Full Report - UK Renal Registry

288 Pages·2007·2.12 MB·English

by  David Ansell

ISSN 1471-3349

The Renal Association

UK Renal Registry

The Ninth Annual Report

December 2006

This report was prepared by
Dr David Ansell, Professor Terry Feest, Dr Alex Hodsman, Dr Raman Rao
Dr Charlie Tomson, Dr Uday Udayaraj, Dr Andrew Williams and Dr Graham Warwick

in association with
F Caskey, K Farrington, R Fluck, J Harper, E Lamb, M Lewis,
J Macdonald, R Ravanan, D Richardson, D Thomas
Editors
Dr D Ansell
Prof T Feest
Dr C Tomson
Dr AJ Williams
Dr G Warwick

Biostatisticians
Prof D van Schalkwyk
Mrs M Steenkamp
Dr J Gilg

Registry Registrars
Dr A Hodsman
Dr R Rao
Dr U Udayaraj

Proof reading by
Mrs F Benoy-Deeney
Ms H Doxford

Suggested citation

Ansell D, Feest TG, Tomson C, Williams AJ, Warwick G
UK Renal Registry Report 2006
UK Renal Registry, Bristol, UK

This report will also become available as a supplement to Nephrology Dialysis & Transplantation. The
individual chapters should then be referenced by their Medline citation.

Publications based on the UK Renal Registry data must include the citation as noted above and the
following notice:

The data reported here have been supplied by the UK Renal Registry of the Renal Association. The
interpretation and reporting of these data are the responsibility of the authors and in no way should be
seen as an official policy or interpretation of the UK Renal Registry or the Renal Association.
The Renal Association
UK Renal Registry
Southmead Hospital
Southmead Rd
Bristol
BS10 5NB
UK
Telephone
0117 959 5665
Fax
0117 959 5664
Email
[email protected]
Web site
www.renalreg.org
General Manager
Hilary Doxford
Systems Manager
David Bull
Clinical Data Managers
Fran Benoy-Deeney
Paul Dawson
Programmers
Matthew Brealey
Andy Langdon
Secretary / PA
Becky Blackwell

UK Renal Registry
Director: Dr D Ansell
Accounts: MCI Ltd
The UK Renal Registry Subcommittee
Chairman: Dr C Tomson
Secretary: Dr E Will
Members: Dr F Caskey
Prof S Davies
Dr R Fluck
Dr J Harper
Dr P Roderick
Dr P Stevens
Dr D Thomas
Mrs N Thomas
Dr A Williams
Ex Officio Renal Association:
Prof J Feehally (President), Dr D Goldsmith (Secretary)
Prof A Rees (Management Board Chair)
Dr G Bell (Executive) Dr C Winearls (Clinical Vice President)
Northern Ireland: Dr D Fogarty
Scotland: Dr K Simpson
Wales: Dr K Donovan
British Association of Paediatric Nephrology: Dr C Reid
British Transplantation Society: Mr A Bakran, Dr C Dudley
Association for Clinical Biochemistry: Dr E Lamb
Department of Health: Mr G Lynch
Royal College of Nursing: Ms A Redmond
Health Commissioners: Mrs Jenny Scott
National Kidney Federation (patient rep): Mr K Tupling
Retired Dr R Burden, Dr D O’Donoghue, Prof T Feest, Ms T Lee,
Members 2006: Dr J Woods
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Contents
Chapter 1: SummaryofFindingsinthe2006UKRenalRegistryReport 1
Chapter 2: Introductiontothe2006UKRenalRegistryReport 3
DavidAnsell, EsWillandCharlieTomson 3
Quality Improvement 3
Geographical areas covered by the UK Renal Registry 4
Future coverage by the Registry 5
Centres submitting 2006 and 2007 data 6
Completeness of returns for four important data items 6
Software and links to the Registry 8
Paediatric Renal Registry links 8
Links with other organisations 8
Commissioning of renal services and PCTs 9
The Registry and clinical governance 9
Anonymity and confidentiality 10
The ‘Health and Social Care Act 2001’: section 60 exemption 10
Support for renal services in Connecting for Health – the National Programme
for IT 10
Support for renal systems managers and informatics staffs 10
Interpretation of the data within the report 11
Future potential 11
Support for Renal Specialist Registrars undertaking a non-clinical secondment 11
New data collection and analysis 11
Recent UK Renal Registry peer reviewed publications 12
Commissioned research and reports 13
Distribution of the Registry Report 13
Chapter 3: NewAdultPatientsStartingRenalReplacementTherapyintheUKin2005 15
KenFarrington,RamanRao,JulieGilg,DavidAnsellandTerryFeest 15
Summary 15
Introduction 16
Adult patients accepted for renal replacement therapy in the UK, 2005 16
Overall take-on rate 16
Local changes in acceptance rate 17
Acceptance rates of individual units 17
Geographical variation in acceptance rates in England, Northern Ireland,
Scotland and Wales 19
Introduction 19
Methods 19
Results 19
Ethnicity 25
Age 27
Gender 29
Primary renal diagnosis 31
First established treatment modality 33
Survival of incident patients 37
Late referral of incident patients 37
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Methodology 37
Late referral by centre and year 38
Time referred before dialysis initiation in the 2005 incident cohort 38
Age and late referral 38
Gender and late referral 39
Ethnicity, social deprivation and late referral 39
Primary renal disease and late referral in 2005 incident cohort 40
Modality and late referral 40
Co-morbidity and late referral 40
Haemoglobin and late referral 40
Renal function at the time of starting RRT 41
eGFR and late referral 41
eGFR and age 41
Changes over time in eGFR at start of RRT 41
Chapter 4: AllPatientsReceivingRenalReplacementTherapyintheUnitedKingdomin2005 43
KenFarrington,RamanRao,RethaSteenkamp,DavidAnsellandTerryFeest 43
Summary 43
Introduction 44
All adult patients receiving Renal Replacement Therapy in the UK, 31/12/2005 44
Prevalent patients by renal unit on 31/12/2005 45
Changes in prevalence 2000–2005 47
Local Authority prevalence 50
Standardised prevalence ratios 50
Vintage of prevalent patients 57
Age of prevalent patients 57
Gender 59
Ethnicity 60
Primary renal disease 62
Diabetes 63
Modalities of treatment 64
Haemodialysis 65
Peritoneal dialysis 67
Change in treatment modality 1997–2005 70
Survival of patients established on RRT 70
One year survival of prevalent dialysis patients 73
One year survival of prevalent dialysis patients in England, Wales and
Scotland from 1997–2005 73
References 76
Chapter 5: TheUKVascularAccessSurvey–Follow-upDataandRepeatSurvey 77
RichardFluck,RamanRao,DirkvanSchalkwyk,DavidAnsellandTerryFeest 77
Summary 77
Introduction 77
Methods 77
Vascular Access Survey 2006 77
Vascular Access Survey 2005 Follow up data and organisational data 78
Results 78
Vascular Access Survey 2006 78
Morbidity data 78
Vascular Access Survey 2005 – follow-up data 80
Data returns 80
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Access modality at start, 6 & 12 months post commencement of renal
replacement therapy 80
Transplantation and transplant waiting list 82
Patient pathway 82
Mortality and incident access and modality 84
Organisational data 84
Discussion 84
Summary and recommendations 85
Acknowledgments 85
References 86
Chapter 6: Co-morbiditiesinUKPatientsattheStartofRenalReplacementTherapy 87
CharlieTomson,UdayUdayaraj,Julie GilgandDavidAnsell 87
Summary 87
Introduction 87
Methods 87
Results 88
Completeness of co-morbidity returns from each participating renal unit 88
Frequency of each co-morbidity condition 90
Frequency of multiple co-morbidity 90
Frequency of co-morbidity by age band 91
Frequency of co-morbidity amongst patients with diabetes 91
Age and co-morbidity in patients starting haemodialysis compared to those
starting peritoneal dialysis 91
Frequency of co-morbidity by ethnic origin 92
Renal function at the time of starting RRT and co-morbidity 95
Haemoglobin concentration at the time of starting RRT and co-morbidity 96
Co-morbidity and subsequent kidney transplantation 96
Co-morbidity and subsequent survival – Introduction 97
Co-morbidity and survival within 90 days of commencing RRT 97
Co-morbidity and survival 1 year after 90 days of commencing RRT 99
Discussion 100
References 100
Chapter 7: HaemodialysisDoseandSerumBicarbonate 103
CharlieTomson,DavidThomas,RamanRao,DirkvanSchalkwykand
DavidAnsell 103
Summary 103
Introduction 103
Completeness of data 103
Dialysis dose 103
Introduction 103
Achieved URR 105
Changes in URR over time 106
Variation of achieved URR with time on dialysis 106
Commentary 106
Serum bicarbonate 110
Introduction 110
Haemodialysis 110
Peritoneal dialysis 112
Transplant 113
Commentary 113
References 114
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Chapter 8: ManagementofAnaemiainHaemodialysisandPeritonealDialysisPatients 115
DonaldRichardson,AlexHodsman,DirkvanSchalkwyk,CharlieTomsonand
GrahamWarwick 115
Summary 115
Introduction 115
Methods 115
Haemoglobin 116
Haemoglobin of patients with CKD 116
Haemoglobin of prevalent haemodialysis patients 120
Haemoglobin of prevalent peritoneal dialysis patients 124
Haemoglobin in incident patients 125
Changes in Haemoglobin by length of time on dialysis over time 133
Factors affecting Haemoglobin 134
Completeness of serum ferritin returns for HD and PD 134
Serum ferritin 134
Erythropoiesis Stimulating Agents 141
Conclusion 147
References 147
Chapter 9: SerumCalcium,Phosphate,ParathyroidHormone,Albumin,Aluminiumand
CholesterolAchievementonReplacementTherapy 149
EdLamb,AlexHodsman,DirkvanSchalkwyk,DavidAnsell and
GrahamWarwick 149
Summary 149
Introduction 149
Methods 150
Serum phosphate 150
Data completeness 150
Achievement of serum phosphate 150
Identification of outliers in achievement of serum phosphate 152
Serum calcium 154
Data completeness 154
Achievement of serum calcium 154
Serum calcium (cid:1) phosphate product 156
Serum parathyroid hormone 158
Data completeness 158
Achievement of serum iPTH 158
Albumin 160
Aluminium 161
Cholesterol 161
Data completeness 161
Achievement of serum cholesterol 161
References 164
Appendix for definition of prevalent cohort for biochemistry chapter 165
Definition of prevalent cohort 165
Chapter 10: FactorsWhichMayInfluenceCardiovascularDiseaseinDialysisandTransplant
Patients–BloodPressure 167
JaniceHarper,AlexHodsman,JulieGilg,DavidAnsellandAndrewJWilliams 167
Summary 167
Introduction 167
Blood Pressure Control 168
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