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Rowan Walker – Chairman 2000 -2007. Chair: Steve Chadban ANZDATA update (Stephen McDonald)...

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Rowan Walker – Chairman 2000 -2007
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Page 1: Rowan Walker – Chairman 2000 -2007. Chair: Steve Chadban ANZDATA update (Stephen McDonald) Analgaesic nephropathy – the end of an epidemic? (Sean Chang)

Rowan Walker – Chairman 2000 -2007

Page 2: Rowan Walker – Chairman 2000 -2007. Chair: Steve Chadban ANZDATA update (Stephen McDonald) Analgaesic nephropathy – the end of an epidemic? (Sean Chang)

Chair: Steve Chadban• ANZDATA update (Stephen McDonald)• Analgaesic nephropathy – the end of an epidemic?

(Sean Chang)• Haemodialysis access -- recent changes (Kevan

Polkinghorne)• Living kidney donor Registry (Steve Chadban)• APD vs CAPD (David Johnson)• HD vs PD in children (Stephen McDonald)

Page 3: Rowan Walker – Chairman 2000 -2007. Chair: Steve Chadban ANZDATA update (Stephen McDonald) Analgaesic nephropathy – the end of an epidemic? (Sean Chang)

ANZDATA update

Stephen McDonald PhD FRACP

Executive Officer, ANZDATA Registry

Page 4: Rowan Walker – Chairman 2000 -2007. Chair: Steve Chadban ANZDATA update (Stephen McDonald) Analgaesic nephropathy – the end of an epidemic? (Sean Chang)

Summary

• Real-time data entry– Evolution of Web-based data entry

• Web-site

• People

• Centre reports

• Potential future developments

• ESKD trends

Page 5: Rowan Walker – Chairman 2000 -2007. Chair: Steve Chadban ANZDATA update (Stephen McDonald) Analgaesic nephropathy – the end of an epidemic? (Sean Chang)

Real-time data entry

• Key development in recent years– Structure remains unchanged– Reporting by web or paper

• New patients• Transplants• Transplant failure

– Events reported as they occur

– Facilitates real-time reporting• Monthly interim summaries

distributed

SURNAME Given Names SEXDATE OF BIRTH

POSTCODE AT ENTRY COUNTRY OF BIRTH (If Australia or NZ - Tick box)

OTHER COUNTRY (Please specify)AUST NZ

CO-MORBID CONDITIONS AT ENTRY

LATE REFERRAL <3 MTHSBEFORE FIRST

TREATMENT(Y/N)

HEIGHT (cms) WEIGHT (kg) CIGARETTE SMOKING

N=NeverF=FormerC=Current

Anzdata RegistryReal Time Entry Form

COMMENTS

K EY EVENTS (fill in at time of occurrence for transplants, graft failures and deaths)

FAX TO ANZDATA (08) 8222.6795

OtherGRAFT FAILURE (DATE)

NEW PATIENT (DATA AT INITIAL TREATMENT)

DATE & MODE OF FIRST TREATMENT

Record from List

Code Day Month Year

TO Name of Hospital

Date of TransferName of Hospital

FROM

INITIAL HOSPITAL CURRENT PARENT HOSPITALHospital/State Hospital/StateHosp. Unit No. Hosp. Unit No Physician

SE. CREATININEBIOPSY Y/NAT ENTRY

RACIAL ORIGIN - Record from list PRIMARY RENAL DISEASE - Record from list

OtherOther

ACCESS

AT 1ST HD

1=Native2= Synthetic3=Tunnel CVC4=Non Tunnel CVC

OtherTRANSPLANT (Date) DONOR SOURCE - Record from list

For Code 8 and 14 Specify other related or un-related donor

Transplanting Unit

DIABETES

N=NoO=Type 1 Insulin dependentP=Type 2 Non Insulin requiringQ=Type 2 Insulin requiring

CHRONIC LUNG CORONARY ARTERY PERIPHERAL VASC.

CEREBROVASC.

Y=YesS=SuspectedN=No

3 9 2007 RTD Form.ppt

DEATH (DATE) CAUSE OF DEATH – Record from listOther

Caring HospitalAt Death

PATIENT TRANSFER

If Pre-eptive Transplantsupply Transplanting Unit and Donor Source in “Key Events” below

PATIENT IDENTITY

REGISTRY No.

Page 6: Rowan Walker – Chairman 2000 -2007. Chair: Steve Chadban ANZDATA update (Stephen McDonald) Analgaesic nephropathy – the end of an epidemic? (Sean Chang)

Web-based systems

• Web-based data entry• Web-based data interrogation systems

Page 7: Rowan Walker – Chairman 2000 -2007. Chair: Steve Chadban ANZDATA update (Stephen McDonald) Analgaesic nephropathy – the end of an epidemic? (Sean Chang)

Export options

Page 8: Rowan Walker – Chairman 2000 -2007. Chair: Steve Chadban ANZDATA update (Stephen McDonald) Analgaesic nephropathy – the end of an epidemic? (Sean Chang)

Website

Page 9: Rowan Walker – Chairman 2000 -2007. Chair: Steve Chadban ANZDATA update (Stephen McDonald) Analgaesic nephropathy – the end of an epidemic? (Sean Chang)

People

• Biostatistician

• Epidemiology Fellow

• Visitors

• Opportunities– Working groups– Steering committee

Page 10: Rowan Walker – Chairman 2000 -2007. Chair: Steve Chadban ANZDATA update (Stephen McDonald) Analgaesic nephropathy – the end of an epidemic? (Sean Chang)

Potential future developments

• Relocation of ANZDATA

• Recommendations of National Clinical Taskforce on Organ and Tissue Donation awaited late 2007– Transplant outcome registries a specific focus

Page 11: Rowan Walker – Chairman 2000 -2007. Chair: Steve Chadban ANZDATA update (Stephen McDonald) Analgaesic nephropathy – the end of an epidemic? (Sean Chang)

Centre reports

• Changes planned– Identification of best-performing units– Format– Continue to report relevant outcome against agreed

benchmarks / CARI targets

• Exploration of adjustment for patient characteristics– Presently use restriction as approach to confounding

• Exploration of cusum graphic approach to presentation of results

Page 12: Rowan Walker – Chairman 2000 -2007. Chair: Steve Chadban ANZDATA update (Stephen McDonald) Analgaesic nephropathy – the end of an epidemic? (Sean Chang)

What is cusum?-1

0-5

05

Cum

ula

tive

sum

O-E

01jan2000 01jul2001 01jan2003 01jul2004 01jan2006

Tx date

Cusum graft failure at 1 year

Page 13: Rowan Walker – Chairman 2000 -2007. Chair: Steve Chadban ANZDATA update (Stephen McDonald) Analgaesic nephropathy – the end of an epidemic? (Sean Chang)

Example

-2

0

2

4

6

Cum

ula

tive

sum

O-E

01jan

2000

01jul

2001

01jan

2003

01jul

2004

01jan

2006

Tx date

Cusum graft failure at 1 year

Page 14: Rowan Walker – Chairman 2000 -2007. Chair: Steve Chadban ANZDATA update (Stephen McDonald) Analgaesic nephropathy – the end of an epidemic? (Sean Chang)

Key ESKD data

• Barbecue-level information

Page 15: Rowan Walker – Chairman 2000 -2007. Chair: Steve Chadban ANZDATA update (Stephen McDonald) Analgaesic nephropathy – the end of an epidemic? (Sean Chang)

Current state of play

• As at 31 Dec 2006 there were– In Australia

• 16041 people receiving some form of kidney replacement therapy

– 9180 people receiving dialysis treatment– 6861 with a functioning transplant– 3 fold increase over past 15 years

• New patient rate 115 per million per year

– In New Zealand• 3212 people in New Zealand receiving some form of kidney

replacement therapy– 1977 people receiving dialysis treatment

• New patient rate 117 per million per year

Page 16: Rowan Walker – Chairman 2000 -2007. Chair: Steve Chadban ANZDATA update (Stephen McDonald) Analgaesic nephropathy – the end of an epidemic? (Sean Chang)

New patients

Australia new RRT patients. Linear increase 5.4% year on year

20

40

60

80

100

120

Inci

dent

ra

te (

pm

py)

1970 1975 1980 1985 1990 1995 2000 2005 2010Year of first treatment

Page 17: Rowan Walker – Chairman 2000 -2007. Chair: Steve Chadban ANZDATA update (Stephen McDonald) Analgaesic nephropathy – the end of an epidemic? (Sean Chang)

New Patient Rates

70

80

90

100

110

120

130

Inci

dent

RR

T r

ate

(p

er m

illio

n p

er y

ear)

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006Year

Australia NZ

Page 18: Rowan Walker – Chairman 2000 -2007. Chair: Steve Chadban ANZDATA update (Stephen McDonald) Analgaesic nephropathy – the end of an epidemic? (Sean Chang)

Age-specific rates

Australian RRT incidence rates by age at start

0

50

100

150

200

250

300

350

400

450

500

19

71

19

73

19

75

19

77

19

79

19

81

19

83

19

85

19

87

19

89

19

91

19

93

19

95

19

97

19

99

20

01

20

03

20

05

Year

Ra

te p

er

mill

ion

0-

5-

15-

25-

35-

45-

55-

65-

75-

85-

Page 19: Rowan Walker – Chairman 2000 -2007. Chair: Steve Chadban ANZDATA update (Stephen McDonald) Analgaesic nephropathy – the end of an epidemic? (Sean Chang)

Transplant numbers

0

200

400

600

0

50

100

150

199

01

991

199

21

993

199

41

995

199

61

997

199

81

999

200

02

001

200

22

003

200

42

005

200

6

199

01

991

199

21

993

199

41

995

199

61

997

199

81

999

200

02

001

200

22

003

200

42

005

200

6Australia New Zealand

Cadaveric Live related Live unrelatedDonor source

Num

ber

ANZDATA, Tx numbers by year and source

Page 20: Rowan Walker – Chairman 2000 -2007. Chair: Steve Chadban ANZDATA update (Stephen McDonald) Analgaesic nephropathy – the end of an epidemic? (Sean Chang)

Prevalent patients – treatment

Australia New Zealand

APD CAPDHospital HD Satellite HD

Home HD Graft

Data for prevalent patients 31 Dec 2006; ANZDATA Registry

Page 21: Rowan Walker – Chairman 2000 -2007. Chair: Steve Chadban ANZDATA update (Stephen McDonald) Analgaesic nephropathy – the end of an epidemic? (Sean Chang)

Prevalent patients – trends

0

5,000

10,000

15,000

Num

ber

199

0

199

1

199

2

199

3

199

4

199

5

199

6

199

7

199

8

199

9

200

0

200

1

200

2

200

3

200

4

200

5

200

6

Australia

APD CAPDHospital HD Satellite HDHome HD Graft

Page 22: Rowan Walker – Chairman 2000 -2007. Chair: Steve Chadban ANZDATA update (Stephen McDonald) Analgaesic nephropathy – the end of an epidemic? (Sean Chang)

Prevalent patients (NZ) - trends

0

1,000

2,000

3,000

Num

ber

199

0

199

1

199

2

199

3

199

4

199

5

199

6

199

7

199

8

199

9

200

0

200

1

200

2

200

3

200

4

200

5

200

6

New Zealand

APD CAPDHospital HD Satellite HDHome HD Graft

Page 23: Rowan Walker – Chairman 2000 -2007. Chair: Steve Chadban ANZDATA update (Stephen McDonald) Analgaesic nephropathy – the end of an epidemic? (Sean Chang)

Prevalent patients – treatment

0

20

40

60

80

100

Pe

rcen

t

NT

NS

W/A

CT

Vic

Qld

SA

WA

Tas

NZ

APD CAPDHospital HD Satellite HDHome HD Graft

Page 24: Rowan Walker – Chairman 2000 -2007. Chair: Steve Chadban ANZDATA update (Stephen McDonald) Analgaesic nephropathy – the end of an epidemic? (Sean Chang)

Thankyou


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