1
0
100
200
300
Num
ber
of P
atie
nts
0 1 2 3 4 5 6 7 8 9 10Years on PD
Prevalent PD patients Australia 31 Dec 2014Time on peritoneal dialysis
0
20
40
60
80
100
Num
ber
of P
atie
nts
0 1 2 3 4 5 6 7 8 9 10Years on PD
Prevalent PD patients New Zealand 31 Dec 2014Time on peritoneal dialysis
Figure 5.1.1 Figure 5.1.2
Stock and Flow
Table 5.1 shows the proportion of home dialysis patients undergoing peritoneal dialysis (PD) in each state and country over 2010-2014. Overall around two-thirds of home dialysis patients undergo PD, although there is some variation between states.
The duration of time spent on PD by prevalent patients is shown in figure 5.1.
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ANZDATA Registry
5-3
819 Patients
0
200
400
600
800
1000
2010 2011 2012 2013 2014
New PatientsTransplantsTransfer to HDDeathsNo. dialysing
New Zealand 2010-2014Stock and flow of peritoneal dialysis patients
2472 Patients
0
500
1000
1500
2000
2500
2010 2011 2012 2013 2014
New PatientsTransplantsTransfer to HDDeathsNo. dialysing
Australia 2010-2014Stock and flow of peritoneal dialysis patients
Figure 5.2.1 Figure 5.2.2
Year 2010 2011 2012 2013 2014
Australia
Patients new to PD 757 837 1009 978 1051
First Dialysis Treatment 500 554 675 708 752
Previous HD 250 275 320 251 281
Previous Transplant 7 8 14 19 18
Transplanted 189 211 209 242 232
Deaths 290 278 246 257 274
Never Transplanted 286 271 239 247 266
Previously Transplanted 4 7 7 10 8
Transfer to HD 511 478 518 552 452
Patients Dialysing 31 December 2089 2080 2247 2307 2472
New Zealand
Patients new to PD 276 244 268 296 269
First Dialysis Treatment 163 154 167 179 183
Previous HD 113 90 97 115 84
Previous Transplant 0 0 4 2 2
Transplanted 45 39 43 38 45
Deaths 117 146 134 121 142
Never Transplanted 111 140 131 117 139
Previously Transplanted 6 6 3 4 3 Transfer to HD 129 137 148 132 139 Patients Dialysing 31 December 832 795 777 834 819
Stock and Flow of Peritoneal Dialysis Patients 2010 - 2014
Table 5.2
Table 5.2 shows the overall stock and flow of PD patients. The number of prevalent patients is stable in each country. Figure 5.2 presents some of these data graphically.
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ANZDATA Registry
5-4
Number of Patients=819
0
5
10
15
20
25
30
Per
cent
0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
New Zealand 2014Age (%) of current peritoneal dialysis patients
Number of Patients=2472
0
5
10
15
20
25
Per
cent
0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Australia 2014Age (%) of current peritoneal dialysis patients
Figure 5.4.1 Figure 5.4.2
Number of Patients=269
0
5
10
15
20
25
30
Per
cent
0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
New Zealand 2014Age (%) of new peritoneal dialysis patients
Number of Patients=1051
0
5
10
15
20
25
Per
cent
0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Australia 2014Age (%) of new peritoneal dialysis patients
Figure 5.3.1 Figure 5.3.2
The age distributions of incident and prevalent PD patients are shown in figures 5.3 and 5.4 respectively.
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ANZDATA Registry
5-5
Category Age group 2010 2011 2012 2013 2014
New Patients
0-14 20 (3%) 22 (3%) 20 (2%) 24 (2%) 27 (3%)
15-24 17 (2%) 29 (3%) 28 (3%) 28 (3%) 29 (3%)
25-34 42 (6%) 41 (5%) 61 (6%) 66 (7%) 50 (5%)
35-44 80 (11%) 87 (10%) 122 (12%) 89 (9%) 117 (11%)
45-54 134 (18%) 155 (19%) 145 (14%) 165 (17%) 166 (16%)
55-64 169 (22%) 181 (22%) 230 (23%) 218 (22%) 228 (22%)
65-74 180 (24%) 181 (22%) 239 (24%) 242 (25%) 267 (25%)
75-84 107 (14%) 128 (15%) 151 (15%) 129 (13%) 151 (14%)
85+ 8 (1%) 13 (2%) 13 (1%) 17 (2%) 16 (2%)
Total 757 837 1009 978 1051
Patients Dialysing
0-14 29 (1%) 26 (1%) 29 (1%) 25 (1%) 31 (1%)
15-24 39 (2%) 44 (2%) 42 (2%) 47 (2%) 41 (2%)
25-34 90 (4%) 96 (5%) 98 (4%) 105 (5%) 94 (4%)
35-44 181 (9%) 185 (9%) 206 (9%) 200 (9%) 219 (9%)
45-54 301 (14%) 310 (15%) 340 (15%) 326 (14%) 336 (14%)
55-64 460 (22%) 455 (22%) 496 (22%) 511 (22%) 543 (22%)
65-74 558 (27%) 515 (25%) 563 (25%) 593 (26%) 688 (28%)
75-84 379 (18%) 399 (19%) 419 (19%) 441 (19%) 459 (19%)
85+ 52 (2%) 50 (2%) 54 (2%) 59 (3%) 61 (2%)
Total 2089 2080 2247 2307 2472
Primary Renal Disease
Glomerulonephritis 200 (26%) 224 (27%) 265 (26%) 236 (24%) 253 (24%)
Analgesic Nephropathy 13 (2%) 9 (1%) 14 (1%) 16 (2%) 8 (1%)
Hypertension 97 (13%) 115 (14%) 123 (12%) 146 (15%) 156 (15%)
Polycystic Disease 53 (7%) 45 (5%) 53 (5%) 50 (5%) 62 (6%)
Reflux Nephropathy 22 (3%) 23 (3%) 34 (3%) 23 (2%) 30 (3%)
Diabetic Nephropathy 251 (33%) 277 (33%) 327 (32%) 322 (33%) 345 (33%)
Miscellaneous 83 (11%) 96 (11%) 141 (14%) 128 (13%) 142 (14%)
Uncertain 38 (5%) 48 (6%) 52 (5%) 57 (6%) 55 (5%)
Total 757 837 1009 978 1051
Incident and prevalent PD patients by age group and primary disease - Australia
Table 5.3.1
Table 5.3 presents the number and proportion of incident and prevalent patients by age group, and incident patients by primary renal disease.
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ANZDATA Registry
5-6
Category Age group 2010 2011 2012 2013 2014
New Patients
0-14 3 (1%) 5 (2%) 6 (2%) 3 (1%) 6 (2%)
15-24 8 (3%) 5 (2%) 11 (4%) 6 (2%) 11 (4%)
25-34 9 (3%) 13 (5%) 11 (4%) 18 (6%) 18 (7%)
35-44 22 (8%) 21 (9%) 26 (10%) 27 (9%) 26 (10%)
45-54 44 (16%) 39 (16%) 64 (24%) 57 (19%) 49 (18%)
55-64 88 (32%) 76 (31%) 77 (29%) 85 (29%) 61 (23%)
65-74 70 (25%) 66 (27%) 58 (22%) 76 (26%) 69 (26%)
75-84 32 (12%) 18 (7%) 14 (5%) 22 (7%) 25 (9%)
85+ 0 (0%) 1 (0%) 1 (0%) 2 (1%) 4 (1%)
Total 276 244 268 296 269
Patients Dialysing
0-14 7 (1%) 9 (1%) 4 (1%) 4 (0%) 7 (1%)
15-24 22 (3%) 24 (3%) 19 (2%) 21 (3%) 22 (3%)
25-34 28 (3%) 26 (3%) 33 (4%) 36 (4%) 34 (4%)
35-44 67 (8%) 58 (7%) 66 (8%) 66 (8%) 66 (8%)
45-54 141 (17%) 121 (15%) 125 (16%) 144 (17%) 138 (17%)
55-64 235 (28%) 240 (30%) 229 (29%) 246 (29%) 225 (27%)
65-74 231 (28%) 224 (28%) 216 (28%) 223 (27%) 223 (27%)
75-84 98 (12%) 89 (11%) 82 (11%) 88 (11%) 92 (11%)
85+ 3 (0%) 4 (1%) 3 (0%) 6 (1%) 12 (1%)
Total 832 795 777 834 819
Primary Renal Disease
Glomerulonephritis 65 (24%) 55 (23%) 59 (22%) 70 (24%) 52 (19%)
Analgesic Nephropathy 3 (1%) 3 (1%) 4 (1%) 2 (1%) 0 (0%)
Hypertension 36 (13%) 29 (12%) 22 (8%) 27 (9%) 28 (10%)
Polycystic Disease 7 (3%) 12 (5%) 13 (5%) 15 (5%) 14 (5%)
Reflux Nephropathy 3 (1%) 4 (2%) 7 (3%) 10 (3%) 8 (3%)
Diabetic Nephropathy 134 (49%) 107 (44%) 124 (46%) 137 (46%) 115 (43%)
Miscellaneous 20 (7%) 23 (9%) 30 (11%) 27 (9%) 44 (16%)
Uncertain 8 (3%) 11 (5%) 9 (3%) 8 (3%) 8 (3%)
Total 276 244 268 296 269
Incident and prevalent PD patients by age group and primary disease - New Zealand
Table 5.3.2
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ANZDATA Registry
5-7
Number of PD patients=819
0
10
20
30
40
50
60
70
80
Per
cent
0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
New Zealand 2014PD patients (%) of all prevalent dialysis
Number of PD patients=2472
0
10
20
30
40
50
60
70
80
Per
cent
0-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+
Australia 2014PD patients (%) of all prevalent dialysis
Figure 5.5.1 Figure 5.5.2
Number (per Million) of Prevalent PD Patients, Australia 2010-2014
2010 2011 2012 2013 2014
Total 2089 (94.82) 2080 (93.11) 2247 (98.86) 2307 (99.76) 2472 (105.23)
APD 1280 (58.10) 1290 (57.74) 1406 (61.86) 1477 (63.87) 1596 (67.94)
CAPD 809 (36.72) 790 (35.36) 841 (37.00) 830 (35.89) 876 (37.29)
Table 5.4.1
Number (per Million) of Prevalent PD Patients, New Zealand 2010-2014
2010 2011 2012 2013 2014
Total 832 (191.93) 795 (182.02) 777 (176.96) 834 (188.49) 819 (182.34)
APD 359 (82.82) 353 (80.82) 376 (85.63) 391 (88.37) 377 (83.94)
CAPD 473 (109.11) 442 (101.20) 401 (91.32) 443 (100.12) 442 (98.41)
Table 5.4.2
Figure 5.5 shows the proportion of dialysis patients using PD as their modality by age. In both Australia and New Zealand PD is the predominant modality for paediatric patients, but HD is the predominant modality for adult patients.
Table 5.4 shows the number of prevalent PD patients, and number per million population, according to PD type.
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ANZDATA Registry
5-8
Icodextrin Usage by Modality Type - December 2014
Australia New Zealand
No Yes Not Reported Total No Yes Not Reported Total
CAPD n 461 358 57 876 214 204 24 442
% 52.63% 40.87% 6.51% 48.42% 46.15% 5.43%
APD n 801 737 58 1596 104 270 3 377
% 50.19% 46.18% 3.63% 27.59% 71.62% 0.80%
Total n 1262 1095 115 2472 318 474 27 819
% 51.05% 44.30% 4.65% 38.83% 57.88% 3.30%
PD Type
Table 5.5
0
20
40
60
80
100
Per
cent
CAPD APD
Dec 12Dec 13Dec 14 Dec 12Dec 13Dec 14
Proportions not presented if <10 patients
Prevalent patients December 2012 - 2014New Zealand
Icodextrin use by modality
YesNo
Icodextrin
0
20
40
60
80
100
Per
cent
CAPD APD
Dec 12Dec 13Dec 14 Dec 12Dec 13Dec 14
Proportions not presented if <10 patients
Prevalent patients December 2012 - 2014Australia
Icodextrin use by modality
YesNo
Icodextrin
Figure 5.6.1 Figure 5.6.2
Peritoneal Dialysis Fluids
Table 5.5 shows the use of icodextrin by country and PD type at the end of 2014. Figure 5.6 shows the trends in icodextrin use over the last three years; the proportion of patients using icodextrin is gradually increasing. Finally, figure 5.7 shows icodextrin use by state and PD type at the end of 2014.
0
20
40
60
80
100
Per
cent
CAPD APD
NT
NS
W/A
CT
VIC
QL
DS
AW
AT
AS
NZ
NT
NS
W/A
CT
VIC
QL
DS
AW
AT
AS
NZ
Proportions not presented if <10 patients
Prevalent patients December 2014Icodextrin use by state and country
YesNo
Icodextrin
Figure 5.7
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ANZDATA Registry
5-9
0
20
40
60
80
100
Per
cent
CAPD APD
Dec 12 Dec 13 Dec 14 Dec 12 Dec 13 Dec 14
Percentages are not graphed if fewer than 10 patients
Prevalent patients December 2012 - 2014New Zealand
Low GDP - lactate use by modality
YesNo
Lactate
0
20
40
60
80
100
Per
cent
CAPD APD
Dec 12 Dec 13 Dec 14 Dec 12 Dec 13 Dec 14
Percentages are not graphed if fewer than 10 patients
Prevalent patients December 2012 - 2014Australia
Low GDP - lactate use by modality
YesNo
Lactate
Figure 5.8.1 Figure 5.8.2
Low GDP - Lactate Usage by Modality Type - December 2014
Australia New Zealand
No Yes Not
Reported Total No Yes
Not Reported
Total
CAPD n 604 215 57 876 295 123 24 442
% 68.95% 24.54% 6.51% 66.74% 27.83% 5.43%
APD n 1356 184 56 1596 317 57 3 377
% 84.96% 11.53% 3.51% 84.08% 15.12% 0.80%
Total n 1960 399 113 2472 612 180 27 819
% 79.29% 16.14% 4.57% 74.73% 21.98% 3.30%
PD Type
Table 5.6
Table 5.6 and figure 5.8 present similar data for low lactate PD solutions, and table 5.7 and figure 5.9 present similar data for low bicarbonate PD solutions. The use of these PD solutions in both Australia and New Zealand is uncommon.
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ANZDATA Registry
5-10
0
20
40
60
80
100
Per
cent
CAPD APD
Dec 12 Dec 13 Dec 14 Dec 12 Dec 13 Dec 14
Percentages are not graphed if fewer than 10 patients
Prevalent patients December 2012 - 2014New Zealand
Low GDP - bicarb use by modality
YesNo
Bicarb
0
20
40
60
80
100
Per
cent
CAPD APD
Dec 12 Dec 13 Dec 14 Dec 12 Dec 13 Dec 14
Percentages are not graphed if fewer than 10 patients
Prevalent patients December 2012 - 2014Australia
Low GDP - bicarb use by modality
YesNo
Bicarb
Figure 5.9.1 Figure 5.9.2
Low GDP - Bicarb Usage by Modality Type - December 2014
Australia New Zealand
No Yes Not
Reported Total No Yes
Not Reported
Total
CAPD n 788 31 57 876 414 4 24 442
% 89.95% 3.54% 6.51% 93.67% 0.90% 5.43%
APD n 1511 28 57 1596 371 3 3 377
% 94.67% 1.75% 3.57% 98.41% 0.80% 0.80%
Total n 2299 59 114 2472 785 7 27 819
% 93.00% 2.39% 4.61% 95.85% 0.85% 3.30%
PD Type
Table 5.7
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ANZDATA Registry
5-11
Peritoneal Dialysis at 90 Days Patient Survival by Era 2003 - 2014
Censored for Transplant % [95% Confidence Interval]
Period No. of Patients 6 months 1 year 3 years 5 years
Australia
2003 - 2005 1839 97[96,98] 91[90,92] 71[69,73] 55[53,57]
2006 - 2008 2164 98[97,99] 93[92,94] 73[71,75] 58[56,60]
2009 - 2011 1875 98[97,98] 94[93,95] 77[75,79] 61[59,64]
2012 - 2014 2297 98[98,99] 96[95,97] 79[76,82] -
2003 - 2005 616 97[96,98] 91[88,93] 64[61,68] 46[42,49]
2006 - 2008 616 98[96,99] 93[90,94] 74[70,77] 53[49,56]
2009 - 2011 656 99[98,100] 94[92,95] 71[67,74] 49[45,53]
2012 - 2014 615 99[97,99] 96[94,97] 71[64,78] -
New Zealand
Table 5.8
Patient Survival
The next section examines PD patient survival. Survival time is for those on PD at day 90, from day 90, and censored at transplantation.
Table 5.8 and figure 5.10 show patient survival by era; survival is gradually improving in each country.
Figure 5.10.1 Figure 5.10.2
0.00
0.25
0.50
0.75
1.00
Pat
ient
Sur
viva
l
0 1 2 3 4 5Years
Cohort2003 - 2005 (616)2006 - 2008 (616)2009 - 2011 (656)2012 - 2014 (615)
2003 - 2014Censored for transplant - New Zealand
Patient survival - peritoneal dialysis at 90 days
0.00
0.25
0.50
0.75
1.00
Pat
ient
Sur
viva
l
0 1 2 3 4 5Years
Cohort2003 - 2005 (1839)2006 - 2008 (2164)2009 - 2011 (1875)2012 - 2014 (2297)
2003 - 2014Censored for transplant - Australia
Patient survival - peritoneal dialysis at 90 days
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ANZDATA Registry
5-12
0.00
0.25
0.50
0.75
1.00
Pat
ient
Sur
viva
l
0 1 2 3 4 5Years
Age<40 (287)40-59 (924)60-74 (1034)
75 (258)
2003 - 2014Censored for transplant - New Zealand
Patient survival - peritoneal dialysis at 90 days
0.00
0.25
0.50
0.75
1.00
Pat
ient
Sur
viva
l
0 1 2 3 4 5Years
Age<40 (1226)40-59 (2548)60-74 (2995)
75 (1406)
2003 - 2014Censored for transplant - Australia
Patient survival - peritoneal dialysis at 90 days
Figure 5.11.1 Figure 5.11.2
Peritoneal Dialysis at 90 Days Patient Survival by Age Group 2003 - 2014
Censored for Transplant % [95% Confidence Interval]
Age Group No. of Patients 6 months 1 year 3 years 5 years
Australia
<40 1226 99[99,100] 98[97,99] 94[93,95] 91[89,93]
40-59 2548 99[98,99] 97[96,97] 84[82,85] 73[71,75]
60-74 2995 97[97,98] 92[91,93] 68[66,70] 48[46,50]
≥75 1406 96[95,97] 87[85,89] 54[51,57] 29[26,32]
<40 287 99[97,100] 98[96,99] 90[85,93] 85[79,89]
40-59 924 98[97,99] 95[93,96] 77[74,80] 59[55,62]
60-74 1034 99[98,99] 92[90,94] 64[61,67] 39[36,43]
≥75 258 95[92,97] 86[81,90] 48[42,55] 22[17,28]
New Zealand
Table 5.9
Table 5.9 and figure 5.11 demonstrate the strong association between patient age and survival.
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ANZDATA Registry
5-13
Figure 5.12.1 Figure 5.12.2
Peritoneal Dialysis at 90 Days Patient Survival by Diabetic Status 2003 - 2014
Censored for Transplant % [95% Confidence Interval]
Period No. of Patients 6 months 1 year 3 years 5 years
Australia Non-diabetic 3406 97[97,98] 92[91,93] 66[65,68] 46[44,48]
Diabetic 4757 98[98,98] 95[94,95] 80[79,81] 68[67,70]
New Zealand Diabetic 1250 98[97,99] 94[93,95] 76[73,79] 61[58,64]
Non-diabetic 1251 98[98,99] 92[90,93] 64[61,67] 38[34,41]
Table 5.10
Table 5.10 and figure 5.12 present these data by diabetic status; as expected, survival is worse in diabetic patients.
0.00
0.25
0.50
0.75
1.00
Pat
ient
Sur
viva
l
0 1 2 3 4 5Years
Non-Diabetic (1250)Diabetic (1251)
2003 - 2014Censored for transplant - New Zealand
Patient survival - peritoneal dialysis at 90 days
0.00
0.25
0.50
0.75
1.00
Pat
ient
Sur
viva
l
0 1 2 3 4 5Years
Non-Diabetic (4757)Diabetic (3406)
2003 - 2014Censored for transplant - Australia
Patient survival - peritoneal dialysis at 90 days
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ANZDATA Registry
5-14
Technique Survival
This section examines PD technique survival, defined as the number of days the patient spent on PD before transferring to HD for at least 30 days or dying. Survival time is calculated from day 90 and censored at transplantation. Survival is shown for the same categories reported for patient survival above. Analogously to patient survival, technique survival is adversely affected by older age and diabetic status, and is improving gradually over time.
Peritoneal Dialysis at 90 Days Technique Survival by Era 2003 - 2014
Censored for Transplant % [95% Confidence Interval]
Age Group No. of Patients 6 months 1 year 3 years 5 years
Australia
2003 - 2005 1839 91[90,93] 77[75,79] 35[33,38] 16[14,18]
2006 - 2008 2164 93[92,94] 78[77,80] 39[36,41] 18[16,20]
2009 - 2011 1875 92[91,93] 80[78,82] 42[39,44] 20[18,23]
2012 - 2014 2297 94[93,95] 83[81,85] 43[39,48] .[.,.]
2003 - 2005 616 95[93,97] 82[79,85] 40[36,44] 19[15,22]
2006 - 2008 616 95[93,96] 84[81,87] 47[43,51] 22[18,25]
2009 - 2011 656 96[94,97] 85[82,88] 46[42,50] 20[16,24]
2012 - 2014 615 95[93,97] 87[84,90] 49[41,56] .[.,.]
New Zealand
Table 5.11
Figure 5.13.1 Figure 5.13.2
0.00
0.25
0.50
0.75
1.00
Tec
hniq
ue S
urvi
val
0 1 2 3 4 5Years
Cohort2003 - 2005 (616)2006 - 2008 (616)2009 - 2011 (656)2012 - 2014 (615)
2003 - 2014Censored for transplant - New Zealand
Technique survival - peritoneal dialysis at 90 days
0.00
0.25
0.50
0.75
1.00
Tec
hniq
ue S
urvi
val
0 1 2 3 4 5Years
Cohort2003 - 2005 (1839)2006 - 2008 (2164)2009 - 2011 (1875)2012 - 2014 (2297)
2003 - 2014Censored for transplant - Australia
Technique survival - peritoneal dialysis at 90 days
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ANZDATA Registry
5-15
Peritoneal Dialysis at 90 Days Technique Survival by Age Group 2003 - 2014
Censored for Transplant % [95% Confidence Interval]
Age Group No. of Patients 6 months 1 year 3 years 5 years
Australia
<40 1226 94[92,95] 80[77,82] 46[41,50] 27[23,32]
40-59 2548 94[93,95] 81[80,83] 43[40,45] 23[20,25]
60-74 2995 92[91,93] 80[79,81] 39[37,41] 18[16,20]
≥75 1406 91[89,92] 75[73,77] 33[30,36] 11[9,13]
<40 287 95[92,97] 87[82,91] 46[39,54] 31[23,39]
40-59 924 95[94,97] 86[83,88] 47[43,51] 25[21,29]
60-74 1034 96[94,97] 84[82,86] 45[42,49] 19[16,22]
≥75 258 93[89,95] 80[75,85] 35[28,41] 10[6,15]
New Zealand
Table 5.12
0.00
0.25
0.50
0.75
1.00
Tec
hniq
ue S
urvi
val
0 1 2 3 4 5Years
Age<40 (287)40-59 (924)60-74 (1034)
75 (258)
2003 - 2014Censored for transplant - New Zealand
Technique survival - peritoneal dialysis at 90 days
0.00
0.25
0.50
0.75
1.00
Tec
hniq
ue S
urvi
val
0 1 2 3 4 5Years
Age<40 (1226)40-59 (2548)60-74 (2995)
75 (1406)
2003 - 2014Censored for transplant - Australia
Technique survival - peritoneal dialysis at 90 days
Figure 5.14.1 Figure 5.14.2
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ANZDATA Registry
5-16
Peritoneal Dialysis at 90 Days Technique Survival by Diabetic Status 2003 - 2014
Censored for Transplant % [95% Confidence Interval]
Period No. of Patients 6 months 1 year 3 years 5 years
Australia Diabetic 3406 92[91,93] 78[76,79] 35[33,36] 14[12,15]
Non-diabetic 4757 93[92,94] 81[79,82] 43[42,45] 23[21,24]
New Zealand Non-diabetic 1251 96[95,97] 84[82,86] 41[38,44] 16[14,19]
Diabetic 1250 95[93,96] 85[83,87] 49[46,52] 26[22,29]
Table 5.13
Figure 5.15.1 Figure 5.15.2
0.00
0.25
0.50
0.75
1.00
Tec
hniq
ue S
urvi
val
0 1 2 3 4 5Years
Non-Diabetic (1250)Diabetic (1251)
2003 - 2014Censored for transplant - New Zealand
Technique survival - peritoneal dialysis at 90 days
0.00
0.25
0.50
0.75
1.00
Tec
hniq
ue S
urvi
val
0 1 2 3 4 5Years
Non-Diabetic (4757)Diabetic (3406)
2003 - 2014Censored for transplant - Australia
Technique survival - peritoneal dialysis at 90 days
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ANZDATA Registry
5-17
Causes of Peritoneal Dialysis Technique Failure in 2014
Causes of technique failure Australia New Zealand
Diverticulitis 2
Recurrent/Persistent Peritonitis 65 18
Total Infective 149 (33)% 42 (30)%
Tunnel/Exit Site Infection 10 5
Unspecified Peritoneal Infection 6 1
Inadequate Fluid Ultrafiltration 27 6
Inadequate Solute Clearance 70 14
Total Dialysis 97 (21)% 20 (14)%
Abdominal Pain 2 2
Cardiovascular Instability 1 1
Catheter Block 8 6
Catheter Fell Out 1 1
Dialysate Leak 15 10
Hernia 18 8
Hydrothorax 4 2
Multiple Adhesions 1 1
Pleural Effusion 1 2
Pregnancy 1
Sclerosing Peritonitis 1
Scrotal Oedema 1
Surgery 19 12
Total Technical 71 (16)% 47 (34)%
Patient Preference 31 2
Total Patient Preference 66 (15)% 8 (6)%
Unable To Manage Self-Care 35 6
Other (Specify) 14 1
Planned Transfer After Acute Pd Start 1
Poor Nutrition 2
Total Other 15 (3)% 3 (2)%
Total Not Reported 54 (12)% 19 (14)%
Table 5.14
The causes of PD technique failure in 2014, apart from deaths on PD, are shown in table 5.14. Peritonitis remains the most common cause of technique failure in Australia, whereas in New Zealand in 2014 technical causes were the most common.
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ANZDATA Registry
5-18
0.00
0.25
0.50
0.75
1.00
0 3 6 9 12 15 18 21 24Months on PD
00-14 (23)15-34 (110)35-54 (375)55-64 (387)65-74 (339)
75 (119)
Related to age at first PDNew Zealand 2010 - 2014
First PD treatment to first peritonitis
0.00
0.25
0.50
0.75
1.00
0 3 6 9 12 15 18 21 24Months on PD
00-14 (113)15-34 (391)35-54 (1260)55-64 (1026)65-74 (1109)
75 (733)
Related to age at first PDAustralia 2010 - 2014
First PD treatment to first peritonitis
Figure 5.16.1 Figure 5.16.2
First PD Treatment to First Episode of Peritonitis By Age at Entry 01-Jan-2010 to 31-Dec-2014
%Survival [95% Confidence Interval]
Age Groups
00-14 15-34 35-54 55-64 65-74 ≥75 All
Australia (n=113) (n=391) (n=1260) (n=1026) (n=1109) (n=733) (n=4632) 3 months 81 [72,87] 91 [88,94] 89 [87,91] 92 [90,93] 91 [89,92] 90 [88,92] 90 [89,91]
6 months 69 [59,78] 85 [81,88] 81 [78,83] 86 [83,88] 85 [83,87] 86 [83,88] 84 [83,85]
9 months 61 [50,71] 78 [73,82] 75 [73,78] 80 [77,82] 79 [77,82] 78 [75,81] 78 [76,79]
1 year 57 [45,68] 73 [67,78] 69 [66,72] 76 [73,79] 74 [71,77] 72 [68,75] 72 [71,74]
2 years 49 [30,65] 57 [48,65] 56 [52,60] 55 [51,60] 57 [53,61] 55 [50,60] 56 [54,58]
3 years 33 [9,60] 31 [17,46] 43 [37,48] 43 [37,48] 44 [38,49] 38 [31,44] 41 [39,44]
New Zealand (n=23) (n=110) (n=375) (n=387) (n=339) (n=119) (n=1353)
3 months 90 [65,97] 94 [87,97] 90 [87,93] 88 [85,91] 88 [84,91] 91 [84,95] 90 [88,91]
6 months 65 [37,83] 85 [75,91] 82 [77,86] 80 [75,84] 82 [77,86] 81 [72,87] 81 [79,83]
9 months 65 [37,83] 80 [70,87] 76 [71,80] 73 [68,77] 77 [71,81] 77 [68,84] 75 [73,78]
1 year 56 [27,77] 75 [64,84] 68 [62,73] 66 [60,71] 71 [65,76] 72 [61,80] 69 [66,71]
2 years 56 [27,77] 63 [49,75] 47 [41,54] 46 [40,52] 55 [48,62] 51 [38,63] 50 [46,54]
3 years - 44 [23,63] 33 [26,41] 32 [25,40] 38 [30,47] 41 [26,55] 35 [31,40]
Survival
Table 5.15
Peritonitis
Table 5.15 and figure 5.16 present the time to first peritonitis over 2010-2014 by age at PD start. Peritonitis is more common in children, but otherwise there is little association between age and time to first peritonitis.
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ANZDATA Registry
5-19
0.00
0.25
0.50
0.75
1.00
0 3 6 9 12 15 18 21 24Months on PD
Asian 35-54 (157)Caucasian 35-54 (777)Indigenous 35-54 (230)Asian 55-64 (109)Caucasian 55-64 (745)Indigenous 55-64 (154)
Related to race and age at first PDAustralia 2005 - 2009
First PD treatment to first peritonitis
Figure 5.17
0.00
0.25
0.50
0.75
1.00
0 3 6 9 12 15 18 21 24Months on PD
Asian 35-54 (193)Caucasian 35-54 (788)Indigenous 35-54 (214)Asian 55-64 (167)Caucasian 55-64 (663)Indigenous 55-64 (141)
Related to race and age at first PDAustralia 2010 - 2014
First PD treatment to first peritonitis
Figure 5.18
In Australia peritonitis is more common in indigenous patients and less common in Asians (figures 5.17 and 5.18). In New Zealand a similar but less pronounced pattern is seen, and the gap between races appears to be narrowing (figures 5.19 and 5.20).
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ANZDATA Registry
5-20
0.00
0.25
0.50
0.75
1.00
0 3 6 9 12 15 18 21 24Months on PD
Asian 35-54 (32)Caucasian 35-54 (147)Indigenous 35-54 (202)Asian 55-64 (30)Caucasian 55-64 (139)Indigenous 55-64 (188)
Related to race and age at first PDNew Zealand 2005 - 2009
First PD treatment to first peritonitis
Figure 5.19
0.00
0.25
0.50
0.75
1.00
0 3 6 9 12 15 18 21 24Months on PD
Asian 35-54 (36)Caucasian 35-54 (134)Indigenous 35-54 (202)Asian 55-64 (41)Caucasian 55-64 (128)Indigenous 55-64 (207)
Related to race and age at first PDNew Zealand 2010 - 2014
First PD treatment to first peritonitis
Figure 5.20
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ANZDATA Registry
5-21
0.00
0.25
0.50
0.75
1.00
0 3 6 9 12 15 18 21 24Months on PD
00-14 (20)15-34 (74)35-54 (241)55-64 (230)65-74 (172)
75 (51)
Related to age at first APDNew Zealand 2010 - 2014
First APD treatment to first peritonitis
0.00
0.25
0.50
0.75
1.00
0 3 6 9 12 15 18 21 24Months on PD
00-14 (91)15-34 (317)35-54 (927)55-64 (708)65-74 (753)
75 (459)
Related to age at first APDAustralia 2010 - 2014
First APD treatment to first peritonitis
Figure 5.21.1 Figure 5.21.2
First home APD Treatment to First Episode of Peritonitis By Age at Entry 01-Jan-2010 to 31-Dec-2014
%Survival [95% Confidence Interval]
Age Groups
00-14 15-34 35-54 55-64 65-74 ≥75 All
Australia (n=91) (n=317) (n=927) (n=708) (n=753) (n=459) (n=3255)
3 months 90 [81, 95] 93 [90, 96] 92 [90, 94] 93 [91, 95] 95 [94, 97] 95 [92, 97] 94 [93, 95]
6 months 79 [67, 87] 85 [81, 89] 87 [84, 89] 90 [87, 92] 91 [88, 93] 90 [87, 93] 88 [87, 90]
9 months 75 [62, 84] 80 [74, 84] 81 [78, 84] 84 [81, 87] 86 [83, 89] 84 [79, 87] 83 [82, 85]
1 year 72 [59, 82] 77 [71, 82] 76 [73, 79] 80 [76, 83] 82 [78, 85] 81 [76, 85] 79 [77, 81]
2 years 65 [45, 79] 59 [48, 69] 64 [59, 68] 59 [53, 65] 66 [61, 71] 65 [59, 71] 63 [61, 66]
3 years 54 [28, 74] 42 [25, 59] 50 [43, 56] 53 [45, 59] 53 [46, 59] 48 [38, 57] 51 [47, 54]
New Zealand (n=20) (n=74) (n=241) (n=230) (n=172) (n=51) (n=788)
3 months 90 [65, 97] 96 [87, 99] 91 [86, 94] 95 [91, 97] 94 [89, 97] 98 [85, 100] 94 [92, 95]
6 months 64 [36, 82] 92 [82, 97] 83 [77, 88] 88 [83, 92] 88 [81, 92] 95 [83, 99] 87 [84, 89]
9 months 55 [26, 76] 86 [73, 93] 79 [73, 84] 80 [73, 85] 83 [75, 88] 90 [75, 96] 81 [77, 84]
1 year 55 [26, 76] 86 [73, 93] 73 [65, 79] 75 [67, 81] 78 [69, 84] 76 [58, 88] 75 [71, 79]
2 years 55 [26, 76] 63 [43, 77] 59 [50, 67] 62 [53, 70] 67 [56, 76] 53 [31, 70] 61 [56, 66]
3 years - 42 [17, 66] 43 [32, 53] 48 [37, 58] 56 [40, 69] 42 [18, 64] 47 [40, 53]
Survival
Table 5.16
Table 5.16 and figure 5.21 show similar data by age group, but restricted to patients who commenced APD.
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ANZDATA Registry
5-22
18
20
24
30
Pa
tien
t-m
on
ths
pe
r e
pis
od
e.3
.4
.5
.6
.7
Epi
sode
s pe
r ye
ar (
95%
CI)
2004 2006 2008 2010 2012 2014
Australia 2005-2014PD peritonitis rate
Figure 5.22
QLD
NSW
ACT
VIC
TAS
SA
NT
WA
12
15
18
20
24
30
Pa
tien
t-m
ont
hs p
er e
piso
de
.4
.6
.8
1
Epi
sode
s pe
r ye
ar (
95%
CI)
By state, Australia 2005-2014PD peritonitis rate
Figure 5.23
Australian Peritonitis Registry
Since October 2003 ANZDATA has collected detailed information on PD peritonitis episodes in Australian patients. A selection of those data are reported here. New Zealand has a separate PD registry and we are in the process of linking that with ANZDATA in order to report similar data for New Zealand.
Figures 5.22-5.26 report the peritonitis rate, expressed as episodes per patient-year on the left y axis and patient-months per episode on the right y axis, according to different categories. The overall peritonitis rate in Australia has dropped considerably over the last few years, but has stabilised over 2012-2014 (figure 5.22). However, there remains significant variation between states (figures 5.23 and 5.24) and individual treating hospitals (figures 5.25 and 5.26).
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ANZDATA Registry
5-23
6
12
18
36
Pat
ient
-mon
ths
per
epis
ode
0
.5
1
1.5
2
Epi
sode
s pe
r ye
ar (
95%
CI)
0 20 40 60Treating unit
Excludes units with <10 person-years PD over 2005-2014
By treating unit, Australia 2005-2014PD peritonitis rate
121836
121836
121836
0.51
1.52
0.51
1.52
0.51
1.52
2005 2008 2011 2014
2005 2008 2011 20142005 2008 2011 2014
QLD NSW ACT
VIC TAS SA
NT WA
Pat
ient
-mon
ths
per
epis
ode
Epi
sode
s pe
r ye
ar (
95%
CI)
By state, Australia 2005-2014PD peritonitis rate
Figure 5.24
Figure 5.25
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ANZDATA Registry
5-24
6
12
18
36
Pat
ient
-mon
ths
per
epis
ode
0
.5
1
1.5
2E
piso
des
per
year
(95
% C
I)
0 10 20 30 40 50Treating unit
Excludes units with <5 person-years PD in 2014
By treating unit, Australia 2014PD peritonitis rate
Figure 5.26
0
20
40
60
80
100
Per
cent
of
perit
oniti
s ep
isod
es
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
Australia 2005-2014Distribution of organisms causing peritonitis
OtherMycobacteriaFungiAnaerobesGram negative orgOther Gram PosStaph aureus, non MRSAMRSACoag neg StaphCulture negative
Figure 5.27
The organisms causing peritonitis are presented in figure 5.27. The distribution of organisms is quite stable, although there has been a gradual increase the proportion of culture negative infections. Figure 5.28 shows these data for 2014 stratified by state.
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ANZDATA Registry
5-25
0
20
40
60
80
100P
erce
nt o
f pe
riton
itis
epis
odes
QLDNSW
ACTVIC
TAS SA NTW
A
Australia 2014Distribution of organisms causing peritonitis
OtherMycobacteriaFungiAnaerobesGram negative orgOther Gram PosStaph aureus, non MRSAMRSACoag neg StaphCulture negative
Figure 5.28
0
20
40
60
80
Per
cent
of
initi
al a
ntib
iotic
reg
imen
s
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
Australia 2005-2014Initial antibiotic regimen
VancomycinAminoglycoside
Figure 5.29
Around half of episodes are initially treated with vancomycin, and the majority receive an aminoglycoside (figure 5.29). Second and third regimens are shown in figure 5.30.
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ANZDATA Registry
5-26
Figure 5.30
17%
33%
10%
40%
First regimen
39%
18%
37%
6%
Second regimen
48%
17%
30%
4%
Third regimen
No No No Yes Yes No Yes YesVanc / gent
147
187
12
63
155
185
28
2
67
2
Culture negative
Coag neg Staph
MRSA
Staph aureus, non MRSA
Other Gram Pos
Gram negative org
Anaerobes
Fungi
Mycobacteria
Other
No culture taken
0 .2 .4 .6 .8 1Proportion
Primary organism
220
319
12
133
15
42
22
110
QLD
NSW
ACT
VIC
TAS
SA
NT
WA
0 .1 .2 .3 .4 .5Proportion
Treating state
Values are total number of peritonitis episodes reported in 2014
Australia 2014Proportion of episodes resulting in permanent HD transfer
Figure 5.31
The proportion of peritonitis episodes resulting in a permanent transfer to haemodialysis varies by organism and, to a lesser extent, state (figure 5.31).
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ANZDATA Registry
5-27
Per
cent
2012 2013 2014 2012 2013 2014
By coronary artery disease statusNew Zealand, December 2012-2014
<90 90-99 100-114 115-124 125Hb(g/L)
Per
cent
2012 2013 2014 2012 2013 2014
By coronary artery disease statusAustralia, December 2012-2014
<90 90-99 100-114 115-124 125Hb(g/L)
Figure 5.33.2 Figure 5.33.1
Figure 5.32 P
erce
nt
Australia New Zealand
2012 2013 2014 2012 2013 2014
December 2012-2014Haemoglobin - peritoneal dialysis
<90 90-99 100-114 115-124 125Hb(g/L)
Anaemia
Figure 5.32 shows the distribution of Hb in PD patients over the last 3 years, and figure 5.33 presents the same data stratified by the presence or absence of coronary artery disease.
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ANZDATA Registry
5-28
70
80
90
100
110
120
130
140
Med
ian
Hb
(g/L
)
1 2 3 4 5 6 7 8 9 10 11Caring hospital
Excludes hospitals with <10 patients
New Zealand 31 December 2014Haemoglobin in peritoneal dialysis patients
Figure 5.34.1 Figure 5.34.2
70
80
90
100
110
120
130
140
Med
ian
Hb
(g/L
)
1 5 10 15 20 25 30 35 40 45Caring hospital
Excludes hospitals with <10 patients
Australia 31 December 2014Haemoglobin in peritoneal dialysis patients
0
10
20
30
40
50
60
70
80
90
100
Per
cent
1 2 3 4 5 6 7 8 9 10 11Caring Hospital
Excludes hospitals with <10 patients
New Zealand 31 December 2014% Peritoneal dialysis patients with Hb 110-129 g/L
0
10
20
30
40
50
60
70
80
90
100
Per
cent
1 5 10 15 20 25 30 35 40 45Caring Hospital
Excludes hospitals with <10 patients
Australia 31 December 2014% Peritoneal dialysis patients with Hb 110-129 g/L
Figure 5.35.1 Figure 5.35.2
Figure 5.34 shows the variation in Hb between treating hospitals; median Hb ranged from 103 to 118g/L in Australia and 106-117g/L in New Zealand. Figure 5.35 shows the proportion of patients with Hb between 110-129g/L; the proportion ranged from 25-67% in Australia and 31-58% in New Zealand.
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ANZDATA Registry
5-29
Per
cent
Australia New Zealand
2012 2013 2014 2012 2013 2014
December 2012-2014Ferritin - peritoneal dialysis
<100 100-199 200-499 500-799 800g/L
Figure 5.36
Figure 5.37
Per
cent
Australia New Zealand
2012 2013 2014 2012 2013 2014
December 2012-2014Transferrin Saturation - peritoneal dialysis
<20 20-29 30-39 40T/Sat(%)
Figure 5.36 shows the distribution of ferritin in HD patients over 2012-14. The proportion of patients with ferritin between 200-500μg/L ranged from 15-58% in Australia and 31-50% in New Zealand (figure 5.38). Figures 5.37 and 5.39 present equivalent data for transferrin saturation.
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ANZDATA Registry
5-30
0
10
20
30
40
50
60
70
80
90
100
Per
cent
1 2 3 4 5 6 7 8 9 10 11Caring Hospital
Excludes hospitals with <10 patients
New Zealand 31 December 2014% Peritoneal dialysis patients with ferritin 200-500 g/L
Figure 5.38.1 Figure 5.38.2
0
10
20
30
40
50
60
70
80
90
100
Per
cent
1 5 10 15 20 25 30 35 40 45Caring Hospital
Excludes hospitals with <10 patients
Australia 31 December 2014% Peritoneal dialysis patients with ferritin 200-500 g/L
0
10
20
30
40
50
60
70
80
90
100
Per
cent
1 2 3 4 5 6 7 8 9 10 11Caring Hospital
Excludes hospitals with <10 patients
New Zealand 31 December 2014% Peritoneal dialysis patients with TSat >20%
0
10
20
30
40
50
60
70
80
90
100
Per
cent
1 5 10 15 20 25 30 35 40 45Caring Hospital
Excludes hospitals with <10 patients
Australia 31 December 2014% Peritoneal dialysis patients with TSat >20%
Figure 5.39.1 Figure 5.39.2
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ANZDATA Registry
5-31
Per
cent
Australia New Zealand
2012 2013 2014 2012 2013 2014
December 2012-2014Serum calcium - peritoneal dialysis
<2.0 2.0-2.1 2.2-2.3 2.4-2.5 2.6Calcium(mmol/L)
Figure 5.40
0
10
20
30
40
50
60
70
80
90
100
Per
cent
1 2 3 4 5 6 7 8 9 10 11Caring Hospital
Excludes hospitals with <10 patients
New Zealand 31 December 2014% PD patients with Calcium 2.1-2.4 mmol/L
0
10
20
30
40
50
60
70
80
90
100
Per
cent
1 5 10 15 20 25 30 35 40 45Caring Hospital
Excludes hospitals with <10 patients
Australia 31 December 2014% PD patients with Calcium 2.1-2.4 mmol/L
Figure 5.41.1 Figure 5.41.2
Biochemistry
Figures 5.40-5.45 present the distribution of calcium, phosphate and calcium-phosphate product. These numbers remain stable compared with previous years.
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ANZDATA Registry
5-32
Per
cent
Australia New Zealand
2012 2013 2014 2012 2013 2014
Serum phosphate - peritoneal dialysisDecember 2012-2014
<1.4 1.4-1.5 1.6-1.7 1.8Phosphate (mmol/L)
Figure 5.42
0
10
20
30
40
50
60
70
80
90
100
Per
cent
1 2 3 4 5 6 7 8 9 10 11Caring Hospital
Excludes hospitals with <10 patients
New Zealand 31 December 2014% PD patients with Phosphate 0.8-1.6 mmol/L
0
10
20
30
40
50
60
70
80
90
100
Per
cent
1 5 10 15 20 25 30 35 40 45Caring Hospital
Excludes hospitals with <10 patients
Australia 31 December 2014% PD patients with Phosphate 0.8-1.6 mmol/L
Figure 5.43.1 Figure 5.43.2
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ANZDATA Registry
5-33
Per
cent
Australia New Zealand
2012 2013 2014 2012 2013 2014
December 2012-2014Calcium phosphate product - peritoneal dialysis
<3.5 3.5-3.9 4.0-4.4 4.5-4.9 5.0Ca X PO4 (mmol2/L
2)
Figure 5.44
0
10
20
30
40
50
60
70
80
90
100
Per
cent
1 2 3 4 5 6 7 8 9 10 11Caring Hospital
Excludes hospitals with <10 patients
New Zealand 31 December 2014% PD patients with Ca X PO4 <4.0 mmol
2/L
2
0
10
20
30
40
50
60
70
80
90
100
Per
cent
1 5 10 15 20 25 30 35 40 45Caring Hospital
Excludes hospitals with <10 patients
Australia 31 December 2014% PD patients with Ca X PO4 <4.0 mmol
2/L
2
Figure 5.45.1 Figure 5.45.2
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Suggested Citation:
ANZDATA Registry. 38th Report, Chapter 5: Peritoneal Dialysis. Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia. 2016. Available at: http://www.anzdata.org.au
2016 ©
C-\ Royal Adelaide Hospital East Wing 9th Floor North Terrace, Adelaide South Australia Australia
www.anzdata.org.au