Changes in Dialysis Practice Patterns in Australia and New Zealand During the COVID-19 Pandemic Period.

Aim: The COVID-19 pandemic caused widespread global disruptions to healthcare systems. There has been no assessment of this on dialysis practice at a binational level.

Methods: A multi-centre retrospective observational cohort study using data from the ANZDATA Registry was performed, with adult incident dialysis patients (1 January 2018 to 31 December 2022). Patients commencing dialysis during 2020-2022 were compared to 2018-2019 for the primary outcome of dialysis incidence rate. Secondary outcomes included estimated glomerular filtration rate (eGFR) at dialysis start, initial treatment location (home vs. facility), modality (haemodialysis vs. peritoneal dialysis), haemodialysis access, frequency, and duration. Commencement during lockdown in 2020-2021 was also analysed.

Results: 11 690 patients commenced dialysis during 2020-2022 and 7366 commenced during 2018-2019, with no differences in incidence rate across the pandemic years (2020: p = 0.163, 2021: p = 0.139, 2022: p = 0.190). Compared to pre-pandemic years, uptake of home-based therapies was higher in 2020 (OR = 1.16, 95% CI 1.06-1.27, p = 0.002) with no difference in 2021 and 2022. Peritoneal dialysis uptake was higher in 2020 (OR = 1.15, 95% CI 1.04-1.26, p = 0.005) and 2021 (OR = 1.11, 95% CI 1.01-1.21, p = 0.037) with no difference in 2022. Haemodialysis patients were less likely to commence with an arteriovenous fistula or graft in 2022, compared to pre-pandemic years (OR = 0.87, 95% CI 0.78-0.96, p = 0.005). Odds of commencing haemodialysis with an arteriovenous fistula or graft were reduced during lockdown (OR = 0.79, 95% CI 0.65-0.95, p = 0.014).

Conclusion: There was no change in the incidence rate of dialysis patients during 2020-2022, although there were differences in home dialysis uptake and starting access type.