Trends from the Dialysis Outcomes Practice Patterns Study-DOPPS in Vascular Access Use in Haemodialysis. Anna Marti Monros, Ronald L Pissoni, Douglas S. Fuller, Joan Fort, Francesco Locatelli, Lawrence Spergel, David Goodkin, Hal Morgenstern, Friedrich K Port.

DOPPS Background DOPPS is an international prospective study of hemodialysis practices and patient outcomes. DOPPS uses random sampling of facilities & patients to provide nationally representative statistics. Data collected at >300 dialysis units across 12 countries in 4 study phases since 1996. Here we report country trends in vascular access use from 3 cross-sections of HD patients in each country (N=27,145) from 2002-2010. As is well known the DOPPS is a prospective study of haemodialysis practices and patient outcomes with data collected at >300 dialysis units across 12 countries since 1996. We report country trends in vascular access use  (VAU) based upon three cross-sections of Haemodialysis patients  in each country (N=27,145) from 2002-2010.

VA Use in Countries with Decreasing Fistula Use & Increasing Catheter Use Here you can see Prevalent cross-sections of patients on dialysis >90 days at time of study entry; weighted by facility sampling fraction; DOPPS 2 (2002-2004), DOPPS 3 (2005-2008), DOPPS 4 (2009-2011) As mentioned earlier We report country trends in vascular access use  (VAU) based upon three cross-sections of Haemodialysis patients  in each country (N=27,145) from 2002-2010. These are the countries where despite literature reports and efforts done from 2002 to 2010 they experienced a decrease in Fistula use and in most of the cases like in Sapin a raise in Catheter use.  Shifts from AVF to CATH were seen in Belgium-Canada-Italy, and Spain: CATH use rising to 49% and 39%. Similar degrees of shifting from AVF to CATH were seen in Belgium, Canada, Italy, and Spain. Prevalent cross-sections of patients on dialysis >90 days at time of study entry; weighted by facility sampling fraction; DOPPS 2 (2002-2004), DOPPS 3 (2005-2008), DOPPS 4 (2009-2011)

Distribution of VA Types in Countries with Stable or Increasing Fistula Use On the other hand countries like  Japan displayed the highest AV fistula  use (AVFU) [92-93%, since 2002]. The US showed the largest % rise in AVFU from 34% in 2002 to 60% by 2010. AVFU also increased in Australia/New Zealand  and the UK to 78% and 74%, respectively, while remaining at ~80% in France, in the UK, CATH use declined, and AVFU raised by 2010. In nearly all other countries, CATH use has increased. Prevalent cross-sections of patients on dialysis >90 days at time of study entry; weighted by facility sampling fraction; DOPPS 2 (2002-2004), DOPPS 3 (2005-2008), DOPPS 4 (2009-2011);

Trend Towards Greater Catheter Use Seen Even in Younger Patients in Some Countries − Age 18-69 − RESULTS: As mentioned  Shifts from AVF to CATH were seen in Belgium-Canada-Italy, and Spain: CATH use rising to 49% and 39%. Similar degrees of shifting from AVF to CATH were seen in Belgium, Canada, Italy, and Spain even among Young patients. Prevalent cross-sections of patients on dialysis >90 days at time of study entry; weighted by facility sampling fraction; DOPPS 2 (2002-2004), DOPPS 3 (2005-2008), DOPPS 4 (2009-2011)

− Age 18-69, without diabetes − Trend Towards Greater Catheter Use Seen Even in Non-diabetic Younger Patients − Age 18-69, without diabetes − RESULTS:  Shifts from AVF to CATH were seen in Belgium-Canada-Italy, and Spain: CATH use rising to 49% and 39%. Similar degrees of shifting from AVF to CATH were seen in Belgium, Canada, Italy, and Spain even among non-diabetic 18-60 yr old patients. Prevalent cross-sections of patients on dialysis >90 days at time of study entry; weighted by facility sampling fraction; DOPPS 2 (2002-2004), DOPPS 3 (2005-2008), DOPPS 4 (2009-2011)

DOPPS 4: Some Countries Show Small Differences in VA Use in Older vs Younger Pts RESULTS: Here you can see Differences in VA use in older versus yourger patients in DOPPS 4 which is to say from 2009 to 2011 Prevalent cross-sections of patients on dialysis >90 days at time of study entry; weighted by facility sampling fraction; DOPPS 2 (2002-2004), DOPPS 3 (2005-2008), DOPPS 4 (2009-2011)

Summary (I) In DOPPS, Japan has consistently displayed the highest AV fistula (AVF) use [92-93%, since 2002], with <2% of pts using a catheter The US, led by the Fistula First Initiative, has shown the largest % rise in AVF use from 34% in 2002 to 60% by 2010 AVF use increased in Aus-NZ and the UK to 78% and 74%, respectively, while remaining at ~80% in France Catheter use has either remained stable or declined in Japan, France, UK and US

Summary (II) In other countries, catheter use has increased substantially from 2002-2010: to 49% and 39% catheter use in Canada and Belgium >2-fold rise to 20-24% in Italy and Spain doubling in Germany to 12% Shifts from AVF to catheter were seen in Belgium, Canada, Italy, Spain, and Germany even among non-diabetic 18-69 yr old pts indicating that these trends extend even to younger pts

Conclusions Substantial changes in VA use have been seen across some countries during the last decade In some nations, VA improvement programs have resulted in increases in AVF use Concerns are raised by the large rises in CATH use in some countries even among younger pts with lower comorbidity burden Greater CATH use has been linked with higher mortality; future analyses will evaluate changes in practices with changes in clinical outcomes CONCLUSIONS: Substantial changes in VAU have been seen during the last decade. The greater CATH use has been linked with mortality, future analyses will evaluate changes in practices with changes in clinical outcomes.  VA improvement programs have resulted in increases in AVFU, while concerns are raised by the large rises in CATH use in other countries even among younger pts with lower comorbidity burden.

Acknowledgements Amgen (since 1996) Our thanks to DOPPS study coordinators, medical directors, and participating patients for their dedicated contributions to DOPPS. The DOPPS would not be possible without the generous financial support of the following companies for their strong commitment to independent scientific research to improve patient care: Amgen (since 1996) Kyowa Hakko Kirin (since 1999, in Japan) Abbott Laboratories (since 2009) Sanofi Renal (since 2009) Baxter Healthcare (since 2011) Vifor Fresenius Medical Care Renal Pharma Ltd (since 2011) Support from DOPPS sponsors is provided without restrictions on publications.

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