Alex Hodsman

UK Renal Registry 17th Annual Report: Chapter 5 Survival and Cause of Death in UK Adult Patients on Renal Replacement Therapy in 2013: National and Centre-specific Analyses.

Introduction: These analyses examine survival from the start of renal replacement therapy (RRT), based on the total incident UK dialysis population reported to the Registry, including the 21% who started on PD and the 5% who received a pre-emptive transplant. Survival of prevalent patients and changes in survival between 1997–2006 are reported. The article includes a discussion on the technical definition for the date of start of both PD and HD. Methods: Survival was calculated for both incident and prevalent patients on RRT and compared between the UK countries after adjustment for age. Survival of incident patients (starting during 2006) was calculated with and without a 90 day RRT start cut off. Survival of incident patients is shown with and without censoring at transplantation. Both the Kaplan–Meier and Cox adjusted models were used to calculate survival. Causes of death were analysed for both groups. Relative risk of death was calculated compared with the general UK population. Results: The 2006 unadjusted 1 year after 90 day survival for patients starting RRT was 86%. In incident 18–64 year olds the unadjusted 1 year survival had risen from 85.9% in 1997 to 91.5% in 2006 and for those aged ≥ 65 it had risen from 63.8% to 72.9%. The age adjusted survival of prevalent dialysis patients rose from 85% in 2000 to 89% in 2007. Diabetic patient survival rose from 76.6% in 2000 to 84.0% in 2007. The relative risk of death on RRT compared with the general population was 30 at age 30 years compared with 3 at age 80 years. In the prevalent RRT dialysis population, cardiovascular disease accounted for 34% of deaths, infection 20% and treatment withdrawal 14%. Conclusions: Incident and prevalent patient survival on RRT in all the UK countries for all age ranges and also for patients with diabetes continued to improve. The relative risk of death on RRT compared with the general population has fallen since 2001. Death rates on dialysis in the UK remained lower than when compared with a similar aged population on dialysis in the USA.

UK Renal Registry 11th Annual Report (December 2008): Chapter 4 ESRD prevalent rates in 2007 in the UK: national and centre-specific analyses.

Introduction: This chapter describes the demographics of UK RRT patients in 2007. Methods: Complete data were electronically collected from 71 UK centres with the remaining 1 centre submitting summary data. A series of crosssectional and longitudinal analyses were performed to describe the demographics of prevalent UK RRT patients in 2007 at a centre and a national level. Results: There were 45,484 adult patients receiving RRT on 31/12/2007. The population prevalence for adults was 746 per million population per year (pmp) with an annual increase in prevalence of approximately 5% per annum. There was substantial variation in standardised prevalence ratios between Primary Care Trust (PCT)/Health Authority (HA) areas which were associated with geographical factors and differences in ethnicity with mean standardised prevalence ratios (SPR) significantly higher in PCTs/HAs with a high proportion of ethnic minorities. The median age of prevalent RRT patients was 57 years (HD 65 years, PD 60 years, transplant 50 years). Median RRT vintage was 5.3 years (HD 2.8 years, PD 2.1 years, transplant 10.4 years). For all ages, crude prevalence rates in males exceeded those in females, peaking in the 75–79 year age band for males at 2,506 pmp and in females in the 70–74 year age band at 1,314 pmp. The most common identifiable diagnosis was glomerulonephritis (15.3%) but in those over 65 it was diabetes (15.1%). The most common treatment modality was transplantation (46.6%), closely followed by centrebased HD (42.1%) in either the primary centre (25.2%) or the satellite unit (16.9%). The HD population has continued to expand, and the PD population to contract. HD was increasingly prominent with increasing age at the expense of transplantation. Conclusions: There were national, area and dialysis centre level variation in the prevalent UK RRT population. This has implications for service planning and ensuring equity of care for RRT patients.

UK Renal Registry 11th Annual Report : Chapter 4 ESRD prevalent rates in 2007 in the UK : national and centre-specific analyses

Introduction: This chapter describes the characteristics of adult patients starting renal replacement therapy (RRT) in the UK in 2007 and the acceptance rate for RRT in Primary Care Trusts (PCT) or equivalent Health Authority (HA) areas in the UK. Methods: The basic demographics are reported for all UK centres and clinical characteristics of patients starting RRT from all except 1 centre in the UK. Late presentation, defined as time between first being seen by a nephrologist and start of RRT being <90 days was also studied. Age and gender standardised ratios for acceptance rate in PCTs or equivalent HAs were calculated. Results: In 2007, the acceptance rate in the UK was 109 per million population (pmp) compared to 111 pmp in 2006. Acceptance rates in England (107 pmp), Scotland (108 pmp) and Northern Ireland (105 pmp) have fallen slightly, whilst that in Wales (140 pmp) has risen. There were wide variations between PCTs/HAs with respect to the standardised ratios which were lower in more PCTs in the North West and South East of England and higher in London, the West Midlands and Wales. The median age of all incident patients was 64.1 years and for non-Whites 57.1 years. There was an excess of males in all age groups starting RRT and nearly 80% of patients were reported to be White. Diabetic renal disease remained the single most common cause of renal failure (21.9%). By 90 days, 67.4% of patients were on haemodialysis, 21.3% on peritoneal dialysis, 5.2% had had a transplant and 6.1% had died or had stopped treatment. The incidence of late presentation in those centres supplying adequate data was 21%. Conclusions: The acceptance rate has fallen in England, Northern Ireland and Scotland but continues to rise in Wales with wide variations in acceptance rate between PCTs/HAs.

UK Renal Registry 11th Annual Report (December 2008): Chapter 10 Biochemistry profile of patients receiving dialysis in the UK in 2007: national and centre-specific analyses

Introduction: The UK Renal Association Clinical Practice Guidelines include clinical performance measures for biochemical parameters in dialysis patients [1]. The UK Renal Registry (UKRR) annually audits dialysis centre performance against these measures as part of its role in promoting continuous quality improvement. Methods: Cross sectional performance analyses were undertaken to compare dialysis centre achievement of clinical audit measures for prevalent haemodialysis (HD) and peritoneal dialysis (PD) cohorts in 2007. The biochemical variables studied were phosphate, adjusted calcium, parathyroid hormone, bicarbonate and total cholesterol. In addition longitudinal analyses were performed (2000–2007) to show changes in achievement of clinical performance measures over time. Results: Serum phosphate was between 1.1–1.8 mmol/L in 53% of HD and 64% of PD patients. Since 2003 there has been annual improvement in phosphate control for both HD and PD patients, largely through a reduction in phosphate >1.8 mmol/L. PD patients this year also showed a reduction in the percentage with a low phosphate. Adjusted calcium was between 2.2–2.6 mmol/L in 73% of HD and 78% of PD patients. Parathyroid hormone was between 16–32 pmol/L in 25% of HD and 27% of PD patients. The audit measure for bicarbonate was achieved in 71% of HD and 50% of PD patients. There was inter-centre variation for all variables studied. Conclusions: The UKRR consistently demonstrates inter-centre variation in achievement of biochemical clinical audit measures. Understanding the causes of this variation is an important part of improving the care of dialysis patients in the UK.

UK Renal Registry 11th Annual Report (December 2008): Appendix D Methodology used for analyses of PCT incidence and prevalence rates and of standardised ratios

The areas used were the 152 (English) Primary Care Trusts (PCTs), the 22 Welsh local health boards, the 32 Scottish council areas and the 26 Northern Ireland district council areas – these different types of area are collectively called PCTs here. Prior to 2007, only some of the boundaries of PCTs and Local Authorities (LAs) in England were similar. There were roughly twice as many PCTs as LAs and the registry reports published analyses by LA in the main report and prevalence rates by PCT as an appendix. In October 2006, the Office for National Statistics reduced the number of PCTs and re-aligned many of the PCT boundaries in England with those of Local Authorities. As a result, in the 2008 Report these analyses will be presented by PCT (not LA). For data for years before the boundaries changed, patients are allocated to the new PCTs as they are now. In Northern Ireland, Scotland and Wales, the Health Authority boundaries align with the LAs and these areas have been included along with the English PCTs in the tables.