Chapter 1: Summary of findings in the 2009 UK Renal Registry Report

In 2008, all renal centres supplied electronic data extracts to the UK Renal Registry. In all analyses, marked variations between centres are reported. In 2008, the acceptance rate in the UK was 108 per million population (pmp). Acceptance rates in Scotland (103 pmp), Northern Ireland (97 pmp) and Wales (117 pmp) have all fallen compared to previous years, although Wales still remained the country with the highest acceptance rate. Diabetic renal disease remained the single most common cause of renal failure (24%). The incidence of late presentation (<90 days) has fallen from 28% in 2003 to 22% in 2008. There were 47,525 adult patients receiving RRT in the UK on 31/12/2008, equating to a UK prevalence of 774 pmp. This represented an annual increase in prevalence of approximately 4.4%. The growth rate from 2007 to 2008 for prevalent patients by treatment modality in the UK was 5.9% for haemodialysis (HD), a fall of 9.2% for peritoneal dialysis (PD) and growth of 4.6% with a functioning transplant. For all ages, prevalence rates in males exceeded those in females, peaking in the 75–79 years age group at 2,582 pmp for males and in the 70–74 years age group at 1,408 pmp for females. The total number of kidney transplants performed in 2008 was 2,486 compared to 2,218 in 2007 and 2,067 in 2006. Compared to 2007, there were 37 (4%) more transplants from heartbeating deceased donors, 139 (46%) more transplants from non-heartbeating deceased donors and 120 (15%) more transplants from living kidney donors. The number of simultaneous kidney/ pancreas transplants fell from 197 in 2007 to 162 in 2008. Analysis of prevalent transplants by chronic kidney disease stage showed 14.7% with an eGFR <30ml/min/1.73 m and 2.1% <15ml/min/1.73 m. Of those with CKD stage 5T, 40.4% had haemoglobin (Hb) concentrations <10.5 g/dl, 25.9% phosphate concentrations 51.8 mmol/L, 9.0% adjusted calcium concentrations 52.6 mmol/L and 40.8% PTH concentrations 532 pmol/L. Reporting of comorbidity at the start of RRTremained incomplete in many centres. Diabetes mellitus and ischaemic heart disease were the most common comorbidities reported at the start of RRT, in 30.1% and 22.7% of patients respectively. In multivariate survival analysis, malignancy and ischaemic/neuropathic ulcers were the strongest independent predictors of poor survival at 1 year after 90 days from the start of RRT. The age-adjusted survival (adjusted to age 60) of prevalent dialysis patients rose from 85% in 2000 to 89% in 2007. Diabetic prevalent patient survival rose from 76.5% in 2000 to 83.0% in 2007. The agestandardised mortality ratio for prevalent RRT patients compared with the general population was 28.6 at age 30 years (and was lower than in the 1998–2001 cohort