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Scottish Renal Association - The Scottish Renal Registry

Renal Association

Scottish Renal Registry Report 2011

Scottish Renal Registry

Report 2011

With demographic data to 2011

and audit data to 2012

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Renal Association

Scottish Renal Registry Report 2011

© NHS National Services Scotland/Crown Copyright 2012

Brief extracts from this publication may be reproduced provided the source is fully acknowledged.

Proposals for reproduction of large extracts should be addressed to:

ISD Scotland Publications

Information Services Division

NHS National Services Scotland

Gyle Square

1 South Gyle Crescent

Edinburgh EH12 9EB

Tel: +44 (0)131 275 6233

Email: nss.isd-publications@nhs.net

Designed and typeset by:

Chris Dunn, ISD Scotland Publications Team

Translation Service

If you would like this leaflet in a different language, large print or Braille (English only), or would

like information on how it can be translated into your community language, please phone

0131 275 6665.

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Renal Association

Scottish Renal Registry Report 2011

CONTENTS

RENAL UNITS AND SATELLITE DIALYSIS UNITS IN SCOTLAND 31 DECEMBER 2011...................II

ACKNOWLEDGMENTS..............................................................................................................III

EXECUTIVE SUMMARY................................................................................................................V

INTRODUCTION.......................................................................................................................VII

SUMMARY OF DATA................................................................................................................VIII

SECTION A INCIDENCE...........................................................................................................1

A1 Incidence of new patients starting RRT......................................................................................... 1

A2 General population and incident RRT population 2011................................................................. 4

A3 Age distribution of patients when starting RRT ............................................................................ 5

A4 Primary renal diagnosis of patients starting RRT ........................................................................... 8

A5 Modality of RRT.......................................................................................................................... 10

SECTION B PREVALENCE.......................................................................................................13

B1 Patients receiving RRT in Scotland according to modality of treatment on 31 December............. 13

B2 Prevalent patients at each renal unit............................................................................................ 17

B3 Prevalent patients in each NHS Board area.................................................................................. 18

SECTION C SURVIVAL............................................................................................................22

C1 Survival analyses......................................................................................................................... 22

C2 Survival of patients aged 45-64 when starting RRT over time..................................................... 25

C3 Comparison of survival by renal unit providing first RRT using Cox regression............................. 28

C4 Survival by NHS Board area of residence..................................................................................... 30

SECTION D KIDNEY TRANSPLANTATION...............................................................................31

D1 Frequency of kidney transplantation in Scotland......................................................................... 31

D2 Transplanted Kidney Survival...................................................................................................... 33

D3 Patient survival after Kidney Transplantation............................................................................... 35

D4 Listing for Kidney Transplantation............................................................................................... 37

SECTION E PERITONEAL DIALYSIS ........................................................................................40

SECTION F

ANAEMIA............................................................................................................42

SECTION G UREA REDUCTION RATIO....................................................................................44

SECTION H

SECTION I

SECTION J

SECTION K

SECTION L

VASCULAR ACCESS FOR HAEMODIALYSIS...........................................46

BONE MINERAL METABOLISM............................................................................49

ANTHROPOMETRIC MEASUREMENTS OF HAEMODIALYSIS PATIENTS.................52

BLOOD PRESSURE...............................................................................................55

CAUSE OF DEATH................................................................................................57

SECTION M STAFFING AND FACILITIES..................................................................................60

APPENDIX 1 ABBREVIATIONS USED IN THE TEXT....................................................................64

APPENDIX 2 RENAL UNITS, SATELLITE DIALYSIS UNITS AND HEALTH BOARD AREA OF UNITS’

LOCATION..........................................................................................................67

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Renal Association

Scottish Renal Registry Report 2011

RENAL UNITS AND SATELLITE DIALYSIS UNITS IN

SCOTLAND 31 DECEMBER 2011

Renal unit

Satellite

dialysis unit

Lerwick

Kirkwall

Wick

Stornoway

Portsoy

Elgin

Inverness

Peterhead

Inverurie

Aberdeen

Fort

William

Dundee

Arbroath

Perth

St Andrews

Alexandria

Dunfermline

Larbert

Kirkcaldy

Greenock

Glasgow Airdrie

Livingston

Edinburgh

Kilmarnock

Melrose

Dumfries

Stranraer

0 50 100km

Contains Ordnance Survey data © Crown copyright and database right 2010.

Contains Royal Mail data © Royal Mail copyright and database right 2010

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Renal Association

Scottish Renal Registry Report 2011

ACKNOWLEDGMENTS

The steering group of the Scottish Renal Registry and the report editors would like to thank the

staff in all renal units in Scotland for their immense help with data collection and checking. Jackie

McDonald of ISD runs the SRR office with skill and dedication and is integral to the work of the

Registry. The SRR website is expertly managed by the web and publications team at ISD.

Many of the SRR projects are each led by an individual or small group. They have done a great

deal of hard and we are very grateful to them. Their names and addresses are shown below:

Section

Coordinators and lead authors

Peritoneal dialysis Michaela Brown 1 Robert Mactier 1

Anaemia Sue Robertson 2

Vascular access Alison Severn 3

Bone mineral metabolism Alison Almond 2

Anthropometric measurements Hazel Ferenbach 4 Susan Reed 4

Blood pressure Bruce Mackinnon 1

Staffing and facilities Shona Methven 5

Cause of death

Ben Bray 1 and the SMARRT steering group

1. Glasgow Renal and Transplant Unit

2. Dumfries & Galloway Royal Infirmary

3. Ninewells Hospital Dundee

4. Royal Infirmary of Edinburgh

5. Monklands Hospital, Airdrie

Our statistical advice is provided by Jenny Boyd and colleagues of ISD, she has analysed or guided

the analysis, of much of the work presented here and we value her advice greatly and have

benefited from her energy and enthusiasm.

We thank the General Register Office for Scotland for allowing us to use and report Crown

copyright data from the population census.

We very much value our collaboration with NHS Blood and Transplant (NHSBT) who through data

linkage provide us with transplant listing status and donor details for patients on the SRR who are

registered with them on the UK national transplant waiting list. We thank them for their support of

the SRR.

We are very grateful to Dominic Cuthbert (strategic development manager) and Jamie Clark

(senior developer) of the Ordnance Survey for once again creating the map of renal units and

satellite dialysis units within this report and presenting it to us.

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Renal Association

Scottish Renal Registry Report 2011

Our computer hardware is supported by Greater Glasgow and Clyde IT department and our

software by VitalPulse. The database software is Proton from Clinical Computing plc. The

Information Technology staff of the hospitals and NHS Scotland support our use of the NHS

computer network.

We are indebted to patients attending all renal units in Scotland and to their friends, families and

carers for their brave and unwavering support and for their continuing encouragement to obtain

and publish hard facts about the quality of the service, quality of life and outcomes. Patients are

full members of the SRR Steering group, they vote on all major decisions and have organised major

projects.

The report has been skilfully published by Chris Dunn and the publications team at ISD.

As the editors, we remain responsible for the content.

Jamie Traynor, Consultant Nephrologist, Technical Director Scottish Renal Registry

Bruce Mackinnon, Consultant Nephrologist, Glasgow Renal and Transplant Unit.

Wendy Metcalfe, Consultant Nephrologist, Chair Scottish Renal Registry.

Scottish Renal Registry

Cirrus House

Marchburn Drive

Glasgow Airport Business Park

Abbotsinch, Paisley

PA3 2SJ

Tel + 00 44 (0)141 282 2253

Web http://www.srr.scot.nhs.uk

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Renal Association

Scottish Renal Registry Report 2011

EXECUTIVE SUMMARY

The first patient was dialysed for established renal failure (ERF) in Scotland in 1960. Up to

31 December 2011, 14034 patients had started renal replacement therapy (RRT) for ERF in

Scotland.

On 31 December 2011 there were 9 adult and one paediatric renal units in Scotland with 24

satellite dialysis units between them. All units contribute fully to the Scottish Renal Registry (SRR)

and all patients receiving RRT for ERF are registered.

The incidence of new patients starting RRT each year has fluctuated over the past 10 years

between 109 per million of the population in 2002, up to 123 in 2005. 96 patients per million

population started RRT for ERF in 2011. There appears to be a decreasing trend in the number of

incident patients over recent years.

There are significant differences in the age standardised incidence of patients starting RRT in the

5 years 2007-2011 between NHS Board areas.

The incidence of new patients starting RRT ranged from 42 per million population (pmp) aged

20-44 years, up to 274 pmp in those aged ≥75 years in 2011. There appears to be a downward

trend in the incidence per 100000 population of patients aged ≥65 years when starting RRT.

23% of patients starting RRT in the 5 years 2007-2011 had ERF due to diabetic nephropathy.

On 31 December 2011 there were 4426 prevalent patients receiving RRT. Of these 51% of patients

had a functioning kidney transplant, 43% were being treated with haemodialysis (HD) and 6%

with peritoneal dialysis (PD). In contrast to the numbers of new patients starting RRT, the number

of prevalent patients is still rising.

There are significant differences in the age standardised prevalence of patients receiving RRT on

31 December 2011 between NHS Board areas.

The life expectancy of patients receiving RRT is shorter than that of the general population. The

survival of patients is influenced by their age at the time of starting RRT and also by their primary

renal diagnosis (PRD). Of those patients starting RRT over the past 25 years when aged 45 to 64

years with glomerulonephritis 47% had died within 5 years of starting treatment and 73% within

10 years. The mortality of patients in the same age group with a PRD of diabetic nephropathy was

79% at 5 years and 96% at 10 years. In contrast the life expectancy of a male from the general

population aged 55 years is 24.7 years.

There is a significant trend of improving survival for patients starting RRT in the 10 years 2002-

2011. There is no significant difference in survival between renal units or NHS Board areas.

194 patients received a kidney transplant in Scotland in 2011. 28% of kidney transplants

performed in 2007-2011 were from live kidney donors. The median age at first transplantation in

the same time period was 46 years. First kidney transplants performed in 2010 had a 95% 1 year

graft survival and a 97% 1 year patient survival.

Several measures of quality of care are reported by the SRR facilitating nationwide comparative

audit and identification of areas of excellence in practice, the SRR thus contributes to the continued

efforts to improve standards of delivered care across Scotland.

The incidence of PD related peritonitis across Scotland was 23.4 months between episodes in 2011.

The UKRA standard is


Renal Association

Scottish Renal Registry Report 2011

81% of patients treated by HD had a blood haemoglobin (Hb) concentration ≥10 g/dL in May

2012. Only 3 of the 9 adult renal units in May 2012, reached the NHS Quality Improvement

Scotland standard (which is that ≥85% of such patients should achieve this level). 52% of patients

had Hb in the range 10-12 g/dL which is the UKRA recommended range.

87% of patients treated by HD achieved a urea reduction ratio of ≥65%.

Vascular access describes the connection between a patient’s circulation and a haemodialysis

machine. In May 2012, 77.2% of HD patients had a form of arteriovenous (AV) fistula which is

the best form of access. 22.8% were using central venous catheters which are prone to infection.

There were significant differences between renal units. Only 44% of patients started HD via AV

access in the first six months of 2012, there were significant differences between units. UKRA

guidance is that at least 65% of incident HD patients should commence HD via AV access.

67% of patients treated by HD had a pre-HD phosphate of


Renal Association

Scottish Renal Registry Report 2011

INTRODUCTION

This eighth report from the Scottish Renal Registry (SRR) follows the outline of previous reports

and presents information about the causes, incidence, prevalence, distribution, methods of

treatment and outcome of patients receiving renal replacement therapy (RRT) for established renal

failure (ERF) between 1960 and 31 December 2011. It also presents audit data relating to measures

of quality of treatment delivered from May 2012.

There is no information in this report about patients with acute kidney injury (AKI) or those with

chronic kidney disease (CKD) before RRT is required.

Funding

The Information Services Division (ISD) of NHS Scotland assumed overall responsibility and

funding for the SRR in April 1999. In the period covered by this report, no financial assistance was

received from commercial organisations.

Other background information

Detailed information about our computer hardware, software, analytic tools, the SRR office, staff,

steering group, projects, data quality assurance, publications, security and confidentiality and

details of how data are provided to external bodies is published on the SRR website.

http://www.srr.scot.nhs.uk

Renal unit anonymity has been progressively removed since 1998.

Patient anonymity is rigorously protected.

Conflict of interest

The SRR Chair, steering group and report editorial group do not have any conflicting interests.

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Renal Association

Scottish Renal Registry Report 2011

SUMMARY OF DATA

Patients

14428 patients have been registered with the SRR from its inception in 1991 until 31 December

2011 when the data for this report were collated. 9617 patients of the patients registered with the

SRR are known to be dead by 31 December 2011. The total number of patients receiving RRT for

ERF who died in 2011 was 454.

Inclusions and exclusions from analyses

Incident patients

All patients starting RRT in Scotland are included in incidence figures (14035 patients). Patients

who have moved into Scotland already receiving RRT, either dialysis or with a functioning kidney

transplant are excluded. The SRR does not routinely record the incidence of RRT for acute kidney

injury (AKI).

Prevalent patients

All patients whose treatment started on or before 31 December 2011 and who were still alive

and resident in Scotland on that date are included. 2 patients who had stopped RRT with no

expectation of recovery, but were still alive on 31 December 2010 are also included. Patients who

have moved outside of Scotland, those who are lost to follow-up (10 patients) and those who have

recovered renal function (within 90 days of starting RRT) are excluded.

Survival analyses

The start date for the survival analyses is the first date of RRT. The end date is the date of death or

the censor date of 31 December 2011. Also censored are those patients moving outside of Scotland

and those lost to follow-up, both groups are censored on the date that the SRR received the last

laboratory or treatment information about them. Patients who were lost to follow up or moved,

but later came back to have RRT in Scotland had their entire period of RRT included for survival

analyses.

Patients recovering native renal function

Patients who recovered renal function within 90 days of starting RRT and have not yet needed to

restart RRT were excluded from the analyses. Patients who recovered, but required more than 90

days RRT remain in the data set.

If a patient had to restart RRT within a 90 day period after initial recovery, the date of first starting

RRT is considered as the beginning of the first period of treatment. If however the initial period of

treatment is less than 90 days, and the period of recovery greater than 90 days, the date of first

RRT is recorded as that on which they restart treatment that lasts for at least 90 days.

Where a patient started RRT and then died before the 91st day or if they recovered before the 91st

day but then died within the next 90 days, their nephrologist was asked to decide whether they

had been treated for acute or established renal failure. Only those with ERF are included in this

report.

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Renal Association

Scottish Renal Registry Report 2011

Primary renal diagnoses

A diagnosis code for the primary renal disease (PRD) has been chosen by the nephrologists

responsible for the care of the patient from the code list published by the ERA-EDTA. To simplify

analysis of the data these codes have been grouped into five categories: glomerulonephritis,

interstitial nephritis, diabetic nephropathy, multi-system disorders and unknown diagnosis. It

is often not possible to make a precise diagnosis for patients presenting with ERF because the

subtle signs of the original disease may have been obscured. The PRD groupings used in all SRR

publications are listed on the SRR website: http://www.srr.scot.nhs.uk/

Attributing the cause of renal failure to a PRD does not tell us anything about the presence or

absence of comorbid illnesses. For example, a patient with vascular disease or diabetes mellitus

may have a different cause for their renal failure.

34 patients have no PRD recorded on the SRR, 4 have moved outside of Scotland. The remaining

30 patients are deceased and their clinical notes have been destroyed. They started RRT in 4 units:

ARI (10), MONK (5), NINE (14), RIE (1).

Renal units in Scotland

All renal units in Scotland contribute fully to the SRR. In the period since the last SRR report

the renal unit previously based in Queen Margaret’s Hospital Dunfermline (QMHD) has moved

to the Victoria Hospital in Kirkcaldy, but retains a satellite dialysis unit in QMHD. The dialysis

unit in Shetland is run as a satellite unit of Aberdeen Royal Infirmary. A complete list of units is

given in Appendix 2.

Presentation of the data

Throughout the report numeric data are shown either in charts or in a separate table. In many

charts the data are shown in five year bands, in order to present all the available data, the first time

band represents a different number of years.

Abbreviations

Throughout this report for brevity and ease of reading some abbreviations are used. These are

listed in full in Appendix 1 and on the SRR website.

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Renal Association

Scottish Renal Registry Report 2011

SECTION A

INCIDENCE

A1

Incidence of new patients starting RRT

A1.1 Incidence of new patients starting RRT 1960-2011

3000

2500

2000

Number

of

patients

1500

2689

2959

2703

1000

2029

500

0

218

378

614

953

1492

1960-1971 1977-1981 1987-1991 1997-2001 2007-2011

1972-1976 1982-1986 1992-1996 2002-2006

Year starting RRT

A1.2 Annual incidence per million population of new patients starting RRT

1982-2011

Year

Number starting RRT Population of Incidence per million

(number of males) Scotland

1982-1986 953 (556) 5138238 * 37

1987-1991 1492 (880) 5083850 * 59

1992-1996 2029 (1173) 5095234 * 80

1997-2001 2689 (1557) 5071900 * 106

2002 551 (313) 5054800 109

2003 608 (332) 5057400 120

2004 579 (321) 5078400 114

2005 628 (363) 5094800 123

2006 593 (353) 5116900 116

2007 575 (336) 5144200 112

2008 551 (317) 5168500 107

2009 551 (335) 5194000 106

2010 519 (317) 5222100 99

2011 507 (290) 5254800 96

Population figures are from the General Register Office for Scotland.

They are population estimates for the 30 June of each year.

* The population estimates shown for the five year bands between 1982 and 2001 are the arithmetical mean of the

mid-year population estimate for each of the years in question, the annual incidence of new patients is averaged

over the five year periods.

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Renal Association

Scottish Renal Registry Report 2011

A1.3 Age standardised incidence of new patients starting RRT 2007-2011 by

NHS Board area of residence

NHS Board Number starting RRT Incidence per 100000

population

Age standardised

incidence per 100000

population

A&A 198 11 10.2

BORD 62 11 10.0

D&G 80 11 9.4

FIFE 232 13 12.6

FV 166 11 11.5

GG&C 622 10 10.8

GRAM 270 10 10.0

HIGH 142 9 8.4

LAN 267 10 9.8

LOTH 346 8 8.9

ORKN 10 10 9.2

SHET 9 8 8.1

TAY 276 14 13.0

WI 16 12 10.8

SCOT 2696 10 10.4

The incidence of new patients starting RRT in each NHS Board area of residence has been standardised to take into

account differences in the age distribution of residents to allow direct comparison between areas.

The age standardised incidence is the total number of residents expected to start RRT in a NHS Board area

population, if the age structure of the Board area was the same as that of Scotland.

A five year incident period from 2007 to 2011 has been used to minimise the impact of year to year fluctuations in

numbers of patients.

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Scottish Renal Registry Report 2011

A1.4 Age standardised incidence of new patients starting RRT 2007-2011 by

NHS Board area of residence

15

13

TAY

FIFE

NHS Board area

+3SD

+2SD

Mean

-2SD

-3SD

Incidence

per

100000

population

11

9

WI

ORKN

SHET

BORD

D&G

FV

HIGH

A&A

GRAM

LAN

LOTH

GG&C

7

5

0 200000 400000 600000 800000 1000000 1200000

NHS Board area population

FIFE and TAY NHS Board areas have age standardised incidence rates, over the period 2007-2011,

more than 3SD above the national mean. These areas have more incident RRT patients than

expected according to the age spread of the NHS Board areas populations.

SHET, HIGH and LOTH have age standardised incidence rates more than 3SD below the national

mean and have fewer incident RRT patients than would be expected if the variation between the

areas were due to differences in age demographic alone.

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Renal Association

Scottish Renal Registry Report 2011

A2 General population and incident RRT population 2011

A2.1 Age specific incidence of new patients starting RRT 2011

per 100000 population

60

55

50

45

Males

Females

Persons

Rate per

100000

age specific

population

40

35

30

20

25

15

10

5

0

0-4 10-14 20-24 30-34 40-44 50-54 60-64 70-74 80-84 ≥90

5-9 15-19 25-29 35-39 45-49 55-59 65-69 75-79 85-89

Age group

A2.2 Age specific incidence and prevalence of RRT patients 2011

Age

Estimated

population

30/06/2011

Number

starting RRT

2011

Incidence

per million

population

of each age

group

All prevalent

patients

receiving RRT

on 30/06/2011

Prevalence

per million

population

of each age

group*

≥75 413074 113 274 584 1414

65-74 479313 128 267 790 1648

45-64 1436617 180 125 1885 1312

20-44 1754025 73 42 1040 593


Renal Association

Scottish Renal Registry Report 2011

A2.3 Age specific incident RRT population 1992 to 2011 per 100000 population

45

40

35

≥75

65-74

45-64

20-44


Renal Association

Scottish Renal Registry Report 2011

A3.2 Number of patients in each age group and median age when starting

RRT 1960-2011

Year starting

RRT


Renal Association

Scottish Renal Registry Report 2011

A3.4 Number of patients in each age group and median age when starting

RRT 2007-2011 by NHS Board area of residence


Renal Association

Scottish Renal Registry Report 2011

A4

Primary renal diagnosis of patients starting RRT

ERA-EDTA Primary Renal Diagnoses (PRD) codes and groupings used in SRR reports are available

on the SRR website: http://www.srr.scot.nhs.uk/Projects/Methods.html

A4.1 Percentage of patients in each diagnosis group starting RRT

1960-2011

% of

patients

100

90

80

70

60

50

40

30

20

10

21

9

29 36

40 37

0

1960-1971

10 10 13

17

1972-1976

6

16

38

30

1977-1981

9

20

34

23 20 19

1982-1986

17 18 21 20 17

13

22

28

1987-1991

16

23

24

1992-1996

Year starting RRT

18 20 23

26 26 24

21 22 22

15 13 14

1997-2001

2002-2006

2007-2011

Unknown

Diabetes

Multisystem

Interstitial

Glomerulonephritis

A4.2 Number of patients in each diagnosis group starting RRT 1960-2011

Year

starting

RRT

Glomerulonephritis

Interstitial Multisystem Diabetes Unknown Missing

1960-1971 87 63 19 1 46 2

1972-1976 139 135 64 3 37 0

1977-1981 185 236 96 35 61 1

1982-1986 220 326 188 86 127 6

1987-1991 299 416 330 188 254 5

1992-1996 382 487 465 331 359 5

1997-2001 394 556 707 477 552 3

2002-2006 380 638 762 590 583 6

2007-2011 390 593 654 610 454 2

TOTAL 2476 3450 3285 2321 2473 30

Please see primary renal diagnosis section on page ix for details of the missing diagnoses.

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Renal Association

Scottish Renal Registry Report 2011

A4.3 Primary renal diagnosis of patients aged less than 45 years starting

RRT 1960-2011

Year

starting

RRT

Glomerulonephritis

Interstitial Multisystem Diabetes Unknown Total

n (%) n (%) n (%) n (%) n (%) n

1960-1971 77 (41%) 60 (32%) 15 (8%) 1 (1%) 37 (18%) 190

1972-1976 112 (42%) 97 (36%) 37 (14%) 1 (0%) 21 (8%) 268

1977-1981 108 (32%) 140 (42%) 41 (12%) 16 (5%) 32 (9%) 337

1982-1986 107 (27%) 147 (36%) 63 (16%) 40 (10%) 46 (11%) 403

1987-1991 130 (26%) 176 (35%) 68 (14%) 60 (12%) 62 (13%) 496

1992-1996 128 (24%) 191 (36%) 64 (12%) 90 (17%) 60 (11%) 533

1997-2001 109 (21%) 166 (33%) 64 (13%) 90 (18%) 81 (16%) 510

2002-2006 114 (21%) 187 (34%) 62 (11%) 115 (21%) 71 (13%) 549

2007-2011 94 (18%) 184 (36%) 58 (11%) 116 (22%) 64 (12%) 516

There are three patients with a missing PRD code.

A4.4 Primary renal diagnosis of patients aged 75 years and older starting

RRT 1982-2011

Year

starting

RRT

Glomerulonephritis

Interstitial Multisystem Diabetes Unknown Total

n (%) n (%) n (%) n (%) n (%) n

1982-1986 1 (10%) 1 (10%) 2 (20%) 1 (10%) 5 (50%) 10

1987-1991 6 (10%) 9 (15%) 17 (27%) 1 (2%) 29 (47%) 62

1992-1996 19 (9%) 32 (16%) 58 (29%) 15 (7%) 78 (39%) 202

1997-2001 52 (11%) 70 (14%) 154 (32%) 50 (10%) 162 (33%) 488

2002-2006 54 (8%) 84 (12%) 265 (37%) 83 (12%) 225 (32%) 711

2007-2011 59 (9%) 79 (13%) 221 (35%) 85 (14%) 180 (29%) 624

There are seven patients with a missing PRD code.

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Renal Association

Scottish Renal Registry Report 2011

A5

Modality of RRT

There are three principal types of RRT: Haemodialysis (HD) is normally performed in a hospital

but can be undertaken in a patient’s home. Peritoneal dialysis (PD) is performed by the patient

in their home either using the technique of continuous ambulatory peritoneal dialysis (CAPD) or

the dialysate exchanges can be performed semi automatically by a machine, known as automated

peritoneal dialysis (APD). Renal transplants are normally donated from a deceased donor, but can

also be donated by a living person. In total 185 patients have received a transplant as their first

mode of RRT (a pre-emptive transplant) in Scotland by the end of 2011.

A5.1 Mode of first RRT 1960-2011

3000

2500

636

585

478

Transplant

PD

HD

2000

Number

of 1500

patients

1000

500

0

198

347

151

462

359

592

618

869

Year starting RRT

628

1388

2013

2335

2140

1960-1971 1977-1981 1987-1991 1997-2001 2007-2011

1972-1976 1982-1986 1992-1996 2002-2006

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Renal Association

Scottish Renal Registry Report 2011

A5.2 Mode of first RRT 1960-2011

Year starting RRT HD PD Transplant Total

1960-1971 198 20 0 218

1972-1981 809 182 1 992

1982-1991 1461 977 7 2445

1992-1996 1388 628 13 2029

1997-2001 2013 636 40 2689

2002 436 106 9 551

2003 492 110 6 608

2004 451 122 6 579

2005 493 126 9 628

2006 463 121 9 593

2007 432 123 20 575

2008 437 94 20 551

2009 454 83 14 551

2010 419 88 12 519

2011 398 90 19 507

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Renal Association

Scottish Renal Registry Report 2011

A5.3 Number of patients on each mode of RRT after one, five and ten years

by mode of first RRT for patients starting RRT in 2000

Mode of

first RRT

2000

Number of

patients

Subsequent

RRT mode

1 year 5 years 10 years

n (%) n (%) n (%)

HD 403 HD 234 (58%) 77 (19%) 12 (3%)

PD 32 (8%) 9 (2%) 1 (0%)

Tx 10 (2%) 41 (10%) 49 (12%)

Deceased 119 (30%) 266 (66%) 330 (82%)

Other* 8 (2%) 10 (3%) 11 (3%)

PD 145 HD 11 (8%) 24 (17%) 8 (5%)

PD 109 (75%) 19 (13%) 1 (1%)

Tx 12 (8%) 41 (28%) 48 (33%)

Deceased 12 (8%) 59 (41%) 85 (59%)

Other* 1 (1%) 2 (1%) 3 (2%)

Tx 11 HD 0 0 0

PD 0 0 0

Tx 11 (100%) 9 (82%) 8 (73%)

Deceased 0 2 (18%) 3 (27%)

* This category includes other outcomes such as lost to follow up and renal recovery.

The percentage of patients receiving each mode of RRT is given at exactly one, five and ten years

after the date of first RRT for each individual, according to their first mode of RRT. Changes in RRT

modality between the reported time points are not shown.

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Renal Association

Scottish Renal Registry Report 2011

SECTION B

PREVALENCE

B1

Patients receiving RRT in Scotland according to modality of

treatment on 31 December

B1.1 Prevalent patients every fifth year between 1971-2011

4500

4000

3500

3000

1840

2262

Transplant

APD

CAPD

Home HD

Hospital HD

Number

of

patients

2500

2000

1500

1000

500

0

1623

235 201

1309

63

169

160

1025

245

643

364

1669

1845

439

304 235

1240

796

179 284 409

1971 1976 1981 1986 1991 1996 2001 2006 2011

Year

B1.2 Prevalent patients every fifth year between 1971-2011

Year Hospital HD Home HD CAPD APD Transplant Total

1971 78 7 3 0 55 143

1976 119 96 3 0 133 351

1981 179 171 104 0 304 758

1986 284 138 235 0 643 1300

1991 409 89 439 24 1025 1986

1996 796 65 364 89 1309 2623

2001 1240 47 245 160 1623 3315

2006 1669 37 169 235 1840 3950

2011 1845 55 63 201 2262 4426

13


Renal Association

Scottish Renal Registry Report 2011

B1.3 Percentage of prevalent patients every year between 2002-2011

% of

patients

100

90

80

70

60

50

40

30

20

10

0

48 48 48 47 47 47 49 49 50 51

5 5 5 5 6 6 5 5 4

7 5 6 5 4 4 3 2 2

5

1

39 40 41 41 42 43 42 42 42 42

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Year

Transplant

APD

CAPD

Home HD

Hospital HD

B1.4 Prevalent patients every year between 2002-2011

Year Hospital HD Home HD CAPD APD Transplant Total

2002 1355 44 228 160 1651 3438

2003 1437 44 192 180 1725 3578

2004 1483 44 204 183 1747 3661

2005 1581 43 202 202 1798 3826

2006 1669 37 169 235 1840 3950

2007 1754 41 144 233 1930 4102

2008 1772 48 109 217 2040 4186

2009 1827 53 96 203 2120 4299

2010 1855 52 86 196 2182 4371

2011 1845 55 63 201 2262 4426

14


Renal Association

Scottish Renal Registry Report 2011

B1.5 Age specific prevalence of RRT patients on 31 December 2011

per 100000 population

300

250

Males

Females

Persons

Rate per

100000

age specific

population

200

150

100

50

0

0-4 10-14 20-24 30-34 40-44 50-54 60-64 70-74 80-84 ≥90

5-9 15-19 25-29 35-39 45-49 55-59 65-69 75-79 85-89

Age group

B1.6 Age specific prevalent RRT population 1992-2011 per 100000 population

180

160

140

120

Rate per

100

100000

population

80

≥75

65-74

45-64

20-44


Renal Association

Scottish Renal Registry Report 2011

B1.7 Percentage of patients on each mode of RRT by age group on

31 December 2011

100

90

80

70

26

11

19

22

14

25

3

13

≥75

65-74

45-64

20-44


Renal Association

Scottish Renal Registry Report 2011

B2

Prevalent patients at each renal unit

The number of patients treated at each renal unit differs considerably. Detailed information about

each renal unit is given on the SRR website: http://www.srr.scot.nhs.uk/Renal_Units/clinics.htm

B2.1 Number and percentage of patients in each age group receiving RRT

at each renal unit on 31 December 2011

≥75

65-74

45-64

20-44


Renal Association

Scottish Renal Registry Report 2011

B3

Prevalent patients in each NHS Board area

Abbreviations for NHS boards are given in Appendix 1.

B3.1 Number of patients in each age group, median age and inter-quartile

range by NHS Board area of residence on 31 December 2011

NHS

Board


Renal Association

Scottish Renal Registry Report 2011

B3.2 Number of patients on each mode of RRT in each NHS Board area of

residence on 31 December 2011

NHS

Board

Hospital HD Home HD CAPD APD Transplant Total

n % n % n % n % n %

A&A 145 41 8 2 6 2 44 12 151 43 354

BORD 49 47 1 1 1 1 6 6 47 45 104

D&G 49 42 0 5 4 8 7 56 47 118

FIFE 153 48 0 0 30 9 139 43 322

FV 114 49 7 3 1 7 3 105 45 234

GG&C 457 42 20 2 8 1 27 2 579 53 1091

GRAM 203 44 3 1 10 2 15 3 235 50 466

HIGH 87 31 6 2 12 4 13 5 162 58 280

LAN 185 40 5 1 3 1 8 2 264 57 465

LOTH 207 36 4 1 11 2 25 4 321 57 568

ORKN 7 41 0 1 6 1 6 8 47 17

SHET 4 33 1 8 0 0 7 58 12

TAY 177 47 0 4 1 16 4 177 47 374

WI 8 47 0 1 6 1 6 7 41 17

Not in

Scotland

0 0 0 0 3 100 3

One patient has been excluded from the table as we do not hold a current postcode.

B3.3 Percentage of patients in each PRD group and their NHS Board area of

residence on 31 December 2011

% of

patients

100

90

80

70

60

50

40

30

13 12

18 15

14

13

13

13

15 21

16

15

36

36 32

33

20

16

12

32

16 13

17 17 14

13

15

13

15

12

14

14 16 14

13

33

34 30 35 39

18

29

6

29

8

8

17

42

12

19

19

28

24

18

18

Unknown

Diabetes

Multisystem

Interstitial

Glomerulonephritis

20

35

10

0

21 19 21 23 21 24 22 25 22 21

A&A

D&G

BORD

FIFE

FV

18

25 22

GRAM LAN ORKN

GG&C HIGH LOTH SHET

NHS Board area

TAY

6

WI

19


Renal Association

Scottish Renal Registry Report 2011

B3.4 Age standardised prevalence rate (per 100000) population of patients

receiving RRT on 31 December 2011 by NHS Board area of residence

NHS Board

Population on

30 June 2011*

RRT population

31 December

2011

Prevalence per

100000

population

Age standardised

prevalence

per 100000

population

A&A 366890 354 96.5 92.3

BORD 113150 104 91.9 85.7

D&G 148060 118 79.7 72.4

FIFE 367292 322 87.7 86.8

FV 295541 234 79.2 79.9

GG&C 1210254 1091 90.1 92.6

GRAMP 555280 466 83.9 84.3

HIGH 311960 280 89.8 84.1

LAN 563185 465 82.6 83.6

LOTH 848727 568 66.9 69.8

ORKN 20160 17 84.3 78.8

SHET 22500 12 53.3 52.8

TAY 405721 374 92.2 89.7

WI 26080 17 65.2 59.8

Scotland 5254800 4422 84.2 84.2

* GROS Mid-year estimates

An additional standardisation analysis adjusting for age and sex was carried out, but made no

significant difference. We have included adjustment for age only so that a comparison can be

made to B3.6 in the 2010 Annual Report.

20


Renal Association

Scottish Renal Registry Report 2011

B3.5 Age standardised prevalence of patients receiving RRT on

31 December 2011 by NHS Board area of residence

Prevalence

per

100000

population

120

100

80

A&A

BORD HIGH TAY

FIFE

GRAM

ORKN FV

LAN

D&G

LOTH

GG&C

NHS Board area

-3SD

-2SD

Mean

+2SD

+3SD

60

WI

SHET

40

0 200000 400000 600000 800000 1000000 1200000

NHS Board area population

21


Renal Association

Scottish Renal Registry Report 2011

SECTION C

SURVIVAL

C1

Survival analyses

A total of 14034 patients who have started RRT in Scotland since 1960 are available for the survival

analysis (no patient has a date of birth missing). Patients who started RRT outside of Scotland are

excluded. Those who moved from Scotland, or are lost to follow-up are censored at the date at

which this occurred, even if death at a later date is reported to the Registry.

C1.1 Proportion of patients surviving at 1 year, 2 years, 5 years and 10 years

from starting RRT 1987-2010 by age and diagnosis group

Age group

Diagnosis

group

Number

starting

RRT

1 year

survival

2 year

survival

5 year

survival

10 year

survival

n % n % n % n %

≥75 years Unknown 643 395 61 245 38 57 9 3


Renal Association

Scottish Renal Registry Report 2011

Age group

Diagnosis

group

Number

starting

RRT

1 year

survival

2 year

survival

5 year

survival

10 year

survival

n % n % n % n %


Renal Association

Scottish Renal Registry Report 2011

C1.3 Survival of patients by year of start of RRT 2002-2011

Patients with insufficient follow-up and those who recovered within 90 days or who were lost to

follow-up within the relevant period have been excluded.

Date

starting

RRT

% surviving

90 days

% surviving

1 year

% surviving

1 year + 90 days

% surviving

2 years

% surviving

2 years + 90 days

2002 89.20 73.7 70.8 61.8 58.3

2003 90.82 76.4 72.4 62.6 60.4

2004 90.29 75.5 72.1 64.2 61.3

2005 91.49 76.6 72.8 62.7 60.2

2006 91.91 78.7 74.4 66.3 63.7

2007 92.78 81.0 77.6 70.8 68.8

2008 93.07 81.8 78.8 71.2 67.6

2009 90.94 78.0 76.2 68.4 65.8

2010 94.25 83.5 79.8

2011 94.20

Note: Censored patients are excluded from this table.

C1.4 Trends in survival of all patients when starting RRT 2002-2011

100

%

Survival

90

80

70

60

90 days survival

trend in 90 days survival

1 year survival

1 year + 90 days

trend in 1 year survival

2 years survival

2 years + 90 days

trend in 2 years survival

50

40

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Year starting RRT

Trend in 90 days survival: year to year OR is 1.07 (95%CI 1.03 -1.10).

Trend in 1 year survival: year to year OR is 1.06 (95%CI is 1.03 - 1.10).

Trend in 2 years survival: year to year OR is 1.06 (95%CI is 1.03 - 1.10).

There is a statistically significant trend in 90 day, 1 year and 2 year survival.

24


Renal Association

Scottish Renal Registry Report 2011

C2

Survival of patients aged 45-64 when starting RRT over time

In order to investigate whether survival has improved for patients starting RRT in more recent

years, the survival of patients in a single diagnosis group, glomerulonephritis, and a single age

group, 45-64 years, was analysed over time. The number of incident patients in these groups has

not changed significantly for the past 20 years - see A4.2 and A4.3.

Data relating to patients starting RRT 2007-2011 are excluded to ensure a minimum available

follow up period of 5 years.

This analysis was repeated for patients of the same age group with a diagnosis of diabetic

nephropathy, these patients have only been treated in appreciable numbers since the middle of

the 1980s.

C2.1 Proportion of patients surviving at 1 year, 2 years, 5 years and 10 years

of patients aged 45-64 years in the glomerulonephritis PRD group

900 patients in the glomerulonephritis PRD group were of age 45-64 years when starting RRT. Of

these 156 started RRT between 2007 and 2011 and were excluded to ensure a minimum of 5 years

of follow-up RRT. A further 28 patients were excluded because of censoring. Of the 772 remaining

patients, 276 died within 5 years of beginning RRT.

Year

starting

RRT

Number of

Patients

1 year survival 2 year survival 5 year survival 10 year survival

n % n % n % n %

1960-1976 36 27 75 21 58 15 42 8 22

1977-1981 73 62 85 56 77 42 58 25 34

1982-1986 80 73 91 66 83 45 56 26 33

1987-1991 106 95 90 89 84 70 66 36 34

1992-1996 159 143 90 132 83 106 67 64 40

1997-2001 149 133 89 120 81 91 61 67 45

2002-2006 119 107 90 99 83 77 65

25


Renal Association

Scottish Renal Registry Report 2011

C2.2 Trend in survival by 5 years of RRT for patients aged 45-64 in the

glomerulonephritis PRD group

100

90

5 year survival

Trend in 5 year survival

80

% of

five

year

survival

70

60

50

40

30

58 56

66 67

61

65

20

42

10

0

1960 -

1976

1977 -

1981

1982 - 1987 -

1986 1991

Year starting RRT

1992 -

1996

1997 -

2001

2002 -

2006

There is an increasing trend in survival which is statistically significant

(OR 1.10, 95% CI 1.00 to 1.20, p= 0.03).

C2.3 Proportion of patients survivng at 1 year, 2 years, 5 years and 10 year

survival of patients aged 45-64 in the diabetic nephropathy PRD group

986 patients in the diabetic nephropathy PRD group were aged 45-64 years when starting RRT.

Of these 247 started RRT between 2006 and 2010 and were excluded, a further 4 patients were

excluded by censoring. Of the remaining 674 patients, 497 died within 5 years of starting RRT.

Year

starting

RRT

Number of

Patients

1 year survival 2 year survival 5 year survival 10 year survival

n % n % n % n %

1987-1991 100 80 80 62 62 23 23 6 6

1992-1996 148 112 76 79 53 30 20 11 7

1997-2001 198 152 77 118 60 45 23 16 8

2002-2006 228 196 86 158 69 79 35 0

26


Renal Association

Scottish Renal Registry Report 2011

C2.4 Trend in survival by 5 years of RRT for patients aged 45-64 in the diabetes PRD

group

40

35

5 year survival

Trend in 5 year survival

30

% of

five

year

survival

25

20

15

35

10

23

20

23

5

0

1987 -1991 1992 -1996 1997 -2001 2002 -2006

Year starting RRT

There is an increasing trend in survival which is statistically significant

(OR 1.28, 95% CI 1.08 to 1.5, p=< 0.005).

27


Renal Association

Scottish Renal Registry Report 2011

C3

Comparison of survival by renal unit providing first RRT using

Cox regression

C3.1 Standardised Mortality Ratio for 1 year mortality by renal unit

providing first RRT for patients starting RRT in 2001-2010

The standardised mortality ratio (SMR) is the number of deaths in every unit divided by the

expected number of deaths in that unit. This makes the SMR a measure of case-mix adjusted

mortality (hence the label ‘standardised’). The expected number of deaths is based on a logistic

regression comprising patient’s age, sex, and diagnosis. A SMR close to one means that the

observed number of deaths is close to the expected number. A SMR higher than one means that

the observed number of deaths is higher than the expected number. The units within the outer

control limits (-3SD, +3SD) are considered equivalent and different only by chance. The control

limits are calculated via the Poisson probability distribution.

1.3

SMR

1.2

1.1

1.0

0.9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

0.0

DGRI MONK NINE RIE

GLAS

VHK

RAIG

ARI

XH

RHSC

0 100 200 300 400 500

Renal unit

+3SD

+2SD

Mean

-2SD

-3SD

Expected mortality in first year of RRT

All adult units fall within three standard deviations of the mean.

Expected mortality based on sex, age groups and groups of diagnoses.

The mortality in first year of RRT for patients starting RRT 2001 - 2010 was 22%.

28


Renal Association

Scottish Renal Registry Report 2011

C3.2 Standardised Mortality Ratio for 5 year mortality by renal unit

providing first RRT for patients starting RRT in 1997-2006

1.2

1.1

1.0

0.9

MONK

DGRI

VHK

XH

RAIG

NINE

ARI

RIE

GLAS

Renal unit

+3SD

+2SD

Mean

-2SD

-3SD

0.8

SMR

0.7

0.6

0.5

0.4

RHSC

0.3

0 100 200 300 400 500 600 700 800 900 1000 1100 1200

Expected mortality in first 5 years of RRT

All units fall within 3 standard deviations of the mean.

Expected mortality based on sex, age groups and groups of diagnoses.

The mortality in first five years of RRT for patients starting RRT 1997 - 2006 was 59%.

29


Renal Association

Scottish Renal Registry Report 2011

C4

Survival by NHS Board area of residence

C4.1 Standardised Mortality Ratio for 1 year mortality for patients starting

RRT 2001-2010 by NHS Board area of residence

1.3

1.2

1.1

1.0

0.9

SMR

0.8

D&G

WI

FV

BORD

FIFE

LOTH

LAN

TAY

HIGH GRAM

A&A

GG&C

NHS Board area

+3SD

+2SD

Mean

-2SD

-3SD

0.7

0.6

ORKN

0.5

0.4

0 100 200 300 400

Expected mortality in first year of RRT

All NHS Boards areas fall within 3 standard deviations of the mean.

The mortality in first year of RRT for patients starting RRT in the ten years 2001-2010 was 22%.

C4.2 Standardised Mortality Ratio for 5 year mortality for patients starting

RRT 1996-2005 by NHS Board area of residence

1.3

1.2

1.1

1.0

SMR

0.9

SHET

WI D&G

ORKN

BORD FV

FIFE

A&A

HIGH

LAN

TAY

GRAM

LOTH

GG&C

NHS Board area

+3SD

+2SD

Mean

-2SD

-3SD

0.8

0.7

0.6

0 100 200 300 400 500 600 700 800 900

Expected mortality in first 5 years of RRT

All NHS Boards areas fall within 3 standard deviations of the mean.

The mortality in first five years of RRT for patients starting RRT 1997 - 2006 was 59%.

30


Renal Association

Scottish Renal Registry Report 2011

SECTION D

KIDNEY TRANSPLANTATION

D1

Frequency of kidney transplantation in Scotland

D1.1 Frequency and donor type, kidney transplants performed in Scotland

1960-2011

1000

900

800

700

61

51

148

274

600

54

169

Number of

kidney

500

transplants

400

34

714 743

701

656

300

594

11

517

200

355

100 13

209

86

0

1960-1971 1977-1981 1987-1991 1997-2001 2007-2011

1972-1976 1982-1986 1992-1996 2002-2006

Live donor

Deceased donor

Year

Between 1960 and 31 December 2011, 5390 kidney transplants were performed in Scotland in

4536 patients.

4512 first kidney transplants were performed, 718 second transplants, 137 third transplants and

23 patients received a fourth or subsequent kidney transplant.

156 patients received a simultaneous transplant of another organ at the same time as a kidney

(143 pancreas, 11 liver, 2 heart).

Kidney transplants performed outside of Scotland are excluded.

31


Renal Association

Scottish Renal Registry Report 2011

D1.2 Age of patients at the time of kidney transplantation

Year of

transplant

n

First kidney transplants

Mean

Age

SD Age Range n Mean

Age

Second and subsequent transplants

SD

Age Range

1960-1971 94 30.2 11.9 8.0 - 64.8 5 33.5 3.9 15.7 - 25.0

1972-1976 194 33.9 11.8 10.1 - 64.3 26 33.5 10.4 11.6 - 55.2

1977-1981 323 36.8 12.8 8.5 - 67.0 66 33.4 9.6 15.6 - 56.3

1982-1986 521 38.8 15.1 2.3 - 77.6 127 35.5 12.3 3.4 - 68.9

1987-1991 646 40.9 15.8 0.3 - 75.2 129 36.3 13.5 5.1 - 69.5

1992-1996 665 42.6 15.7 2.1 - 76.2 129 36.8 12.5 3.9 - 66.1

1997-2001 666 42.0 15.5 4.0 - 85.1 138 38.9 12.0 5.2 - 71.3

2002-2006 568 43.4 15.1 4.2 - 78.1 118 39.2 11.0 16.4 - 39.2

2007-2011 835 45.9 15.3 2.4 - 78.5 140 43.7 11.2 18.2 - 69.2

D1.3 Year of first kidney transplant and diagnosis group

Year of

transplant

Glomerulonephritis

Interstitial Multisystem Diabetes Unknown

n % n % n % n % n %

1960-1971* 38 40.4 27 28.7 9 9.6 0 19 20.4

1972-1976 85 43.8 70 36.1 18 9.3 0 21 10.8

1977-1981 123 38.1 136 42.1 36 11.1 5 1.5 23 7.1

1982-1986 145 27.8 213 40.9 64 12.3 39 7.5 60 11.5

1987-1991 188 29.1 237 36.7 94 14.6 46 7.1 81 12.5

1992-1996 191 28.7 241 36.2 91 13.7 77 11.6 65 9.8

1997-2001 178 26.7 251 37.7 83 12.5 64 9.6 90 13.5

2002-2006 141 24.8 202 35.6 66 11.6 83 14.6 76 13.4

2007-2011 181 21.7 331 39.6 100 12.0 109 13.1 114 13.7

* One patient who received a first kidney transplant between 1960-1971 has missing PRD

32


Renal Association

Scottish Renal Registry Report 2011

D2

Transplanted Kidney Survival

D2.1 Graft survival of first kidney transplants by year of transplantation

1960 - 2010

Year of

transplant

% grafts surviving

1 year

% grafts surviving

5 years

% grafts surviving

10 years

1960-1970 83.7 79.1 76.7

1971-1975 71.5 66.2 65.6

1976-1980 67.7 57.3 51.2

1981-1985 74.7 59.9 53.6

1986-1990 86.0 71.9 62.0

1991-1995 85.3 73.9 66.4

1996-2000 92.5 83.5 75.3

2001-2005 92.6 86.5

2006 97.2 89.6

2007 91.7

2008 92.8

2009 97.2

2010 94.8

Survival of first kidney transplants only is shown in the table.

Grafts with insufficient follow-up and those that did not fail in patients dying within the relevant

period have been excluded from the table.

33


Renal Association

Scottish Renal Registry Report 2011

D2.2 Trends in first graft survival by year of transplantation 1960-2010

100

90

80

70

%

Survival

60

50

40

30

20

1year survival

5 year survival

10 year survival

trend in 1 year survival

trend in 5 year survival

trend in 10 year survival

10

0

1960-1970 1976-1980 1986-1990 1996-2000 2006-2010

1971-1975 1981-1985 1991-1995 2001-2005

Year of transplant

Trend in 1 year survival: year to year OR 1.06 (95% CI 1.05 - 1.07)

Trend in 5 year survival: year to year OR 1.05 (95% CI 1.04 - 1.06)

Trend in 10 year survival: year to year OR 1.03 (95% CI 1.02 - 1.04)

The trends in 1 year, 5 years and 10 years patient survival are all statistically significant

(Wald-statistic,df=1,p


Renal Association

Scottish Renal Registry Report 2011

D3

Patient survival after Kidney Transplantation

D3.1 Patient survival after first kidney transplant by year of transplantation

1960-2010

Year of

transplant

% patients surviving

1 year

% patients surviving

5 years

% patients surviving

10 years

1960-1970 72.1 51.2 39.5

1971-1975 74.2 58.3 47.7

1976-1980 88.3 76.5 62.5

1981-1985 93.2 78.0 59.9

1986-1990 94.4 82.0 65.1

1991-1995 93.6 79.9 63.2

1996-2000 96.2 87.8 78.1

2001-2005 97.3 87.2

2006 97.2 88.7

2007 98.1

2008 98.9

2009 92.1

2010 97.4

Patient survival is reported from the time of first kidney transplant. Those with insufficient followup

are excluded.

35


Renal Association

Scottish Renal Registry Report 2011

D3.2 Trends in patient survival by year of first kidney transplant 1960 -2010

100

90

80

70

60

%

50

Survival

40

30

20

10

0

trend in 1 year survival

% patients surviving 1 year

% patients surviving 5 years

trend in 5 year survival

% patients surviving 10 years

trend in 10 year survival

1960-1970 1976-1980 1986-1990 1996-2000 2006-2010

1971-1975 1981-1985 1991-1995 2001-2005

Year of transplant

Trend in 1 year survival: year to year OR 1.07 (95% CI 1.05 - 1.08)

Trend in 5 year survival: year to year OR 1.05 (95% CI 1.04 - 1.06)

Trend in 10 year survival: year to year OR 1.04 (95% CI 1.03 - 1.05)

The trends in 1 year, 5 years and 10 years patient survival are all statistically significant

(Wald-statistic,df=1,p


Renal Association

Scottish Renal Registry Report 2011

D4

Listing for Kidney Transplantation

D4.1 Percentage and prevalence per 100000 population of RRT patients

with functioning kidney transplant or on transplant waiting list

31 December 2011 by NHS Board area of residence

All RRT

patients

31/12/2011

Patients with kidney

transplant

Transplant or

transplant listed

n % n %

NHS Board

population

Prevalence

per

100000

population

A&A 354 151 42.7 212 59.9 366890 57.8

BORD 104 47 45.2 67 64.4 113150 59.2

D&G 118 56 47.5 76 64.4 148060 51.1

FIFE 322 139 43.2 192 59.7 367292 52.3

FV 234 105 44.9 149 64.1 295541 50.4

GG&C 1091 579 53.1 791 72.5 1210254 65.4

GRAM 466 235 50.4 314 67.4 555280 56.5

HIGH 280 162 57.9 196 70.0 311960 62.8

LAN 465 264 56.8 333 71.6 563185 59.1

LOTH 568 320 56.3 414 72.9 848727 48.8

ORKN 17 8 14.7 9 53.0 20160 44.6

SHET 12 7 58.3 9 75.0 22500 40.0

TAY 374 177 47.3 229 61.2 405721 56.4

WI 17 7 41.2 9 52.9 26080 34.5

Scotland 4422 2257 51.0 3001 67.9 5254800 57.1

The percentage of patients in each NHS Board area treated by all forms of RRT (PD, HD,

Transplant) who are either on the transplant waiting list or have a functioning transplant are

shown. Patients who were on the transplant waiting list but had suspended rather than active

status are included.

37


Renal Association

Scottish Renal Registry Report 2011

D4.2 Prevalence per 100000 population of RRT patients with functioning

kidney transplant or on transplant waiting list 31 December 2011 by

NHS Board area of residence

100

90

80

70

Prevalence

per

60

100000

population

50

40

BORD

D&G

ORKN

SHET

HIGH

A&A

TAY

FIFE

FV

LAN

GRAM

LOTH

GG&C

NHS Board Area

-3SD

-2SD

Mean

+2SD

+3SD

30

WI

20

0 200000 400000 600000 800000 1000000 1200000 1400000

NHS Board area population

ORKN, SHET, WI and LOTH all have a prevalence of transplanted or transplant listed populations

more than 3SD below the Scottish average.

GG&C prevalence per 100000 population is more than 3SD above the mean. However both LOTH

and GG&C have a high proportion (>72%) of prevalent RRT patients who have a kidney transplant

or are on the national kidney transplant waiting list as shown in D4.1.

38


Renal Association

Scottish Renal Registry Report 2011

D4.3 Frequency of first kidney transplants and time from start of RRT to

activation on transplant waiting list, by NHS Board area of residence at

transplantation 2002-2011

Number

of first

transplants

2002-2011

Pre-emptive

transplants

(number

from DD)

LD

transplant

within

first year

RRT*

Number

of patients

with listing

date**

Median

time from

start of RRT

to listing

(days)

A&A 92 4 (3) 4 87 297 140 — 635

BORD 27 1 (0) 4 24 25 -114 — 424

D&G 43 4 (2) 7 35 35 85 — 318

FIFE 97 12 (7) 8 88 65 -67 — 294

FV 72 8 (3) 13 56 252 146 — 443

GG&C 343 37 (11) 49 286 195 84 — 392

GRAM 146 11 (2) 20 128 119 34 — 333

HIGH 103 9 (2) 17 87 106 11 — 333

LAN 146 9 (2) 16 132 290 160 — 488

LOTH 216 15 (3) 27 191 119 -63 — 342

ORKN 7 0 1 7 145 24 — 527

SHET 4 0 1 3 259

TAY 97 12 (6) 16 84 51 -33 — 202

WI 4 2 (2) 0 4 41 -93 — 143

Scotland 1397 124 (43) 183 1212 171 26 — 385

IQR

*Includes pre-emptive LD transplants

** Patients receiving LD pre-emptive transplants excluded

Six patients received a kidney transplant in Scotland in this time period who were not Scottish

residents, they are excluded from the analyses. 124 patients received a pre-emptive transplant

between 2002-2011, 81 from a live donor (LD). A further 102 patients received a LD transplant

within one year of starting RRT, 54 of whom were never listed on the UK national transplant

waiting list.

The Renal Association guideline suggests that patients with progressive deterioration in renal

function suitable for transplantation should be placed on the national transplant list within six

months (-182.5 days) of their anticipated dialysis start date. Patients listed for transplantation for

periods longer than six months prior to starting RRT have their duration of listing truncated to six

months in the analysis.

39


Renal Association

Scottish Renal Registry Report 2011

SECTION E

PERITONEAL DIALYSIS

The prospective national audit of the incidence of peritoneal dialysis (PD) related peritonitis,

adequacy of peritoneal dialysis and causes of PD technique failure is reported to the SRR from all

adult renal units in Scotland every six months. The causative organism and clinical outcome of

each episode of peritonitis is recorded.

The standard definition of peritonitis used by the SRR can be found on the SRR website:

http://www.srr.scot.nhs.uk/Projects/Projects3.html#periton

Peritonitis data from 01 January 2000 to 31 December 2011 are reported here, and peritoneal

dialysis adequacy and technique failure data from 2011.

The number of prevalent adult patients on PD fell during 2011 from 273 patients on 31 December

2010 to 250 on 31 December 2011.

E1 Peritonitis rates in adult renal units 2000-2011

Renal unit Peritonitis rates (months between episodes) Prevalent PD

2000-2007 2008 2009 2010 2011

patients

31 December

2011

ARI 17.7 23.0 33.3 19.3 20.0 22

XH 27.2 22.8 22.4 20.8 40.3 46

DGRI 29.8 38.6 17.1 24.8 67.0 13

GLAS* - - - 25.2 15.5 50

GRI 19.7 25.9 29.0 - -

MONK 28.9 13.5 26.5 17.2 54.3 10

NINE 23.1 31.2 40.3 18.4 38.4 23

RAIG 15.3 23.9 33.2 19.6 32.7 18

RIE 15.6 13.0 15.2 15.5 18.0 40

VHK 18.7 27.3 14.5 14.9 22.7 28

WIG* 19.6 12.7 16.1 - -

Scotland 19.9 18.5 18.7 18.8 23.4 250

*GRI and WIG merged in August 2010; their data are combined for 2010 and 2011 as GLAS.

Peritonitis rates are quoted as the number of patient months between infections.

Although the national peritonitis rate improved to 1 episode every 23 months in 2011, during the

past 4 years there was wide variation in the incidence of peritonitis in the some units as well as

wide variation between units.

40


Renal Association

Scottish Renal Registry Report 2011

E2 Organisms causing PD peritonitis 2011

Organism

Number of

peritonitis episodes

% of total

Coagulase negative Staphylococcus 45 34.6

Staphylococcus aureus 15 11.5

Gram negative bacilli 20 15.4

Other bacteria (e.g. Streptococci) 25 19.2

Fungal 2 1.5

Culture negative 23 17.7

Total 130

This spectrum of causative organisms is similar to previous SRR reports and to reports from other

regional and national registries.

E3 Causes of PD technique failure 2011

Cause of PD failure Number of patients % of total

Peritonitis 33 38.8

Inadequate dialysis/ poor ultrafiltration 32 37.6

Failed peritoneal access 7 8.2

High intra peritoneal pressure 7 8.2

Switch to haemodialysis 4 4.7

Withdrawal of RRT 2 2.4

Total 85

Peritonitis and inadequacy of dialysis/ poor ultrafiltration remain the commonest causes of PD

technique failure and subsequent switching of PD patients to HD.

All prevalent PD patients at the end of June 2011 and at the end of December 2011 had a most

recent total creatinine clearance > 50/L/week/1.73m 2 .

41


Renal Association

Scottish Renal Registry Report 2011

SECTION F

ANAEMIA

The anaemia audit was performed in May 2012; all patients in Scotland receiving hospital or home

haemodialysis on 02 May 2012 were included in the audit. We excluded results where patients had

a recent blood transfusion. There were 1832 results from 1873 patients (98%).

Haemoglobin concentration (Hb) was measured in a predialysis blood sample after the first short

interdialytic gap of the audit week, or as soon as possible thereafter. Auditing after the short

(2 day) gap is done in order to minimise the potential effect of dilution due to fluid overload.

The target for achieved haemoglobin in individual patients remains unclear. NHS Quality

Improvement Scotland (NHS QIS) suggests a unit specific target of Hb ≥10 g/dL in ≥85% of

patients after 3 months of RRT. The UK Renal Association updated their guidelines in 2010 and in

version 5, there is now a recommended target Hb of 10-12g/dL, but only for those CKD patients

receiving ESA therapy.

In light of the changing guidelines and uncertainty over target Hb we have revised the levels in our

audit to look at % patients in each unit with Hb ≥10g/dl, Hb 10-12g/dl and Hb >12g/dl.

F1 Mean Hb of HD patients in each dialysis unit May 2012

13

Mean Hb

g/dL)

12

11

Portsoy

WI Hosp QHMD

Balfour St Johns

WGH

G Bain Inverurie Raig

DGRI BGH

St And P'headPRI

GCH Arbroath

BHFW

WIG

IRH

GH Elgin VoL

VHK

GRI

Stob

NINE

FVR

RIE

ARI

Vict

XH

Unit

+3SD

+2SD

Mean

-2SD

-3SD

MONK

Wick

10

RHSC

0 20 40 60 80 100 120 140 160 180

Number of patients with data per unit

Patients with Hb >12.0g/dL and confirmed as not receiving ESA therapy (90 patients) are excluded

from the funnel plot analysis. Portsoy is the only outlier, not falling within 3 SD of the population

mean, with a mean Hb 12.4g/dL.

42


Renal Association

Scottish Renal Registry Report 2011

F2

Number of

patients

Missing

data or

recently

transfused

% patients

with Hb

data

% total

patients

with Hb ≥

10g/dL

% total

patients

with Hb

10.0-12.0

g/dL

% total

patients

with Hb >

12.0g/dL

Upper

quartile

Median Hb

g/dL

Lower

quartile

Number of HD patients, median Hb and achievement of audit standards

by renal unit May 2012

Range g/dL 6.8 -

14.6

ARI XH DGRI GLAS MONK NINE RAIG RHSC* RIE VHK Scotland

219 150 50 590 181 181 84 5 266 147 1873

7 4 1 9 3 2 3 1 8 3 41

97 97 98 98 98 99 96 80 97 98 96

76 79 94 80 78 90 81 60 85 82 81

50 54 69 50 54 64 49 50 50 42 52

28 26 26 31 25 27 33 20 36 40 31

12.1 12.0 12.1 12.2 12.0 12.1 12.1 11.3 12.4 12.4 12.2

11.2 10.9 11.4 11.3 11.2 11.3 11.5 10.6 11.7 11.7 11.3

10.1 10.2 10.9 10.2 10.3 10.6 10.4 9.5 10.7 10.6 10.4

7.6 -

14.7

8.7 -

13.9

6.2 -

15.3

7.3 -

14.9

* The standards set for adults are not applicable to children.

7.3 -

18

7.1 -

15

7.6 -

12

6.7 -

14.8

5.4 -

15.7

5.4 -

18

Three units, DGRI, NINE and RIE, achieved the NHS QIS standard of 85% of patients with

Hb ≥10g/dL.

The denominator includes those patients for whom data was not available.

81% of patients in Scotland had Hb ≥10g/dL and 52% achieved a Hb 10.0-12.0g/dL. 312 (17%)

patients had a Hb >12.5g/dL of whom 62 were confirmed as not receiving ESA therapy.

43


Renal Association

Scottish Renal Registry Report 2011

SECTION G

UREA REDUCTION RATIO

The quality of haemodialysis treatment for ERF can be assessed by measuring the urea reduction

ratio (URR). The NHS QIS standard for adult patients is to achieve a URR ≥ 65% in at least 85% of

patients. The UKRA guideline for adult patients on three times per week HD is to achieve a URR

consistently >65%.

The URR audit was performed in May 2012; all patients in Scotland receiving hospital or home

haemodialysis on 02 May 2012 were included in the audit. There were 1776 results from 1873

patients (95%).

More information about the standards and the audit is available on the SRR website.

G1

Number

of patients

Number

of patients

with

missing

data

% patients

with URR

in whom

URR >65%

Upper

quartile

Median

URR

Lower

quartile

Number of haemodialysis patients, median URR and achievement of

audit standard by renal unit May 2012

ARI XH DGRI GLAS MONK NINE RAIG RHSC* RIE VHK Scotland

219 150 50 590 181 181 84 5 266 147 1873

15 9 2 28 11 16 5 2 2 7 97

90 92 90 88 85 82 84 33 86 89 87

76 80 79 79 77 78 77 69 76 75 78

73 75 75 75 72 73 73 64 73 72 73

69 71 71 70 67 68 69 58 68 69 69

* Data for RHSC. The standards set for adult patients are not applicable to children; data are given for reference

purposes only.

44


Renal Association

Scottish Renal Registry Report 2011

G2

Mean achieved URR in HD patients in May 2012 by satellite renal unit

URR %

80

70

GCH

P'head

IRH

WI Hosp

Portsoy WGH

Wick Inverurie BGH

Balfour VoL DGRI RAIG

BHFW Arbroath QHMD

St And

Perth

G Bain

St Johns

GH Elgin

VHK

GRI

FVR

Stob

NINE

RIE

ARI

Vict

XH

Unit

+3SD

+2SD

Mean

-2SD

-3SD

MONK

WIG

RHSC

60

0 25 50 75 100 125 150 175 200

Number of patients with data per unit

45


Renal Association

Scottish Renal Registry Report 2011

SECTION H

VASCULAR ACCESS FOR HAEMODIALYSIS

Details of vascular access used for haemodialysis for all hospital and home haemodialysis patients

were collected during the the SRR census week in May 2012.

1873 patients with established renal failure were being treated by haemodialysis, details of vascular

access were available for 1769 (94.4%).

H1 Types of vascular access for haemodialysis patients May 2012

Type of Access Number Percentage

Arteriovenous 1366 77.2

Fistula 1284 72.6

Graft 72 4.1

AV access – details not

known

10 0.6

Central venous catheter 403 22.8

Tunnelled 379 21.4

Non-tunnelled 24 1.4

Total 1769

As in previous years, males were significantly more likely than females to be using AV access

(81% v. 72%; Chi square p


Renal Association

Scottish Renal Registry Report 2011

H2

Percentage of haemodialysis patients with AV access by renal unit:

Census results 2007, 2009, 2010, 2011 and May 2012

100

90

80

70

60

% of

50

patients

40

30

20

9697

98

95

91

86

8081

8081

6567

63

60

52

737473

75

71

6365

59

55

52

84

78

72 72 72

94939496

91

50 50

84 86

83 85

78

75

72 73

71 71 7375757677

70

66

2007

2009

2010

2011

2012

10

20 20

0

ARI XH DGRI GLAS GRI MONK NINE RAIG RHSC RIE VHK WIG Scotland

Renal unit

0

Rates of AV access (for patients with data submitted) in the adult units in May 2012 ranged from

59% to 98% (Chi square p < 0.001).

The Renal Association guideline suggests that 85% of all prevalent adult patients on haemodialysis

should receive dialysis via a functioning arteriovenous fistula.

GRI and WIG units merged in 2010, data from those units are shown separately for 2007 and 2009

and amalgamated thereafter.

The renal unit previously based at QMHD moved to VHK at the end of 2011, those results are all

now shown under VHK.

H3 Percentage of patients with AV access by dialysis unit May 2012

100

90

80

70

Arbroath PRI RAIG

QHMD

WI Hosp

VoL St Johns

WGH

St And DGRI BGH IRH

GCH

VHK

NINE

Stob

FVR

RIE

ARI

Vict

Unit

+3SD

+2SD

Mean

-2SD

-3SD

% of

patients

60

50

WIG

GRI

XH

MONK

40

30

20

0 25 50 75 100 125 150 175 200

Number of patients with data per unit

47


Renal Association

Scottish Renal Registry Report 2011

Balfour, GH Elgin, G Bain, Inverurie, P’head, Portsoy, BHFW, Wick all had 100% prevalence of AV

access and are not shown on the funnel plot to enhance clarity.

RHSC had no patients with AV access and similarly are not shown on the funnel plot.

H4

Unit

Vascular access used for first hemodialysis for incident patients

1 January to 30 June 2012

Number

of incident

patients

AV access Tunnelled CVC Non-tunnelled CVC

n % n % n %

ARI 18 12 67 0 - 6 33

XH 14 6 43 5 36 3 21

DGRI 10 4 40 4 40 2 20

GLAS 80 37 46 26 33 17 21

MONK 27 7 26 17 63 3 11

NINE 19 7 37 12 63 0 -

RAIG 7 5 71 1 14 1 14

RHSC 2 0 - 2 100 0 -

RIE 33 15 45 17 52 1 3

VHK 12 4 33 5 42 3 25

Scotland 222 97 43.7 89 40.1 36 16.2

The SRR has collected the access used for first haemodialysis for incident patients since the start of

2012.

There were 222 incident RRT patients who started treatment on haemodialysis in the first six

months of 2012. Details of the vascular access used for first dialysis was available for 100% of

patients.

The Renal Association guideline suggests that 65% of all incident adult haemodialysis patients

should commence dialysis with an arteriovenous fistula.

48


Renal Association

Scottish Renal Registry Report 2011

SECTION I

BONE MINERAL METABOLISM

The laboratory data relating to bone mineral metabolism were audited in May 2012 for all

prevalent patients receiving hospital or home haemodialysis. Pre dialysis blood samples were

collected after a short interdialytic gap. Any samples marked ‘post haemodialysis’ were excluded.

As recommended by the Working Group of Senior Scottish Clinical Biochemists on bone

biochemistry targets in the management of renal failure, the PTH data in this report are presented

according to the recommended assay specific targets appropriate to each renal unit.

The working group’s recommendations have been adopted across Scotland. Those

recommendations; the local ranges for corrected calcium for the biochemistry laboratories that

serve each dialysis unit; and assay specific PTH ranges are available on the SRR website:

http://www.srr.scot.nhs.uk/Projects/Projects1.html#calc

I1

Renal

Unit

Achievement of guideline targets for phosphate, corrected calcium and

PTH in haemodialysis patients by renal unit May 2012

Number

of

patients

% with

PO4

result

Mean

PO4

mmol/L

% with

result


Renal Association

Scottish Renal Registry Report 2011

I2

Percentage of patients achieving pre-HD PO4 target of


Renal Association

Scottish Renal Registry Report 2011

The graph shows the percentage of patients within each unit, who were hypocalcaemic

(cCa< lower limit of normal range (LLN)), normocalcaemic (cCa in normal range (NR)) and

hypercalcaemic (cCa>upper limit of normal range (ULN)) according to the local assay ranges for

the biochemistry laboratory serving each dialysis unit.

The UKRA guideline suggests that corrected calcium should be maintained within the local normal

range, the normal range differs between renal units, therefore actual calcium values are not

shown.

I4

Distribution of pre HD serum PTH in haemodialysis patients by renal

unit May 2012

100

90

80

8 6

15

35

7

28

7 10 11

15

70

60

% of

50

patients

40

30

20

10

0

46

46

57

54 67

66

61

67 56

57

54

46 48

36

39

33

28

24

24 22

11

15

ARI XH DGRI GLAS MONK NINE RAIG RHSC RIE VHK Scotland

Renal unit

PTH >9xULN

PTH in range - 2-9xULN

PTH


Renal Association

Scottish Renal Registry Report 2011

SECTION J

ANTHROPOMETRIC MEASUREMENTS

OF HAEMODIALYSIS PATIENTS

Patients’ measured height and weight were recorded in the May 2012 census, all prevalent home

and hospital HD patients on 2 May 2012 were included. Height and weight measurements were

available for 1735 (92.6%) of the 1873 prevalent HD patients. Body mass index (BMI) can be

calculated using height and weight in adult patients. Patients aged under 18 (6 patients) and those

with one or more limb amputations (85 patients) are excluded from the analyses.

The data collection form and methods are available on the SRR website:

http://www.srr.scot.nhs.uk/Projects/Main.html#census

J1 Distribution of BMI (kg/m 2 ) by renal unit May 2012

% of

patients

100

90

80

70

60

50

40

2

5.9

9.8

31.4

9.1 7.3

5.3 7.3

15.9

24.4

28

17.1

3.7 5

2.7

8.1

5.5 6.3 5

3.9

6.8

8.1

7.6

5.9

6.2

7.1

13.5

14.9

13.9

15.5 11.2

14.3

16.5

31.9

33.5 33.8 31.1

29

34.2

30.7

BMI ≥40

BMI 35-39.9

BMI 30-34.9

BMI 25-29.9

BMI 20-24.9

BMI 18.5-19.9

BMI


Renal Association

Scottish Renal Registry Report 2011

J2

Distribution of mean BMI (kg/m 2 ) by NHS Board area of residence

May 2012

33

32

31

30

29

28

27

BMI

26

25

24

23

22

21

SHET

ORKN

WI

D&G

BORD FV

HIGH

TAY

A&A

FIFE LAN LOTH

GRAM

NHS Board area

+3SD

+2SD

Mean

-2SD

-3SD

GG&C

20

0 40 80 120 160 200 240 280 320 360 400

Number of patients

The mean BMI of HD patients in Scotland was 26.9 kg/m2 (overweight).

J3

Median BMI (kg/m 2 ) of patients in each primary renal diagnosis group

May 2012

Diagnosis group Number of patients Median BMI IQR

Glomerulonephritis 291 25.7 22.4 - 29.9

Interstitial 433 25.2 22.2 - 28.8

Multisystem 284 25.0 22.1 - 29.1

Diabetes 308 28.3 23.9 - 33.2

Unknown 309 25.6 21.8 - 29.0

There are significant differences in BMI between PRD groups (p


Renal Association

Scottish Renal Registry Report 2011

J4 Distribution of HD patients BMI by year 2009 to 2012

40

35

30

25

% of

patients

20

15

10

5

0

33 34 34 33 34

29 30 31

15 15 14 14

5 5 5 5 5 6 6 6

6 6 5 6 5 5 5

3

BMI


Renal Association

Scottish Renal Registry Report 2011

SECTION K

BLOOD PRESSURE

Pre-dialysis systolic and diastolic blood pressures in patients receiving haemodialysis at home or in

hospital were collected on the census day in May 2012. Blood pressure measures were available for

1773 (94.7%) of the 1873 patients.

Information on co-morbidity and the use of drugs which affect blood pressure are not available.

There is no recognised target for pre-dialysis blood pressure.

K1 Pre HD systolic blood pressure by renal unit May 2012

Systolic BP

(mmHg)

160

150

140

130

RAIG

MONK

DGRI VHK

NINE ARI

XH

RIE

GLAS

Unit

+3SD

+2SD

Mean

-2SD

-3SD

120

RHSC

110

0 100 200 300 400 500 600

Number of patients

Mean pre-dialysis systolic BP for HD patients in XH was more than three standard deviations (SD)

below the population mean, and for HD patients in RAIG was more than 3 SD above the mean.

55


Renal Association

Scottish Renal Registry Report 2011

K2 Pre HD diastolic blood pressure by renal unit May 2012

90

80

Diastolic BP

(mmHg) 70

RHSC

DGRI

RAIG

MONK

VHK

ARI

RIE

GLAS

Unit

+3SD

+2SD

Mean

-2SD

-3SD

60

NINE

XH

50

0 100 200 300 400 500 600

Number of patients

Mean pre-dialysis diastolic BP in HD patients in XH and NINE are more than 3 SD below the

population mean. HD patients in RAIG, MONK and RIE had mean pre-HD diastolic BP more than

3 SD above the population mean.

K3 Mean achieved pre-dialysis blood pressure 2006-2012

Systolic BP

(mmHg)

2006 2007 2008 2009 2010 2011 2012

139 138 137 136 139 141 139

SD 28.7 25.7 25.3 27.9 30.1 26.5 36.3

Diastolic BP

(mmHg)

73 74 72 70 72 73 71

SD 16.5 15.1 16.2 16.5 16.1 14.1 16.8

Results from each annual SRR census are shown in the table. Despite uncertainty regarding target

pre-dialysis blood pressure there appears to have been no major change in mean achieved blood

pressure in HD in Scotland over the last 7 years.

56


Renal Association

Scottish Renal Registry Report 2011

SECTION L

CAUSE OF DEATH

The cause and location of death of patients treated by RRT in Scotland who have died since

1 January 2008 are collected as part of the Scottish Mortality Audit of Renal Replacement Therapy

(SMARRT). Whilst these data have been collected routinely since the inception of the SRR, the level

of completeness of the data about the circumstances of death have been poor prior to this specific

study.

Cause of death has been coded in accordance with ERA-EDTA codes and then aggregated into six

groups: cardiovascular, infection, RRT complication, treatment withdrawal, malignancy and other

causes of death. The RRT complication group includes deaths due to: hyperkalaemia, haemorrhage

from vascular access, PD peritonitis and encapsulating sclerosing peritonitis.

A complete list of the ERA-EDTA cause of death codes and SMARRT groupings is available on the

SRR website: http://www.srr.scot.nhs.uk/Projects/Projects2.html#mortality

This report contains data about the cause and location of deaths of patients occurring in the

two years between 01 January 2010 and 31 December 2011. There were 892 deaths among RRT

recipients. Cause of death data are available for 777 (87%) and information on location of death is

available for 804 (90%).

L1 Cause of death and modality of RRT at death 2010-2011

% of

deaths

100

90

80

70

60

50

40

30

12 10

12

21

6

6

9

2

27

22

25

2

25

1

23

Other

Treatment withdrawal

Malignancy

RRT complication

Infection

Cardiovascular

20

10

34

39

25

0

HD PD Transplant

Mode of RRT at death

57


Renal Association

Scottish Renal Registry Report 2011

L2 Location of patient death 2010-2011

Location Number of patients Percentage of patients

Usual place of residence 190 21.3

Hospital 565 63.3

Hospice 20 2.2

Community hospital 20 2.2

Place of death unknown 9 1.0

Data missing 88 9.9

Total 892

L3 Cause of death and age at death 2008-2011

100

% of

deaths

90

80

70

60

50

40

30

27

4

8

10

16

15 13 13

9

17

25

15

11

3

2

8

2

21

23

23

Other

Treatment withdrawal

Malignancy

RRT complication

Infection

Cardiovascular

20

10

36 38

34

30

0

20 - 44 45 - 64 65 - 74 ≥75

Age group at death

58


Renal Association

Scottish Renal Registry Report 2011

L4 Cause of death by year 2008-2011

Number

of deaths

170

160

150

140

130

120

110

100

90

80

70

60

50

40

30

20

10

0

2008 2009 2010 2011

Year of death

Cardiovascular

Infection

RRT complication

Malignancy

Treatment withdrawal

Other

There is no significant difference in the proportions of each cause of death group when the

duration of RRT prior to death is taken into account. Patients who died in the four years 2008-2011

within a year of starting RRT (435 patients, 21.6% of those with data) had the same distribution of

cause of death group as those dying after more than one year of RRT (1581 patients, 78.4%).

59


Renal Association

Scottish Renal Registry Report 2011

SECTION M

STAFFING AND FACILITIES

The staffing and facilities in Scottish renal units were surveyed on 30 August 2011 by distribution

of an electronic questionnaire to each parent unit. The response rate was 100%.

The results were compared with those of the previous SRR surveys conducted on 30 August 2007

and 2009.

The findings were compared with the recommendations of the British Renal Society (BRS) 1 and

Royal College of Physicians London (RCP) 2 .

On the survey date there were 10 parent units (nine adult and one paediatric) and 23 satellite

haemodialysis units.

Selected results are shown here. The full survey report and survey form including definitions is

available on the SRR website at: http://www.srr.scot.nhs.uk/Renal_Units/Main.html

M1

Number of medical staff (clinical WTE) per 100000 population

by renal unit on 30 August 2011

1.8

Consultant nephrologists

Non-consultant nephrologists

Junior doctors on rotation

1.6

1.7

1.4

1.2

1.3

Number of

doctors (WTE)

per 100000

population

1

0.8

0.6

0.4

1.0

0.7

0.7

0.5

0.8

0.8

0.7

0.8

0.6 0.6

0.5

1.0

0.8

1.1

1.1

0.9

0.4

0.9

0.6

0.9

0.6

0.5

0.2

0

0.3

0.3

0.2

0.2

0

0.1

0

0.1

0.1

ARI XH DGRI GLAS MONK NINE QMHD RAIG RIE RHSC Scotland

Renal unit

WTE: whole time equivalent

Non-consultant nephrologist includes ST 3 – 7 trainees and non-consultant career grade doctors.

60


Renal Association

Scottish Renal Registry Report 2011

M2

Number of consultant nephrologists (clinical WTE) per 100 patients

receiving RRT by renal unit on 30 August 2007, 2009 and 2011

2

1.8

1.6

1.4

1.2

Number of

consultants (WTE) 1

per 100

0.8

RRT patients

0.6

1.0

1.2

1.2

1.0

1.0

0.8

0.8

0.8 0.8

0.6

1.2

1.0

0.9 0.9 0.9

0.8

1.3

1.6

1.7

1.4

1.3

1.0

0.9 0.9

0.8

2007

2009

2011

1.1

1.1

1.1

1.0 1.0 1.0

0.4

0.2

0

BRS ARI XH DGRI GLAS MONK NINE QMHD RAIG RIE Scotland

Renal unit

All numbers are rounded to one decimal place, this accounts for the difference in height of bars with the same value

label.

The British Renal Society (BRS) recommendation is for 1 WTE nephrologist per 100 adult patients

receiving RRT. This is shown in the green bar.

M3

Number of inpatient beds available per 100000 population

by renal unit on 30 August 2011

9

8

7

7.4

8.6

Nephrology beds

GIM beds

Number of

inpatient beds

per 100000

population

6

5

4

6.0

5.3

4.7

3

2

1

0

2.9

3.3 3.3

3.2

2.8

2.9

2.5

2.5

2.5

1.9

0.8

RCP ARI XH DGRI GLAS MONK NINE QMHD RAIG RIE RHSC Scotland

Renal unit

GIM: General internal medicine

The recommendation of the Royal College of Physicians (London) (RCP) is shown in the green bar.

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Renal Association

Scottish Renal Registry Report 2011

M4 Number of haemodialysis sessions available per week per 100000

population by renal unit on 30 August 2007, 2009 and 2011

250

200

2007

2009

2011

Number of

HD sessions

per week

per 100000

population

150

100

50

124

119

120

156

139

131 132

196

131

111

88 86 88

117

86

128

196

155

95

116

129

134

148

134

96

101

103

115

134

123

0

1 1 3

ARI XH DGRI GRI/WIG MONK NINE QMHD RAIG RIE RHSC Scotland

Renal unit

(Adult)

M5

Number of haemodialysis nurses per 4.5 haemodialysis patients by

renal unit on 30 August 2011

2.5

Untrained nurses

Trained nurses

2

0.2

Number of HD

nurses per 4.5

HD patients

1.5

1

0.4

0.3

1.9

0.4

0.04

0.6

0.4

0.5

0.4

0.4

0.5

1.0

1.3

0.9

0.9

1.0

0.9

1.4 1.5

1.3

1.2

0

BRS ARI XH DGRI GLAS MONK NINE QMHD RAIG RIE RHSC Scotland

Renal unit

British Renal Society (BRS) recommendations suggest 1 WTE haemodialysis nurse per 4.5

haemodialysis patients.

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Renal Association

Scottish Renal Registry Report 2011

M6

Number of peritoneal dialysis nurses per peritoneal dialysis patient by

renal unit on 30 August 2011

0.25

Untrained nurses

Trained nurses

0.2

Number of

PD nurses

per PD

patient

0.15

0.1

0.05

0.05

0.08

0.05

0.06

0.10

0.02

0.07

0.09

0.13

0.07

0.03

0.12

0.06

0.20

0.01

0.09

0

BRS ARI XH DGRI GLAS MONK NINE QMHD RAIG RIE RHSC Scotland

Renal unit

British Renal Society (BRS) recommendations suggest 1 WTE peritoneal dialysis nurse per 20

peritoneal dialysis patients (equivalent 0.05/ 1 patient).

References

(1) The Renal Team. A Multi-Professional Renal Workforce Plan for Adults and Children with Renal Disease.

Recommendations of the National Renal Workforce Planning Group 2002. British Renal Society. Available at:

www.britishrenal.org

(2) Consultant Physicians Working for Patients. Royal College of Physicians, 2nd Edition, London, 2001.

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Renal Association

Scottish Renal Registry Report 2011

APPENDIX 1

ABBREVIATIONS USED IN THE TEXT

Some definitions and further details of parent and satellite renal units are given in the SRR website

at: http://www.srr.scot.nhs.uk/Renal_Units/Main.html

Abbreviation

AKI

APD

AV

AVF

AVG

BMI

BP

BRS

CAPD

cCa

CI

CKD

CSBS

CVC

DD

df

DM

DN

EPR

ERA-EDTA

ERF

ESA

ESRD

g/dL

GIM

GN

GROS

Hb

HD

HHD

HR

IQR

ISD

ISO

ISPD

IU/L

IV

KDOQI

Kg

LD

LLN

Expanded text

Acute Kidney Injury

Automated Peritoneal Dialysis

Arteriovenous

Arteriovenous Fistula

Arteriovenous Graft

Body Mass Index

Blood Pressure

British Renal Society

Continuous Ambulatory Peritoneal Dialysis

Corrected calcium

Confidence Interval

Chronic Kidney Disease

Clinical Standards Board for Scotland

Central Venous Catheters

Deceased Donor

degrees of freedom

Diabetes Mellitus

Diabetic Nephropathy

Electronic Patient Record

European Renal Association-European Dialysis and Transplant Association

Established (chronic) Renal Failure

Erythropoiesis Stimulating Agent

End Stage Renal Disease

Grams per decilitre

General Internal Medicine

Glomerulonephritis

General Register Office for Scotland

Haemoglobin concentration

Haemodialysis

Home Haemodialysis

Hazard Ratio

Interquartile Range

Information Services Division NHS Scotland

International Standards Organisation

International Society for Peritoneal Dialysis

International Unit per Litre

Intravenous

Kidney Disease Outcomes Quality Initiative

Kilogram

Living Donor

Lower Limit of Normal range

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Renal Association

Scottish Renal Registry Report 2011

m 2

Max

MDRD

Min

mmol/L

NHS

NHSBT

NHS QIS

NHSScotland

NK

NR

OR

PD

pmol/L

PMP

PO4

PRD

PTH

RA

RCP

RRT

SD

SMARRT

SMR

SRA

SRR

Tx

UK

UKRA

UKRR

UL

ULN

URR

WHO

WTE

Metre squared

Maximum

Modification of Diet in Renal Disease

Minimum

Millimole/ litre

National Health Service

NHS Blood and Transplant

NHS Quality Improvement Scotland

National Health Service in Scotland

Not Known

Normal Range

Odds Ratio

Peritoneal Dialysis

picomol / litre

Patients per million population

Phosphate

Primary Renal Diagnosis

Parathyroid Hormone

Renal Association

Royal College of Physicians

Renal Replacement Therapy

Standard Deviation

Scottish Mortality Audit of Renal Replacement Therapy

Standardised Mortality Ratio

Scottish Renal Association

Scottish Renal Registry

Transplant

United Kingdom

United Kingdom Renal Association

UK Renal Registry

Upper Limit

Upper Limit of Normal range

Urea Reduction Ratio

World Health Organisation

Whole Time Equivalent

Renal and Satellite units

Abbreviation Expanded text

Arbroath

Arbroath Infirmary dialysis unit

ARI

Aberdeen Royal Infirmary

Balfour

Balfour Hospital

BGH

Borders General Hospital

BHFW

Belford Hospital, Fort William

DGRI

Dumfries and Galloway Royal Infirmary

FVR

Forth Valley Royal Hospital

G Bain

Gilbert Bain Hospital

GCH Stran Galloway Community Hospital, Stranraer

65


Renal Association

Scottish Renal Registry Report 2011

GH Elgin

Dr Gray’s Hospital, Elgin

GLAS

Glasgow Renal and Transplant Unit

GRI

Glasgow Royal Infirmary

Inverurie

Inverurie Dialysis unit

IRH

Inverclyde Royal Hospital

MONK

Monklands Hospital

NINE

Ninewells Hospital

P’head

Peterhead Community Hospital

Portsoy

Portsoy Dialysis unit

PRI

Perth Royal Infirmary

QMHD

Queen Margaret’s Hospital, Dunfermline

RAIG

Raigmore Hospital

RHSC

Royal Hospital for Sick Children Glasgow

RIE

Royal Infirmary of Edinburgh

St And

St Andrews Community Hospital

St John’s

St John’s Hospital

Stob

Stobhill Hospital

VHK

Victoria Hospital, Kirkcaldy

Vict

Victoria Hospital

VoL

Vale of Leven Hospital

XH

Crosshouse Hospital

WGH

Western General Hospital

Wick

Caithness General Hospital

WIG

Western Infirmary Glasgow

WI Hosp

Western Isles Hospital

NHS Boards

Abbreviation

A&A

BORD

D&G

FIFE

FV

GRAM

GG&C

HIGH

LAN

LOTH

ORKN

SHET

TAY

WI

Expanded text

Ayrshire & Arran

Borders

Dumfries & Galloway

Fife

Forth Valley

Grampian

Greater Glasgow and Clyde

Highland

Lanarkshire

Lothian

Orkney

Shetland

Tayside

Western Isles

66


Renal Association

Scottish Renal Registry Report 2011

APPENDIX 2

RENAL UNITS, SATELLITE DIALYSIS

UNITS AND HEALTH BOARD AREA OF

UNITS’ LOCATION

Parent Renal

Unit

Satellites Health Board Full name

ARI GRAM Aberdeen Royal Infirmary

Balfour ORKN Balfour Hospital, Orkney

G Bain SHET Gilbert Bain Hospital, Lerwick

GH Elgin GRAM Dr Gray’s Hospital, Elgin

Inverurie GRAM Inverurie Dialysis Unit

P’head GRAM Peterhead Community Hospital

Portsoy GRAM Dialysis Unit, Campbell Hospital, Portsoy

XH A&A Crosshouse Hospital, Kilmarnock

DGRI D&G Dumfries and Galloway Royal Infirmary

GCH Stran D&G Galloway Community Hospital, Stranraer

GLAS GG&C Glasgow Renal and Transplant Unit

Western Infirmary, Glasgow

FVR FV Forth Valley Royal Hospital

GRI GG&C Glasgow Royal Infirmary

IRH GG&C Inverclyde Royal Hospital, Greenock

Stob GG&C Stobhill Hospital, Glasgow

Vict GG&C Victoria Hospital, Glasgow

VoL GG&C Vale of Leven Hospital, Alexandria

MONK LAN Monklands Hospital, Airdrie

NINE TAY Ninewells Hospital, Dundee

Arbroath TAY Arbroath Infirmary Dialysis unit

PRI TAY Perth Royal Infirmary

VHK FIFE Victoria Hospital, Kirkcaldy

St And FIFE St Andrews Community Hospital

QMHD FIFE Queen Margaret Hospital, Dunfermline

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Renal Association

Scottish Renal Registry Report 2011

Parent Renal

Unit

Satellites Health Board Full name

RAIG HIGH Raigmore Hospital, Inverness

BHFW HIGH Belford Hospital, Fort William

Wick HIGH Caithness General Hospital

WI Hosp WI Western Isles Hospital, Stornoway

RHSC GG&C Royal Hospital for Sick Children, Glasgow

RIE LOTH Royal Infirmary of Edinburgh

BGH BORD Borders General Hospital, Melrose

St John’s LOTH St John’s Hospital, Livingston

WGH LOTH Western General Hospital, Edinburgh

68


Renal Association

Scottish Renal Registry Report 2011

Scottish Renal Registry

Cirrus House

Marchburn Drive

Glasgow Airport Business Park

Abbotsinch, Paisley, PA3 2SJ

Tel + 00 44 (0) 141 282 2253

Web www.srr.scot.nhs.uk

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