Download - The Scottish Renal Registry

srr.scot.nhs.uk

Download - The Scottish Renal Registry

SRR BP audit 2008

Aileen Helps; Bruce Mackinnon; Jan

Kerssens


SRR BP audit

• Contributed to by all Scottish Renal Units

• Ideally data from all haemodialysis patients from

a particular session

• 1 st

st Monday in May

• Pre-dialysis blood pressures

• Target is less than 140/90mmHg although the

optimal target in this population is undefined

• No distinction made for those who were

hypotensive


BP by unit

RHSCG

60

DGRI

50

1

RAIG

21

70

QMHD

99

8

XH

MONK

NINE

127

121

138

9

27

33

BPs

Missing BPs

ARI

192

3

WIG

217

49

RIE

259

18

GRI

287

31

0 50 100 150 200 250 300 350


Pre dialysis systolic and diastolic

BPs


% systolic BP


% diastolic BP


Percentage of patients meeting

the target of 140/90mmHg by unit

(2008)

100%

RHSC

90%

Percentage

80%

70%

60%

50%

40%

RAIG

DGRI

QMHD

XH

MONK

NINE

WIG

ARI

RIE

GRI

Centres

+3sd

+2sd

Mean%

-2sd

-3sd

30%

0 50 100 150 200 250 300 350

Number of patients


BP split by primary renal diagnosis

190

165

Blood pressure in mmHg

140

115

90

65

Systolic

140

90

Diastolic

40

PriGlo IntNephr MultDis DiabNephr Nknow n/Oth

Primary Renal Diagnosis Groups


BP sorted by URR

190

Blood pressure in mmHg

165

140

115

90

65

Systolic

140

90

Diastolic

40

less than 70%

70% or more

URR Groups


BP by haemoglobin

190

Blood pressure in mmHg

165

140

115

90

65

Systolic

140

90

Diastolic

40

Less than 12.5 gr/dL 10.5 - 12.5 gr/dL More than 12.5 gr/dL

Hb Groups


2008 data compared with 2007

100%

80%

60%

40%

20%

0%

2007 2008

RHSC

DGRI

GRI

QMHD

XH

NINE

WIG

ARI

RIE

RAIG

MONK


Percentage of patients meeting

the target of 140/90mmHg by unit

(2008)

100%

RHSC

90%

Percentage

80%

70%

60%

50%

40%

RAIG

DGRI

QMHD

XH

MONK

NINE

WIG

ARI

RIE

GRI

Centres

+3sd

+2sd

Mean%

-2sd

-3sd

30%

0 50 100 150 200 250 300 350

Number of patients


England, Wales and Northern

Ireland data (2007)

Renal Registry Report 2007


Limitations

• Not a complete dataset

• No record of antihypertensives/ / other

medications

• No accounting for intradialytic weight gains/

post dialysis BPs

• Does time of day/ dialysis shift make any

difference


Why bother

• Timely publication of a meta-analysis analysis in The

Lancet, February 2009 (Heerspink(

et al)

• 8 RCTs, , 1679 patients, 495 cardiovascular events

• Weighted mean SBP 4.5mHg lower and DBP

2.3mmHg lower

• BP lowering treatment was associated with

lower risks of cardiovascular events, all cause

mortality and cardiovascular mortality

• Consistent results within the studies


Questions

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