UK Renal Registry 19th Annual Report: Chapter 12 Multisite Dialysis Access Audit in England, Northern Ireland and Wales in 2015 and 2014 PD One Year Follow-up: National and Centre-specific Analyses

Data are presented from the fifth combined vascular and peritoneal dialysis (PD) access audit. In 2015, 53 of 62 centres in England, Wales and Northern Ireland returned data on first access for 4,032 incident haemodialysis (HD) and 1,075 incident PD recipients. Of the 5,107 incident patients, 21.0% started PD, 30.3% started HD with an arteriovenous fistula (AVF) or graft (AVG), 28.7% with a tunnelled line (TL) and 19.9% with a non-tunnelled line (NTL). Wide variation in definitive access use (defined as primary AVF, AVG or PD) was apparent between centres. Only 10 centres achieved the 60% target for AVF/AVG use amongst incident HD recipients. Seventeen centres achieved the 80% target for AVF/AVG/PD use amongst prevalent dialysis recipients. Timely presentation to a nephrologist and referral to a dialysis access surgeon were key determinants of the likelihood of definitive access: 60.0% of patients known to a nephrologist for over 90 days initiated dialysis with definitive access compared with 15.2% of those who were known to a nephrologist for 90 days or less. Among incident HD patients who were reviewed by a surgeon three months prior to starting dialysis, AVF/AVG use was 70.9% compared with 10.0% in those who were not. AVF/AVG use amongst incident HD recipients increased with rising age and body mass index (BMI). This was due to lower rates of PD and preemptive transplant (PTx) amongst older patients and the obese. In centres that placed non-surgical PD catheters, 25.9% of incident renal replacement therapy (RRT) patients started PD, compared with 21.0% overall.