JT HUGHES1,2, SW MAJONI1,2,3 , F BARZI1, S SIGNAL2, J KAPOJOS2, A ABEYARATNE2, M SUNDARAM2, P GOLDRICK4, SL JONES4, R McFARLANE5, LT CAMPBELL3, D STEPHENS3, 4, A CASS1
1Menzies School of Health Research, Charles Darwin University, Darwin, NT; 2Department of Nephrology, Division of Medicine, Royal Darwin Hospital, NT; 3Northern Territory Clinical School, Flinders University, Darwin NT; 4Intensive Care Unit, Royal Darwin Hospital; 5Chemical Pathology, Territory Pathology, Department of Health, Darwin, NT
Background: The Northern Territory (NT) has the highest national prevalence of dialysis-dependent end stage kidney disease (ESKD). All haemodialysis initiation in the Top-End region occurs at the Royal Darwin Hospital dialysis unit (DU), or intensive care unit (ICU) with continuous veno-venous haemofiltration if critically unwell.
Aim: to describe the survival of clients presenting for an incident haemodialysis (i-HD) treatment in the Top-End NT between 1 January 2011 to 21 December 2012.
Methods: Admissions data describing the incident HD (i-HD) treatment in clients (>18 years) were identified from the ANZICS database and DU diary (available for 01/07/2011-31/12/2012). Planned dialysis at i-HD was defined as admission within DU of <8 hours. Survival was calculated to date of death or follow-up (censored at 31/12/2015). Requirement for ongoing maintenance dialysis (mRRT) after 90 days was confirmed by ANZDATA and chart review.
Results: Admissions for i-HD occurred in 176 clients (52.7% male, Indigenous 71%, mean age 50.5 (range 18.5-87.1) years, median eGFR within 90 days of i-HD 24 (IQR 8-61) ml/min/1.73m2), at the DU 39.2%, ICU 47.2% or both units (DU-ICU) 13.6%. In this period, 57 clients (32.4%) at i-HD continued with mRRT, though only 17/57 (29.8%) had i-HD as a planned-dialysis. 136 (77.2%) clients survived 30 days, with 50.6% overall survival. Survival was higher in clients with i-HD in DU than ICU (69.6 v 37.3%%, p<0.001) or ICU-DU (69.6 v 41.7%, p=0.01). Survival was unrelated to planned-dialysis (p=0.08).
Discussion: The Top-End NT has a high demand for dialysis support with incident haemodialysis in the context of critical illness and unplanned-dialysis; though only critical illness was associated with lower survival. Further research understanding factors associated with unplanned dialysis is required.