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Background: The use of haemodiafiltration (HDF) for the management of patients with end‐stage kidney failure is increasing worldwide. Factors associated with HDF use have not been studied and may vary in different countries and jurisdictions. The aim of this study was to document the pattern of increase and variability in uptake of HDF in Australia and New Zealand, and to describe patient‐ and centre‐related factors associated with its use. Methods: Using the Australian and New Zealand Dialysis and Transplant Registry, all incident patients commencing haemodialysis (HD) between 2000 and 2014 were included. The primary outcome was HDF commencement over time, which was evaluated using multivariable logistic regression stratified by country. Results: Of 27 433 patients starting HD, 3339 (14.4%) of 23 194 patients in Australia and 810 (19.1%) of 4239 in New Zealand received HDF. HDF uptake increased over time in both countries but was more rapid in New Zealand than Australia. In Australia, HDF use was more likely in males (odds ratio (OR) 1.13, 95% confidence interval (CI) = 1.03–1.24, P = 0.009) and less likely with older age (reference <40 years; 40–54 years OR = 0.85; 95% CI = 0.72–0.99; 55–69 years OR = 0.79; 95% CI = 0.67–0.91; >70 years OR = 0.48; 95% CI = 0.41–0.56); higher body mass index (body mass index (BMI) < 18.5 kg/m2 OR = 0.62; 95% CI = 0.46–0.84; 18.5–29.9 kg/m2 reference; >30 kg/m2 OR = 1.46; 95% CI = 1.33–1.61), chronic lung disease (OR = 0.84; 95% CI = 0.76–0.94; P < 0.001), cerebrovascular disease (OR = 0.76; 95% CI = 0.67–0.85; P < 0.001) and peripheral vascular disease (OR = 0.77; 95% CI = 0.70–0.85; P < 0.001). No association was identified with race. In New Zealand, HDF use was more likely in Maori and Pacific Islanders (OR = 1.32; 95% CI = 1.05–1.66) and Asians (OR = 1.75; 95% CI = 1.15–2.68) compared to Caucasians, and less likely in males (OR = 0.76; 95% CI = 0.62–0.94; P = 0.01). No association was identified with BMI or co‐morbidities. In both countries, centres with a higher ratio of HD to peritoneal dialysis (PD) were more likely to prescribe HDF. Larger Australian centres were more likely to prescribe HDF (36–147 new patients/year OR = 26.75, 95% CI = 18.54–38.59; 17–35/year OR = 7.51, 95% CI = 5.35–10.55; 7–16/year OR = 3.00; 95% CI = 2.19–4.13; ≤6/year reference). Conclusion: Haemodiafiltration uptake is increasing, variable and associated with both patient and centre characteristics. Centre characteristics not explicitly captured elsewhere explained 36% of variability in HDF uptake in Australia and 48% in New Zealand. SUMMARY AT A GLANCE: The use of haemodiafiltration (HDF) for the management of patients with end‐stage renal disease is increasing worldwide. In this study of the pattern of HDF in Australia and New Zealand, the authors described that HDF uptake is increasing, variable and associated with both patient and centre characteristics. In particular, HDF uptake increase was more rapid in New Zealand than Australia, where HDF use in NZ was more likely in Maori and Pacific Islanders and Asians compared to Caucasians. [ABSTRACT FROM AUTHOR]

Aims: (1) To determine incidence and reasons for transfer from maintenance haemodialysis (HD) to peritoneal dialysis (PD); (2) To compare mortality of HD patients transferred to PD with those who initiated and remained on PD. Methods: A 1:2 matched cohort of ANZDATA included patients dialyzing over 3 months dividing into 2 groups. Group A (HD to PD) was compared to group B (initiated and remained on PD) and matched PD group (Group C). We compared mortality by total time on dialysis regardless of modality. Results: Of 20 882 patients, there were 911 in group A. The transfer rate from HD to PD was 5%, 6.7% and 7.4% at 1,4 and 8 years, respectively. Median time before switching of patients in Group A was 5.9 (4.0–10.9) months. The commonest reported reason for transfer was patient preference (63.8%). Mortality was significantly worse in Group A if dialysis vintage was ≤6 months and from 12–24 months (P < 0.05), whereas there was no difference in mortality if dialysis vintage was 6–12 months or ≥ 24 months (P = 0.073 and P = 0.153, respectively). Overall, mortality of patients in group A was higher than that in group B after adjusting for age, race, chronic lung disease, peripheral vascular disease, cerebrovascular disease, diabetes, haemoglobin and phosphate (hazard ratio = 1.335, 95% confidence interval = 1.172–1.520). Conclusion: Haemodialysis patients transferred to PD had higher mortality than those initiated on PD, strengthening the case for PD first policy. SUMMARY AT A GLANCE: In this matched cohort analysis, patients who were started on peritoneal dialysis had better survival than patients who were transferred from haemodialysis to peritoneal dialysis, even though the average time of conversion was around 6 months after dialysis and the major reason of conversion was patient preference. These findings lend support to the PD‐first policy. [ABSTRACT FROM AUTHOR]

Background It is unclear if haemodiafiltration improves patient survival compared with standard haemodialysis. Observational studies have tended to show benefit with haemodiafiltration, while meta-analyses have not provided definitive proof of superiority. Methods Using data from the Australia and New Zealand Dialysis and Transplant Registry, this binational inception cohort study compared all adult patients who commenced haemodialysis in Australia and New Zealand between 2000 and 2014. The primary outcome was all-cause mortality. Cardiovascular mortality was the secondary outcome. Outcomes were measured from the first haemodialysis treatment and were examined using multivariable Cox regression analyses. Patients were censored at permanent discontinuation of haemodialysis or at 31 December 2014. Analyses were stratified by country. Results The study included 26 961 patients (4110 haemodiafiltration, 22 851 standard haemodialysis; 22 774 Australia, 4187 New Zealand) with a median follow-up of 5.31 (interquartile range 2.87–8.36) years. Median age was 62 years, 61% were male, 71% were Caucasian. Compared with standard haemodialysis, haemodiafiltration was associated with a significantly lower risk of all-cause mortality [adjusted hazard ratio (HR) for Australia 0.79, 95% confidence interval (95% CI) 0.72–0.87; adjusted HR for New Zealand 0.88, 95% CI 0.78–1.00]. In Australian patients, there was also an association between haemodiafiltration and reduced cardiovascular mortality (adjusted HR 0.78, 95% CI 0.64–0.95). Conclusion Haemodiafiltration was associated with superior survival across patient subgroups of age, sex and comorbidity. [ABSTRACT FROM AUTHOR]