Date post: | 04-Jan-2016 |
Category: |
Documents |
Upload: | lambert-franklin |
View: | 217 times |
Download: | 1 times |
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