Access to dialysis in New Zealand renal services.
OBJECTIVE
To assess the equity of access to dialysis treatment in New Zealand renal services.


METHODS
All patients with chronic renal failure assessed by NZ renal services for whom a decision regarding dialysis was made in the years 1997 and 1998 were entered into the study. Information collected included patient demographics, cause of renal failure, scores for comorbidity and activities of daily living (ADL), renal centre and dialysis decision.


RESULTS
Records were available for 823 patients, of whom 710 were offered dialysis and 676 accepted treatment. Compared with those who accepted an offer of dialysis, those not offered treatment were older (67.4 vs 53.3 years, p <0.001), and had higher scores for comorbidity (340 vs 128, p <0.001) and ADL (150 vs 32, p <0.001), but there was no difference in primary disease incidence. Patients at one centre were referred with significantly higher average comorbidity, and at two centres with significantly different ADL scores, than those referred to the reference centre. The acceptance rate was significantly lower at one centre when adjusted for age, ethnicity, gender, and comorbidity and ADL scores.


CONCLUSIONS
Of all referred patients, 13.7% were not offered dialysis treatment. They had significantly higher comorbidity, and were older and more disabled than those patients offered treatment. There was one centre with a significantly lower adjusted acceptance rate.
Collins
John
J
Department of Renal Medicine, Auckland Hospital, Auckland, New Zealand. johnco@adhb.govt.nz
Metcalf
Patricia
P
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D003953:Diagnosis-Related Groups; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data*; D006435:Renal Dialysis / Q000706:statistics & numerical data*