K. R. Polkinghorne

Survival on Home Dialysis in New Zealand

Background New Zealand (NZ) has a high prevalence of both peritoneal dialysis (PD) and home haemodialysis (HD) relative to other countries, and probably less selection bias. We aimed to determine if home dialysis associates with better survival than facility HD by simultaneous comparisons of the three modalities. Methods We analysed survival by time-varying dialysis modality in New Zealanders over a 15-year period to 31-Dec-2011, adjusting for patient co-morbidity by Cox proportional hazards multivariate regression. Results We modelled 6,419 patients with 3,254 deaths over 20,042 patient-years of follow-up. Patients treated with PD and facility HD are similar; those on home HD are younger and healthier. Compared to facility HD, home dialysis (as a unified category) associates with an overall 13% lower mortality risk. Home HD associates with a 52% lower mortality risk. PD associates with a 20% lower mortality risk in the early period (<3 years) that is offset by a 33% greater mortality risk in the late period (>3 years), with no overall net effect. There was effect modification and less observable benefit associated with PD in those with diabetes mellitus, co-morbidity, and in NZ Maori and Pacific People. There was no effect modification by age or by era. Conclusion Our study supports the culture of home dialysis in NZ, and suggests that the extent and duration of survival benefit associated with early PD may be greater than appreciated. We are planning further analyses to exclude residual confounding from unmeasured co-morbidity and other sociodemographic factors using database linkage to NZ government datasets. Finally, our results suggest further research into the practice of PD in NZ Maori and Pacific People, as well as definitive study to determine the best timing for switching from PD in the late phase.

Effect of fish oil and aspirin on arteriovenous fistula failure in haemodialysis - a randomized controlled trial

EFFECT OF FISH OIL AND ASPIRIN ON ARTERIOVENOUS FISTULA FAILURE IN HAEMODIALYSIS – A RANDOMIZED CONTROLLED TRIAL IRISHA,VIECELLIA, HAWLEYC, HOOI L, PASCOEE, PAUL-BRENT P, BADVE S, MORI T, CASS A, KERR P, VOSS D, ONG L, POLKINGHORNE K, for the Omega-3 Fatty Acids (Fish Oils) and Aspirin in Vascular Access Outcomes in Renal Disease (FAVOURED) Study Collaborative Group. Department of Nephrology Fiona Stanley Hospital, Perth, Australia, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia, Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia, Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia, Department of Medicine and Hemodialysis Unit, Hospital Sultanah Aminah, Johor Bahru, Malaysia, Department of Nephrology, St George Hospital, Sydney, Australia, The George Institute for Global Health, Sydney, Australia, Menzies School of Health Research, Charles Darwin University, Darwin, Australia, Department of Nephrology, Monash Medical Centre, Melbourne, Australia, Department of Medicine, Monash University, Melbourne, Australia, Middlemore Renal Services, Middlemore Hospital, Auckland, New Zealand, Department of Nephrology, Penang Hospital, Georgetown, Malaysia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

A comparison of arteriovenous fistula failure between Malaysian and Australian and New Zealand participants enrolled in the favoured trial

D’EMDEN M, FITCHETT D, GILJANOVIC KÎS S, WOERLE H, ZINMAN B, INZUCCHI S University of Queensland, Australia, St Michael’s Hospital, Division of Cardiology, University of Toronto, Toronto, Canada, Eli Lilly (Suisse) S.A., Representative Office, Zagreb, Croatia, Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada, Division of Endocrinology, University of Toronto, Toronto, Canada, Section of Endocrinology, Yale University School of Medicine, New Haven, United States of America