Kevan Polkinghorne Aarti Gulyani Stephen McDonald Kylie Hurst CHAPTER 5 HAEMODIALYSIS (including home haemodialysis) 2012 Annual Report—35th Edition ANZDATA Registry Annual Report 2012
Figure 5.1 Stock and Flow of Haemodialysis Patients Australia Patients new to HD First Dialysis Treatment Previous Dialysis (PD) Failed Transplant Transplanted Deaths Never Transplanted Previous Transplant Transfer to PD Patients Dialysing (HD) at 31 December Patients Dialysing (HD) at Home at 31 December % of all Home Dialysis (HD and PD) Patients31%30%31%32% New Zealand Patients new to HD First Dialysis Treatment Previous Dialysis (PD) Failed Transplant Transplanted Deaths Never Transplanted Previous Transplant Transfer to PD Patients Dialysing (HD) at 31 December Patients Dialysing (HD) at Home at 31 December % of all Home Dialysis (HD and PD) Patients31%30%32%34%36% ANZDATA Registry Annual Report 2012
Figure 5.2 ANZDATA Registry Annual Report 2012
Figure 5.3 Stock and Flow of Haemodialysis Patients Australia Number (%) Age Groups New Patients * years9 (0%)13 (1%)9 (0%)14 (1%)17 (1%) years45 (2%)42 (2%)45 (2%)43 (2%) years94 (5%)101 (5%)88 (4%)78 (4%)81 (4%) years187 (9%)173 (8%)178 (9%)172 (8%)196 (9%) years315 (16%)345 (16%)313 (15%)314 (15%)323 (15%) years437 (22%)448 (21%)447 (22%)441 (22%)478 (22%) years484 (24%)542 (25%)516 (25%)482 (24%)522 (24%) years405 (20%)432 (20%)416 (20%)408 (20%)418 (20%) >=85 years44 (2%)57 (3%)58 (3%)84 (4%)63 (3%) Total2020 (100%)2153 (100%)2070 (100%)2036 (100%)2141 (100%) Patients Dialysing years5 (0%)10 (0%)9 (0%)10 (0%)12 (0%) years98 (1%)88 (1%)91 (1%)99 (1%)108 (1%) years305 (4%)290 (4%)292 (4%)291 (3%)285 (3%) years737 (10%)693 (9%)695 (8%)694 (8%)725 (8%) years1211 (16%)1275 (16%)1316 (16%)1314 (15%)1335 (15%) years1619 (21%)1721 (22%)1781 (22%)1861 (22%)1931 (22%) years1803 (24%)1895 (24%)1985 (24%)2064 (24%)2133 (24%) years1602 (21%)1685 (21%)1772 (21%)1871 (22%)1978 (22%) >=85 years213 (3%)267 (3%)310 (4%)391 (5%)422 (5%) Total7593 (100%)7924 (100%)8251 (100%)8595 (100%)8929 (100%) Primary Renal Disease * Glomerulonephritis484 (24%)463 (22%)506 (24%)426 (21%)477 (22%) Analgesic Nephropathy 46 (2%) 40 (2%)38 (2%)27 (1%) Hypertension319 (16%)322 (15%)288 (14%)285 (14%)326 (15%) Polycystic Disease127 (6%)125 (6%)123 (6%)136 (7%)122 (6%) Reflux Nephropathy56 (3%)59 (3%)61 (3%)43 (2%)49 (2%) Diabetic Nephropathy642 (32%)748 (35%)686 (33%)741 (36%)774 (36%) Miscellaneous215 (11%)233 (11%)231 (11%)250 (12%)252 (12%) Uncertain131 (6%)157 (7%)135 (7%)117 (6%)114 (5%) Total2020 (100%)2153 (100%)2070 (100%)2036 (100%)2141 (100%) * New patients receiving first haemodialysis treatment ANZDATA Registry Annual Report 2012
Figure 5.4 ANZDATA Registry Annual Report 2012
Figure 5.5 Stock and Flow of Haemodialysis Patients New Zealand Number (%) Age Groups New Patients * years3 (1%)5 (1%)2 (0%)1 (0%) years21 (6%)19 (5%)10 (2%)12 (3%)15 (4%) years17 (4%)15 (4%)24 (6%)12 (3%)19 (5%) years45 (12%)34 (9%)54 (13%)40 (10%)44 (11%) years63 (17%)84 (21%)89 (21%)97 (24%)78 (19%) years100 (26%)117 (30%)103 (24%)112 (28%)105 (26%) years88 (23%)89 (23%)93 (22%)82 (21%)100 (25%) years39 (10%)30 (8%)51 (12%)39 (10%)38 (9%) >=85 years4 (1%)1 (0%)3 (1%) Total380 (100%)394 (100%)429 (100%)398 (100%)403 (100%) Patients Dialysing years3 (0%) 4 (0%)1 (0%) years39 (3%)38 (3%)41 (3%)45 (3%)40 (3%) years80 (6%)76 (6%)90 (6%)89 (6%)90 (6%) years160 (12%)149 (11%)162 (11%)165 (11%)172 (11%) years261 (20%)275 (20%)309 (21%)329 (21%)331 (21%) years364 (27%)373 (28%)403 (27%)431 (28%)448 (28%) years297 (22%)293 (22%)316 (21%)323 (21%)343 (22%) years108 (8%)126 (9%)146 (10%)152 (10%)147 (9%) >=85 years13 (1%)10 (1%)11 (1%)15 (1%)19 (1%) Total1325 (100%)1343 (100%)1481 (100%)1553 (100%)1591 (100%) Primary Renal Disease * Glomerulonephritis89 (23%)72 (18%)97 (23%)89 (22%)98 (24%) Analgesic Nephropathy3 (1%)1 (0%) 2 (0%) Hypertension43 (11%)33 (8%)43 (10%)38 (10%)41 (10%) Polycystic Disease15 (4%)14 (4%)18 (4%)13 (3%)19 (5%) Reflux Nephropathy8 (2%)9 (2%)3 (1%)6 (2%)8 (2%) Diabetic Nephropathy163 (43%)204 (52%)212 (49%)205 (52%)173 (43%) Miscellaneous47 (12%)46 (12%)41 (10%)36 (9%)39 (10%) Uncertain12 (3%)15 (4%)14 (3%)11 (3%)23 (6%) Total380 (100%)394 (100%)429 (100%)398 (100%)403 (100%) * New patients receiving first haemodialysis treatment ANZDATA Registry Annual Report 2012
Figure 5.6 ANZDATA Registry Annual Report 2012
Figure 5.7 ANZDATA Registry Annual Report 2012
Figure 5.8 ANZDATA Registry Annual Report 2012
Figure 5.9 ANZDATA Registry Annual Report 2012
Figure 5.10 Blood Flow Rates (mls/minute) Country No. Pts *CVV HD excluded NR** Mls/Minute < >400 Aust December December December December December NZ December December December December December ANZDATA Registry Annual Report 2012
Figure 5.11 Blood Flow Rate by Type of Access December 2011 Blood Flow Rate AustraliaNew Zealand AVFAVGCVC*NR**AVFAVGCVCNR** <20010 (.1%)1 (.1%)17 (1.5%)03 (.3%)01 (.3%) (2.5%)34 (4.9%)62 (5.3%)064 (5.5%)3 (3.8%)40 (11.5%) (12%)98 (14.2%)302 (25.9%)2 (2.2%)190 (16.4%)25 (31.3%)114 (32.9%)1 (33.3%) (58%)421 (61.1%)684 (58.7%)7 (7.9%)671 (57.8%)49 (61.3%)186 (53.6%) (23.7%)119 (17.3%)93 (8%)2 (2.2%)213 (18.3%)3 (3.8%)6 (1.7%)0 >= (3.6%)15 (2.2%)5 (.4%)1 (1.1%)19 (1.6%)000 NR**5 (.1%)1 (.1%)2 (.2%)77 (86.5%)1 (.1%)002 (66.7%) Total6986 (100%)689 (100%)1165 (100%)89 (100%)1161 (100%)80 (100%)347 (100%)3 (100%) * Number of patients having C.V.V. HD not included. NR** - Not Reported ANZDATA Registry Annual Report 2012
Figure 5.12 ANZDATA Registry Annual Report 2012
Figure 5.13 ANZDATA Registry Annual Report 2012
Figure 5.14 Duration and Number of Sessions Per Week December 2011 Sessions Per week Hours of Each Treatment Total < >5.5Not Reported Australia (7.6%)78 (14.1%)46 (8.3%)126 (22.7%)17 (3.1%)245 (44.2%) 554 (100%) <=3361 (4.4%)3264 (40.2%)1807 (22.2%)2369 (29.1%)129 (1.6%)195 (2.4%)2 (0%)8127 (100%) >=570 (42.4%)43 (26.1%)3 (1.8%)5 (3%)1 (.6%)43 (26.1%) 165 (100%) Not reported 1 (1.2%) 82 (98.8%)83 (100%) Total473 (5.3%)3385 (37.9%)1856 (20.8%)2501 (28%)147 (1.6%)483 (5.4%)84 (.9%)8929 (100%) New Zealand (4.7%)31 (18.3%)18 (10.7%)59 (34.9%)10 (5.9%)43 (25.4%) 169 (100%) <=320 (1.4%)455 (32.6%)346 (24.8%)473 (33.9%)34 (2.4%)67 (4.8%) 1395 (100%) >=59 (37.5%)7 (29.2%)2 (8.3%) 1 (4.2%)3 (12.5%) 24 (100%) Not reported 1 (33.3%) 2 (66.7%)3 (100%) Total37 (2.3%)493 (31%)366 (23%)535 (33.6%)45 (2.8%)113 (7.1%)2 (.1%)1591 (100%) * Intermediate durations are rounded up, e.g is included in 4.5 ANZDATA Registry Annual Report 2012
Figure 5.15 ANZDATA Registry Annual Report 2012
Figure 5.16 ANZDATA Registry Annual Report 2012
Figure 5.17 ANZDATA Registry Annual Report 2012
Figure 5.18 ANZDATA Registry Annual Report 2012
Figure 5.19 ANZDATA Registry Annual Report 2012
Figure 5.20 ANZDATA Registry Annual Report 2012
Figure 5.21 Haemodialysis Percentage ≥ 5 Sessions per Week By Australian State and Country Australia New Zealand QldNSW/ACTVicTasSANTWA Dec-1161 (3.7%)24 (.8%)50 (2.2%)2 (1.3%)7 (1.2%)3 (.7%)18 (2.1%)24 (1.5%) Dec-1052 (3.2%)25 (.9%)48 (2.2%)3 (2.1%)8 (1.4%)5 (1.2%)15 (1.9%)28 (1.8%) Dec-0941 (2.6%)28 (1%)40 (1.9%)2 (1.4%)7 (1.3%)-10 (1.3%)28 (1.9%) Dec-0851 (3.5%)25 (1%)46 (2.2%)2 (1.5%)10 (2%)1 (.3%)12 (1.6%)34 (2.5%) ANZDATA Registry Annual Report 2012
Figure 5.22 Haemodialysis Percentage ≥ 4.5 Hours Per Session Three Sessions per Week By Australian State and Country Australia New Zealand QldNSW/ACTVicTasSANTWA Dec (51.2%)1917 (65.9%)889 (38.6%)100 (63.3%)133 (22.2%)318 (72.6%)213 (24.3%)916 (57.6%) Dec (51.1%)1857 (65.9%)757 (34%)79 (54.1%)138 (24.5%)300 (74.8%)201 (25%)827 (53.4%) Dec (50.3%)1746 (64.5%)663 (31.2%)81 (54.7%)132 (24.4%)305 (79.6%)192 (24.7%)753 (50.9%) Dec (49.3%)1734 (66.1%)642 (30.9%)55 (41%)105 (21.4%)278 (76.8%)176 (22.9%)651 (48.5%) ANZDATA Registry Annual Report 2012
Figure 5.23 Haemodialysis Percentage >12 Hours per Week By Australian State and Country Australia New Zealand QldNSW/ACTVicTasSANTWA Dec (61.3%)2176 (74.8%)1087 (47.1%)112 (70.9%)160 (26.8%)328 (74.9%)272 (31%)1105 (69.5%) Dec (61.4%)2080 (73.8%)959 (43%)92 (63%)167 (29.6%)310 (77.3%)255 (31.7%)993 (64.1%) Dec (61.5%)1988 (73.4%)873 (41.1%)92 (62.2%)161 (29.8%)308 (80.4%)238 (30.7%)905 (61.1%) Dec (60.5%)1950 (74.4%)841 (40.5%)64 (47.8%)131 (26.7%)285 (78.7%)215 (28%)781 (58.2%) ANZDATA Registry Annual Report 2012
Figure 5.24 Haemodialysis at 90 Days Patient Survival Censored for Transplant % [95% Confidence Interval] No. of Patients Survival 6 months1 year3 years5 years Australia [96, 97]90 [89, 91]68 [67, 70]50 [48, 52] [95, 97]90 [88, 90]67 [66, 69]48 [47, 50] [95, 96]90 [89, 91]69 [67, 70]52 [50, 53] [96, 97]91 [90, 92]-- New Zealand [95, 98]93 [90, 95]71 [67, 75]47 [42, 51] [95, 98]90 [88, 93]70 [66, 73]48 [44, 52] [95, 98]92 [89, 93]69 [65, 72]50 [45, 55] [96, 98]94 [92, 95]-- ANZDATA Registry Annual Report 2012
Figure 5.25 ANZDATA Registry Annual Report 2012
Figure 5.26 ANZDATA Registry Annual Report 2012
Figure 5.27 ANZDATA Registry Annual Report 2012
Figure 5.28 ANZDATA Registry Annual Report 2012
Figure 5.29 Haemodialysis at 90 Days Patient Survival - Diabetic / Non Diabetic Censored for Transplant % [95% Confidence Interval] Survival No. of Patients 6 months1 year3 years5 years Australia Non Diabetic [96, 96]90 [89, 90]70 [69, 71]52 [51, 53] Diabetic [96, 97]90 [89, 91]67 [65, 68]46 [44, 48] New Zealand Non Diabetic [96, 98]92 [90, 93]74 [71, 76]54 [51, 58] Diabetic [96, 98]92 [90, 94]68 [65, 70]43 [40, 47] ANZDATA Registry Annual Report 2012
Figure 5.30 ANZDATA Registry Annual Report 2012
Figure 5.31 ANZDATA Registry Annual Report 2012
Figure 5.32 Haemodialysis at 90 Days Patient Survival - By Age Group Censored for Transplant % [95% Confidence Interval] Age Groups No. of Patients Survival 6 months1 year3 years5 years Australia 0-39 years [99, 100]97 [96, 98]88 [86, 90]81 [78, 84] years [97, 98]94 [93, 95]80 [78, 81]66 [64, 68] years [95, 96]89 [88, 89]66 [64, 67]46 [45, 48] >=75 years [93, 94]84 [83, 85]52 [50, 54]28 [27, 30] New Zealand 0-39 years [98, 100]97 [95, 99]83 [77, 87]71 [64, 78] years [96, 98]94 [93, 95]79 [76, 82]57 [53, 60] years93196 [95, 97]90 [88, 92]64 [60, 67]40 [36, 44] >=75 years22895 [91, 97]81 [76, 86]43 [35, 50]18 [12, 25] ANZDATA Registry Annual Report 2012
Figure 5.33 ANZDATA Registry Annual Report 2012
Figure 5.34 ANZDATA Registry Annual Report 2012
Figure 5.35 Haemodialyser Membrane Types by Surface Area 31-DEC-2011 Dialyser Membrane Type Flux Square Metres Total < >1.9 Australia Cellulose TriacetateHigh DiacetateLow PolyamixHigh PolyamixLow PolyethersulfoneHigh PolynephronHigh PolysulphoneHigh PolysulphoneLow Polysulphone-HelixoneHigh PolysynthaneLow Total New Zealand PolyamixHigh PolyamixLow PolysulphoneLow Polysulphone-HelixoneHigh Total ANZDATA Registry Annual Report 2012
Figure 5.36 Number of Patients at end of 2011 by HD Modality NTNSW/ACTVICQLDSAWATASNZTotal HAEMODIALYSIS-HOLLOW FIBRE DIALYSERS HAEMOFILTRATION HAEMODIAFILTRATION Total ANZDATA Registry Annual Report 2012
Figure 5.37 ANZDATA Registry Annual Report 2012
Figure 5.38 ANZDATA Registry Annual Report 2012
Figure 5.39 ANZDATA Registry Annual Report 2012
Figure 5.40 ANZDATA Registry Annual Report 2012
Figure 5.41 ANZDATA Registry Annual Report 2012
Figure 5.42 AUST ANZDATA Registry Annual Report 2012
Figure 5.42 NZ ANZDATA Registry Annual Report 2012
Figure 5.43 ANZDATA Registry Annual Report 2012
Figure 5.44 ANZDATA Registry Annual Report 2012
Figure 5.45 ANZDATA Registry Annual Report 2012
Figure 5.46 ANZDATA Registry Annual Report 2012
Figure 5.47 ANZDATA Registry Annual Report 2012
Figure 5.48 ANZDATA Registry Annual Report 2012
Figure 5.49 ANZDATA Registry Annual Report 2012
Figure 5.50 ANZDATA Registry Annual Report 2012
Figure 5.51 ANZDATA Registry Annual Report 2012
Figure 5.52 ANZDATA Registry Annual Report 2012
Figure 5.53 ANZDATA Registry Annual Report 2012
Figure 5.54 ANZDATA Registry Annual Report 2012
Figure 5.55 ANZDATA Registry Annual Report 2012
Figure 5.56 ANZDATA Registry Annual Report 2012
Figure 5.57 ANZDATA Registry Annual Report 2012
Figure 5.58 ANZDATA Registry Annual Report 2012
Figure 5.59 ANZDATA Registry Annual Report 2012
Figure 5.60 ANZDATA Registry Annual Report 2012
Figure 5.61 ANZDATA Registry Annual Report 2012
Figure 5.62 ANZDATA Registry Annual Report 2012
Figure 5.63 ANZDATA Registry Annual Report 2012
Figure 5.64 Urea Reduction Ratio - Prevalent Patients Three Sessions per Week - December 2011 Hours per Session Urea Reduction Ratio % < 65>=65Total Australia <4 hours 41 (13.4%)265 (86.6%)306 4 hours 266 (8.9%)2725 (91.1%)2991 >4-5 hours 282 (7.3%)3575 (92.7%)3857 >5 hours 23 (9.6%)217 (90.4%)240 Total 612 (8.3%)6782 (91.7%)7394 New Zealand <4 hours 8 (44.4%)10 (55.6%)18 4 hours 104 (26.0%)296 (74.0%)400 >4-5 hours 174 (24.0%)550 (76.0%)724 >5 hours 17 (20.7%)65 (79.3%)82 Total 303 (24.8%)921 (75.2%)1224 ANZDATA Registry Annual Report 2012
Figure 5.65 ANZDATA Registry Annual Report 2012
Figure 5.66 ANZDATA Registry Annual Report 2012
Figure 5.67 ANZDATA Registry Annual Report 2012
Figure 5.68 ANZDATA Registry Annual Report 2012
Figure 5.69 ANZDATA Registry Annual Report 2012
Figure 5.70 ANZDATA Registry Annual Report 2012
Figure 5.71 ANZDATA Registry Annual Report 2012
Figure 5.72 ANZDATA Registry Annual Report 2012
Figure 5.73 ANZDATA Registry Annual Report 2012
Figure 5.74 ANZDATA Registry Annual Report 2012
Figure 5.75 ANZDATA Registry Annual Report 2012
Figure 5.76 ANZDATA Registry Annual Report 2012
Figure 5.77 ANZDATA Registry Annual Report 2012
Figure 5.78 ANZDATA Registry Annual Report 2012
Figure 5.79 Vascular Access at First Treatment Haemodialysis as Initial Modality 1-Jan-2008 to 31-Dec AVF or AVGCVCAVF or AVGCVCAVF or AVGCVCAVF or AVGCVC Australia QLD 139 (36%)250 (64%)152 (41%)219 (59%)138 (40%)207 (60%)131 (40%)197 (60%) NSW/ACT 189 (34%)374 (66%)185 (37%)316 (63%)200 (37%)339 (63%)223 (39%)347 (61%) Vic 185 (47%)212 (53%)214 (50%)216 (50%)200 (45%)246 (55%)230 (51%)223 (49%) Tas 12 (35%)22 (65%)16 (43%)21 (57%)19 (61%)12 (39%)19 (61%)12 (39%) SA 70 (53%)61 (47%)89 (61%)58 (39%)55 (40%)82 (60%)91 (68%)42 (32%) NT 39 (49%)41 (51%)27 (46%)32 (54%)25 (45%)30 (55%)38 (49%)40 (51%) WA 67 (34%)131 (66%)66 (38%)106 (62%)52 (31%)114 (69%)86 (41%)124 (59%) New Zealand 73 (23%)247 (77%)111 (31%)249 (69%)83 (25%)250 (75%)93 (30%)220 (70%) ANZDATA Registry Annual Report 2012
Figure 5.80 ANZDATA Registry Annual Report 2012
Figure 5.81 ANZDATA Registry Annual Report 2012
Figure 5.82 ANZDATA Registry Annual Report 2012
Figure 5.83 ANZDATA Registry Annual Report 2012
Figure 5.84 ANZDATA Registry Annual Report 2012
Figure 5.85 ANZDATA Registry Annual Report 2012
Figure 5.86 ANZDATA Registry Annual Report 2012
Figure 5.87 ANZDATA Registry Annual Report 2012
Figure 5.88 ANZDATA Registry Annual Report 2012
Figure 5.89 ANZDATA Registry Annual Report 2012
Figure 5.90 ANZDATA Registry Annual Report 2012
Figure 5.91 Prevalent Vascular Access at 31-Dec-2011 Dec 2008Dec 2009Dec 2010Dec 2011 AVF or AVGCVCAVF or AVGCVCAVF or AVGCVCAVF or AVGCVC Australia QLD 1283 (87%)192 (13%)1372 (88%)196 (13%)1426 (88%)196 (12%)1429 (87%)212 (13%) NSW/ACT 2200 (84%)421 (16%)2259 (83%)449 (17%)2387 (85%)430 (15%)2479 (86%)415 (14%) Vic 1860 (90%)215 (10%)1899 (89%)227 (11%)1972 (88%)257 (12%)2049 (89%)256 (11%) Tas 110 (82%)24 (18%)118 (80%)30 (20%)128 (88%)18 (12%)134 (85%)24 (15%) SA 429 (88%)61 (12%)484 (90%)56 (10%)504 (89%)60 (11%)556 (93%)42 (7%) NT 328 (91%)34 (9%)366 (96%)17 (4%)367 (92%)34 (8%)394 (90%)42 (10%) WA 562 (73%)205 (27%)593 (76%)183 (24%)619 (78%)179 (22%)634 (78%)174 (22%) New Zealand 983 (73%)360 (27%)1111 (75%)369 (25%)1204 (78%)345 (22%)1241 (78%)347 (22%) ANZDATA Registry Annual Report 2012
Figure 5.92 ANZDATA Registry Annual Report 2012
Figure 5.93 ANZDATA Registry Annual Report 2012
Figure 5.94 ANZDATA Registry Annual Report 2012
Figure 5.95 ANZDATA Registry Annual Report 2012
Figure 5.96 ANZDATA Registry Annual Report 2012
Figure 5.97 ANZDATA Registry Annual Report 2012
Figure 5.98 ANZDATA Registry Annual Report 2012
Figure 5.99 ANZDATA Registry Annual Report 2012
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The distribution of prevalent home dialysis patients by age group is shown in Figure Figure ANZDATA Registry Annual Report 2012
Figure Proportion (%) of Prevalent Patients aged ≥ 65 years Treated with Home Haemodialysis State Australia Queensland5.40%5.50%5.40%5.10%4.90% New South Wales/ACT9.00%8.30%8.10%7.70%7.40% Victoria4.90%4.70%4.40%4.00%3.80% Tasmania2.10%2.50%2.80%3.30%2.60% South Australia0.50%0.60%0.70%0.90%1.10% Northern Territory3.70%4.30%5.60%5.30%5.00% Western Australia1.50% 1.90%2.50%2.60% New Zealand 9.60%9.50%10.30%11.10%11.20% ANZDATA Registry Annual Report 2012
Figure ANZDATA Registry Annual Report 2012
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Definitions in use CARI guidelinesCaring for Australasians with Renal Impairment guidelines Quotidian HD> 3 sessions/week and/or > 5.5 hours/session Long Hour HD= 6.5 hours per HD session High Flux DialyserUltrafiltration coefficient (kuf) >20 ml/hr/mmHg as specified by the manufacturer) AVFNative vein arteriovenous fistula AVGSynthetic arteriovenous bridge graft CVCCentral venous HD catheter (Includes both tunnelled and non-tunnelled unless otherwise stated) Obese BMI = 30 Morbid Obesity BMI = 35 ANZDATA Registry Annual Report 2012