Changes in Dialysis Practice Patterns in Australia and New Zealand During the COVID-19 Pandemic Period

Daniela Potter^{1

2

3}, Kevan R Polkinghorne^{4

5}, Annie Conway⁶, Christopher E Davies^{6

7}, Eric Au⁶, Andrew Pilmore⁸, Helmant Kulkarni^{9

10}, Mathew Blake Roberts¹¹, Peter Kolovos¹², Claire Dendle^{13

14}, Solomon Menahem^{14

15}, Sradha Kotwal^{16

17}

Affiliations

¹ Department of Renal Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia.
² University of New South Wales, Sydney, New South Wales, Australia.
³ University of Western Sydney, Sydney, New South Wales, Australia.
⁴ Department of Medicine, Monash University, Melbourne, Victoria, Australia.
⁵ Department of Nephrology, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia.
⁶ Australia & New Zealand Dialysis & Transplant (ANZDATA) Registry, South Australian Health & Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.
⁷ Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
⁸ Department of Renal Medicine, Auckland District Health Board, Auckland, New Zealand.
⁹ Department of Nephrology, East Metropolitan Health Services, Perth, Western Australia, Australia.
¹⁰ University of Western Australia & Curtin Medical School, Bentley, Western Australia, Australia.
¹¹ Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
¹² Department of Renal Medicine, Nepean Hospital, Penrith, New South Wales, Australia.
¹³ Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia.
¹⁴ Departments of Rural Health, Monash University, Melbourne, Victoria, Australia.
¹⁵ Renal Medicine, Latrobe Regional Hospital, Traralgon, Victoria, Australia.
¹⁶ Prince of Wales Hospital, University of New South Wales, Sydney, Australia.
¹⁷ The George Institute for Global Health, University of New South Wales, Sydney, Australia.

PMID: 40685329
PMCID: PMC12277125
DOI: 10.1111/nep.70077

Observational Study

Changes in Dialysis Practice Patterns in Australia and New Zealand During the COVID-19 Pandemic Period

Daniela Potter et al. Nephrology (Carlton). 2025 Jul.

. 2025 Jul;30(7):e70077.

doi: 10.1111/nep.70077.

Authors

Affiliations

¹ Department of Renal Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia.
² University of New South Wales, Sydney, New South Wales, Australia.
³ University of Western Sydney, Sydney, New South Wales, Australia.
⁴ Department of Medicine, Monash University, Melbourne, Victoria, Australia.
⁵ Department of Nephrology, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia.
⁶ Australia & New Zealand Dialysis & Transplant (ANZDATA) Registry, South Australian Health & Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia.
⁷ Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
⁸ Department of Renal Medicine, Auckland District Health Board, Auckland, New Zealand.
⁹ Department of Nephrology, East Metropolitan Health Services, Perth, Western Australia, Australia.
¹⁰ University of Western Australia & Curtin Medical School, Bentley, Western Australia, Australia.
¹¹ Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
¹² Department of Renal Medicine, Nepean Hospital, Penrith, New South Wales, Australia.
¹³ Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia.
¹⁴ Departments of Rural Health, Monash University, Melbourne, Victoria, Australia.
¹⁵ Renal Medicine, Latrobe Regional Hospital, Traralgon, Victoria, Australia.
¹⁶ Prince of Wales Hospital, University of New South Wales, Sydney, Australia.
¹⁷ The George Institute for Global Health, University of New South Wales, Sydney, Australia.

PMID: 40685329
PMCID: PMC12277125
DOI: 10.1111/nep.70077

Abstract

Aim: The COVID-19 pandemic caused widespread global disruptions to healthcare systems. There has been no assessment of this on dialysis practice at a binational level.

Methods: A multi-centre retrospective observational cohort study using data from the ANZDATA Registry was performed, with adult incident dialysis patients (1 January 2018 to 31 December 2022). Patients commencing dialysis during 2020-2022 were compared to 2018-2019 for the primary outcome of dialysis incidence rate. Secondary outcomes included estimated glomerular filtration rate (eGFR) at dialysis start, initial treatment location (home vs. facility), modality (haemodialysis vs. peritoneal dialysis), haemodialysis access, frequency, and duration. Commencement during lockdown in 2020-2021 was also analysed.

Results: 11 690 patients commenced dialysis during 2020-2022 and 7366 commenced during 2018-2019, with no differences in incidence rate across the pandemic years (2020: p = 0.163, 2021: p = 0.139, 2022: p = 0.190). Compared to pre-pandemic years, uptake of home-based therapies was higher in 2020 (OR = 1.16, 95% CI 1.06-1.27, p = 0.002) with no difference in 2021 and 2022. Peritoneal dialysis uptake was higher in 2020 (OR = 1.15, 95% CI 1.04-1.26, p = 0.005) and 2021 (OR = 1.11, 95% CI 1.01-1.21, p = 0.037) with no difference in 2022. Haemodialysis patients were less likely to commence with an arteriovenous fistula or graft in 2022, compared to pre-pandemic years (OR = 0.87, 95% CI 0.78-0.96, p = 0.005). Odds of commencing haemodialysis with an arteriovenous fistula or graft were reduced during lockdown (OR = 0.79, 95% CI 0.65-0.95, p = 0.014).

Conclusion: There was no change in the incidence rate of dialysis patients during 2020-2022, although there were differences in home dialysis uptake and starting access type.

Keywords: COVID‐19; clinical practice patterns; delivery of healthcare; health services administration; renal dialysis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

**FIGURE 1**
Lockdown periods across Australia and New Zealand, 2020–2021. ACT = Australian Capital Territory, NSW = New South Wales, NT = Northern Territory, NZ = New Zealand, QLD = Queensland, SA = South Australia, TAS = Tasmania, VIC = Victoria, WA = Western Australia.

See this image and copyright information in PMC

References

1. El Karoui K. and De Vriese A. S., “COVID‐19 in Dialysis: Clinical Impact, Immune Response, Prevention, and Treatment,” Kidney International 101, no. 5 (2022): 883–894. - PMC - PubMed
1. Hilton J., Boyer N., Nadim M. K., Forni L. G., and Kellum J. A., “COVID‐19 and Acute Kidney Injury,” Critical Care Clinics 38, no. 3 (2022): 473–489. - PMC - PubMed
1. Health AIo, Welfare , Australia's Health 2022: Data Insights (AIHW, 2022), https://www.aihw.gov.au/reports/australias‐health/australias‐health‐2022....
1. Levey A. S., Stevens L. A., Schmid C. H., et al., “A New Equation to Estimate Glomerular Filtration Rate,” Annals of Internal Medicine 150, no. 9 (2009): 604–612. - PMC - PubMed
1. Queensland Government , “Revoked and Superseded Public Health Directions,” June, 2024, https://www.health.qld.gov.au/system‐governance/legislation/cho‐public‐h....

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Changes in Dialysis Practice Patterns in Australia and New Zealand During the COVID-19 Pandemic Period

Affiliations

Changes in Dialysis Practice Patterns in Australia and New Zealand During the COVID-19 Pandemic Period

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Research Materials

Miscellaneous