New adult patients starting renal replacement therapy in the UK in 2005 (Chapter 3)

Abstract

In 2005, the acceptance rate for renal replacement therapy (RRT) in adults in the UK was 108 per million population (pmp). This was derived from complete data for adults in the UK, as data were obtained separately from the five English renal units not currently returning to the Registry. In addition, 87 children started RRT (see Chapter 13) giving a total incidence of 110 pmp. From 2001 to 2005 there has been an 7.3% rise in the acceptance numbers in those 42 renal units with full reporting throughout that period. In the UK, for adults in 2005, the crude acceptance rates in Local Authorities (LA) varied from 0 (in two very small LA areas in Scotland and Northern Ireland) to 271 pmp; the standardized rate ratios for acceptance varied from 0 to 2.76. Excluding the two areas with null returns, 20 areas had significantly low ratios, all of them in England. Thirty had significantly high ratios, seven in Northern Ireland, four in Scotland, three in Wales and seven in London. Over the period 2001-2005, 25 areas had a significantly low standardized acceptance rate; 24 in England and one in Scotland. All except one of these had ethnic minority populations of <10%. Thirty-seven had high standardized acceptance rates, seven in Scotland where ethnicity data were not available, 14 from areas with ethnic minority populations in excess of 10%, and 12 were in Wales or the Southwest of England. The median age of patients starting RRT in England has increased from 63.8 years in 1998 to 65.2 years in 2005. The median age of incident non-White patients is significantly lower at 56.8 years. In England, the acceptance rate is highest in the 75-79 age band at 408 pmp, as in Scotland at 580 pmp; in Wales the peak is in the 80-84 age band at 525 pmp, as in Northern Ireland with a rate of 825 pmp. Diabetic renal disease (20%) remains the most common specific primary renal disease. There was a significant positive correlation between the percentage of incident RRT patients with diabetic renal disease and the percentage of non-Whites in the incident cohort. Haemodialysis (HD) was the first modality of RRT in 76% of patients, peritoneal dialysis (PD) in 21% and pre-emptive transplant in 3%. In 1998, the proportion whose first modality was HD was 58% and this continues to increase. By day 90, 8% had died, a further 1% had stopped treatment or been transferred out leaving 91% of the original cohort on RRT. Of these, 71% were on HD, 26% on PD and 3% had received a transplant. Data on first referral to a nephrologist were available from 22 centres for the period 2000-2005 (for a total of 5611 patients and 59 centre-years). In 2005, the mean percentage of patients referred late (<90 days before dialysis initiation) was 30% (centre range 13-48%). This was similar to the value in 2000. Patients referred late were older, a higher proportion of them were male, a lower proportion non-White, and a lower proportion with no recorded comorbidity. Patients with polycystic kidney disease and diabetic nephropathy tended to be referred early compared with the whole incident cohort and those with uncertain aetiology and no recorded diagnosis referred late. Estimated GFR (eGFR) at the start of RRT appears to be higher in older than younger patients. eGFR is significantly lower in those referred late compared with those referred earlier and this is especially marked in the older patients. The geometric mean eGFR of all patients starting RRT rose from 6 in 1997 to above 7.5 in 2003, since when it has remained stable.