Summary of Findings in the 2006 UK Renal Registry Report (Chapter 1)

In 2005, the acceptance rate for renal replacement therapy (RRT) in adults in the UK was 108 pmp and this was derived from 100% complete data returns for the UK. From 2001 to 2005 there has been a 7.3% rise in the acceptance numbers in those 42 renal units with full reporting throughout that period. The median age of patients starting RRT in England has increased from 63.8 years in 1998 to 65.2 years in 2005. Patients starting on peritoneal dialysis (PD) were on average 9 years younger than those on haemodialysis (HD) and had fewer comorbidities present. HD was the first modality of RRT in 76% of patients, PD in 21% and pre-emptive transplant in 3%. Patients starting RRT without any comorbidity present had a lower estimated glomerular filtration rate (eGFR) than those with comorbid conditions. Twelve percent of patients starting RRT had a previous MI and 31% of those starting RRT aged over 65 years had IHD. Patients with a previous MI or CABG, started RRT with slightly higher mean haemoglobin than those without comorbid conditions or other comorbid conditions. Estimated GFR at the start of RRT appears to be higher in older than younger patients. Mean eGFR of all patients starting RRT rose from 6 in 1997 to above 7.5 in 2003, since when it has remained stable. In 2005, the mean percentage of patients referred late (<90 days before dialysis initiation) was 30% (centre range 13–48%). This was similar to the value in 2000. From the date of first RRT, the 1 year survival of all patients (unadjusted for age) is 79%. From the 90th day of RRT (to allow comparison with other countries’ 1 year survival), the 1 year survival is 83%. The age adjusted (60 years) survival for the 1 year after 90 day period is 86%. There is a high death rate in the first 90 days on RRT (6% of all patients starting RRT), a period not included in reports by many registries and other studies. The 5 year survival (including deaths within the first 90 days) rates are 58, 53, 44, 28, 20 and 12%, respectively for patients aged 18–34, 35–44, 45–54, 55–64, 65–74 and 75þ years. The ‘vintage effect’ of increasing hazard of death with length of time on RRT, prominent in data from the US, is only noted in older age groups (65–75 and 75þ years) at 5–6 years after starting RRT. In the multivariate survival analysis of incident patients, the presence of ischaemic/neuropathic ulcers was the predictor of worst survival, followed by malignancy, previous MI and age per 10 year increment.