Assessment of urea removal in haemodialysis and the impact of the European Best Practice Guidelines

Couchoud, Cécile; Jager, Kitty J.; Tomson, Charles; Cabanne, J.-F.; Collart, Frédéric; Finne, Patrik; Francisco, Angel de; Frimat, Luc; Gârneaţă, Liliana; Leivestad, Torbjørn; Lemaı̂tre, V.; Limido, Aurelio; Ots, Mai; Resić, Halima; Stojceva-Taneva, Olivera; Kooman, Jeroen P.

doi:10.1093/ndt/gfn641

Cited by 20 publications

(10 citation statements)

References 23 publications

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“…Such reactions are triggered by negatively charged biomaterials such as Polyacrylonitrile (AN69) capable of activating factor XII, leading to the generation of bradykinin. Normally this is rapidly degraded by serine proteinase kininase II but in the presence of ACE inhibition plasma bradykinin levels increase and can cause anaphylaxis [39]. In view of this interaction the ACE inhibitor should be changed to an angiotensin II antagonist in patients starting dialysis with a synthetic membrane which is capable of generating bradykinin.…”

Section: Rationalementioning

confidence: 99%

Renal Association Clinical Practice Guideline on Haemodialysis

2011

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Section: Rationalementioning

confidence: 99%

Renal Association Clinical Practice Guideline on Haemodialysis

2011

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“…Research however, is an important part of improving the quality of existing analyses and developing new ones. A number of articles have been published in peer-reviewed journals since the publication of the last Report [11][12][13][14][15][16][17][18] in addition to articles published in collaboration with the EDTA-ERA Registry [19][20][21][22]. A full list of publications involving analyses of UKRR data is available on the UKRR website at www.renalreg.org.…”

Section: Peer-reviewed Publications Since the Last Annual Reportmentioning

confidence: 99%

Chapter 2: Introduction

Tomson

Maggs²

2010

Nephron Clin Pract

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The 12th Annual Report from the UK Renal Registry (UKRR) contains analyses of data submitted from every centre providing clinical supervision of renal replacement therapy (RRT) in England, Wales, Northern Ireland and (via the Scottish Renal Registry) Scotland. The data are largely extracted direct from clinical information systems used for direct clinical care [1] and the inclusion of laboratory data permit analyses not only of the incidence, prevalence, and outcomes of RRT in the UK, but also the achievement of clinical performance measures as defined by the Renal Association’s Clinical Practice Guidelines. The UKRR remains unique amongst renal registries in not only publishing centre-specific analyses of outcomes, including laboratory variables but also including age-adjusted survival statistics. Data are still incomplete, particularly on those data items that require clinical input, including primary renal disease and comorbidity at the start of RRT, and these deficiencies limit the Registry’s ability to perform analyses that are fully adjusted for case-mix. In England, the issue of a Dataset Change Notice [2] has made submission of a defined dataset on each patient undergoing RRT mandatory, but how quickly this will accelerate improvement in data returns remains to be determined.

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“…Data were available for 71% (13,191) of the total prevalent population (18,520) treated with HD who met the inclusion criteria for these analyses. However it was available for 92% of the prevalent HD patients treated in one of the 62 units providing any data for URR (14,407). Of the total incident patient population (4,526) starting HD during 2008 there were data available for URR for 2,278 (50%) patients during the 3 months after they had started treatment.…”

Section: Data Completenessmentioning

confidence: 99%

“…A recent survey undertaken by the Quality European Studies (QUEST) initiative has reported that URR is the most common method used to assess small solute removal in HD patients in Europe with equilibrated Kt/V being used in a minority of centres [14].…”

Section: Introductionmentioning

confidence: 99%

Chapter 8: Adequacy of Haemodialysis in UK Renal Centres in 2008: national and centre-specific analyses

et al. 2010

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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: Seventy-two renal centres in the UK submit data electronically to the UK Renal Registry (UKRR). Two groups of patients were included in the analyses: the prevalent patient population on 31st December 2008 and the incident patient population for 2008. Centres returning data on <50% of their patient population were excluded from centre-specific comparisons. Results: Data regarding URR were available from 62 renal centres in the UK. Fifty-one centres provided URR data on more than 90% of prevalent patients. There has been an increase from 56% in 1998 to 83% in 2008 in the proportion of patients in the UK who met the UK Clinical Practice Guideline for URR (>65%). There was considerable variation from one centre to another, with 9 centres attaining the RA clinical practice guideline in >90% of patients and 5 centres attaining the standard in <70% of patients. The HD dose (URR) delivered to patients who had just started dialysis treatment was lower than that of patients who had been treated for longer and increased further with time. Conclusions: The delivered dose of HD for patients with established renal failure has increased over 10 years. Whilst the large majority of patients in the UK achieved the target URR there was considerable variation between centres in the percentage of patients achieving this.

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Assessment of urea removal in haemodialysis and the impact of the European Best Practice Guidelines

Cited by 20 publications

References 23 publications

Renal Association Clinical Practice Guideline on Haemodialysis

Renal Association Clinical Practice Guideline on Haemodialysis

Chapter 2: Introduction

Chapter 8: Adequacy of Haemodialysis in UK Renal Centres in 2008: national and centre-specific analyses

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