Registry Report Highlights and Insights in 2007/8

User Group 2008

Overview

• Registry Reports• Data security• Renal IT / CfH• Update on sites• Highlights from Report• New analyses• Work in progress• External Collaborations

Registry Reports

Hard copies available as per usualCDs available to all (1st time)

2007 not printed as NDT supplement

2008 Nephron supplement

Registry Reports

Commissioner specific Report

Transplant specific Report to BTS

Data Security Issues

Queries related to sending data

PIAG Compliant

Caldicott Guardian

Encryption of data transmissionPGP www.pgp.com

New renal units submitting 2007 data

• Manchester Royal Infirmary• Stoke

• Kent• St Georges

• Doncaster• Colchester

Renal units recently changed systems

• Cambridge (in house)• Derby (vitaldata)• Doncaster (mediqal)• Wrexham (renalware)• Swansea (vitaldata)

• Liverpool• Gloucester

New data items

• Pre RRT

• CKD 5

• Access – vascular & PD

• HD individual session logging

New data items• Daily dialysis• Assisted PD

• Transplant waiting list status

• Pr:Crt / LDL / CRP • Phosphate binders• Calcimimetics• ACE / ARBs

Connecting for HealthAdditional Supply Capability

& Capacity (ASCC)Myself, Es Will, Rob Higgins

• supplement existing supply capacity, enable new supply to be met through a readily available approved Framework.

enable the streamlined procurement of IT systems and services from suppliers

Need £2,000,000 to get on list

Lot 2 - Clinical Information Technology

Service Category 2.26 – Renal ServicesApproved suppliers

National

British Telecom PLC

FileTek UK Ltd

Perot Systems Europe Ltd

Siemens PLC

Specialist SME

Capula Healthcare Ltd

Clinical Computing plc

Epic Systems Corporation

Mediqal H I Ltd

ASCC renal =??

• CCL• Mediqal (& Siemens)• Chi (with BT)

Renal Assoc Web site

• Data on standards achievement

0

20

40

60

80

100

120

140

160

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Year

Ra

te p

er

mill

ion

po

pu

latio

n

ScotlandWalesEnglandN Ireland

Take on rates

Modalities - incident

Cycling PD >= 6 nights/wk6.2%

CAPD Connect0.4%

CAPD Disconnect15.6%

Transplant4.7%

Cycling PD < 6 nights/wk0.5%

Hosp - HD52.0%

Satellite HD20.6%

Home - HD0.1%

eGFR at start -by year

5.5

6.0

6.5

7.0

7.5

8.0

8.5

9.0

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year

Ge

om

etr

ic m

ea

n e

GF

R m

l/min

/1.7

3m2

HD

PD

Duration of pre RRT care

0

5

10

15

20

25

18-24 25-34 35-44 45-54 55-64 65-74 75-84 ≥ 85

Age band

Mon

ths

Months from referral to starting RRT

Growth in prevalence

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,00019

82

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

Year

Num

ber

of p

atie

nts

PD

Home HD

HD

Transplant

Co-morbidities by ethnicityComorbities by ethnicity

0

10

20

30

40

50

60

70

80

90

100

18-34 35-44 45-54 55-64 65-74 75+Age group

Per

cent

age

of p

atie

nts

South Asian

Black

White

1 year after 90 days death rateper 1,000 patient years by nation

0

50

100

150

200

250

300

350

400

450

500

550

600

18-34 35-44 45-54 55-64 65-74 75-84 85+Age group

De

ath

ra

te

EnglandN IrelandScotlandWales

Survival from day 0 RRT

0

10

20

30

40

50

60

70

80

90

100

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5 6.0 6.5 7.0 7.5 8.0 8.5 9.0 9.5

Period (years)

Pe

rce

nta

ge

su

rviv

al

18-34

35 -44

45-54

55-64

65-74

75+

50% survival

80 – 2 yrs70 – 3 yrs60 – 5 yrs50 – 10 yrs

Survival and censoring

0

10

20

30

40

50

60

70

80

90

100

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5 6.0 6.5 7.0 7.5 8.0 8.5 9.0 9.5

Period (years)

Pe

rce

nta

ge

su

rviv

al

18-34

35 -44

45-54

55-64

65-74

75+0

10

20

30

40

50

60

70

80

90

100

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5 6.0 6.5 7.0 7.5 8.0 8.5 9.0 9.5

Period (years)

Pe

rce

nta

ge

su

rviv

al

18-34

35 -44

45-54

55-64

65-74

75+

Not censored censored at transplant

50

55

60

65

70

75

80

85

90

95

1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

KM

su

rviv

al 1 year

2 year

3 year

4 year

5 year

6 year

7 year

Improvement in survivalby year of start, age < 65yrs

0

10

20

30

40

50

60

70

80

1997 1998 1999 2000 2001 2002 2003 2004 2005

Vintage

KM

sur

viva

l

1 year

2 year

3 year

4 year

5 year

6 year

7 year

Improvement in survivalby year of start, age 65+ yrs

Improvement in URR by year

50

55

60

65

70

75

80

85

1998

1999

2000

2001

2002

2003

2004

2005

2006

1998

1999

2000

2001

2002

2003

2004

2005

2006

Year

Pe

rce

nta

ge

of p

atie

nts

% of patients URR >65%and 95% CI

Median URR and quartiles

Me

dia

n U

RR

(%

)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Year of start

Per

cent

age

of in

cide

nt p

atie

nts

≥12.0%

11.0-11.9%

10.0-10.9%

9.0-9.9%

<9.0%

Haemoglobin in incident patientsby year of start of RRT

Percentage of patients with Hb > 10 g/dl by centre 31/12/07

65

70

75

80

85

90

95

100

0 100 200 300 400 500 600 700 800 900 1,000 1,100

Number of patients with haemoglobin measurement in each centre

Pe

rce

nta

ge

with

Hb

≥1

0 g

/dL

% with Hb ≥10g/dL

+3 SD

+2 SD

Mean

-2 SD

-3 SD

Variation in mean EPO dose with Hb achievement -HD only

What are the interactions causing this variation?

? HD dose? Age? Comorbidity

????

10.0

10.5

11.0

11.5

12.0

12.5

13.0

6,000 8,000 10,000 12,000 14,000

Mean ESA dose (IU/w eek)

Med

ian

Hb

g/dL

PlymouthWolverhampton

SouthendBasildon

Other analyses

• Phosphate

• Transplantation

Non -Report analyses

Standards and Survival on home HD

• Survival benefit of transplantation

• Hb and survival by year of RRT

• Pre RRT care

• Daily Dialysis

Median eGFR prior to RRT- by time since first renal referral

6

8

10

12

14

16

-15 -12 -9 -6 -3 0

Time pre-RRT (months)

Med

ian

eGF

R (

ml/m

in/1

.73m

2)

<3m (n=536)

3-6m (n=202)

6-12m (n=324)

>12m (n=1,729)

6

8

10

12

14

16

-15 -12 -9 -6 -3 0Time pre-RRT (months)

Me

dia

n e

GF

R (

ml/m

in/1

.73

m2

)

Wolve

Truro

Bristol

Hull

Exeter

Leic

Liv RI

Ports

Sheff

n=3,816

Median eGFR prior to RRT-by renal unit

(excludes data from late presenters)

6

8

10

12

14

16

-15 -12 -9 -6 -3 0Time pre-RRT (months)

eG

FR

(m

l/min

/1.7

3m

2)

>=100 (n=68)

90-99 (n=175)

80-89 (n=409)

70-79 (n=392)

<70 (n=291)

Median eGFR prior to RRT-by Diastolic BP at 6 months pre-RRT

(excludes data from late presenters)

Renal Data Map Atlas

• Grant from Dept Health

• East Midlands PHO

Afzal Choudry

Registry research funded by bequest

• 3 Registrars studying for higher degrees (fees fully funded by bequest)

Other activities

• Dr from Hungary on 3 month ERA grant

• EU grant on data standardisation

• ERA studies

This is your Registry

what would you like us to do?

Thanks for all your hard work