Epidemiology of ESKD in Ireland

Data from 2013/2014 NRO Censusand the

17th Annual Report of the UKRR 2014

The Future for Irish ESKD Epidemiology

HSE National Renal Office

Methodology

• NRO Annual Census 31st December 2013/14

• UKRR Annual Report 2014

• KDCPMS records used for 1st time 2014

• Standardised data collection instrument for others

• Not patient-linked unless in KDCPMS

• Improved external validation (with KDCPMS)

• Death/modality transfer not analysed

• Await my concluding exhortation/threat………………….

Caveat re Prevalent Transplant Numbers

• We exercise caution every year regarding how exact thisfigure can be

• These patients are more mobile; may attend at more than onesite for follow-up

• We continuously revise the figures from previous years, basedon updated data

• We believe that we are more exact with each successive year

• KDCPMS is improving precision in this regard

Renal Replacement Therapies (RRT)

• Transplant (TX)

• Haemodialysis (HD)Centre HD (cHD)Satellite HD (sHD)Contracted Satellite HD (sHDc)

Northern Ireland HD (NI)

• Home Dialysis (PD/HHD)

CSO population estimates

• April 2005 4,133,800

Census 2006 4,232,900

• April 2007 4,375,800• April 2008 4,485,100• April 2009 4,533,400• April 2010 4,554,900

Census 2011 4,574,900

• April 2012 4,585,400• April 2013 4,593,100• April 2014 4,609,600

2014 INCIDENT ESKD PATIENTS ATTENDING ADULT UNITS

Incident adult ESKD patients (n)

6 22 9 20 22 22

377

422

307330 330 327

63

42

56

63 71 56

0

50

100

150

200

250

300

350

400

450

500

2008 2009 2010 2011 2012 2013

Home

HD

TX

xxx patients

xx% HDxx% PDxx% TX

xx p.m.p.

All Island 2013 (Adult)

RoI (4.6)

Incident: 88pmp

405

HD 81%

PD 14%

TX 5%

NI (1.8)

98pmp (95%CI 84-113)

180

67%

22%

11%

2014 PREVALENT ESKD PATIENTSATTENDING ADULT UNITS

Prevalent ESKD patients (n)

1623 1728 1824 1891 2007 2079 2156 2211

13291401

14731554

1557 1560 15561628191

200188

195191

209 204202

211

2028 44

48

0

500

1000

1500

2000

2500

3000

3500

4000

4500

HHD

PD

HD

TX

4089 patients

39.8% HD

6.1% PD/HHD 54.1%TX

887 p.m.p.353

HD54 PD/HHD480

TX

All Island 2013 (Adult)

RoI (4.6)

Prevalent: 862pmp

3960

HD 40%

PD 5%

TX 55%

NI (1.8)

845pmp (95%CI 803-887)

1546

42%

5%

53%

Change in 2014

• ESKD +129 3.3% 28.0 pmp18.3 pmp

• HD +72 4.6%• PD/HHD +2 0.8%

• Dialysis +74 4.1% 16.1 pmp1.5 pmp

• TX +55 2.6% 11.9 pmp16.8 pmp

Change 2007-14

Annualised

• ESKD +946 30% +135 (84-186)

• HD +299 23% +43 (-4-81)

• PD/HHD +59 31% +8 (-10-26)

• Dialysis +284 19% +47 (7-97)

• TX +533 32% +89 (55-116)

Modalities

55%

25%

14%

6%

Transplant

Centre HD

Satellite HD

Home Therapies

Detailed Modalities

54%

26%

4%

10%

0%

5%

1%

TX

CHD

SHD

SHDc

NI

PD

HHD

Detailed Dialysis Modalities

57%

8%

21%

1% 11%

2%

CHD

SHD

SHDc

NI

PD

HHD

REGIONAL ANALYSISESKD PATIENTS ATTENDING

ADULT UNITS

Renal Services in 6 Hospital Groups

Hospital Group Renal Units Contracted Satellite HD Unit

Home Programme

RCSI Hospitals Group (0.8)

BHCGH

Beacon Droghedafmc Northern Cross

PD/HHD

Dublin East Hospitals Group(0.7)

SVUHMMUH

Beacon Sandyfordfmc Northern CrossBeacon Drogheda

PDPD

Dublin Midlands Hospitals Group (0.8)

AMNCH/SJHMRHT

Beacon TallaghtBeacon Sandyford

PD/HHD

South/South West Hospitals Group (1.15)

CUH/KGHWUH

fmc Kilkenny PD/HHDPD/HHD

University of Limerick Hospitals Group (0.35)

LUH fmc Limerick PD

Saolta Healthcare Group (0.8)

MPUH/GUH/MGHLGH/SGH

Wellstone Galway PD/HHD

NI Renal Units

• Belfast 0.64

• West NI 0.35

• Antrim 0.29

• Ulster 0.27

• Newry 0.26

ESKD Patients 31/12/14(total patients under governance of 6 Hospital Groups)

789

204

338

491

120

269

256

153

205

245

75

130

49

99

76

81

88

44

69

47

5

1

5

42

25

46

49

22

18

23

4

17

4

0 100 200 300 400 500 600 700 800 900 1000 1100 1200

RCSI

Dublin East

Dublin Midlands

South/South-West

LUHG

Saolta

TX

cHD

sHD

sHDc

NI

PD

HHD

ESKD Patients 31/12/14(total dialysis patients under governance of 6 Hospital Groups)

256

153

205

245

75

130

49

99

76

81

88

44

69

47

5

1

5

42

25

46

49

22

18

23

4

17

4

0 50 100 150 200 250 300 350 400 450

RCSI

Dublin East

Dublin Midlands

South/South-West

LUHG

Saolta

cHD

sHD

sHDc

NI

PD

HHD

ESKD Patients 31/12/14(total patients under governance of 11 Parent Units)

20

769

100

104

294

44

157

334

120

182

87

73

183

81

72

90

115

94

151

75

68

62

49

56

43

66

30

49

88

43

69

47

10

2

1

5

1

5

42

15

10

46

10

39

22

18

23

4

5

12

4

0 100 200 300 400 500 600 700 800 900 1000 1100 1200

CGH

Beaumont

MMUH

SVUH

AMNCH/SJH

MRHT

WRH

CUH/KGH

LUHG

GUHG/MGH

LGH/SGH

TX

cHD

sHD

sHDc

oHD

NI

PD

HHD

ESKD Patients 31/12/13(total patients under governance of 16 Parent Units)

10

750

98

112

280

40

145

335

115

195

76

110

44

82

490

89

64

250

115

129

176

106

129

183

138

161

105

113

106

127

212

92

42

19

13

45

17

33

16

19

15

6

15

27

18

20

3

5

13

3

0 100 200 300 400 500 600 700 800 900 1000 1100

CGH

Beaumont

MMUH

SVUH

AMNCH/SJH

MRHT

WUH

CUH/KGH

LUHG

GUHG/MGH

LGH/SGH

West NI

Ulster

Antrim

Belfast

Newry

TX

cHD

PD

HHD

ESKD Patients 31/12/13(total dialysis patients under governance of 16 Parent Units)

64

169

79

82

90

106

91

142

65

59

63

113

106

127

212

92

81

36

47

86

38

41

73

102

42

42

19

13

45

17

33

16

19

15

6

15

27

18

0 50 100 150 200 250 300 350

CGH

Beaumont

MMUH

SVUH

AMNCH/SJH

MRHT

WUH

CUH/KGH

LUHG

GUHG/MGH

LGH/SGH

West NI

Ulster

Antrim

Belfast

Newry

cHD

sHD

PD

ESKD Patients 31/12/13(total Tx patients under governance of 16 Parent Units)

10

750

98

112

280

40

145

335

115

195

76

110

44

82

490

89

0 100 200 300 400 500 600 700 800

CGH

Beaumont

MMUH

SVUH

AMNCH/SJH

MRHT

WUH

CUH/KGH

LUHG

GUHG/MGH

LGH/SGH

West NI

Ulster

Antrim

Belfast

Newry

ESKD PATIENTS ATTENDING PAEDIATRIC UNITS

Prevalent Paediatric ESKD

patients (n)

64

3

10

2

4

0

10

20

30

40

50

60

70

80

CUHT OLHC

PD

HD

TX

83 patients12%

HD7% PD81% TX

18 p.m.p.2

HD1.3 PD14.7 TX

TRANSPLANT ACTIVITY

Transplants 2009-14

146

90

158131 136

112

18

23

27

3238

40

8

8

7

1

11

6

1

0

20

40

60

80

100

120

140

160

180

200

2009 2010 2011 2012 2013 2014

K/LoH

SPK

LDK

DDK

The Future

Last 5 years reported to USRDS this yearNo report to EDTA/ERA Registry or UKRR

Why?

Discipline, Discipline, Discipline……….

KDCPMS is the toolForthcoming Administration Support

National Dataset –From all patients classified as HD, Home Therapy,

Transplant follow-up

Data Item Notes

Current Status HD/ PD/ Tx

Age HD/ PD/ Tx

Sex HD/ PD/ Tx

Primary Renal Diagnosis New EDTA codes

Date of 1st RRT First ever RRT

Transplant List Status HD/ PD/ Tx

Date of Dx Prescription HD only

Date of Fluid Prescription HD only

Most recent Dx Date HD only

Access used in last Dx session HD only

e.g. Access rates for all-Ireland

e.g. Fistula vs. Catheter vs. Unrecorded rates in all Units are shown below.

Data completion is challenging

Crucial to get patient classification correct:Clinical Supervision, Treatment Location, Modality

Snapshot of raw data

extract showing complete

data in green and

incomplete data in red

Census Reporting Protocol1. All units review and validate their records

Start with Lead Nephrologist and Renal SystemAdmin (RSA) checking classification and lists

2. NRO issues a “% completion” report for all units(missing data)

3. Lead Nephrologist and RSA complete the minimumdataset for all

4. NRO extracts report 23hrs 31st December 2015