UK Renal Registry 11th Annual Report (December 2008): Chapter 9 Haemoglobin, ferritin and erythropoietin amongst patients receiving dialysis in the UK in 2007: national and centre-specifıc analyses

Abstract

Background: The UK Renal Association (RA) and National Institute for Health and Clinical Excellence (NICE) have published Clinical Practice Guidelines which include recommendations for management of anaemia in established renal failure. Aims: To determine the extent to which the guidelines for anaemia management are met in the UK. Methods: Quarterly data (haemoglobin (Hb) and factors that influence Hb) extracts from renal centres in England, Wales and Northern Ireland (EWNI), and annual data from the Scottish Renal Registry for incident and prevalent renal replacement therapy (RRT) cohorts for 2007 were analysed by the UK Renal Registry (UKRR). Results: In the UK, in 2007 58% of patients commenced dialysis therapy with Hb ≥ 10.0 g/dl (median Hb 10.3 g/dl). Of incident patients 81% and 87% had a Hb ≥ 10.0 g/dl by 3 and 6 months of dialysis treatment respectively. The median Hb of haemodialysis (HD) patients was 11.6 g/dl with an interquartile range (IQR) of 10.6–12.6 g/dl. Of HD patients 86% had a Hb ≥ 10.0 g/dl. The median Hb of peritoneal dialysis (PD) patients in the UK was 11.9 g/dl (IQR 11.0–12.8 g/dl). 91% of UK PD patients had a Hb ≥ 10.0 g/dl. The median ferritin in HD patients in EWNI was 417 mg/L (IQR 270–598) and 95% of HD patients had a ferritin ≥ 100 mg/L. The median ferritin in PD patients was 255 mg/L (IQR 143–411) with 85% of PD patients having a ferritin ≥ 100 mg/L. In EWNI the mean ESA dose was higher for HD than PD patients (9,300 vs. 6,100 IU/week). Conclusions: This year for the first time there has been a small fall (from 85.9% in 2006 to 85.6%) in the percentage of HD patients with an Hb of ≥ 10 g/dl. This contrasts with previous annual improvements in this figure and is related to implementation of the new Hb Standard which has a target range of 10.5–12.5 g/dl.