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Aim: To determine if a Comprehensive Geriatric Assessment (CGA) will allow frail older patients with chronic kidney disease (CKD) to better attain their treatment goals and improve their frailty and quality of life, while being cost-effective. Background(s): There is an increasing number of frail older patients with CKD. Many of them face deteriorating health and functional status, which adversely affects their quality of life. CGA is an effective intervention to improve survival and independence of older people but its effect in people with CKD remains unknown. Method(s): GOAL is a NHMRC-funded cluster randomized controlled trial developed by consumers, clinicians and researchers. It will recruit patients from January 2021 aged >=65 with CKD stage 3-5/5D and a Frailty Index >0.25. The intervention clusters will receive a CGA by a geriatrician to identify medical, social and functional needs, optimize medication prescribing and arrange multidisciplinary referral if required. The primary outcome is attainment of patient determined goals assessed by standardized Goal Attainment Scaling (GAS) at 3 months. Secondary outcomes include GAS scores at 6 and 12 months, quality of life (EQ-5D-5L), frailty (Frailty Index - Short Form), transfer to residential aged care facilities, cost effectiveness and safety (causespecific hospitalizations, mortality) at 12 months. Result(s): A two-arm design of 16 clusters with 1:1 allocation (~500 participants) has 90% power to detect a clinically meaningful mean difference in GAS score of 10 units. Conclusion(s): The GOAL trial addresses patient-prioritized outcomes and will be conducted, disseminated and implemented in partnership with patients and their caregivers. This is the first study, internationally, to evaluate the clinical and cost effectiveness of CGA in improving patient-important health outcomes in frail older people with CKD.

Aim: To determine if a Comprehensive Geriatric Assessment (CGA) will allow frail older patients with chronic kidney disease (CKD) to better attain their treatment goals and improve their frailty and quality of life, while being cost-effective. Background(s): There is an increasing number of frail older patients with CKD. Many of them face deteriorating health and functional status, which adversely affects their quality of life. CGA is an effective intervention to improve survival and independence of older people but its effect in people with CKD remains unknown. Method(s): GOAL is a NHMRC-funded cluster randomized controlled trial developed by consumers, clinicians and researchers. It will recruit patients from January 2021 aged >=65 with CKD stage 3-5/5D and a Frailty Index >0.25. The intervention clusters will receive a CGA by a geriatrician to identify medical, social and functional needs, optimize medication prescribing and arrange multidisciplinary referral if required. The primary outcome is attainment of patient determined goals assessed by standardized Goal Attainment Scaling (GAS) at 3 months. Secondary outcomes include GAS scores at 6 and 12 months, quality of life (EQ-5D-5L), frailty (Frailty Index - Short Form), transfer to residential aged care facilities, cost effectiveness and safety (causespecific hospitalizations, mortality) at 12 months. Result(s): A two-arm design of 16 clusters with 1:1 allocation (~500 participants) has 90% power to detect a clinically meaningful mean difference in GAS score of 10 units. Conclusion(s): The GOAL trial addresses patient-prioritized outcomes and will be conducted, disseminated and implemented in partnership with patients and their caregivers. This is the first study, internationally, to evaluate the clinical and cost effectiveness of CGA in improving patient-important health outcomes in frail older people with CKD.

Background: Hemodialysis treatment prescription varies widely around the world. This study explored patient- and center-level characteristics associated with weekly haemodialysis hours. Method(s): Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data was analyzed. Characteristics associated with weekly duration were evaluated using mixed-effects linear regression models with patient- and center-level covariates as fixed effects, and dialysis center and state as random effects using the 2017 prevalent in-centre hemodialysis (ICHD) and home hemodialysis (HHD) cohorts. Evaluation of patterns of weekly duration over time analyzed the 2000 to 2017 incident ICHD and HHD cohorts. Result(s): Overall, 12,494 ICHD and 1,493 HHD prevalent patients in 2017 were included. Median weekly treatment duration was 13.5 (interquartile range (IQR) 12-15) hours for ICHD and 16 (IQR 15-20) hours for HHD. Male sex, younger age, higher body mass index, arteriovenous fistula/graft use, Aboriginal and Torres Strait Islander ethnicity and longer dialysis vintage were associated with longer weekly duration for both ICHD and HHD. No center characteristics were associated with weekly duration. Variability in duration across centers was very limited in ICHD compared to HHD, with variation in HHD being associated with state. Duration did not vary significantly over time for ICHD, whereas longer weekly HHD treatments were reported between 2006 and 2012 compared to before and after this period. Conclusion(s): This study in the Australian and New Zealand hemodialysis population showed that weekly treatment duration was primarily associated with patient characteristics. No center effect was demonstrated. Practice patterns seemed to differ across states/countries, with more variability in HHD than in ICHD. (Figure Presented).

Background: Hemodialysis treatment prescription varies widely around the world. This study explored patient- and center-level characteristics associated with weekly haemodialysis hours. Method(s): Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data was analyzed. Characteristics associated with weekly duration were evaluated using mixed-effects linear regression models with patient- and center-level covariates as fixed effects, and dialysis center and state as random effects using the 2017 prevalent in-centre hemodialysis (ICHD) and home hemodialysis (HHD) cohorts. Evaluation of patterns of weekly duration over time analyzed the 2000 to 2017 incident ICHD and HHD cohorts. Result(s): Overall, 12,494 ICHD and 1,493 HHD prevalent patients in 2017 were included. Median weekly treatment duration was 13.5 (interquartile range (IQR) 12-15) hours for ICHD and 16 (IQR 15-20) hours for HHD. Male sex, younger age, higher body mass index, arteriovenous fistula/graft use, Aboriginal and Torres Strait Islander ethnicity and longer dialysis vintage were associated with longer weekly duration for both ICHD and HHD. No center characteristics were associated with weekly duration. Variability in duration across centers was very limited in ICHD compared to HHD, with variation in HHD being associated with state. Duration did not vary significantly over time for ICHD, whereas longer weekly HHD treatments were reported between 2006 and 2012 compared to before and after this period. Conclusion(s): This study in the Australian and New Zealand hemodialysis population showed that weekly treatment duration was primarily associated with patient characteristics. No center effect was demonstrated. Practice patterns seemed to differ across states/countries, with more variability in HHD than in ICHD. (Figure Presented).

Introduction: An arteriovenous access, including fistula and graft, is preferred to a central venous catheter (CVC) but the majority of patients start haemodialysis with a CVC. The aims of this study were to examine patient- and centre-level factors associated with incident arteriovenous access versus CVC use and the contribution of these factors to centre variation in incident arteriovenous access use. Method(s): Using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, all adult (>=18yo) patients commencing haemodialysis between 1 January 2004 and 31 December 2015 were included. The primary outcome, vascular access type (arteriovenous access versus CVC) at haemodialysis initiation, was analysed using logistic regression models with a random effect for dialysis centre. Patient-level factors examined included sex, age, race, body mass index (BMI), smoking status, primary kidney disease, late referral to nephrology (<3 months), cardiovascular disease (ischaemic heart disease, cerebrovascular disease, peripheral vascular disease), diabetes mellitus, chronic lung disease, and previous renal replacement therapy (RRT). Centre-level factors included centre size, transplantation facility status, percentage of home haemodialysis patients, mean weekly haemodialysis hours, and percentage of patients achieving target blood flow rates, phosphate levels, haemoglobin, and weekly Kt/V. Result(s): The study included 27,123 patients from 61 centres. The mean proportion of patients starting haemodialysis with an arteriovenous access varied from 15% to 61% (median 39%). Patient-level factors associated with an increased likelihood of starting haemodialysis with an arteriovenous access were male sex, BMI >25kg/m2and polycystic kidney disease as primary kidney disease. Patient-level factors associated with a decreased likelihood of starting haemodialysis with an arteriovenous access included BMI<18.5kg/m2, late nephrologist referral, diabetes mellitus, ca

Introduction: An arteriovenous access, including fistula and graft, is preferred to a central venous catheter (CVC) but the majority of patients start haemodialysis with a CVC. The aims of this study were to examine patient- and centre-level factors associated with incident arteriovenous access versus CVC use and the contribution of these factors to centre variation in incident arteriovenous access use. Method(s): Using data from the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, all adult (>=18yo) patients commencing haemodialysis between 1 January 2004 and 31 December 2015 were included. The primary outcome, vascular access type (arteriovenous access versus CVC) at haemodialysis initiation, was analysed using logistic regression models with a random effect for dialysis centre. Patient-level factors examined included sex, age, race, body mass index (BMI), smoking status, primary kidney disease, late referral to nephrology (<3 months), cardiovascular disease (ischaemic heart disease, cerebrovascular disease, peripheral vascular disease), diabetes mellitus, chronic lung disease, and previous renal replacement therapy (RRT). Centre-level factors included centre size, transplantation facility status, percentage of home haemodialysis patients, mean weekly haemodialysis hours, and percentage of patients achieving target blood flow rates, phosphate levels, haemoglobin, and weekly Kt/V. Result(s): The study included 27,123 patients from 61 centres. The mean proportion of patients starting haemodialysis with an arteriovenous access varied from 15% to 61% (median 39%). Patient-level factors associated with an increased likelihood of starting haemodialysis with an arteriovenous access were male sex, BMI >25kg/m2and polycystic kidney disease as primary kidney disease. Patient-level factors associated with a decreased likelihood of starting haemodialysis with an arteriovenous access included BMI<18.5kg/m2, late nephrologist referral, diabetes mellitus, ca

Aim: As part of the FAVOURED Study, we examined the effect of fish oil and aspirin on arteriovenous fistula (AVF) interventions and central venous catheter (CVC) use. Background(s): Successful creation of an AVF is limited by early thrombosis and maturation failure requiring interventions and/or placement of CVC. These complications may be reduced by pleotropic effects of fish oil upon vascular biology and inflammation, and platelet inhibition by aspirin. Method(s): In 567 adult participants planned for AVF creation, all were randomised to fish oil (4g/d) or placebo, and 406 to aspirin (100mg/d) or placebo, starting 1 day pre-surgery and continued for 12 weeks. Pre-specified secondary outcomes included rates of rescue interventions for AVF thrombosis, non-rescue interventions, and the frequency and duration of CVC requirements within 12 months of access creation. Result(s): The mean age was 55 years, 64% were male and 47% diabetic. Fish oil supplementation significantly reduced the overall rate of access interventions compared to placebo (0.82 vs 1.14 interventions/1000 patient-days, incident rate ratio [IRR] 0.72, 95% confidence interval [CI] 0.54-0.97, p=0.03), driven by a reduction in rescue interventions (0.09 vs 0.17 interventions/1000 patient-days, IRR 0.53, 95% CI 0.34-0.84). Similarly, low-dose aspirin significantly reduced rescue intervention rates (IRR 0.45, 95% CI 0.27-0.78) but not overall intervention rates (IRR 0.84, 95% CI 0.59-1.19). Half of the participants required a CVC and neither fish oil nor aspirin reduced the frequency or duration of CVC requirements compared to placebo. Conclusion(s): Fish oil and aspirin given for 3 months both independently reduced intervention rates in newly created AVF but they had no significant effects on CVC requirements. Reduction in access interventions benefits patients, reduces costs and warrants further study.

Introduction and Aims: Successful creation of a native arteriovenous fistula (AVF) for patients in need of haemodialysis is limited by early thrombosis and maturation failure requiring interventions and/or placement of central venous catheters (CVC). These complications maybe reduced by pleotropic effects of omega-3 polyunsaturated fatty acids (fish oils) upon vascular biology and inflammation and platelet inhibition by aspirin. As part of the Omega-3 Fatty Acids (Fish Oils) and Aspirin in Vascular Access Outcomes in Renal Disease (FAVOURED) Study, we examined the effect offish oil supplementation and aspirin use on the rate of AVF interventions and need for CVC. Method(s): 567 adults with chronic kidney disease currently receiving or expecting to receive haemodialysis within 12 months were randomly allocated to fish oil (4g/d) or placebo. A subset of 406 participants was randomised to aspirin (100mg/d) or placebo. Treatment commenced 1 day prior to surgery and continued for 12 weeks. This study examined secondary and exploratory outcomes including AVF interventions for acute thrombosis, interventions to assist AVF maturation and the need for CVC placement within 12 months of access creation. Relative risks [RR] for binary outcomes and incidence rate ratios [IRR] for count outcomes are reported. Result(s): The mean age was 55 years, 64% were male and 47% diabetic. Fish oil supplementation significantly reduced the overall rate of access interventions compared to placebo (0.82 vs 1.14 interventions/1000 patient-days, IRR 0.72,95% confidence interval [CI] 0.54-0.97, p=0.03), driven by a reduction in rescue interventions (0.09 vs 0.17 interventions/1000 patient-days, IRR 0.53,95% CI 0.34-0.84); Table 1A. Similarly, low-dose aspirin significantly reduced rescue intervention rates (IRR 0.45,95% CI 0.27-0.78) but not overall intervention rates (IRR 0.84,95% CI 0.59-1.19); Table 1B. Half of the participants required a CVC and neither fish oil nor aspirin reduced the freque

Introduction and Aims: Technique failure is a major complication of peritoneal dialysis (PD) treatment and is associated with significant risk to patients and health services. The first year has been recognised as a particularly vulnerable period, with studies estimating that just under one-half of patients who develop technique failure do so within this time. This study aimed to identify the key risk factors and risk periods for early transfer to haemodialysis or death in incident PD patients. Method(s): Using data from the ANZDATA Registry, this study included all adult patients who commenced PD in Australia and New Zealand between 2000 and 2014. Competing risk regression models were used to analyse the primary outcome, which was technique failure within the first year (kidney transplantation was the competing risk), as well as the secondary outcomes, which examined each cause of technique failure (kidney transplantation and other causes of technique failure were the competing risks). Patients were censored at the time of kidney transplantation, recovery of renal function, loss to follow up, or at 365.25 days after commencement of PD. Result(s): Of 16,748 patients who commenced PD during the study period, 4,389 patients reached the primary outcome. Factors associated with increased risk included age >70 years, diabetes or vascular disease, prior renal replacement therapy, late referral to a nephrology service, or management in a smaller centre. Asian or other race and use of continuous ambulatory PD were associated with reduced risk, as was commencement of PD between 2010 and 2014. Although the risk of technique failure due to death or infection was constant over the first year, mechanical and other causes accounted for a greater number of cases within the initial 9 months of treatment. [Figure Presented] Conclusion(s): Several modifiable and non-modifiable factors are associated with early technique failure. Variation in the principal cause of early technique fai

Aim: As part of the FAVOURED Study, we examined the effect of fish oil and aspirin on arteriovenous fistula (AVF) interventions and central venous catheter (CVC) use. Background(s): Successful creation of an AVF is limited by early thrombosis and maturation failure requiring interventions and/or placement of CVC. These complications may be reduced by pleotropic effects of fish oil upon vascular biology and inflammation, and platelet inhibition by aspirin. Method(s): In 567 adult participants planned for AVF creation, all were randomised to fish oil (4g/d) or placebo, and 406 to aspirin (100mg/d) or placebo, starting 1 day pre-surgery and continued for 12 weeks. Pre-specified secondary outcomes included rates of rescue interventions for AVF thrombosis, non-rescue interventions, and the frequency and duration of CVC requirements within 12 months of access creation. Result(s): The mean age was 55 years, 64% were male and 47% diabetic. Fish oil supplementation significantly reduced the overall rate of access interventions compared to placebo (0.82 vs 1.14 interventions/1000 patient-days, incident rate ratio [IRR] 0.72, 95% confidence interval [CI] 0.54-0.97, p=0.03), driven by a reduction in rescue interventions (0.09 vs 0.17 interventions/1000 patient-days, IRR 0.53, 95% CI 0.34-0.84). Similarly, low-dose aspirin significantly reduced rescue intervention rates (IRR 0.45, 95% CI 0.27-0.78) but not overall intervention rates (IRR 0.84, 95% CI 0.59-1.19). Half of the participants required a CVC and neither fish oil nor aspirin reduced the frequency or duration of CVC requirements compared to placebo. Conclusion(s): Fish oil and aspirin given for 3 months both independently reduced intervention rates in newly created AVF but they had no significant effects on CVC requirements. Reduction in access interventions benefits patients, reduces costs and warrants further study.

Introduction and Aims: Successful creation of a native arteriovenous fistula (AVF) for patients in need of haemodialysis is limited by early thrombosis and maturation failure requiring interventions and/or placement of central venous catheters (CVC). These complications maybe reduced by pleotropic effects of omega-3 polyunsaturated fatty acids (fish oils) upon vascular biology and inflammation and platelet inhibition by aspirin. As part of the Omega-3 Fatty Acids (Fish Oils) and Aspirin in Vascular Access Outcomes in Renal Disease (FAVOURED) Study, we examined the effect offish oil supplementation and aspirin use on the rate of AVF interventions and need for CVC. Method(s): 567 adults with chronic kidney disease currently receiving or expecting to receive haemodialysis within 12 months were randomly allocated to fish oil (4g/d) or placebo. A subset of 406 participants was randomised to aspirin (100mg/d) or placebo. Treatment commenced 1 day prior to surgery and continued for 12 weeks. This study examined secondary and exploratory outcomes including AVF interventions for acute thrombosis, interventions to assist AVF maturation and the need for CVC placement within 12 months of access creation. Relative risks [RR] for binary outcomes and incidence rate ratios [IRR] for count outcomes are reported. Result(s): The mean age was 55 years, 64% were male and 47% diabetic. Fish oil supplementation significantly reduced the overall rate of access interventions compared to placebo (0.82 vs 1.14 interventions/1000 patient-days, IRR 0.72,95% confidence interval [CI] 0.54-0.97, p=0.03), driven by a reduction in rescue interventions (0.09 vs 0.17 interventions/1000 patient-days, IRR 0.53,95% CI 0.34-0.84); Table 1A. Similarly, low-dose aspirin significantly reduced rescue intervention rates (IRR 0.45,95% CI 0.27-0.78) but not overall intervention rates (IRR 0.84,95% CI 0.59-1.19); Table 1B. Half of the participants required a CVC and neither fish oil nor aspirin reduced the freque

Introduction and Aims: Technique failure is a major complication of peritoneal dialysis (PD) treatment and is associated with significant risk to patients and health services. The first year has been recognised as a particularly vulnerable period, with studies estimating that just under one-half of patients who develop technique failure do so within this time. This study aimed to identify the key risk factors and risk periods for early transfer to haemodialysis or death in incident PD patients. Method(s): Using data from the ANZDATA Registry, this study included all adult patients who commenced PD in Australia and New Zealand between 2000 and 2014. Competing risk regression models were used to analyse the primary outcome, which was technique failure within the first year (kidney transplantation was the competing risk), as well as the secondary outcomes, which examined each cause of technique failure (kidney transplantation and other causes of technique failure were the competing risks). Patients were censored at the time of kidney transplantation, recovery of renal function, loss to follow up, or at 365.25 days after commencement of PD. Result(s): Of 16,748 patients who commenced PD during the study period, 4,389 patients reached the primary outcome. Factors associated with increased risk included age >70 years, diabetes or vascular disease, prior renal replacement therapy, late referral to a nephrology service, or management in a smaller centre. Asian or other race and use of continuous ambulatory PD were associated with reduced risk, as was commencement of PD between 2010 and 2014. Although the risk of technique failure due to death or infection was constant over the first year, mechanical and other causes accounted for a greater number of cases within the initial 9 months of treatment. [Figure Presented] Conclusion(s): Several modifiable and non-modifiable factors are associated with early technique failure. Variation in the principal cause of early technique fai