UK RRT Incidence in 2009: national and centre-specific analyses

Introduction: This chapter describes the characteristics of<br/>adult patients on renal replacement therapy (RRT) in the<br/>UK in 2009. The prevalence rates per million population<br/>(pmp) were calculated for Primary Care Trusts in England,<br/>Health and Social Care Areas in Northern Ireland, Local<br/>Health Boards in Wales and Health Boards in Scotland.<br/>These areas will be referred to in this report as ‘PCT/HBs’.<br/>Methods: Data were electronically collected from all 72<br/>renal centres within the UK. A series of cross-sectional and<br/>longitudinal analyses were performed to describe the<br/>demographics of prevalent RRT patients in 2009 at centre<br/>and national level. Age and gender standardised ratios for<br/>prevalence rates in PCT/HBs were calculated. Results:<br/>There were 49,080 adult patients receiving RRT in the UK<br/>on 31st December 2009, equating to a UK prevalence of<br/>794 pmp. This represented an annual increase in prevalent<br/>numbers of approximately 3.2% although there was significant<br/>variation between centres and PCT/HB areas. The<br/>growth rate from 2008 to 2009 for prevalent patients by<br/>treatment modality in the UK was 4.2% for haemodialysis<br/>(HD), a fall of 7.2% for peritoneal dialysis (PD) and a<br/>growth of 4.4% with a functioning transplant. There has<br/>been a slow but steady decline in the proportion of PD<br/>patients from 2000 onwards. Median RRT vintage was 5.4<br/>years. The median age of prevalent patients was 57.7<br/>years (HD 65.9 years, PD 61.2 years and transplant 50.8<br/>years). For all ages, prevalence rates in males exceeded<br/>those in females: peaks for males were in the 75–79 years<br/>age group at 2,632 pmp and for females in the 70–74<br/>years age group at 1,445 pmp. The most common identifiable<br/>renal diagnosis was biopsy-proven glomerulonephritis<br/>(16.0%), followed by diabetes (14.7%). Transplantation was<br/>the most common treatment modality (48%), HD in 44%<br/>and PD 8%. However, HD was increasingly common with<br/>increasing age and transplantation less common. Conclusions:<br/>The HD and transplant population continued to<br/>expand whilst the PD population contracted. There were<br/>national, regional and dialysis centre level variations in<br/>prevalence rates. This has implications for service planning<br/>and ensuring equity of care for RRT patients.