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2007 – The Tenth Annual Report
Chapter 1: Summary of Findings in the 2007 UK Renal Registry Report
In 2006, the overall annual acceptance rate for the whole UK was 113pmp, an increase from 110pmp in 2005. The rates in England (109 pmp) and Wales (135 pmp) continued to increase, whilst those in Scotland (114 pmp) and Northern Ireland (114 pmp) have fallen. From 2002 to 2006 there has been a 12% rise in the number accepted, the percentage rise being greater in England (14%) than in Scotland (5%) and Wales (4%). The median age of patients starting RRT in the UK was 65.0 years. In non-Whites this was 59.1 years. By day 90, 8% had died and <1% stopped treatment. HD was the first modality of RRT in 77% of patients, a rise from 58% in 1998. 23% of all patients were referred late (<90 days before RRT start), a slight fall from previous years. Diabetes (either as primary renal disease or co-morbidity) and ischaemic heart disease were the most common co-morbid conditions, seen in 29% and 24% of patients respectively.
In univariate Cox regression analysis, the association for most co-morbid conditions with mortality at 1 year after 90 days from start of RRT, was more pronounced for patients <65 years compared to those aged 565 years. In multivariate Cox analysis, malignancy and ischaemic/neuropathic ulcers were the strongest predictors of poor survival, followed by liver disease, increasing age, previous MI and dia- betes.
At the end of 2006, 43,901 adult patients were receiving RRT in the UK, a population prevalence of 725 pmp, an increase from 694pmp in 2005 (6.9% growth).The growth in England (7.6%) exceeded that in Wales (4.0%), Scotland (3.5%) and Northern Ireland (4.5%). For all ages, crude prevalence rates in males exceeded those in females, peaking in the 75–79 age band for males at 2,411 pmp and in females in the 60–64 age band at 1,221 pmp.
Of RRT patients in the UK, 45% had a transplant, 43% were on centre-based HD,1%onhomeHDand11%onPDwhichis falling.
The age adjusted survival of incident patients starting RRT continued to improve. There was an improvement for patients starting on HD and PD. The one year after 90 day survival was 87.3% (95% CI 86.7–88.1). There has been a survival improvement for both the under and over 65 year age groups. The last 8 years have shown an annual 3% relative improvement in survival in both the under and over 65 year age group.
The ‘vintage effect’ of increasing hazard of death with length of time on RRT, prominent in data from the US, was not seen in the UK within the 9 year incident cohort follow up period.
The 5 year survival rates (including deaths within the first 90 days) were 87%, 78%, 67%, 48%, 29% and 18% respectively for patients aged 18–34, 35–44, 45–54, 55–64, 65–74 and >75 years (last years published survival data had an error).
Overall, 80% of prevalent haemodialysis patients met the UK Renal Association stan- dard for URR (>65%) in 2006 an increase from 56% in 1998.
At start of RRT, 40% of patients had a Hb <10 g/dl. The median Hb at commencement of dialysis was 10.4 g/dl. By 3 and 6 months after the start of RRT, 80% and 86% of incident patients had a Hb 510g/dl respectively. The median Hb on HD was 11.8 g/dl and 12.0 g/dl on PD.
The median ferritin in HD patients was 418 mg/L with 95% having a ferritin 100 mg/L. The median ferritin in PD patients was 250 mg/ L with 85% having a ferritin 100 mg/L.
A higher proportion of HD patients required ESA therapy than PD patients (93% vs 79%).
The mean ESA dose was higher for HD than PD patients (9,223 vs 5,969 IU/week). A serum phosphate of <1.8 mmol/L was achieved by 67% of dialysis patients (65% of HD patients, 73% of PD patients). An adjusted serum calcium concentration between 52.2– 42.6 mmol/L was achieved by 75% of dialysis patients (74% of HD patients, 79% of PD patients). A serum calcium