Chapter 10 Multisite Dialysis Access Audit in England, Northern Ireland and Wales and 2015 Peritoneal.

In 2016, 55 of 62 centres in England, Wales and Northern Ireland returned data on first access for 4,564 incident haemodialysis (HD) and 1,246 incident PD recipients. Of these 5,810 incident patients, 50% started dialysis with definitive access: 21.5% started PD, 28.5% started HD with an arteriovenous fistula (AVF) or graft (AVG), 28.4% with a tunnelled line (TL) and 21.7% with a non-tunnelled line (NTL). Wide variation in definitive access use (defined as primary AVF, AVG or PD) was apparent between centres. Sixteen centres achieved the 60% target for AVF/ AVG use amongst incident HD recipients. Seventeen centres achieved the 80% target for AVF/ AVG/PD use amongst prevalent dialysis recipients. Timely presentation to a nephrologist and referral to a dialysis access surgeon remained key determinants of the likelihood of definitive access at dialysis initiation For late-presenting patients, definitive access 90 days after initiating dialysis ranged between 42.9% and 0.0% by centre, implying variation in the responsiveness of dialysis access pathways. For centres returning data on one-year PD access outcomes, 70.7% of patients starting PD continued to use this modality or have been transplanted one year later. The mean one-year PD catheter failure rate was 18.4%. This report demonstrates wide variation in practice between centres across several domains in the provision of dialysis access.