D PPS Dialysis Outcomes and Practice Patterns Study

Trends from the Dialysis Outcomes Practice Patterns Study-DOPPS in Vascular Access

Use in Haemodialysis.

Anna Marti Monros, Ronald L Pissoni, Douglas S. Fuller, Joan Fort,

Francesco Locatelli, Lawrence Spergel, David Goodkin, Hal

Morgenstern, Friedrich K Port.

DOPPS Background

• DOPPS is an international prospective study of hemodialysis practices and patient outcomes.

• DOPPS uses random sampling of facilities & patients to provide nationally representative statistics.

• Data collected at >300 dialysis units across 12 countries in 4 study phases since 1996.

• Here we report country trends in vascular access use from 3 cross-sections of HD patients in each country (N=27,145) from 2002-2010.

2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 40

20

40

60

80

100

55 50 4558 60 56

64 59 57

7972 67

87 8376

83 81 79

1415

6

16 1213

32 4

1111

9

5 6

5

12 10 931 3549

26 28 32 33 38 39

1017

24

9 1020

6 9 12

AV-Fistula AV-Graft Catheter

Canada Sweden Belgium Italy GermanySpainPhase:

% of Patients

VA Use in Countries with Decreasing Fistula Use & Increasing Catheter Use

Prevalent cross-sections of patients on dialysis >90 days at time of study entry; weighted by facility sampling fraction; DOPPS 2 (2002-2004), DOPPS 3 (2005-2008), DOPPS 4 (2009-2011)

2 3 4 2 3 4 2 3 4 2 3 40

20

40

60

80

100

93 93 92

7381 78 81 76 79

69 68 74

3447

62

6 6 6

1911

78

1010

7 46

4528

19

9 815 11 14 11

24 2820 22 25 20

AV-Fistula AV-Graft Catheter

Japan France UK USPhase:

% of Patients

Australia/NZ

Distribution of VA Types in Countries with Stable or Increasing Fistula Use

Prevalent cross-sections of patients on dialysis >90 days at time of study entry; weighted by facility sampling fraction; DOPPS 2 (2002-2004), DOPPS 3 (2005-2008), DOPPS 4 (2009-2011);

2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 40

20

40

60

80

100

595150

7262

67

908578 81

7672

605958

868382

949493

748076

847679

717171

36

49

63

14

15

5

5

57

5

13

99

131010

101110

5 5 6

1811

8

8

109

7 49

4326

18

2834

45

2737

29

6 817

61519

273132

4 6 8 8 916

81512

222520 21

2518

Catheter AV-Graft AV-Fistula

CA BE IT SW GESP JP ANZ FR UK USPhase:

% of Patients

Prevalent cross-sections of patients on dialysis >90 days at time of study entry; weighted by facility sampling fraction; DOPPS 2 (2002-2004), DOPPS 3 (2005-2008), DOPPS 4 (2009-2011)

Trend Towards Greater Catheter Use Seen Even in Younger Patients in Some Countries

− Age 18-69 −

2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 4 2 3 40

20

40

60

80

100

615556

77

6266

908678

8378

74

5961

49

888482

949493

778182 857679 757268

41

5765

16

148

7

67

5

11

78

1614

16

99 12

5 6 6

1712 98

1113

65 11

41

22

17

2331

36

22

3627

4 717

61519

252535

3 6 6 6 6 9 713 8

192321 192118

Catheter AV-Graft AV-Fistula

CA BE IT SW GESP JP ANZ FR UK USPhase:

% of Patients

Prevalent cross-sections of patients on dialysis >90 days at time of study entry; weighted by facility sampling fraction; DOPPS 2 (2002-2004), DOPPS 3 (2005-2008), DOPPS 4 (2009-2011)

Trend Towards Greater Catheter Use Seen Even in Non-diabetic Younger Patients− Age 18-69, without diabetes −

<70,

70+ <70,

70+ <70,

70+ <70,

70+ <70,

70+0

20

40

60

80

100

93 9079 80 76 80

7178

63 58

6 8

9 108

6

91

1820

2 212 10

16 1420 21 18 21

Catheter AV-Graft AV-Fistula

Japan ANZFrance UK USAge :

% of Patients

Prevalent cross-sections of patients on dialysis >90 days at time of study entry; weighted by facility sampling fraction; DOPPS 2 (2002-2004), DOPPS 3 (2005-2008), DOPPS 4 (2009-2011)

DOPPS 4: Some Countries Show Small Differences in VA Use in Older vs Younger Pts

Summary (I)

• In DOPPS, Japan has consistently displayed the highest AV fistula (AVF) use [92-93%, since 2002], with <2% of pts using a catheter

• The US, led by the Fistula First Initiative, has shown the largest % rise in AVF use from 34% in 2002 to 60% by 2010

• AVF use increased in Aus-NZ and the UK to 78% and 74%, respectively, while remaining at ~80% in France

• Catheter use has either remained stable or declined in Japan, France, UK and US

Summary (II)

• In other countries, catheter use has increased substantially from 2002-2010:– to 49% and 39% catheter use in Canada and

Belgium– >2-fold rise to 20-24% in Italy and Spain– doubling in Germany to 12%

• Shifts from AVF to catheter were seen in Belgium, Canada, Italy, Spain, and Germany even among non-diabetic 18-69 yr old pts indicating that these trends extend even to younger pts

Conclusions• Substantial changes in VA use have been seen

across some countries during the last decade

• In some nations, VA improvement programs have resulted in increases in AVF use

• Concerns are raised by the large rises in CATH use in some countries even among younger pts with lower comorbidity burden

• Greater CATH use has been linked with higher mortality; future analyses will evaluate changes in practices with changes in clinical outcomes

Acknowledgements• Our thanks to DOPPS study coordinators, medical directors, and

participating patients for their dedicated contributions to DOPPS.

• The DOPPS would not be possible without the generous financial

support of the following companies for their strong commitment to

independent scientific research to improve patient care:

– Amgen (since 1996)– Kyowa Hakko Kirin (since 1999, in Japan)

– Abbott Laboratories (since 2009)

– Sanofi Renal (since 2009)

– Baxter Healthcare (since 2011)

– Vifor Fresenius Medical Care Renal Pharma Ltd (since 2011)

• Support from DOPPS sponsors is provided without restrictions on

publications.

D PPS Dialysis Outcomes and Practice Patterns Study

Thanks.