All patients receiving renal replacement therapy in the United Kingdom in 2005 (Chapter 4)
1Lister Hospital, Stevenage and 2UK Renal Registry, Bristol
Correspondence and offprint requests to: Ken Farrington, UK Renal Registry, Southmead Hospital, Southmead Rd, Bristol, BS10 5NB, UK. Email: ken.farrington{at}nhs.net
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Abstract |
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Summary data are provided for the whole United Kingdom. There were 41 776 adult patients alive on renal replacement therapy (RRT) in the UK at the end of 2005, a prevalence for adults of 694 pmp. Addition of 748 children under the age of 18 on RRT gives a total prevalence of 706 pmp. The more detailed analysis includes data on 37 534 patients from 65 of the 70 units which returned detailed data to the Registry: all in Northern Ireland, Scotland and Wales, and 45 of the 50 units in England. The annual increase in prevalence in the 38 renal units participating in the Registry since 2000 was 5.0%. There is substantial variation in the crude Local Authority area prevalence from 299 pmp to 1275 pmp.
In general, areas with large ethnic minority populations had high standardized prevalence ratios (SPR). Nevertheless several Local Authority areas in South Wales (Methyr Tydfil, Swansea and Rhondda/Cynon/Taff) had a higher SPR than would be predicted from the local ethnic mix. Another group in North West England (Bury, Rochdale, Oldham and Salford), had a lower SPR than expected from the local ethnic mix. The median age of prevalent patients on RRT was 56.6 years, that of patients on HD 64.5 years, PD 59.2 years and transplanted patients 49.7 years. The median vintage of the whole RRT population was 5.1 years: that of transplanted patients was 9.8 years, HD patients 2.8 years and PD patients 2.1 years. The maximal prevalence rate (SPR) occurred in men (2270 pmp) in the 75–79-year age band and women (1144 pmp) in the 65–74-year age band.
Of RRT patients in the UK, 45% had a transplant, 41.7% were on centre-based haemodialysis and 12% on peritoneal dialysis. The proportion of patients on home haemodialysis remained very small (1.2%) in spite of the recent NICE guidelines. The haemodialysis population is continuing to expand, mainly through growth in the proportion of patients undergoing dialysis in satellite units. The peritoneal dialysis population is continuing to contract in spite of the small but progressive rise in automated PD.
The most common identifiable diagnosis in those under 65 was glomerulonephritis (18.0%) and in those over 65 it was diabetes (13.4%).
One-year survival rates of prevalent patients in the different centres contributing to the UK Renal Registry are presented. The centres agreed to remove anonymity. There is no evidence of any significant differences in survival of prevalent patients between UK centres.
The one-year survival of prevalent dialysis patients increased significantly from 1998 to 2004 in England (83.3% to 87.1% P = 0.0001 for linear trend), Scotland (84.0% to 87.0% P = 0.023 for linear trend) and Wales (83.4% to 86.1% P = 0.027 for linear trend). The test for non-linearity in this trend (indicating that there has been a large increase which is now tailing off) was significant for England and Wales.
Keywords: chronic kidney disease; dialysis; end stage renal disease; epidemiology; haemodialysis; one-year survival; peritoneal dialysis; prevalence; quality improvement; renal replacement therapy; renal transplantation