title: Temporal Changes in Mortality Risk by Dialysis Modality in the Australian and New Zealand Dialysis Population.
abstract: BACKGROUND
  In most studies, home dialysis associates with greater survival than facility hemodialysis (HD). However, the relationship between mortality risk and modality can vary by era. We describe and compare changes in survival with facility HD, peritoneal dialysis, and home HD over a 15-year period using data from The Australia and New Zealand Dialysis and Transplant Registry (ANZDATA).
  
  
  METHODS
  An observational inception cohort study, using Cox proportional hazards and competing-risks regression.
  
  
  METHODS
  All adult patients initiating renal replacement therapy in Australia and New Zealand since March 31, 1998, followed up to December 31, 2012.
  
  
  METHODS
  Era at dialysis inception (1998-2002, 2003-2007, and 2008-2012). We adjusted for time-varying dialysis modality and comorbid conditions, demographics, initial state/country of treatment, late referral for nephrology care, primary kidney disease, and kidney function at dialysis inception.
  
  
  RESULTS
  Patient mortality.
  
  
  RESULTS
  Survival on dialysis therapy has improved despite increasing patient comorbid conditions. Compared to 1998 to 2002, there has been a 21% reduction in mortality for those on facility HD therapy, a 27% reduction for those on peritoneal dialysis therapy, and a 49% reduction for those on home HD therapy.
  
  
  CONCLUSIONS
  Potential for residual confounding from limited collection of comorbid conditions; analyses lack data for blood pressure, fluid volume status, socioeconomics, medication, and biochemical parameters.
  
  
  CONCLUSIONS
  Our study indicates that outcomes on dialysis therapy are improving with time and that this improvement is most marked with home dialysis modalities, especially home HD. This might be the result of better dialysis care (eg, improving predialysis care and more appropriate selection of patients for home dialysis). Other contributing factors are possible, such as improvements in general care of patient comorbid conditions and improvements in dialysis technology, although further research is needed to clarify these issues.
authors.affiliation: Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Renal Medicine, Counties Manukau, Health, Auckland, New Zealand; Baxter Healthcare (Asia Pacific), Shanghai, People's Republic of China. Electronic address: mrmarsh@woosh.co.nz.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Marshall
authors.affiliation: Department of Nephrology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia; Department of Medicine, Monash University, Clayton, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia; Department of Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), The Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Kevan R
authors.initials: KR
authors.lastname: Polkinghorne
authors.affiliation: Department of Nephrology, Monash Medical Centre, Monash University, Clayton, Victoria, Australia; Department of Medicine, Monash University, Clayton, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia; Department of Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Kerr
authors.affiliation: Renal Unit, Geelong Hospital, Barwon Health, Geelong, Victoria, Australia.
authors.forename: John W M
authors.initials: JW
authors.lastname: Agar
authors.affiliation: Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hawley
authors.affiliation: Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), The Royal Adelaide Hospital, Adelaide, South Australia, Australia; School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: McDonald
mesh_terms: D000368:Aged; D001315:Australia / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006437:Hemodialysis, Home / Q000401:mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009520:New Zealand / Q000453:epidemiology; D010530:Peritoneal Dialysis / Q000401:mortality; D006435:Renal Dialysis / Q000401:mortality*; D018570:Risk Assessment
keywords: ANZDATA; Home hemodialysis; competing risks; dialysis modality; epidemiology; era effect; facility hemodialysis; home dialysis; multivariable analysis; patient mortality; peritoneal dialysis; secular change; survival; temporal change; time series