UK renal registry 17th annual report: Chapter 1 UK renal replacement therapy incidence in 2013: National and Centre-specific analyses

Abstract

Introduction: This chapter describes the characteristics of adult patients starting renal replacement therapy (RRT) in the UK in 2013 and the incidence rates for RRT by Clinical Commissioning Groups and Health Boards (CCG/HBs) in the UK. Methods: Basic demographic and clinical characteristics, including presentation time (time between first being seen by a nephrologist and start of RRT), and age/gender standardised incidence ratios in CCG/HBs, are reported on patients starting RRT at all UK renal centres. Results: In 2013, RRT was started in 7,006 patients across the UK, with an incidence rate similar to 2012 at 109 per million population (pmp). There were wide variations between CCG/HBs in standardised incidence ratios. The median age for White patients was 66.0 and for non-White patients 57.0 years. Diabetic renal disease remained the single most common cause of renal failure (25%). By 90 days, 66.1% of patients were on haemodialysis (HD), 19.0% on peritoneal dialysis (PD), 9.5% had a functioning transplant and 5.3% had died or stopped treatment. There continued to be variability between centres in the use of PD as an initial treatment. The mean eGFR at the start of RRT was 8.5 ml/ min/1.73 m2 similar to previous years. Late presentation (<90 days) fell from 23.9% in 2006 to 18.4% in 2013. Fiftyone percent of patients who started on HD had died within five years of starting. This compared to 33% and 5% for those starting on PD or transplant respectively. Conclusions: The incidence of new patients starting RRT in the UK has remained largely unchanged for almost 10 years in contrast to the rising numbers of prevalent patients (+48% since 2003). The year on year increase in pre-emptive transplantation is encouraging but the variability between centres in the percentages starting on PD should be explored further.