Variability in Dialysis Access Over Time and Across Centres in Australia and New Zealand: Effect of Centre- and Patient-Related Factors on Dialysis Access Quality Indicators.

Abstract

Aim: The Australian and New Zealand Society of Nephrology (ANZSN) established a quality indicator (QI) program to measure performance and reduce variation of nephrology care. This program relies on registry data from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). ANZDATA also conducts surveys to ascertain more granular characteristics of participating nephrology units to better understand variation in practice. This study assessed ANZDATA and nephrology unit surveys to determine patient- and centre-level factors that may account for variation in dialysis access QIs.

Methods: Dialysis access QIs were evaluated over a 5-year period using ANZDATA (2016-2020). Patient characteristics were derived from the same period and dataset. Centre characteristics were determined from the 2020-unit binational survey. Statistical analysis involved multivariable regression with fixed effects for patient- and centre-characteristics and a random effect by centre.

Results: Wide variation was seen across dialysis access QIs. Using multivariable regression, patient-level characteristics associated with definitive dialysis access at commencement of dialysis included male gender and body mass index decreasing from 30 kg/m². Centres with a home haemodialysis nurse and a 'peritoneal dialysis (PD) first policy' were associated with higher rates of definitive dialysis access. There was also a progressive relationship with the number of full-time equivalent (FTE) medical staff if the unit already had an FTE greater than 10. Inclusion of centre-level variables reduced the variance in the model by 68%.

Conclusion: This study demonstrates certain patient- and centre-level characteristics are associated with definitive dialysis access at the commencement of dialysis in Australia and New Zealand. Interventional trials for PD first programmes and different models of care for vascular access are needed.