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Epidemiology of ESKD in Ireland
Data from 2013/2014 NRO Censusand the
17th Annual Report of the UKRR 2014
The Future for Irish ESKD Epidemiology
HSE National Renal Office
Methodology
• NRO Annual Census 31st December 2013/14
• UKRR Annual Report 2014
• KDCPMS records used for 1st time 2014
• Standardised data collection instrument for others
• Not patient-linked unless in KDCPMS
• Improved external validation (with KDCPMS)
• Death/modality transfer not analysed
• Await my concluding exhortation/threat………………….
Caveat re Prevalent Transplant Numbers
• We exercise caution every year regarding how exact thisfigure can be
• These patients are more mobile; may attend at more than onesite for follow-up
• We continuously revise the figures from previous years, basedon updated data
• We believe that we are more exact with each successive year
• KDCPMS is improving precision in this regard
Renal Replacement Therapies (RRT)
• Transplant (TX)
• Haemodialysis (HD)Centre HD (cHD)Satellite HD (sHD)Contracted Satellite HD (sHDc)
Northern Ireland HD (NI)
• Home Dialysis (PD/HHD)
CSO population estimates
• April 2005 4,133,800
Census 2006 4,232,900
• April 2007 4,375,800• April 2008 4,485,100• April 2009 4,533,400• April 2010 4,554,900
Census 2011 4,574,900
• April 2012 4,585,400• April 2013 4,593,100• April 2014 4,609,600
2014 INCIDENT ESKD PATIENTS ATTENDING ADULT UNITS
Incident adult ESKD patients (n)
6 22 9 20 22 22
377
422
307330 330 327
63
42
56
63 71 56
0
50
100
150
200
250
300
350
400
450
500
2008 2009 2010 2011 2012 2013
Home
HD
TX
xxx patients
xx% HDxx% PDxx% TX
xx p.m.p.
All Island 2013 (Adult)
RoI (4.6)
Incident: 88pmp
405
HD 81%
PD 14%
TX 5%
NI (1.8)
98pmp (95%CI 84-113)
180
67%
22%
11%
2014 PREVALENT ESKD PATIENTSATTENDING ADULT UNITS
Prevalent ESKD patients (n)
1623 1728 1824 1891 2007 2079 2156 2211
13291401
14731554
1557 1560 15561628191
200188
195191
209 204202
211
2028 44
48
0
500
1000
1500
2000
2500
3000
3500
4000
4500
HHD
PD
HD
TX
4089 patients
39.8% HD
6.1% PD/HHD 54.1%TX
887 p.m.p.353
HD54 PD/HHD480
TX
All Island 2013 (Adult)
RoI (4.6)
Prevalent: 862pmp
3960
HD 40%
PD 5%
TX 55%
NI (1.8)
845pmp (95%CI 803-887)
1546
42%
5%
53%
Change in 2014
• ESKD +129 3.3% 28.0 pmp18.3 pmp
• HD +72 4.6%• PD/HHD +2 0.8%
• Dialysis +74 4.1% 16.1 pmp1.5 pmp
• TX +55 2.6% 11.9 pmp16.8 pmp
Change 2007-14
Annualised
• ESKD +946 30% +135 (84-186)
• HD +299 23% +43 (-4-81)
• PD/HHD +59 31% +8 (-10-26)
• Dialysis +284 19% +47 (7-97)
• TX +533 32% +89 (55-116)
Modalities
55%
25%
14%
6%
Transplant
Centre HD
Satellite HD
Home Therapies
Detailed Modalities
54%
26%
4%
10%
0%
5%
1%
TX
CHD
SHD
SHDc
NI
PD
HHD
Detailed Dialysis Modalities
57%
8%
21%
1% 11%
2%
CHD
SHD
SHDc
NI
PD
HHD
REGIONAL ANALYSISESKD PATIENTS ATTENDING
ADULT UNITS
Renal Services in 6 Hospital Groups
Hospital Group Renal Units Contracted Satellite HD Unit
Home Programme
RCSI Hospitals Group (0.8)
BHCGH
Beacon Droghedafmc Northern Cross
PD/HHD
Dublin East Hospitals Group(0.7)
SVUHMMUH
Beacon Sandyfordfmc Northern CrossBeacon Drogheda
PDPD
Dublin Midlands Hospitals Group (0.8)
AMNCH/SJHMRHT
Beacon TallaghtBeacon Sandyford
PD/HHD
South/South West Hospitals Group (1.15)
CUH/KGHWUH
fmc Kilkenny PD/HHDPD/HHD
University of Limerick Hospitals Group (0.35)
LUH fmc Limerick PD
Saolta Healthcare Group (0.8)
MPUH/GUH/MGHLGH/SGH
Wellstone Galway PD/HHD
NI Renal Units
• Belfast 0.64
• West NI 0.35
• Antrim 0.29
• Ulster 0.27
• Newry 0.26
ESKD Patients 31/12/14(total patients under governance of 6 Hospital Groups)
789
204
338
491
120
269
256
153
205
245
75
130
49
99
76
81
88
44
69
47
5
1
5
42
25
46
49
22
18
23
4
17
4
0 100 200 300 400 500 600 700 800 900 1000 1100 1200
RCSI
Dublin East
Dublin Midlands
South/South-West
LUHG
Saolta
TX
cHD
sHD
sHDc
NI
PD
HHD
ESKD Patients 31/12/14(total dialysis patients under governance of 6 Hospital Groups)
256
153
205
245
75
130
49
99
76
81
88
44
69
47
5
1
5
42
25
46
49
22
18
23
4
17
4
0 50 100 150 200 250 300 350 400 450
RCSI
Dublin East
Dublin Midlands
South/South-West
LUHG
Saolta
cHD
sHD
sHDc
NI
PD
HHD
ESKD Patients 31/12/14(total patients under governance of 11 Parent Units)
20
769
100
104
294
44
157
334
120
182
87
73
183
81
72
90
115
94
151
75
68
62
49
56
43
66
30
49
88
43
69
47
10
2
1
5
1
5
42
15
10
46
10
39
22
18
23
4
5
12
4
0 100 200 300 400 500 600 700 800 900 1000 1100 1200
CGH
Beaumont
MMUH
SVUH
AMNCH/SJH
MRHT
WRH
CUH/KGH
LUHG
GUHG/MGH
LGH/SGH
TX
cHD
sHD
sHDc
oHD
NI
PD
HHD
ESKD Patients 31/12/13(total patients under governance of 16 Parent Units)
10
750
98
112
280
40
145
335
115
195
76
110
44
82
490
89
64
250
115
129
176
106
129
183
138
161
105
113
106
127
212
92
42
19
13
45
17
33
16
19
15
6
15
27
18
20
3
5
13
3
0 100 200 300 400 500 600 700 800 900 1000 1100
CGH
Beaumont
MMUH
SVUH
AMNCH/SJH
MRHT
WUH
CUH/KGH
LUHG
GUHG/MGH
LGH/SGH
West NI
Ulster
Antrim
Belfast
Newry
TX
cHD
PD
HHD
ESKD Patients 31/12/13(total dialysis patients under governance of 16 Parent Units)
64
169
79
82
90
106
91
142
65
59
63
113
106
127
212
92
81
36
47
86
38
41
73
102
42
42
19
13
45
17
33
16
19
15
6
15
27
18
0 50 100 150 200 250 300 350
CGH
Beaumont
MMUH
SVUH
AMNCH/SJH
MRHT
WUH
CUH/KGH
LUHG
GUHG/MGH
LGH/SGH
West NI
Ulster
Antrim
Belfast
Newry
cHD
sHD
PD
ESKD Patients 31/12/13(total Tx patients under governance of 16 Parent Units)
10
750
98
112
280
40
145
335
115
195
76
110
44
82
490
89
0 100 200 300 400 500 600 700 800
CGH
Beaumont
MMUH
SVUH
AMNCH/SJH
MRHT
WUH
CUH/KGH
LUHG
GUHG/MGH
LGH/SGH
West NI
Ulster
Antrim
Belfast
Newry
ESKD PATIENTS ATTENDING PAEDIATRIC UNITS
Prevalent Paediatric ESKD
patients (n)
64
3
10
2
4
0
10
20
30
40
50
60
70
80
CUHT OLHC
PD
HD
TX
83 patients12%
HD7% PD81% TX
18 p.m.p.2
HD1.3 PD14.7 TX
TRANSPLANT ACTIVITY
Transplants 2009-14
146
90
158131 136
112
18
23
27
3238
40
8
8
7
1
11
6
1
0
20
40
60
80
100
120
140
160
180
200
2009 2010 2011 2012 2013 2014
K/LoH
SPK
LDK
DDK
The Future
Last 5 years reported to USRDS this yearNo report to EDTA/ERA Registry or UKRR
Why?
Discipline, Discipline, Discipline……….
KDCPMS is the toolForthcoming Administration Support
National Dataset –From all patients classified as HD, Home Therapy,
Transplant follow-up
Data Item Notes
Current Status HD/ PD/ Tx
Age HD/ PD/ Tx
Sex HD/ PD/ Tx
Primary Renal Diagnosis New EDTA codes
Date of 1st RRT First ever RRT
Transplant List Status HD/ PD/ Tx
Date of Dx Prescription HD only
Date of Fluid Prescription HD only
Most recent Dx Date HD only
Access used in last Dx session HD only
e.g. Access rates for all-Ireland
e.g. Fistula vs. Catheter vs. Unrecorded rates in all Units are shown below.
Data completion is challenging
Crucial to get patient classification correct:Clinical Supervision, Treatment Location, Modality
Snapshot of raw data
extract showing complete
data in green and
incomplete data in red
Census Reporting Protocol1. All units review and validate their records
Start with Lead Nephrologist and Renal SystemAdmin (RSA) checking classification and lists
2. NRO issues a “% completion” report for all units(missing data)
3. Lead Nephrologist and RSA complete the minimumdataset for all
4. NRO extracts report 23hrs 31st December 2015
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