Ethnicity, Socioeconomic Status, and Attainment of Clinical Practice Guideline Standards in Dialysis Patients in the United Kingdom

Udayaraj, Udaya; Ben‐Shlomo, Yoav; Roderick, Paul; Steenkamp, Retha; Ansell, David; Tomson, Charles; Caskey, Fergus

doi:10.2215/cjn.06311208

Cited by 17 publications

(19 citation statements)

References 45 publications

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“…Data on use of calcium containing phosphate binders, vitamin D analogues, duration of HD session and type of vascular access are not available to explore the reasons for these differences. These results are slightly different from those previously reported [21] on a cohort of patients starting RRT between 1997-2004 in which attainment of Hb 100 g/L was lower amongst Black patients and attainment of PTH 32 pmol/L was lower for South Asian and Black patients. These differences were probably due to the different range used for each of the laboratory measures analysed in this report to comply with current UK guidelines.…”

Section: Discussioncontrasting

confidence: 99%

UK Renal Registry 16th Annual Report: Chapter 6 Demographics and Outcomes of Patients from Different Ethnic Groups on Renal Replacement Therapy in the UK

Udayaraj

Pruthi²,

Casula³

et al. 2013

Nephron Clin Pract

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Introduction: This chapter describes the patient characteristics and outcomes for the three main ethnic groups (White, South Asian, Black) on renal replacement therapy (RRT) in the UK. Methods: Data on patients (>18 years old) from all 71 UK adult renal centres starting RRT between 2003 and 2012 were considered. Scottish centres were excluded due to poor ethnicity data. Results: The age-gender standardized incidence ratio of RRT was higher (2-3 times) in regions with a high ethnic minority population compared to those with a low ethnic minority population. South Asian and Black patients were significantly younger than Whites; had more diabetes causing established renal failure and lived in more deprived areas. The proportion of patients with at least one comorbidity was greater amongst White patients compared to South Asian and Black patients. The proportion of patients starting PD and having preemptive transplantation was lower amongst both ethnic minorities. The attainment of various laboratory standards was comparable or better for the ethnic minorities compared to White patients except for calcium standard attainment (for South Asians) and haemodialysis dose attainment (for Black patients). Compared to White patients, both ethnic minorities had similar rates of listing for deceased donor kidney transplantation but had lower rates of transplantation once wait-listed, and lower rates of living kidney donor transplantation. One and five year kidney allograft adjusted survival was poorer for Black patients but similar for South Asians compared to White patients. Black and South Asian patients had a better adjusted survival on dialysis compared to White patients. Conclusions: The persistent high incidence of RRT, the better survival on dialysis and the poor access to kidney transplantation for South Asian and Black patients and early allograft loss for Black patients will impose a disproportionate demand on dialysis provision in those areas with a high ethnic minority population.

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Section: Discussioncontrasting

confidence: 99%

UK Renal Registry 16th Annual Report: Chapter 6 Demographics and Outcomes of Patients from Different Ethnic Groups on Renal Replacement Therapy in the UK

Udayaraj

Pruthi²,

Casula³

et al. 2013

Nephron Clin Pract

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“…For example, patients dialysing in inner London dialysis units had lower phosphates, in keeping with reports of lower phosphates associated with social deprivation [21] . In addition, those centres with the highest proportion of patients from the ethnic minorities, typically originating from the South Asian subcontinent and Afro-Caribbean and Africa similarly had more patients with low phosphate and calcium.…”

Section: Discussionsupporting

confidence: 78%

Do Differences in Dialysis Prescription Impact on KDOQI Bone Mineral Targets? The Pan Thames Renal Audit

2010

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Background and Objectives:Patients achieving the Kidney Disease Outcomes Quality Initiative (KDOQI) bone mineral clinical practice guidelines have been reported to have improved survival. Many factors affecting calcium and phosphate control are not modifiable; however, we wished to determine whether differences in dialysis treatment could affect achievement of KDOQI clinical guideline targets. Methods: We audited pre-mid-week session calcium and phosphate levels in 5,324 adult patients receiving thrice weekly dialysis in the 14 Pan Thames centres: 60% male, mean age 62 ± 16 years, median dialysis vintage 29 months (14–58), 84% treated by haemodialysis, 16% by online haemodiafiltration, median session time 4.0 h (3.5–4.0). Results: Patients achieving the KDOQI guidelines varied between the centres: 23.4–60% for calcium, 31.7–56.7% for phosphate, 60–87.3% for calcium-phosphate product, 17.1–46.8% for parathyroid hormone (PTH) and 1.8–10.8% for all 4 targets. Those centres which used the highest dialysate calcium concentrations (1.5 mmol/l, 3 mEq/l) had more patients above the KDOQI serum calcium and more below the PTH target, than those centres using the lowest calcium dialysates (1 mmol/l, 2 mEq/l), with χ² = 85.1 and χ² = 52.4, p < 0.001, respectively. On logistic regression analysis, serum phosphate was negatively associated with duration of dialysis session time (F = 21.4, p = 0.000) and haemodiafiltration (F = 9.6, p = 0.000), respectively. Conclusions: Although many of the factors determining calcium and phosphate control in haemodialysis patients are unmodifiable, dialysate calcium concentration, the duration of the dialysis session and haemodiafiltration all had an impact on calcium, phosphate and PTH.

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“…At initiation of dialysis treatment, the UKRR collects information about diabetes, smoking status, and history of CVD according to ischemic heart disease (angina, previous myocardial infarction, coronary artery bypass graft or angioplasty), cerebrovascular disease and peripheral vascular disease (claudication, ischemic or neuropathic ulcers, non coronary angioplasty, vascular graft or aneurysm, amputation for peripheral vascular disease) 19. Socio-economic status was assed by Townsend scores, which are based on postal codes, and range from least deprived to most deprived (score 1 to 5) 20. In addition, hemoglobin, serum albumin, calcium, phosphate, creatinine (predialysis) and ferritin were considered for the analyses.…”

Section: Methodsmentioning

confidence: 99%

Predicting Mortality in Incident Dialysis Patients: An Analysis of the United Kingdom Renal Registry

Wagner

Ansell

Kent

et al. 2011

American Journal of Kidney Diseases

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Background The risk of death in dialysis patients remains high, but varies significantly among patients. No prediction tool is widely used in current clinical practice. We aimed to predict long-term mortality in incident dialysis patients with easily obtainable variables. Study Design Prospective nationwide multicenter cohort study in the United Kingdom (UK Renal Registry); Models were developed using Cox proportional hazards. Setting and Participants Patients initiating hemodialysis or peritoneal dialysis between 2002 and 2004, who survived at least three months on dialysis treatment, were followed for three years. Analyses were restricted to subjects in whom information on comorbid conditions and laboratory measurements were available (n=5447). The dataset was divided into datasets for model development (n=3631, training) and validation (n=1816) by random selection. Predictors Basic patient characteristics, comorbidity and laboratory variables. Outcomes All cause mortality censored for kidney transplant, recovery of kidney function, and loss to follow-up. Results In the training dataset, 1078 patients (29.7%) died within the observation period. The final model of the training dataset included patient characteristics (age, race, primary kidney disease, treatment modality), comorbidities (diabetes, history of cardiovascular disease, smoking) and laboratory variables (hemoglobin, serum albumin, creatinine, calcium) and reached a C-statistic of 0.75 (95% CI, 0.73–0.77) and could accurately discriminate between patients with low (6%), intermediate (19%), high (33%) and very high (59%) mortality risk. The model was further applied to the validation dataset and achieved a C-statistic of 0.73 (95% CI, 0.71–0.76). Limitations Number of missing comorbidity data and lack of an external validation dataset. Conclusions Basic patient characteristics, comorbidity and laboratory variables can predict three-year mortality in incident dialysis patients with sufficient accuracy. Identification of subgroups of patients according to mortality risk can guide future research and subsequently target treatment decisions in individual patients.

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Ethnicity, Socioeconomic Status, and Attainment of Clinical Practice Guideline Standards in Dialysis Patients in the United Kingdom

Cited by 17 publications

References 45 publications

UK Renal Registry 16th Annual Report: Chapter 6 Demographics and Outcomes of Patients from Different Ethnic Groups on Renal Replacement Therapy in the UK

UK Renal Registry 16th Annual Report: Chapter 6 Demographics and Outcomes of Patients from Different Ethnic Groups on Renal Replacement Therapy in the UK

Do Differences in Dialysis Prescription Impact on KDOQI Bone Mineral Targets? The Pan Thames Renal Audit

Predicting Mortality in Incident Dialysis Patients: An Analysis of the United Kingdom Renal Registry

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