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BMC Nephrology

, 14:278

Dialysis and Transplantation

Abstract

BackgroundAustralians 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.

MethodsNon-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.

ResultsA 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.

ConclusionsPD 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.

KeywordsANZDATA Australia Dialysis Mortality Outcomes Peritoneal dialysis Remoteness Rural AbbreviationsPDPeritoneal dialysis

ANZDATAAustralia and New Zealand Dialysis and Transplant Registry

MCMajor city

IRInner regional

OROuter regional

REMRemote-very remote

CIConfidence intervals

HDHaemodialysis

CAPDContinuous ambulatory peritoneal dialysis

APDAutomated peritoneal dialysis.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2369-14-278 contains supplementary material, which is available to authorized users.

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Author: Nicholas A Gray - Blair S Grace - Stephen P McDonald

Source: https://link.springer.com/







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