Demography and survival of patients receiving treatment for chronic renal failure in Australia and New Zealand: report on dialysis and renal transplantation treatment from the Australia and New Zealand dialysis and transplant registry

Abstract

There were 7,059 (403 per million) Australian patients and 1,341 (388 per million) New Zealand patients receiving renal replacement treatment at the end of 1992. Fifty-three percent and 50%, respectively, were dependent on a functioning transplant, 87% and 80%, respectively, from a cadaver donor. In Australia the majority of dialysis patients depended on hemodialysis (68%) and continuous ambulatory peritoneal dialysis (CAPD) (31%); 68% of patients were dialysing at home or in a satellite (free-standing) facility. The majority (62%) of home dialysis patients used CAPD treatment. In New Zealand there were 44% of patients on hemodialysis; 83% dialyzed at home and the majority (65%) used CAPD treatment. Few dialysis units (five of 71) in Australia were “for-profit” facilities; there was none in New Zealand. Universal health care has been available for renal replacement treatment for 20 years. The annual incidence of new patients increased steadily during the past 10 years, to 61 per million (Australia) and 69 per million (New Zealand) in 1992. There were disproportionate numbers of indigenous Australian Aboriginals (51%), New Zealand Maoris (30%), and Polynesian Pacific Islanders (11%) compared with their distribution in the general population. There was a considerable increase in elderly and diabetic patients during the period from 1983 to 1992: in Australia, 25% of patients were over 65 years of age and 14% of patients were diabetic, and in New Zealand, 16% of patients were over 65 years of age and 25% of patients were diabetic. The renal transplantation rate has remained unchanged since 1983 at 27 per million in Australia, but has increased markedly from 20 to 33 per million in New Zealand. The annual transplantation rate was 20% to 30% of those patients aged 15 to 64 years who were likely to be transplanted. The multifactorial analysis of risk factors for survival of dialysis patients showed age, male gender, CAPD treatment, Aboriginal race, and diabetic or analgesic nephropathy to be associated with lower rates of survival. Deaths were commonly due to a cardiac cause (43%), mostly myocardial infarction, or to infection (17%) or withdrawal from treatment (14%). The overall death rate was 12% of patients at risk in 1992. Multifactorial analysis of risk factors for graft survival in transplanted patients showed patient age, diabetic nephropathy, donor age, single-drug regimen, and low transplant activity (operations) at a center to be associated with lower rates of survival. In 1992, deaths were commonly due to a cardiac cause (32%), 80% of which were related to myocardial infarction; 33% of deaths were due to malignancy and 17% were due to infection. The death rate of patients with a functioning transplant was 2.44% of those at risk. As fewer grafts were lost to rejection in the past few years, a higher proportion of grafts were being lost due to the patient's death (42% rejection and 38% death) in 1992. The graft loss rate was only 6% of all grafts at risk.