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Introduction: The UK Renal Association Clinical Practice Guidelines include clinical performance measures for biochemical variables 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 2009. The biochemical variables studied were phosphate, adjusted calcium, parathyroid hormone, bicarbonate and total cholesterol. In addition longitudinal analyses were performed (2000-2009) to show changes in achievement of clinical performance measures over time., Results: Sixty-one percent of HD and 70% of PD patients had phosphate between 1.1-1.8 mmol/L. Seventy-four percent of HD and 75% of PD patients had adjusted calcium between 2.2-2.5 mmol/L. Twenty-eight percent of HD and 32% of PD patients had parathyroid hormone between 16-32 pmol/L. Seventy-two percent of HD and 83% of PD patients achieved the audit measure for bicarbonate. There was significant inter-centre variation for all variables studied., Conclusions: The UKRR consistently demonstrates significant 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., (Copyright © 2011 S. Karger AG, Basel.)

Background: The British Association for Paediatric Nephrology Registry was established thirteen years ago to analyse data related to renal replacement therapy for children. The registry receives data from the 13 paediatric nephrology centres in the UK. In 2008 the registry was relocated to the UK Renal Registry (UKRR)., Aim: To provide centre specific data so that individual centres can reflect on the contribution that their data makes to the national picture and to determine the extent to which their patient parameters meet nationally agreed audit standards for the management of children with established renal failure., Method: Data were submitted to the UKRR for analysis electronically via renal IT systems from 5 centres and on paper-based returns from the remaining centres. Data were analysed to calculate summary statistics and where applicable the percentage achieving an audit standard. The standards used were those set out by the Renal Association and the National Institute for Health and Clinical Excellence., Results: Data were received from all but one centre. Anthropometric data confirmed that children with ERF in the UK are short compared with their peers with no change in recent trends. In the UK as a whole, the control of blood pressure, anaemia and bone biochemistry is suboptimal, but for some parameters these appear to be better in the 2008 cohort than in the 1999-2008 cohort., Conclusions: Key features of this report are the provision of centre specific data and comparison of data to audit standards. It is hoped that this information will provide a basis for discussion and a stimulus to improve the care of children with ERF., ((c) 2010 S. Karger AG, Basel.)

Background: Outcome in patients treated with haemodialysis (HD) is influenced by the delivered dose of dialysis. The UK Renal Association (RA) publishes Clinical Practice Guidelines which include recommendations for dialysis dose. The urea reduction ratio (URR) is a widely used measure of dialysis dose., Aim: To determine the extent to which patients received the recommended dose of HD in the UK., Methods: Seventy-two renal centres in the UK submit data electronically to the UK Renal Registry (UKRR). Two groups of patients were included in the analyses: the prevalent patient population on 31st December 2008 and the incident patient population for 2008. Centres returning data on <50% of their patient population were excluded from centre-specific comparisons., Results: Data regarding URR were available from 62 renal centres in the UK. Fifty-one centres provided URR data on more than 90% of prevalent patients. There has been an increase from 56% in 1998 to 83% in 2008 in the proportion of patients in the UK who met the UK Clinical Practice Guideline for URR (>65%). There was considerable variation from one centre to another, with 9 centres attaining the RA clinical practice guideline in >90% of patients and 5 centres attaining the standard in <70% of patients. The HD dose (URR) delivered to patients who had just started dialysis treatment was lower than that of patients who had been treated for longer and increased further with time., Conclusions: The delivered dose of HD for patients with established renal failure has increased over 10 years. Whilst the large majority of patients in the UK achieved the target URR there was considerable variation between centres in the percentage of patients achieving this., ((c) 2010 S. Karger AG, Basel.)

Introduction: This chapter describes the characteristics of adult patients on renal replacement therapy (RRT) in the UK in 2008 and the prevalence rate per million population (pmp) in Primary Care Trusts and local authorities (Council Areas or District Councils) (PCT/LAs) were calculated., Methods: Complete data were electronically collected from all 72 renal centres within the UK. A series of cross-sectional and longitudinal analyses were performed to describe the demographics of prevalent RRT patients in 2008 at centre and national level in the UK. Age and gender standardised ratios of actual to expected for prevalence rates in PCT/LAs were calculated., Results: There were 47,525 adult patients receiving RRT in the UK on 31/12/2008, equating to a UK prevalence of 774 pmp. This represents an annual increase in prevalence of approximately 4.4% although there was significant variation between PCT/LA areas. The pmp growth rate from 2007 to 2008 for prevalent patients by treatment modality in the UK was 5.9% for haemodialysis (HD), a fall of 9.2% for peritoneal dialysis (PD) and growth of 4.6% with a functioning transplant. Over the long term (1982-2007), the steady growth in transplant prevalent numbers was maintained at 4%. There was a slow but steady decline in PD patient numbers from 1999 onwards. Median RRT vintage was 5.3 years. The median age of prevalent patients was 57.3 years (HD 65.5 years, PD 61.0 years and transplant 50.4 years). For all ages, prevalence rates in males exceeded those in females peaking in the 75-79 years age group at 2,582 pmp for males and 70-74 years age group at 1,408 pmp for females. The most common identifiable renal diagnosis was biopsy-proven glomerulonephritis (16.0%), followed by diabetes (14.1%). Transplantation was the most common treatment modality (47%) followed closely by HD (43%). However, HD was increasingly common with increasing older age at the expense of transplantation., Conclusions: The HD and transplant population continued to expand whilst the PD population contracted. There was national, regional and dialysis centre level variation in prevalence rates. This has implications for service planning and ensuring equity of care for RRT patients., ((c) 2010 S. Karger AG, Basel.)

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 performance measures for prevalent haemodialysis (HD) and peritoneal dialysis (PD) cohorts in 2008. The biochemical variables studied were phosphate, adjusted calcium, calcium phosphate product, parathyroid hormone, bicarbonate, total cholesterol and HbA1c. In addition, longitudinal analyses were performed (2000-2008) to show changes in achievement of clinical performance measures over time., Results: Serum phosphate was between 1.1 and 1.8 mmol/L in 55% of HD and 64% of PD patients, which was similar to 2007. There was a fall in overall mean phosphate concentration to 1.55 mmol/L. A revised adjusted serum calcium target of 2.2-2.5 mmol/L was achieved by 63% of HD and 65% of PD patients. For comparison, the previous target of 2.2-2.6 mmol/L was achieved by 74% and 78% respectively, a figure little changed since 2005. The downward trend in serum calcium results evident for the previous nine years appears to have halted. The calcium phosphate target of <4.8 mmol(2)/L(2) was achieved by 84% of HD and 87% of PD patients, continuing the steady improvement over the past nine years and reflecting the downward trend in phosphate results. As in previous years, a minority of patients achieved the PTH target range of 16-32 pmol/L and there was considerable heterogeneity between centres. Although analytical and biological variability may have contributed to this, centres achieving the standards relating to one mineral parameter tended to achieve the standards in others suggesting that treatment factors were also relevant. The audit measure for bicarbonate was achieved in 71% of HD and 82% of PD patients. Eighty-five percent of HD patients and 69% of PD patients achieved a value for total cholesterol <5 mmol/L. This was the first year that HbA1c has been audited. Overall, 43% of diabetic dialysis patients exceeded the target of 7.5% HbA1c and there was considerable variation between centres., Conclusion: There is wide variation between centres in attainment of biochemical performance measures. There is some evidence in bone mineral metabolism that centres performing well in one variable are more likely to also meet the other standards. The inter-centre variation may be explained in part by laboratory practices and case mix but probably also represents variation in practice and in effectiveness of processes of care. Apart from glycaemic control there are a number of analytical and clinical factors that affect HbA1c that would be worthy of further investigation as a cause of variability., ((c) 2010 S. Karger AG, Basel.)

Aims: To describe the demographics of the paediatric RRT population in the UK and analyse changes in demographics with time., Methods: Extraction and analysis of data from the UK Paediatric Renal Registry and the UK Renal Registry (UKRR)., Results: The UK paediatric established renal failure (ERF) population in December 2008 was 905 patients. The prevalence under the age of 16 years was 56 per million age related population (pmarp) and the incidence 7.4 pmarp. The incidence and prevalence for South Asian patients was much higher than that of the White and Black populations. Renal dysplasia was the most common cause of ERF accounting for 33% of prevalent cases. Diseases with autosomal recessive inheritance were a common cause of ERF in all ethnic groups, 23.5% of prevalent and 18% of incident cases. Whilst the incidence and prevalence of diseases with autosomal recessive inheritance in the South Asian population was 3 times that of the white population, this was not the sole reason for the increased proportion of South Asian patients with ERF, as diseases with no defined inheritance were twice as common in this ethnic group than in White patients. Prevalent mortality stood at 9.4%. Most deaths were in patients presenting with ERF early in life and mortality varied markedly according to the aetiology of ERF. The proportion with new grafts from living donors has steadily risen to 54%. Children from ethnic minority groups were less likely to have an allograft and living donation was less frequent in this population. For those on dialysis, 56% were receiving peritoneal dialysis. This was the main treatment modality for patients under 4 years of age., Conclusions: The paediatric ERF population continued to expand slowly. Incidence and prevalence rates were stable and similar to other developed nations. The high incidence in patients from ethnic minority groups will lead to a greater proportion of the population being from these groups in time. To maintain the high proportion of engrafted patients it will be necessary to encourage living donation in the ethnic minority population. Case note analysis of the factors involved in mortality would be valuable., ((c) 2010 S. Karger AG, Basel.)