N KHANAL1,2 , PD LAWTON3, A CASS3, SP MCDONALD1,2
1School of Medicine, University of Adelaide, Adelaide, South Australia; 2Australia & New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide; 3Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory
Aim: To determine the relationship of dialysis attendance with wait-listing for kidney transplantation (KT) among NT based end stage kidney disease (ESKD) patients
Background: Substantial differences exist in the rates of wait-listing of Indigenous ESKD patients. Little is known about the association of dialysis attendance and wait-listing. When dialysis attendance is less than prescribed, it may affect nephrologists’ decision whether or not to refer patient for transplantation due to concerns about outcomes in the post-transplant period. We examined the relationship of facility haemodialysis (FHD) attendance with wait-listing in NT based ESKD patients.
Methods: We used NT hospital separations data, linked with waiting-list, demographic, comorbidity and transplant related information from the ANZDATA registry. Inclusion criteria: NT based ESKD patients who started renal replacement therapy between 28th June 2006 and 31st December 2011, were on FHD and wait-listed by 30th June 2012 censored for transplantation, death, renal recovery and lost to follow-up (n=295). Outcome measure: first active placement on waiting list. Predictors: attendance at FHD during the study period.
Results: Of 295 participants, 266 (90.2%) were Indigenous. Based on mean weekly FHD attendance, patients were divided in three groups: >2.75/week (n=106), 2.5 to 2.75/week (n=55) and <2.5/week (n=134). 21 patients (7.0%) were listed, of whom 15 (71.4%) received deceased donor transplants. Of 19 KT, there were 4 (21.04%) live donor transplants. Compared to >2.75 dialysis sessions/week, likelihood for listing was similar in those attending 2.5-2.75/week (HR 0.8 [95% CI 0.2-4.2]) and < 2.5/ week, (HR 1.7 [0.5-5.5]).
Conclusions: In the NT, rates of placement on the waiting list among those receiving FHD are low. FHD attendance was not associated with wait-listing, although the statistical power was limited.