Chapter 8: Adequacy of Haemodialysis in UK Renal Centres in 2008: 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: 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.

Effect of a Quality Improvement Program to Improve Guideline Adherence and Attainment of Clinical Standards in Dialysis Care: Report of Outcomes in Year 1

“…Our achievement of national standards of dialysis care had not changed significantly since UKRR benchmarking began. Funnel plot analysis excluded outlier performance status [11][12][13][14] . Life expectancy in Greater Manchester is one of the lowest in the UK, and case mix considered a potential factor affecting outcomes [15] .…”