Chapter 8: Adequacy of haemodialysis in UK adult patients in 2009: National and centre-specific analyses

Abstract

Background: Outcome in patients treated with haemodialysis (HD) is influenced by the delivered dose of dialysis. The UK Renal Association (RA) publishes Clinical Practice Guidelines which include recommendations for dialysis dose. The urea reduction ratio (URR) is a widely used measure of dialysis dose. Aim: To determine the extent to which patients received the recommended dose of HD in the UK. Methods: All seventy-two UK renal centres submitted data to the UK Renal Registry (UKRR). Two groups of patients were included in the analyses: the prevalent patient population on 31st December 2009 and the incident patient population for 2009. Centres returning data on <50% of their patient population were excluded from centre-specific comparisons. Results: Data regarding URR were available from 63 renal centres in the UK. Fifty-one centres provided URR data on more than 90% of prevalent patients. The proportion of patients in the UK who met the UK Clinical Practice Guideline for URR (>65%) increased from 56% in 1998 to 85.5% in 2009. There was considerable variation between centres, with 19 centres attaining the RA clinical practice guideline in >90% of patients and 5 centres attaining the guideline in <70% of patients. The delivered HD dose (URR) was lower in patients who had just commenced dialysis treatment compared to patients who had survived longer on HD. Conclusions: The delivered dose of HD for patients with established renal failure has increased over the last decade. Whilst the majority of UK patients achieved the target URR there was considerable variation between centres in the percentage of patients achieving the guideline. Copyright © 2011 S. Karger AG, Basel.