Measures of care in adult renal transplant recipients in the United Kingdom (Chapter 11)
1University Hospital of Wales, Cardiff, 2UK Renal Registry, Bristol, 3Royal Liverpool University Hospital, Liverpool and 4Morriston Hospital, Swansea
Correspondence and offprint requests to: Rommel Ravanan, UK Renal Registry, Southmead Hospital, Southmead Rd, Bristol, BS10 5NB, UK. Email: rommel.ravanan{at}cardiffandvale.wales.nhs.uk
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Abstract |
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The total number of patients active on the transplant waiting list (adult and paediatric) on 31 December 2005 was 5736, an 8% increase from the previous year. On 31 December 2005, 45.7% of prevalent adult RRT patients in the UK, had a functioning renal transplant which equated to 19 074 patients. During 2005, the death rate in prevalent transplant patients was 2.7 per 100 patient years. An additional 3.1% of all prevalent transplants failed with patients returning to dialysis.
During 2005, deceased heart beating donor numbers decreased by 18% compared to 2004. In comparison, non-heart beating donors and living kidney donors increased by 35% and 17%, respectively, in 2005. The proportion of renal transplants performed from deceased heart beating donors fell from 68% in 2004 to 60% in 2005. There is wide variation in prevalence per million population (pmp) of transplanted patients resident in each local authority area across the United Kingdom. Total 11.4% of incident transplants in 2005 were due to patients with diabetes. The median eGFR was 46.1 ml/min/1.73 m2, with 18% of prevalent transplant recipients having an eGFR <30 ml/min/1.73 m2. The median Hb in prevalent transplant recipients was 12.9 g/dl, with 10% of patients having an Hb <10 g/dl. The median systolic and diastolic BP was 136 and 79 mmHg, respectively, with only 25% of patients within guidelines.
Transplant function analysed by CKD stages 1–2 (eGFR < 60), 3 (eGFR 30–59), 4 (eGFR 15–29) and 5 (eGFR < 15), shows that these categories account for 24%, 59%, 15% and 2.5% of patients, respectively. Haemoglobin values fall with decreasing eGFR such that of the 2.5% of transplant patients with eGFR <15 ml/min, 27% had an Hb <10 g/dl and 51% <11 g/dl. Control of iPTH was poor in transplant recipients in CKD stages 4 and 5, with 22% and 50% of patients, respectively, having a PTH > 32 pmol/l (=300 ng/l). Patients with failing transplants are less likely to achieve RA targets of key biochemical variables when compared to patients on dialysis. There is still wide variability in the completeness of data returns from individual units.
Keywords: chronic kidney disease; eGFR; end stage renal disease; epidemiology; renal transplantation; transplant CKD stage; transplant function; transplant survival