2013 Annual Report highlightsand new directions for the Registry

UK Renal Registry2014 Annual Audit Meeting

Dr Fergus CaskeyMedical Director, UK Renal Registry

Annual Report 2013

• Published December 2013– Data up to 31st December 2012

• April: extract 1st quarter• April-June: data extracts obtained & validated• July: database closed• July-August: dataset cleaned; stats performed• Sept-Nov: chapters written, edited & formatted• December: published

• Second report in 2013

Annual Report 2013• Informatics, data management and programming

– Fiona Braddon, Shaun Mannings, Fran Benoy-Deeney, Lynsey Billett, Paul Dawson, Jo Wilson, Matthew Brealey, George Swinnerton

• Authors and editors†– Anna Casula, Julie Gilg, David Pitcher, Rishi Pruthi, Ani Rao,

Catriona Shaw, Retha Steenkamp

– Victoria Briggs, Fergus Caskey, Lisa Crowley, Andrew Davenport, Anne Dawnay, Ken Farrington, Terry Feest, Richard Fluck, Damian Fogarty, Iain McPhee, Rommel Ravanan, Paul Roderick, Manish Sinah, Martin Wilkie, Andrew Williams

• Business– Ron Cullen, Hilary Doxford, Steph Shearn, Laura Woodward

† First authors and last authors

Terry Feest Award

• Involved in Registry from very start (including pilot)

• Helped set up the Welsh data validation exercise

• Contribution to Registry Committee and Study Groups

• Editorial support for annual report• Championing local high quality

data

Dr Andrew WilliamsSwansea

RRT incidence1980-2012, by age

Gilg J. Chapter 1. UKRR Annual Report 2013

RRT incidence1990-2012, by country

Gilg J. Chapter 1. UKRR Annual Report 2013

eGFR at start of RRT

Restricted to centres reporting since 2003Gilg J. Chapter 1. UKRR Annual Report 2013

Trends in late presentation

Restricted to centres with 75+ completenessGilg J. Chapter 1. UKRR Annual Report 2013

Late presentation in 2011/2012

Late presentation < 90 daysRestricted to centres with 75+ completenessGilg J. Chapter 1. UKRR Annual Report 2013

7%

32%

Transplant wait listingprevalence by age by country

Pruthi R. Chapter 4. UKRR Annual Report 2013

Ethnicity

Udayaraj U. Chapter 6. UKRR Annual Report 2013

Access to transplant (adjusted HR)waiting list transplant living donor transplant

White ref ref refS Asian 1.10 (0.97-1.24) 0.74 (0.65-0.85) 0.66 (0.45-0.96)Black 0.95 (0.79-1.14) 0.66 (0.49-0.87) 0.40 (0.21-0.73)

SurvivalTrends in 1 year after 90 day survival

Pruthi, R. Chapter 8. UKRR Annual Report 2013

SurvivalAdjusting for comorbidity with HES data

“The addition of a combination of 16 comorbid conditions present at the start of RRT reduced the number of centres with worse than expected survival to one.”

Fotheringham NDT 2014

6 outliers

4 outliers

1 outliers

SurvivalMonthly hazard of death

SurvivalMonthly hazard of death

Survival

"The Registry now asks all nephrologists to complete the timeline as accurately as possible, recording the date of first

dialysis or haemofiltration and, separately, the date on which the patient was deemed to be chronic. This will allow us to

distinguish between patients who have an acute start and those whose start on RRT was planned.“

UKRR 2009

Dialysis Access AuditEngland, Wales and Northern Ireland

Briggs, V. Chapter 14. UKRR Annual Report 2013Referred < 90 days

% PD catheter failures in 1 year by centre

Reported infectionsEngland only

Crowley L. Chapter 15. UKRR Annual Report 2013

Trends in MRSA

Funnel plot of MRSA rates

Current and new directions

Core work• Data timeliness

– 2013 database closed end June 2014 for report published December 2014

– Three sites significantly behind schedule

• Data quality– Plans for fixed term appointment to establish source data verification – Sensitivity and specificity for core data items

• Benchmarking• Research

• Renal Data Collaboration– Proof of concept completed, contract signed with InterSystems, training

begun

Core work• Dataset

– Version 3.30 end July 2014– PD dataset– Then vascular access dataset

• Patient Council– Fiona Loud agreed to chair, advertised for potential members,

interviews May 2014, first meeting July 2014

• Beyond ESRD– Obtained Section 251 exemption for CKD2+ and dialysis dependent

AKI, June 2013– Applying for Section 251 exemption for any AKI

Core work• Specialist Commissioning Dashboard

– Asked by Specialist Commissioners to take over quarterly Dashboard data collection

– Four indicators• PD peritonitis rate• Adequacy of Haemodialysis Dose• Rate of Staph Aureus bacteraemia in patients treated with

chronic HD• Access to Transplant listing

UKRR accountability

National Clinical Director

Commissioners

NHS England

Patients

Major projects

• Acute Kidney Injury– Partnership with NHS England over 2 years– Six workstreams – risk, education, detection, intervention,

implementation, measurement– Registry leading on measurement– Launch meeting 8th April 2014– Inclusion of Wales, Scotland and Northern Ireland

Major projects

• Patient participation– Funding awarded by NHS England (Patient Experience) Feb-

March 2014– Board to be establish to oversee work around:– Patient reported outcome measures (HRQoL)– Patient reported experience measures– Patient activation measures– Quality of shared decision making– Inclusion of Wales, Scotland and Northern Ireland

The PROMs Pilot - DRAFT• 10 sites• All dialysis patients – HD (in centre/ satellite/ home), PD• PROM/ PREM collected quarterly for 12 months

– Paper vs electronic– Local versus central

• PROM:– EQ-5D– POS-s renal (symptoms)– ? Recovery time question (for HD)

• PREM:– Scottish Renal Patient Experience Questionnaire

Qualitative evaluation Health economic evaluationTranslation

PROMs – a European consensus

“Consensus meeting on collecting quality of life and patient experience data in renal registries in Europe”

•ERA-EDTA Registry QUEST funded•Bristol 23rd June 2014•Delegates invited from all interested renal registries in Europe

UKRRpast present and future work

HaemodialysisPeritoneal dialysis

Kidney transplantation

AKI dialysis dependent

AKI in 1y & 2y care

CKD 2-4 in 2y care

CKD 2-4 in 1y & 2 care

DemographicsCase-mixLaboratory data

PROMs & PREMsActivation & QSDM

Research

• Research methods Study Group– First meeting March 2014

• Solve analytical problems from dialysis and transplant study groups• Plan high impact analyses

• Appointment of Tony Wing Fellow– BKPA funded fellow appointed March 2014 to start August 2014

• Data linkage opportunities– Revised work proposal forms soon on UKRR website– Now three levels (including no analysis input from UKRR)

Research

• Current PhD Students– Dr Claire Castledine

• Explaining regional variation in renal service provision in the UK• PhD awarded

– Retha Steenkamp• Multiple imputation and prognostic survival modelling• Submitted

– Dr Catriona Shaw• CKD outcomes with MINAP / NICOR linkage (London)

– Dr Rishi Pruthi• Qualitative research in the ATTOM Study (Southampton)

– Dr Ani Rao• Mixed methods alongside EQUAL (pre dialysis CKD in the elderly) (Bristol)

• A different model in the future?

Any questions?