PERITONEAL DIALYSIS USE AND PRACTICE PATTERNS IN MAJOR CITIES COMPARED TO AREAS OUTSIDE OF MAJOR CITIES IN AUSTRALIA: A 10 YEAR REGISTRY ANALYSIS

Introduction:

Approximately 28% of Australians live in rural and remote areas, where patients often face poorer health outcomes than those in major cities (MC), largely due to barriers like healthcare workforce shortages and limited specialist services. While peritoneal dialysis (PD) offers the advantage of home-based treatment, its use has declined among patients requiring kidney replacement therapy (KRT) . This study examines patient factors and outcomes in those residing outside of MC compared to those residing in MC areas, building on previous data to explore temporal changes in PD uptake and outcomes in Australia in the last decade.

Methods:

We conducted a retrospective registry study using data from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA).

All Australian adults (≥ 18 years) who received PD (defined as receiving PD at 90 days) between 1 January 2011 and 31 December 2021 were included. Remoteness was classified at the residential postcode level according to the Australian Statistical Geographical Classification (2016) remote area index at the start of KRT as either MC or outside MC, which includes inner regional, outer regional, remote and very remote areas. Exclusion criteria included <18 years of age, and missing postcode data.

Primary outcomes of interest were technique failure, PD peritonitis and all-cause mortality after initiation of PD.

Results:

A total of 9,576 patients received PD treatment during the study period. Of these, the majority were males (63.5%) and 86.4% (n=8273) received PD from day 1 of KRT as their first KRT modality. The remaining (13.6%, n=1303) patients commenced KRT with HD  and later transitioned to PD during the study period. Postcode data was missing in 23 patients. A total of 27 patients had missing SEIFA scores.  The proportion of patients from MC was 71% (n=6,784) compared with 29% (n=2,769) outside MC. There was no difference in uptake of PD between MC and outside MC (figure 1) and this did not change over the study period (figure 2). PD technique failure (figure 3) was more common outside MC [Odds ratio (OR) 1.3 {confidence interval (CI) 1.2 – 1.4}, p<0.001], however, the proportion of PD withdrawal was similar between groups. Technique failure was also more frequent in patients with lower disadvantage (17% vs 13.8%, p<0.001), education and occupation decile (15.9% vs 13.7%, p<0.001). PD peritonitis was recorded in 3662 of 9576 patients. There were 7529 peritonitis episodes (66.2% in MC and 33.8% outside MC) in 3655 patients. Compared to patients from MC, the odds ratio for the first episode of peritonitis was 1.4 (CI 0.5 – 3.5, p=0.5) in those residing outside MC. Patients outside MC undertaking PD were less likely to receive a kidney transplant (26.9% vs 29.9%, p=0.003). There was no difference in all-cause mortality after initiation of PD.

Conclusions:

PD outcomes, particularly technique failure and access to transplantation, were worse for patients outside MC. Compared to HD, PD allows patients to receive treatment at home thus avoiding displacement to access facility HD. Further work is required to understand the causes for these differences and rectify the disadvantage of PD outside MC.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.