@article{fcb40e3e32e848a28826f20bdb5d2659,
title = "Dialysis modality utilization patterns and mortality in older persons initiating dialysis in Australia and New Zealand",
abstract = "Aim: The benefits of dialysis in the older population remain highly debated, particularly for certain dialysis modalities. This study aimed to explore the dialysis modality utilization patterns between in-centre haemodialysis (ICHD), peritoneal dialysis (PD) and home haemodialysis (HHD) and their association with outcomes in older persons. Methods: Older persons (≥75 years) initiating dialysis in Australia and New Zealand from 1999 to 2018 reported to the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry were included. The main aim of the study was to characterize dialysis modality utilization patterns and describe individual characteristics of each pattern. Relationships between identified patterns and survival, causes of death and withdrawal were examined as secondary analyses, where the pattern was considered as the exposure. Results: A total of 10 306 older persons initiated dialysis over the study period. Of these, 6776 (66\%) and 1535 (15\%) were exclusively treated by ICHD and PD, respectively, while 136 (1\%) ever received HHD during their dialysis treatment course. The remainder received both ICHD and PD: 906 (9\%) started dialysis on ICHD and 953 (9\%) on PD. Different individual characteristics were seen across dialysis modality utilization patterns. Median survival time was 3.0 (95\%CI 2.9–3.1) years. Differences in survival were seen across groups and varied depending on the time period following dialysis initiation. Dialysis withdrawal was an important cause of death and varied according to individual characteristics and utilization patterns. Conclusion: This study showed that dialysis modality utilization patterns in older persons are associated with mortality, independent of individual characteristics.",
keywords = "dialysis, dialysis modality, haemodialysis, kidney failure, older persons, peritoneal dialysis",
author = "Isabelle Ethier and Campbell, \{Scott B.\} and Yeoungjee Cho and Hawley, \{Carmel M.\} and Isbel, \{Nicole M.\} and Rathika Krishnasamy and Roberts, \{Matthew A.\} and David Semple and Matthew Sypek and Viecelli, \{Andrea K.\} and Johnson, \{David W.\}",
note = "Funding Information: Centre Hospitalier de l{\textquoteright}Universit{\'e} de Montr{\'e}al and the Fondation du CHUM; National Health and Medical Research Council, Grant/Award Number: 1196033; Queensland Advancing Clinical Research Fellowship Funding information Funding Information: YC reports personal fees from Baxter, and grant support from Fresenius Medical Care, PKD Australia, NHMRC and Baxter CEC Grant, outside the submitted work. CH reports personal fees from Janssen, GlaxoSmithKline and Osuka, and grant support from Baxter, Fresenius, Shire, PKD Aus and NHMRC, outside the submitted work. NI reports personal fees from Alexion Pharmaceuticals, outside the submitted work. RK reports personal fees from Baxter Healthcare and Amgen and grant support from Baxter, outside the submitted work. DJ reports personal fees from AWAK, Astra‐Zeneca, Bayer, Boehringer‐Ingelheim \& Lilly, Ono, Baxter Healthcare and Fresenius Medical Care, and grant support from Baxter Extramural Grant and Baxter CEC Grant, outside the submitted work. The other authors do not have any interest in the information contained in the manuscript to disclose. Funding Information: The authors gratefully acknowledge the contributions of the entire Australia and New Zealand nephrology community (physicians, surgeons, database managers, nurses, renal operators and patients) in providing information for and maintaining the ANZDATA database. Reporting and interpretation of these data should in no way be seen as an official policy or interpretation of the ANZDATA Registry and are the responsibility of the authors. IE would like to acknowledge the Centre Hospitalier de l'Universit{\'e} de Montr{\'e}al and the Fondation du CHUM for their support through a fellowship grant. YC is supported by an Australian National Health and Medical Research Council (NHMRC) Emerging Leader Investigator Grant. AV is supported by a Queensland Advancing Clinical Research Fellowship and an Australian NHMRC Emerging Leader Grant (1196033). DJ is supported by an Australian NHMRC Leadership Investigator Grant. Publisher Copyright: {\textcopyright} 2022 Asian Pacific Society of Nephrology.",
year = "2022",
month = aug,
doi = "10.1111/nep.14073",
language = "English",
volume = "27",
pages = "663--672",
journal = "Nephrology",
issn = "1320-5358",
publisher = "Wiley-Blackwell",
number = "8",
}