The 21st UK Renal Registry Annual Report: A Summary of Analyses of Adult Data in 2017

Pyart, Rhodri; Evans, Katharine; Steenkamp, Retha; Casula, Anna; Wong, Esther; Magadi, Winnie; Mu, James

doi:10.1159/000504851

Cited by 36 publications

(23 citation statements)

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“…We chose to explore eGFR decline assuming linearity given that this is a widely used and well-established method [ 21 – 23 ]. We calculated estimated glomerular filtration rate (eGFR) using the Schwartz formula [ 24 ] if aged < 18 years and the 4-variable Modification of Diet in Renal Disease formula [ 25 ] otherwise.…”

Section: Methodsmentioning

confidence: 99%

Associations with kidney transplant survival and eGFR decline in children and young adults in the United Kingdom: a retrospective cohort study

et al. 2020

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Background Although young adulthood is associated with transplant loss, many studies do not examine eGFR decline. We aimed to establish clinical risk factors to identify where early intervention might prevent subsequent adverse transplant outcomes. Methods Retrospective cohort study using UK Renal Registry and UK Transplant Registry data, including patients aged < 30 years transplanted 1998–2014. Associations with death-censored graft failure were investigated with multivariable Cox proportional hazards. Multivariable linear regression was used to establish associations with eGFR slope gradients calculated over the last 5 years of observation per individual. Results The cohort (n = 5121, of whom n = 371 received another transplant) was 61% male, 80% White and 36% had structural disease. Live donation occurred in 48%. There were 1371 graft failures and 145 deaths with a functioning graft over a 39,541-year risk period. Median follow-up was 7 years. Fifteen-year graft survival was 60.2% (95% CI 58.1, 62.3). Risk associations observed in both graft loss and eGFR decline analyses included female sex, glomerular diseases, Black ethnicity and young adulthood (15–19-year and 20–24-year age groups, compared to 25–29 years). A higher initial eGFR was associated with less risk of graft loss but faster eGFR decline. For each additional 10 mL/min/1.73m2 initial eGFR, the hazard ratio for graft loss was 0.82 (95% CI 0.79, 0.86), p < 0.0001. However, compared to < 60 mL/min/1.73m2, higher initial eGFR was associated with faster eGFR decline (> 90 mL/min/1.73m2; − 3.55 mL/min/1.73m2/year (95% CI -4.37, − 2.72), p < 0.0001). Conclusions In conclusion, young adulthood is a key risk factor for transplant loss and eGFR decline for UK children and young adults. This study has an extended follow-up period and confirms common risk associations for graft loss and eGFR decline, including female sex, Black ethnicity and glomerular diseases. A higher initial eGFR was associated with less risk of graft loss but faster rate of eGFR decline. Identification of children at risk of faster rate of eGFR decline may enable early intervention to prolong graft survival.

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Section: Methodsmentioning

confidence: 99%

Associations with kidney transplant survival and eGFR decline in children and young adults in the United Kingdom: a retrospective cohort study

et al. 2020

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“…At the end of 2017, 64,887 patients with end-stage kidney disease (ESKD) were receiving kidney replacement therapy in England [1]. ESKD is a chronic condition in which treatment is life-saving but not curative [2].…”

Section: Introductionmentioning

confidence: 99%

Emotional distress and adjustment in patients with end-stage kidney disease: A qualitative exploration of patient experience in four hospital trusts in the West Midlands, UK

et al. 2020

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Objectives To explore patient perceptions and experiences of mild-to-moderate emotional distress and the support offered by kidney units to patients with end-stage kidney disease. Methods In-depth, semi-structured qualitative interviews with patients (n = 46) being treated for end-stage kidney disease in four hospital Trusts, with data analysed thematically. Results Patients described multiple sources of distress and talked about the substantial burden that emotional challenges raised for their ability to manage their condition and develop coping strategies. Many patients did not feel it appropriate to disclose their emotional issues to staff on the kidney unit, due to a perceived lack of time for staff to deal with such issues, or a perception that staff lacked the necessary skills to provide resolution. Five themes were identified from the patient interviews, broadly related to patients’ experience of distress, and the support offered by the kidney unit: i) the emotional burden that distress placed on patients; ii) patients’ relationship with the treatment for their condition; iii) strategies for coping and adjustment; iv) patient-staff interactions and the support offered by the kidney unit, and v) the mediating impact of the treatment environment on patient experience of distress and their ability to raise emotional issues with staff. Conclusions Many patients felt unprepared for the likelihood of experiencing emotional issues as part of their condition, for which pre-dialysis education could help in managing expectations, along with support to help patients to develop appropriate coping strategies and adjustments. These findings demonstrate the importance of recognising patient distress and ensuring that talking about distress becomes normalised for patients with end-stage kidney disease.

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“…In reality, there is significant variation in practice across the UK, with waiting times, pre-emptive transplant rates and percentage of dialysis patients treated with an LDKT differing markedly across the country. 2 There appears to be little awareness of the referral and work-up process among most non-renal practitioners and junior doctors. 10 The UK guidelines for LDKT were last updated in 2018 and summarise the evaluation process.…”

Section: Let's Talk About Itmentioning

confidence: 99%

“…Only a minority of these patients (9%) received a transplant as their primary treatment. 2 The rising prevalence of CKD mandates increased focus on strategies to improve uptake of transplantation to reduce both the overall burden of disease and costs associated with dialysis.…”

Section: Introductionmentioning

confidence: 99%

Living donor kidney transplantation: Let's talk about it

Sharma

Roy²,

Piscoran

et al. 2020

Clinical Medicine

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Transplantation is the preferred treatment option for end-stage renal disease as it offers superior results and patient reported outcomes in comparison to dialysis. Patients treated with a transplant live longer, healthier and more independent lives. Transplantation is also more cost-effective, reducing the overall burden of renal disease. Despite the rising incidence of renal failure, the uptake of living donor kidney transplantation has been static across the UK for several years. Among transplantation, living donation offers a number of advantages compared with deceased donor transplantation. The procedure is more likely to be performed pre-dialysis and the elective nature allows for better perioperative planning. Awareness for living donation processes among healthcare professionals, patients and the public appears to be poor. Sharing information regarding the process will help educate colleagues, dispel myths and, crucially, allow patients the opportunity to talk about this treatment option with their hospital doctor.

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The 21st UK Renal Registry Annual Report: A Summary of Analyses of Adult Data in 2017

Cited by 36 publications

References 0 publications

Associations with kidney transplant survival and eGFR decline in children and young adults in the United Kingdom: a retrospective cohort study

Associations with kidney transplant survival and eGFR decline in children and young adults in the United Kingdom: a retrospective cohort study

Emotional distress and adjustment in patients with end-stage kidney disease: A qualitative exploration of patient experience in four hospital trusts in the West Midlands, UK

Living donor kidney transplantation: Let's talk about it

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