2014 Annual Report highlights and new directions for the UK Renal Registry

UK Renal Registry2015 Annual Audit Meeting

Dr Fergus CaskeyMedical Director, UK Renal Registry

Setting the theme…

@UKRenalRegistry

Jo Partington

Keith Simpson

Outline• Core work

– New dataset: PD, CKD4+ and dialysis/ Pex for AKI– Linkage– UKRDC

• National Programmes– AKI– Patient participation

• Research

Core work

UKRR Dataset v4.0

PD datasetDashboard informationCKD4+

Dialysis and plasma exchange for AKI

Developing a PD data set

Dialysis for AKI

13.02.2014 Acute haemodialysis Hospital Southmead25.03.2014 Haemodialysis Hospital Southmead

Plasma exchange for AKI

The example of plasma exchange for AKI

“Report every dialysis or plasma exchange session for acute kidney injury to the UK Renal Registry”

Sept 2014

Plasma exchange(performed in a renal unit)

Non-renal patiente.g. neurology or

haematology

Renal patient

AKI(stage 1, 2 or 3)

CKDe.g. HLAi or ABOi pre

transplant

Nephritice.g. vasculitis

or aHUS

Nephrotice.g. FSGS

Green = covered by s251 permissions and mandate Orange = covered by s251 permissions but not mandatedRed = not covered by mandate or s251 permissions

UKRR Dataset v4.0

PD datasetDashboard informationCKD4+

Dialysis and plasma exchange for AKI

Effective from Jan 2016

Jan 2015 in England

RRT incidence and prevalence

eGFR at start

Dialysis survival

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

Prevalent survival by centre

To publish or not?•Patient council•RIGB and Exec Committee

-> Must publish and escalate as before

•Don’t stress variation in patient summaries this year•Use co-morbidity data where available

•Work towards routine HES linkage in all 4 countries

Infections

Infections

PHE Infection data

• MRSA, MSSA, Cdiff and E Coli – mandatory reporting• Renal flag NOT mandatory

– Some patients not identified as renal– Some incorrectly identified as renal

• Validation time consuming and variable

Plan:• Link all UKRR data with all PHE infection data• Receive linked data set and send to renal units for validation

National Programmes

AKI National Programme Board

Risk Education Detection ImplementationIntervention Measurement

NHS England Patient Safety Steering Group

Hydration Sub-Group

Software Implementation Sub-Group

Algorithm Sub-Group

Best Practice in E-alert Group

Expert Reference Group

Advisory Group

National Programme 1.AKI

NHSBT

BAPN

RaDaRUK Renal Data Collaboration

SRR

UK RR

RPV

Patient

Research and Audit

Renal UnitsLABS

LABSLABS

Primary care –

prescribing etc

HES, RGOS etc

meta data

NHSBT

BAPN

RaDaRUK Renal Data Collaboration

SRR

UK RR

RPV

Patient

Research and Audit

Renal UnitsLABS

LABSLABS

Primary care –

prescribing etc

HES, RGOS etc

meta data

AKI dataPrimary and secondary careDirect from labs

National algorithm and mandate to report

By 9th March 2015

Research

ResearchStudy Groups•Dialysis: chair Simon Davies•Transplant: chair Iain McPhee•CKD: incorporated into UKKRC SG•Research methods: chair Fergus Caskey•Patient council: chair Fiona Loud

Research fellows•Retha Steenkamp PhD awarded•Tony Wing fellow (BKPA & KRUK) – Alex Hamilton – commenced•Current PhD fellows

– Rishi Pruthi (ATTOM)– Catriona Shaw (MINAP)– Ani Rao (EQUAL)

•New ACF call•Non-clinical fellows (doctoral/ pot-doctoral) adverts

Late referral (2012/2013)

5%

30%

Chapter 1. UKRR Annual Report 2014

ASSIST CKD

• eGFR graph generated in high risk patient in labs

• Sent to GP with information• Aim to reduce late referral• Stepped wedge roll out to

gather evidence of effectiveness (or not)

Michael Nation at KRUKHugh Gallagher at St HeliersScaling up Hugh Rayner’s work at Birmingham Heartlands

In collaboration with Prof Stephen Walters in ScHARR and Dr Erik

Lenguerrand at UoB

Research: grants awarded• Health Foundation

– ASSIST-CKD (St Heliers with KRUK)– AKI Care Bundle (Derby)

• NIHR HTA – SIMPLIFIED (Cambridge)

• NIHR RfPB– UK PDOPPS-catheter (Sheffield)

• Other– NIHR HS&DR (ICNARC)– NIHR HTA (Oxford)– NIHR SBRI D4D x2 (UKRR and Atlantis HC)

Stepped wedge CRCT

Registry RCT

IV analysis

AcknowledgementsThank you to all the UK renal centres for providing data to the UK Renal Registry.

And thank you to all those who contributed to the writing of the 2014 annual report or participated in the Registry’s National Programme initiatives and Study Groups!

@UKRenalRegistrywww.renalreg.com

CROSS TALK IN RENAL EPIDEMIOLOGYUKRR & ERA-EDTA RegistryThursday 28th May, London 13:15 – 16:45

1. Selection bias in renal research2. Missing data3. Linkage to achieve big data

4. IV analysis5. Propensity scores6. Time dependent confounding