uk renal registry 10th annual report 2007 fig 9.1 annual change in percentage of dialysis patients...

UK Renal Registry 10th Annual Report 2007

Fig 9.1 Annual change in percentage of dialysis patients with serum phosphate < 1.8mmol/L and ≥1.1 -≤1.8mmol/L

1999 - 2006 E,W and NI

40

45

50

55

60

65

70

75

8019

99

2000

2001

2002

2003

2004

2005

2006

1999

2000

2001

2002

2003

2004

2005

2006

Year

Per

cena

tge

of p

atie

nts

% w ith P04 < 1.8mmol/L

% w ith P04 =1.1-=1.8mmol/L

Peritoneal DialisysPeritoneal DialysisHaemodialysis


Fig 9.2 Annual change in percentage with serum phosphate between 1.1-1.8mmol/L, >1.8mmol/L and <1.1mmol/L

1999 - 2006 UK

0

10

20

30

40

50

60

70

8019

99

2000

2001

2002

2003

2004

2005

2006

1999

2000

2001

2002

2003

2004

2005

2006

Year

Perc

enta

ge o

f pat

ient

s

% w ith phos 1.1-1.8

% < 1.1 mmol/L

% >1.8mmol/L

Haemodialysis Peritoneal Dialysis


Fig 9.3 Median serum phosphate mmol/L: dialysis

0.6

0.8

1.0

1.2

1.4

1.6

1.8

2.0

2.2

2.4

2.6

1 L

Wes

t 1

Red

ng13

Wirr

al 4

Tyr

one

0 U

lste

r 0

Che

lms

0 L

Kin

gs 1

Wol

ve 0

Ant

rim 2

Lee

ds11

L G

uys

8 C

lwyd

0 N

ottm

2 S

wan

se 2

Yor

k 4

Liv

Ain

16 M

anW

st 0

Bris

tol

30 C

amb

15 C

arsh

12 L

Rfre

e 2

Oxf

ord

2 E

xete

r 2

Liv

RI

4 N

orw

ch12

Dud

ley

2 B

right

n 1

Ipsw

i 0

Bra

dfd

0 G

louc

1 D

orse

t 4

Bel

fast

2 S

then

d 4

Sun

d 4

L B

arts

2 B

ango

r 0

Che

str

1 B

asld

n 4

B Q

EH 0

Der

ry 3

New

ry 2

Car

dff

1 L

eic

5 S

tevn

g 3

Der

by 1

Mid

dlbr

0 N

ewc

1 S

heff

5 B

Hea

rt 3

Por

ts 1

Ply

mth

1 T

ruro

1 S

hrew

0 P

rest

n 4

Car

lis 4

Eng

land

3 N

Irel

and

12 W

ales

5 E

,W&N

I

Centre

Ser

um p

hosp

hate

mm

ol/L

Upper quartile

Median phosphateLow er quartile

N = 17,319


Fig 9.4 Percentage of patients with serum phosphate <1.8mmol/L : HD

Percentage of patients with serum phosphate <1.8mmol/L : HD

40

45

50

55

60

65

70

75

80

85

90

95

100

Centre

Per

cent

age

of p

atie

nts

Upper 95% confidence interval% with P04 < 1.8mmol/LLower 95% confidence interval


Fig 9.5 Confidence in centre ranking for percentage of HD patients with phosphate<1.8mmol/L

0

10

20

30

40

50

Centre

Ran

k

Upper 95% Conf idence interval

Median rank

Low er 95% Conf idence interval


Fig 9.6 Percentage of patients with serum phosphate ≥1.1-≤1.8mmol/L : HD

20

30

40

50

60

70

80

90

100

0 D

erry

5 W

irral

8 C

lwyd

4 T

yron

e 0

Glo

uc 4

Nor

wch

0 U

lste

r 1

Yor

k 1

Not

tm 4

B Q

EH 0

Red

ng 0

L K

ings

1 S

wan

se 0

Dor

set

4 L

iv A

in13

L G

uys

0 A

ntrim

1 D

erby

2 O

xfor

d 1

Sth

end

0 C

helm

s18

Car

sh16

Dud

ley

4 B

elfa

st 6

Ste

vng

1 B

asld

n 0

Bra

dfd

1 L

eic

2 E

xete

r 0

Bris

tol

36 C

amb

1 S

heff

1 W

olve

2 L

eeds

1 M

iddl

br14

L R

free

3 B

ango

r 5

B H

eart

2 L

iv R

I 1

New

ry 1

Por

ts 3

Brig

htn

18 M

anW

st 0

L W

est

4 S

und

3 C

ardf

f 0

New

c 0

Che

str

0 P

rest

n 1

Tru

ro 0

L B

arts

2 P

lym

th 0

Ipsw

i 1

Shr

ew 5

Car

lis 4

Eng

land

2 N

Irel

and

12 W

ales

5 E

,W&N

I

Centre

Per

cent

age

of p

atie

nts

Upper 95% confidence interval% with P04 =1.1-=1.8mmol/LLower 95% confidence interval


Fig 9.7 Percentage of patients with serum phosphate <1.8mmol/L : PD

30

40

50

60

70

80

90

100

9 Y

ork

1 R

edng

0 C

amb

2 W

olve

0 A

ntrim

0 C

helm

s 2

Liv

RI

2 D

orse

t 0

Bas

ldn

2 L

eeds

3 L

Wes

t 3

Sw

anse

0 B

ango

r 0

L K

ings

9 H

ull

5 B

Hea

rt 6

L R

free

1 B

right

n 4

Ipsw

i 1

L G

uys

2 L

eic

2 D

udle

y 0

Ply

mth

2 S

tevn

g 3

Car

sh 2

Nor

wch

11 L

Bar

ts 0

Tru

ro 0

Oxf

ord

10 M

anW

st 5

Bel

fast

0 C

ovnt

0 B

risto

l 0

Exe

ter

1 C

ardf

f 4

Mid

dlbr

0 N

ottm

9 D

erby

0 P

rest

n 2

New

c 0

Shr

ew 0

She

ff 0

Bra

dfd

6 B

QEH

10 P

orts

0 G

louc

4 E

ngla

nd 6

N Ir

elan

d13

Wal

es 5

E,W

&NI

Centre

Per

cent

age

of p

atie

nts

Upper 95% conf idence interval

% w ith P04 <1.8mmol/L

Low er 95% confidence interval


Fig 9.7 Percentage of patients with serum phosphate ≥1.1-≤1.8mmol/L : PD

30

40

50

60

70

80

90

100

9 Y

ork

0 A

ntrim

2 D

orse

t 9

Hul

l 2

Wol

ve 0

Cam

b 0

Ban

gor

3 S

wan

se 4

Ipsw

i 0

Che

lms

1 L

Guy

s 0

Not

tm 0

Tru

ro 0

Ply

mth

6 L

Rfre

e 1

Red

ng 1

Brig

htn

2 N

ewc

2 L

iv R

I 0

Bas

ldn

0 B

risto

l 3

Car

sh 2

Dud

ley

2 L

eeds

0 L

Kin

gs 0

Bra

dfd

10 M

anW

st 9

Der

by 0

Shr

ew 5

B H

eart

2 N

orw

ch 2

Lei

c 6

B Q

EH 4

Mid

dlbr

11 L

Bar

ts 1

Car

dff

0 C

ovnt

0 O

xfor

d 5

Bel

fast

0 S

heff

0 P

rest

n 0

Exe

ter

2 S

tevn

g 3

L W

est

10 P

orts

0 G

louc

4 E

ngla

nd 6

N Ir

elan

d13

Wal

es 5

E,W

&NI

Centre

Per

cent

age

of p

atie

nts

Upper 95% confidence interval

% w ith P04=1.1-=1.8mmol/L



Fig 9.9 Percentage of patients with serum phosphate divided into bands

0

2

4

6

8

10

12

<0.8 0.8-<0.9

0.9-<1 1-<1.1 1.1-<1.2 1.2-<1.3

1.3-<1.4

1.4-<1.5

1.5-<1.6

1.6-<1.7

1.7-<1.8

1.8-<1.9

1.9-<2.0

2.0-<2.1

2.1-<2.2

2.2-<2.3

2.3-<2.4

2.4-<2.5

2.5-<2.6

2.6+

Serum phosphate band

Perc

enta

ge o

f pat

ient

s

HD patients

PD patients


Fig 9.10 Funnel plot for percentage achievement of phosphate <1.8mmol/L:HD

20

30

40

50

60

70

80

90

100

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

Number of patients in centre

Per

cent

age

of p

atie

nts

with

P0 4

=1.8

mm

ol/L

% w ith phosphate <1.8mmol/L

Upper 99.9% CIUpper 95% CI

Mean

Low er 95% CILow er 99.9% CI


Fig 9.11 Funnel plot for percentage achievement of phosphate ≥1.1-≤1.8mmol/L :HD

20

30

40

50

60

70

80

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


Perc

enta

ge o

f pat

ient

s w

ith P

04 1

.1-

=1.8

mm

ol/L

% with phosphate =1.1-=1.8mmol/LUpper 99.9% CIUpper 95% CIMeanLower 95% CILower 99.9% CI


Fig 9.12 Funnel plot of percentage achievement of phosphate <1.8mmol/L:PD

30

40

50

60

70

80

90

100

25 50 75 100 125 150 175 200


Per

cent

age

of p

atie

nts

with

P04

=1.8

mm

ol/L

% with phosphate <1.8mmol/LUpper 99.9% CIUpper 95% CIMeanLower 95% CILower 99.9% CI


Fig 9.13 Funnel plot of percentage achievement of phosphate ≥1.1-≤1.8mmol/L:PD

30

40

50

60

70

80

90

100

25 50 75 100 125 150 175 200


Per

cent

age

of p

atie

nts

with

P0

4 =1

.1-

=1.8

mm

ol/L

% with P04 =1.1-=1.8mmol/LUpper 99.9% CIUpper 95% CIMeanLower 95% CILower 99.9% CI


Fig 9.14 Annual change in percentage of dialysis patients achieving serum corrected Ca ≥2.2-≤2.6mmol/L split by modality 1999-2006

50

55

60

65

70

75

80

85

90

1999

2000

2001

2002

2003

2004

2005

2006

1999

2000

2001

2002

2003

2004

2005

2006

Per

cent

age

of p

atie

nts

Haemodialysis Peritoneal dialysis

– Upper 95% CI¦ % w ith Corrected Ca =2.2-=2.6mmol/L

– Lower 95% CI


Fig 9.15 Percentage of patients with corrected calcium ≥2.2-≤2.6mmol/L : HD

40

50

60

70

80

90

100

Centre

Per

cent

age

of p

atie

nts

Upper 95% confidence interval % with corrected Ca=2.2-=2.6mmol/LLower 95% confidence interval

N = 13,960


Fig 9.16 Funnel plot of percentage achieving corrected calcium ≥2.2-≤2.6mmol/L:HD

40

50

60

70

80

90

100

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


Per

cent

age

of p

atie

nts

with

cor

rect

ed c

alci

um

=2.2

-=2.

6mm

ol/L

% with corrected calcium =2.2-=2.6mmol/LUpper 99.9% CIUpper 95% CIMeanLower 95% CILower 99.9% CI


Fig 9.17 Percentage of patients with corrected calcium ≥2.2-≤2.6mmol/L : PD

40

50

60

70

80

90

100

2 D

orse

t 0

Bas

ldn

2 N

orw

ch

2 L

eeds

9 D

erby

0 O

xfor

d

0 G

louc

2 S

tevn

g 9

Por

ts

0 C

helm

s 1

Red

ng 0

Ban

gor

0 S

heff

0 B

radf

d 0

Cam

b 0

Cov

nt

2 W

olve

0 B

risto

l 3

Lei

c

3 L

Wes

t 5

B H

eart

0 P

lym

th

1 L

Guy

s 9

Yor

k 5

Bel

fast

5 B

QEH

0 L

Kin

gs 9

Hul

l

2 D

udle

y 1

Brig

htn

11 L

Bar

ts

0 E

xete

r 1

Car

dff

6 L

Rfr

ee

4 M

iddl

br 2

Liv

RI

3 C

arsh

0 P

rest

n 0

Ant

rim 4

Ipsw

i11

Man

Wst

2 N

ewc

3 S

wan

se 0

Not

tm

0 T

ruro

0 S

hrew

4 E

ngla

nd

6 N

Irel

and

13 W

ales

4 E

,W&N

I

Centre

Per

cent

age

of p

atie

nts


"% w ith corrected Ca =2.2-=2.6mmol/L"

Low er 95% confidence interval N = 3,366


Fig 9.18 Median calcium*phosphate product: Dialysis

2.0

2.5

3.0

3.5

4.0

4.5

5.0

5.5

Centres

Cal

cium

*pho

spat

e pr

oduc

t

Upper quartileMedian Ca*P 04 productLower quartile

N = 17,307


Fig 9.19 Percentage of patients with calcium*phosphate product <4.4mmol²/L² : Haemodialysis

40

50

60

70

80

90

100

Centre

Per

cent

age

of p

atie

nts

Upper 95% confidence interval% with Ca*Phos product <4.4mmol²/L²Lower 95% confidence interval N = 13,945


Fig 9.20 Funnel plot of percentage achieving Calcium*Phosphate product <4.4mmol²/L²:HD

30

40

50

60

70

80

90

100

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

Number of patients in unit

Per

cent

age

with

Ca*

P04

pro

duct

<4.4

mm

ol²/L

²

% w ith Ca*Phos product<4.4mmol²/L²

Upper 99.9% CI

Upper 95% CI

Mean

Low er 95% CI

Low er 99.9% CI


Fig 9.21 Percentage of patients with calcium*phosphate product <4.4mmol²/L²: Peritoneal dialysis

40

50

60

70

80

90

100

Centre

Per

cent

age

of p

atie

nts

Upper 95% conf idence interval% w ith corrected Ca*Phos product <4.4mmol²/L²Low er 95% conf idence interval

N = 3,362


Fig 9.22 Percentage of patients with Calcium*phosphate product <4.8mmol²/L²: Dialysis

50

55

60

65

70

75

80

85

90

95

100

Centre

Perc

enta

ge o

f pat

ient

s

Upper 95% confidence interval% with Ca*P04 product<4.8mmol²/L²

Lower 95% confidence interval N = 17,307


Fig 9.23 Change in percentage of patients achieving serum corrected calcium*phosphate product ≤4.4 mmol²/L²

1998 - 2006

50

55

60

65

70

75

80

85

90

95

100

199

8

199

9

200

0

20

01

20

02

20

03

20

04

20

05

20

06

199

8

199

9

200

0

200

1

200

2

200

3

20

04

20

05

20

06

Pe

rce

nta

ge o

f pa

tie

nts

Upper 95% CI

% w ith Ca*P04 produc t =4.4 mmol²/L²

Low er 95% CI

HD P D


Fig 9.24 Median iPTH in dialysis patients

0

10

20

30

40

50

60

70

80

Centre

iPTH

pm

ol/L

Upper quartileMedian iPTHLower quartile

N = 14,641


Fig 9.25 Percentage of patients on dialysis with iPTH < 32 pmol/L

30

40

50

60

70

80

90

100

Centre

Perce

ntage

of pa

tients


% with iPTH<32pmol/L

Lower 95% confidence intervalN = 14,641


Fig 9.26 Percentage of patients on dialysis with iPTH 16-32 pmol/L

0

10

20

30

40

50

60

Centre

Per

cent

age

of p

atie

nts


% w ith iPTH =16-=32pmol/L


N = 14,641


Fig 9.27 Median serum bicarbonate : Haemodialysis

17

19

21

23

25

27

29

31

33

Centre

Ser

um b

icar

bona

te m

mol

/L

Upper quartileMedian bicarbonateLower quartileN= 11,621


Fig 9.28 Percentage of patients with bicarbonate ≥20-≤26mmol/L : Haemodialysis

30

40

50

60

70

80

90

100

Centre

Per

cent

age

of p

atie

nts


% w ith bicarb 20-26mmol/L


N = 11,621


Fig 9.29 Percentage with serum bicarbonate ≥20-≤26mmol/L: HD

30

40

50

60

70

80

90

100

0 50 100 150 200 250 300 350 400 450 500 550 600 650


Per

cent

age

with

bic

arbo

nate

=20

-=2

6mm

ol/L

% w ith bicarb =20-=26mmol/L

Upper 99.9% CI

Upper 95% CI

Low er 95% CI

Low er 99.9% CI


Fig 9.30 Median serum bicarbonate : Peritoneal dialysis

19

21

23

25

27

29

31

33

35

Centre

Ser

um b

icar

bona

te m

mol

/L

Upper quartileMedian bicarbonateLower quartile

N = 2,862


Fig 9.31 Percentage of patients with bicarbonate ≥25-≤29mmol/L :

Peritoneal dialysis

0

10

20

30

40

50

60

70

80

90

100

0 Sh

eff

2 N

ewc

0 B

asldn

11 H

ull

4 M

iddlbr

0 Gl

ouc

0 B

ristol

0 Sh

rew

5 B

Hear

t 0

Chelm

s 1

Redn

g15

Pre

stn 2

Wolv

e 6

Leic

9 De

rby

5 Yo

rk10

Tru

ro 2

Leed

s 0

Plym

th 2

Ste

vng

0 E

xeter

0 An

trim

0 Do

rset

2 No

rwch

12 L

Barts

5 Be

lfast

3 Ca

rdff

10 B

QEH

4 L

Wes

t 4

Ipswi

3 Sw

anse

4 D

udley

0 Ca

mb 0

Brad

fd23

Por

ts 4

Brig

htn

2 Liv

RI

6 B

ango

r22

Oxfo

rd 1

L Gu

ys 3

Cars

h20

Eng

land

8 N

Irela

nd15

Wal

es19

E,W

&NI

Centre

Perce

ntage

of pa

tients


% with bicarb =25-=29mmol/LLower 95% confidence interval

N = 2,862


Fig 9.32 Percentage with serum bicarbonate ≥25-≤29mmol/L:PD

10

20

30

40

50

60

70

80

90

0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180 190 200

Number of patients

Per

cent

age

with

bic

arb

=25

-=29

mm

ol/L

% with bicarb =25-=29mmol/LUpper 99.9% CIUpper 95% CIMeanLower 95% CILower99.9% CI


Fig 9.33 Median serum total cholesterol: Dialysis

2.5

3.0

3.5

4.0

4.5

5.0

5.5

15 H

ull

10 Y

ork

21 C

arsh

16 D

orse

t24

Liv

Ain

37 B

Hea

rt10

Bra

dfd

9 B

risto

l 1

Mid

dlbr

1 S

hrew

5 C

arlis

1 B

asld

n12

Sth

end

9 E

xete

r12

L G

uys

4 N

orw

ch13

Oxf

ord

17 C

lwyd

6 L

Kin

gs 3

Tyr

one

7 B

ango

r13

Car

dff

12 Ip

swi

3 C

helm

s35

Cam

b 6

L B

arts

10 L

Rfre

e 5

Lei

c 3

Not

tm 3

Red

ng 3

New

ry 0

Pre

stn

8 G

louc

46 S

tevn

g 4

B Q

EH13

L W

est

6 L

eeds

9 S

heff

2 S

wan

se 3

Tru

ro 9

Wol

ve 5

New

c 0

Der

ry17

Che

str

21 M

anW

st15

Wirr

al 9

Bel

fast

44 D

udle

y 4

Sun

d 0

Uls

ter

0 A

ntrim

13 P

lym

th20

Eng

land

5 N

Irel

and

16 W

ales

19 E

,W&N

I

Centre

Med

ian

chol

este

rol m

mol

/L

Upper quartileMedian total cholesterolLower quartile

N = 14,754


Fig 9.34 Median serum cholesterol: transplant

3.5

4.0

4.5

5.0

5.5

6.0

26 A

ntrim

30 H

ull

7 B

risto

l11

Cam

b40

Por

ts10

Exe

ter

40 B

Hea

rt31

Glo

uc26

Oxf

ord

9 S

hrew

8 C

arlis

19 Ip

swi

19 T

ruro

11 B

QEH

0 B

asld

n17

Mid

dlbr

12 W

olve

9 D

orse

t12

She

ff15

New

ry43

Brig

htn

8 L

Guy

s 3

Nor

wch

21 C

arsh

16 D

udle

y26

Sth

end

10 P

rest

n 2

L W

est

5 T

yron

e10

L R

free

12 N

ottm

32 S

tevn

g12

Yor

k 3

Bel

fast

11 C

ardf

f 9

L K

ings

11 L

eic

1 S

und

8 B

radf

d18

L B

arts

5 L

eeds

4 P

lym

th 3

New

c 3

Red

ng 2

Sw

anse

9 M

anW

st20

Eng

land

7 N

Irel

and

10 W

ales

19 E

,W&N

I

Centre

Med

ian

chol

este

rol m

mol

/L

Upper quartile

Median total cholesterol

Low er quartile

N = 12,729


Fig 9.35 Serum cholesterol distribution by modality 31/12/2006

0

5

10

15

20

25

30

35

40

45

1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 10 -11 11-12 12-13

Cholesterol mmol/L

Per

ecen

tage

of p

atie

nts

HD

PD

Tx


Fig 9.36 Percentage of patients with cholesterol ≤5mmol/L, 1997 - 2006, England, Wales and Northern Ireland

10

20

30

40

50

60

70

80

90

10019

97

1998

1999

2000

2001

2002

2003

2004

2005

2006

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Year

Per

cent

age

of p

atie

nts

Upper 95% CI% with cholesterol = 5 mmol/LLower 95% CI

Haemodialysis Peritoneal dialysis Transplant

uk renal registry 10th annual report 2007 fig 9.1 annual change in percentage of dialysis patients...

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