1,721,011 research outputs found
UK Renal Registry 18th Annual Report (December 2015) Chapter 5: Survival and causes of death in UK adult patients on renal replacement therapy in 2014: national and centre-specific analysis
No full textUK Renal Registry 19th Annual Report: Chapter 5 Survival and Causes of Death in UK Adult Patients on Renal Replacement Therapy in 2015: National and Centre-specific Analyses
No full textUK renal registry 20th annual report: Chapter 5 survival and cause of death in UK adult patients on renal replacement therapy in 2016: National and centre-specific analyses
No full textShort-term (90 day) age adjusted survival of incident RRT patients in the 2015 cohort was similar to the 2014 cohort (96.5% versus 96.8%). One year after 90 day age adjusted survival for incident RRT patients in the 2015 cohort fell slightly to 90.0% compared with the previous year (90.2%). There was a difference in one year after 90 day incident survival by age group and diagnosis of diabetes: patients with diabetes aged ,65 years had worse one year after 90 day survival than patients without diabetes, but for older patients with diabetes (565 years) survival was similar compared to those patients without diabetes. One year age adjusted survival for prevalent dialysis patients was similar at 88.0% in the 2015 cohort, compared with 88.3% in the 2014 cohort. Age adjusted one year survival for prevalent dialysis patients with diabetic primary renal disease has been declining slightly from 2012 onwards. Centre and UK country variability was evident in incident and prevalent patient survival after adjusting to age 60. Further adjustment for comorbidity was not possible due to missing data. The relative one year risk of death for prevalent RRT patients compared with the general population was approximately 21 for age group 35-39 years compared with 1.5 at age 85+ years, but the relative risk of death for younger patients has improved over time. In the prevalent RRT population, cardiovascular disease was the most common cause of death and accounted for 24% of deaths, with infection accounting for 20%. Treatment withdrawal accounted for 17% of deaths and has increased in recent years from historical levels.</p
UK Renal registry 11th annual report, chapter 7 survival and causes of death of UK adults patients on renal replacement therapy in 2007: national and centre-specific analyses
No full textIntroduction: these analyses examine survival from the start of renal replacement therapy (RRT), based on the total incident UK dialysis population reported to the Registry, including the 21% who started on PD and the 5% who received a pre-emptive transplant. Survival of prevalent patients and changes in survival between 1997-2006 are reported. The article includes a discussion on the technical definition for the date of start of both PD and HD. Methods: survival was calculated for both incident and prevalent patients on RRT and compared between the UK countries after adjustment for age. Survival of incident patients (starting during 2006) was calculated with and without a 90 day RRT start cut off. Survival of incident patients is shown with and without censoring at transplantation. Both the Kaplan-Meier and Cox adjusted models were used to calculate survival. Causes of death were analysed for both groups. Relative risk of death was calculated compared with the general UK population. Results: the 2006 unadjusted 1 year after 90 day survival for patients starting RRT was 86%. In incident 18-64 year olds the unadjusted 1 year survival had risen from 85.9% in 1997 to 91.5% in 2006 and for those aged ges 65 it had risen from 63.8% to 72.9%. The age adjusted survival of prevalent dialysis patients rose from 85% in 2000 to 89% in 2007. Diabetic patient survival rose from 76.6% in 2000 to 84.0% in 2007. The relative risk of death on RRT compared with the general population was 30 at age 30 years compared with 3 at age 80 years. In the prevalent RRT dialysis population, cardiovascular disease accounted for 34% of deaths, infection 20% and treatment withdrawal 14%. Conclusions: incident and prevalent patient survival on RRT in all the UK countries for all age ranges and also for patients with diabetes continued to improve. The relative risk of death on RRT compared with the general population has fallen since 2001. Death rates on dialysis in the UK remained lower than when compared with a similar aged population on dialysis in the US
Patterns and effects of missing comorbidity data for patients starting renal replacement therapy in England, Wales and Northern Ireland
No full textBackground. Renal Registries play a key role in assessing quality of care and outcomes of renal replacement therapy and comparisons of outcomes between groups should adjust for differences in comorbidities. This study aimed to describe patterns of missing comorbidity data and differences in survival between patients with comorbidity data returned and those with missing comorbidity data. Methods. Trends in comorbidity data returns by year (1998–2006) and within centres were examined using descriptive statistics. Survival of patients was described using Kaplan–Meier graphs (log-rank tests) and hazard ratios were calculated using Cox proportional hazard models. Last follow-up was at 31 December 2007. A range of sensitivity analyses were carried out, including multiple imputation. Results. Among 34 059 patients, there were 62% who had no comorbidity data. The completeness of comorbidity data increased markedly from 17% in 1998 to 47% in 2003, but had fallen back to 37% by the year 2006. Those with a missing comorbidity generally do considerably worse than those without the comorbidity and in most cases more closely follow the survival curve of those with the comorbidity. Multiple imputation analysis suggested that those with missing information on comorbidity have higher prevalence of comorbidity than seen in those with available data. Treating missing comorbidity entries as indication of absent comorbidity (i.e. a tick only if yes policy) would lead to an attenuation of the effect of comorbidity on survival. Conclusions. Missing data lead to difficulties in performing between centre comparisons. A ‘tick if present policy’ in comorbidity data collection should be discouraged. Much more work is needed to fully understand why levels of missing comorbidity data are so high and to identify strategies to improve recording. <br/
Outcomes in patients on home haemodialysis in England and Wales, 1997–2005: a comparative cohort analysis
No full textBackground: The UK national policy promotes expansion of home haemodialysis, but there are no recent data on characteristics and outcomes of a national home haemodialysis population. Methods: We compared incident home haemodialysis patients in England and Wales (n = 225, 1997–2005) with age- and sex-matched incident peritoneal dialysis, hospital haemodialysis and satellite haemodialysis patients with follow-up until 31 December 2006. Cox regression analyses included time-dependent changes of wait-listing for transplantation (a proxy for health status), start of home haemodialysis and transplantation. Results: There was a median delay of 12 months between starting renal replacement therapy (RRT) and home haemodialysis. During that first year of RRT, >?50% of home haemodialysis patients were wait-listed for kidney transplantation; hospital haemodialysis patients had a lower rate of wait-listing over time [hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.44–0.70; P < 0.001]. In crude analyses, there was a marked survival advantage of home haemodialysis patients compared with other modalities (log-rank P-value < 0.001). In adjusted analyses, being on home haemodialysis yielded a long-term survival benefit compared with peritoneal dialysis (HR 0.61, 95% CI 0.40–0.93), and a borderline advantage compared with hospital haemodialysis (HR 0.68, 95% CI 0.44–1.03). There was no evidence of an advantage compared with satellite haemodialysis (HR 0.94, 95% CI 0.65–1.37). Conclusions: Home haemodialysis patients have better survival compared with other dialysis modalities. Some of this crude survival advantage is due to selection of a healthier patient cohort as evidenced by higher transplant wait-listing rates. The advantage over peritoneal dialysis persisted after adjustment for wait-listing and transplantation over time. <br/
Ethnicity, socioeconomic status, and attainment of clinical practice guideline standards in dialysis patients in the United Kingdom
No full textBackground and objectives: the role of socioeconomic status (SES) and its contribution to ethnic differences in standards attainment among dialysis patients is not known.Design, setting, participants, & measurements: we examined associations between area- level SES (Townsend index) and ethnicity (white, black, South Asian) and standards attainment in 14,117 incident dialysis patients (1997–2004) in the UK.Results: deprived patients were less likely to achieve hemoglobin (Hb) ? 10g/dl (trend P < 0.001) but not after controlling for patient and center characteristics (trend P = 0.1). There was no association with hemodialysis dose and parathyroid hormone (PTH) standard but deprived patients had better attainment of phosphate (PO4) <5.6 mg/dl, calcium (Ca) and Calcium-phosphate (CaPO4) standard (e.g., most deprived versus least deprived adjusted odds ratio [OR] 1.25, 95% confidence intervals [CI] 1.12, 1.38). There was no association with SES using a lower limit for PO4 (3.5 – 5.5 mg/dl). Compared with Whites, Blacks had lower attainment of Hb (adjusted OR 0.57, 95% CI 0.45, 0.71) and PTH standards (adjusted OR 0.27, 95% CI 0.22, 0.33) but better attainment of PO4 and CaPO4, while South Asians experienced better or comparable outcomes for most standards except Ca and PTH.Conclusions: there was no evidence of socioeconomic inequity in standards attainment or a consistent pattern of inequity by ethnic group. The lower attainment of some standards in ethnic minorities may reflect biologic differences rather than ethnicity-related inequity of car
Association between glycemia and mortality in diabetic individuals on renal replacement therapy in the U.K.
Full text linkOBJECTIVE: In the U.K., one-third of patients receiving treatment with dialysis have diabetes. Guidelines from organizations representing patients with renal disease or diabetes advocate tight glycemic control in patients with end-stage renal disease, despite glucose-lowering trials having excluded these patients. RESEARCH DESIGN AND METHODS: Using national U.K. Renal Registry data, we tested whether glycemia as measured by hemoglobin (Hb) A(1c) (HbA(1c)) level is associated with death in adults with diabetes starting hemodialysis or peritoneal dialysis between 1997 and 2006, and observed for at least 6 months. Of 7,814 patients, we excluded those who had died within 6 months; had received transplants; were lost/recovered; or lacked measures of HbA1c, ethnicity, or Hb. Categorizing HbA1c measured in the first 6 months of starting dialysis as 8.5% was 1.5 (1.2-1.9). The projected difference in median survival time between younger patients with a reference HbA1c value versus >8.5% was 1 year. CONCLUSIONS: In the absence of trials, and confounding notwithstanding, these observational data support improved glycemic control in younger patients prior to and during dialysis
Comparison of outcomes of in-centre haemodialysis patients between the 1st and 2nd COVID-19 outbreak in England, Wales and Northern Ireland: a UK Renal Registry analysis
Full text linkIntroduction: this retrospective cohort study compares in-centre haemodialysis (ICHD) patients’ outcomes between the 1st and 2nd wave of the COVID-19 pandemic in England, Wales and Northern Ireland.Methods: all people aged ≥18 years receiving ICHD at 31/12/2019, who were still alive and not in receipt of a kidney transplant at 1 March and who had a positive polymerase chain reaction (PCR) test for SARS-CoV-2 between 01/03/2020 and 31/01/2021 were included. The COVID-19 infections were split into two ‘waves’: wave1 from March to August 2020, and wave2 from September 2020 to January 2021. Cumulative incidence of COVID-19, multivariable Cox models for risk of positivity, median and 95% credible interval of reproduction number in dialysis units were calculated separately for wave1 and wave2. Survival and hazard ratios for mortality were described with age and sex adjusted Kaplan Meier plots and multivariable Cox proportional models. Results : 4,408 ICHD patients had COVID-19 during the study period. Unadjusted survival at 28 days was similar in both waves [wave1 75.6% (95% CI 73.7-77.5), wave2 76.3% (95% CI 74.3-78.2)], but death occurred more rapidly after detected infection in wave1. Long vintage treatment and not being on the transplant waiting list were associated with higher mortality in both waves. Conclusions: risk of death of patients on ICHD treatment with COVID-19 remained unchanged between the first and second outbreaks. This highlights that this vulnerable patient group needs to be prioritised for interventions to prevent severe COVID-19, including vaccination, and the implementation of measures to reduce the risk of transmission alone is not sufficient.<br/
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