المؤلفون: Udayaraj, Udaya¹, Pruthi, Rishi², Casula, Anna², Roderick, Paul³

المصدر: Nephron Clinical Practice. Feb2014, Vol. 125 Issue 1-4, p111-125. 15p.

مصطلحات موضوعية: *MEDICAL registries, *NEPHROLOGY, *ETHNIC groups, *KIDNEY transplantation, *MINORITIES

مستخلص: Introduction: This chapter describes the patient characteristics and outcomes for the three main ethnic groups (White, South Asian, Black) on renal replacement therapy (RRT) in the UK. Methods: Data on patients (>18 years old) from all 71 UK adult renal centres starting RRT between 2003 and 2012 were considered. Scottish centres were excluded due to poor ethnicity data. Results: The age-gender standardized incidence ratio of RRT was higher (2-3 times) in regions with a high ethnic minority population compared to those with a low ethnic minority population. South Asian and Black patients were significantly younger than Whites; had more diabetes causing established renal failure and lived in more deprived areas. The proportion of patients with at least one comorbidity was greater amongst White patients compared to South Asian and Black patients. The proportion of patients starting PD and having preemptive transplantation was lower amongst both ethnic minorities. The attainment of various laboratory standards was comparable or better for the ethnic minorities compared to White patients except for calcium standard attainment (for South Asians) and haemodialysis dose attainment (for Black patients). Compared to White patients, both ethnic minorities had similar rates of listing for deceased donor kidney transplantation but had lower rates of transplantation once wait-listed, and lower rates of living kidney donor transplantation. One and five year kidney allograft adjusted survival was poorer for Black patients but similar for South Asians compared to White patients. Black and South Asian patients had a better adjusted survival on dialysis compared to White patients. Conclusions: The persistent high incidence of RRT, the better survival on dialysis and the poor access to kidney transplantation for South Asian and Black patients and early allograft loss for Black patients will impose a disproportionate demand on dialysis provision in those areas with a high ethnic minority population. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

المؤلفون: Pruthi, Rishi, Ravanan, Rommel, O'Neill, John, Roderick, Paul, Pankhurst, Laura, Udayaraj, Udaya

المصدر: Nephron Clinical Practice; Jun2013 Supplement, Vol. 123, p183-193, 11p

مصطلحات موضوعية: KIDNEY transplantation, HEALTH services accessibility, COMORBIDITY, ORGAN donors

مصطلحات جغرافية: UNITED Kingdom

الشركة/الكيان: GREAT Britain. National Health Service

مستخلص: Background: Renal transplantation is recognised as being the optimal treatment modality for many patients with established renal failure. This analysis aimed to explore inter-centre variation in access to renal transplantation in the UK. Methods: Transplant activity and waiting list data were obtained from NHS Blood and Transplant, demographic and laboratory data were obtained from the UK Renal Registry. All incident RRT patients starting treatment between 1st January 2006 and 31st December 2008 from 72 renal centres were considered for inclusion. The cohort was followed until 31st December 2010 (or until transplantation or death, whichever was earliest). Results: Age, ethnicity and primary renal diagnosis were associated with both accessing the kidney transplant waiting list and receiving a kidney transplant. A patient starting dialysis in a non-transplanting renal centre was less likely to be registered for transplantation (OR 0.80, 95% CI 0.74-0.87) or receive a transplant from a donor after cardiac death or a living kidney donor (OR 0.69, 95% CI 0.61-0.77) compared with patients cared for in transplanting renal centres. Once registered for kidney transplantation, patients in both transplanting and non-transplanting renal centres had an equal chance of receiving a transplant from a donor after brainstem death (OR 0.92, 95% CI 0.79-1.08). Conclusion: There was wide variation in access to kidney transplantation between UK renal centres which cannot be explained by differences in case mix. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

: Copyright of Nephron Clinical Practice is the property of Karger AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: MacPhee, Iain, Webb, Lynsey, Casula, Anna, Udayaraj, Udaya

المصدر: Nephron Clinical Practice; Aug012 Supplement, Vol. 120, pc55-c79, 25p

مصطلحات موضوعية: KIDNEY transplant patients, BIOCHEMISTRY, BLOOD pressure, ETHNICITY, ORGAN donors

مصطلحات جغرافية: UNITED Kingdom

مستخلص: Introduction: National transplant registries routinely focus on centre-specific patient and graft survival rates following renal transplantation. However other outcomes such as graft function (as measured by eGFR), haemoglobin and blood pressure are also important quality of care indicators. Methods: Renal transplant activity, incident graft survival data and donor information were obtained from NHS Blood and Transplant. Laboratory and clinical variables and prevalent survival data were obtained from the UK Renal Registry. Data were analysed separately for prevalent and one year post-transplant patients. Results: The numbers of live and deceased kidney donors increased in 2010. The death-censored graft failure rate fell slightly to 2.4% and the transplant patient death rates remained stable at 2.5 per 100 patient years. There was centre variation in outcomes including eGFR and haemoglobin in prevalent and 1 year post-transplant patients. Analysis of prevalent transplants by chronic kidney disease stage showed 13.7% with an eGFR <30 ml/min/1.73 m² and 1.5% with an eGFR <15ml/min/1.73 m². Of those with CKD stage 5T, 36.1% had haemoglobin concentrations <10.5g/dl, 22.9% phosphate concentrations 51.8mmol/L and 6.2% adjusted calcium concentrations 52.6 mmol/L. Malignancy (23%) and infection (22%) remained the commonest two causes of death in prevalent transplant patients. Conclusion: Significant variations in clinical outcomes (unadjusted for patient-specific variables) amongst kidney transplant recipients continued to exist in the UK and may reflect differences in healthcare delivery between renal centres. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

: Copyright of Nephron Clinical Practice is the property of Karger AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Farrington, Ken¹ ken.farrington@nhs.net, Udayaraj, Udaya², Gilg, Julie², Feehally, John³

المصدر: Nephron Clinical Practice. Mar2009 Supplement 1, Vol. 111, pc13-c41. 1p. 17 Charts, 13 Graphs.

مصطلحات موضوعية: *HEMODIALYSIS, *MEDICAL care, *KIDNEY diseases, *PRIMARY care, *BLOOD filtration

مستخلص: Introduction: This chapter describes the characteristics of adult patients starting renal replacement therapy (RRT) in the UK in 2007 and the acceptance rate for RRT in Primary Care Trusts (PCT) or equivalent Health Authority (HA) areas in the UK. Methods: The basic demographics are reported for all UK centres and clinical characteristics of patients starting RRT from all except 1 centre in the UK. Late presentation, defined as time between first being seen by a nephrologist and start of RRT being <90 days was also studied. Age and gender standardised ratios for acceptance rate in PCTs or equivalent HAs were calculated. Results: In 2007, the acceptance rate in the UK was 109 per million population (pmp) compared to 111 pmp in 2006. Acceptance rates in England (107 pmp), Scotland (108 pmp) and Northern Ireland (105 pmp) have fallen slightly, whilst that in Wales (140 pmp) has risen. There were wide variations between PCTs/HAs with respect to the standardised ratios which were lower in more PCTs in the North West and South East of England and higher in London, the West Midlands and Wales. The median age of all incident patients was 64.1 years and for non-Whites 57.1 years. There was an excess of males in all age groups starting RRT and nearly 80% of patients were reported to be White. Diabetic renal disease remained the single most common cause of renal failure (21.9%). By 90 days, 67.4% of patients were on haemodialysis, 21.3% on peritoneal dialysis, 5.2% had had a transplant and 6.1% had died or had stopped treatment. The incidence of late presentation in those centres supplying adequate data was 21%. Conclusions: The acceptance rate has fallen in England, Northern Ireland and Scotland but continues to rise in Wales with wide variations in acceptance rate between PCTs/HAs. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

المؤلفون: Udayaraj, Udaya¹, Tomson, Charles RV¹, Gilg, Julie¹, Ansell, David¹, Fogarty, Damian²

المصدر: Nephron Clinical Practice. Mar2009 Supplement 1, Vol. 111, pc97-c111. 1p. 1 Diagram, 15 Charts, 4 Graphs.

مصطلحات موضوعية: *HEMODIALYSIS, *ENDOCRINE diseases, *BLOOD filtration, *ISCHEMIA, *CORONARY disease, *COMORBIDITY

مستخلص: Introduction: The prevalence of 13 comorbid conditions and smoking status at the time of starting renal replacement therapy (RRT) in England, Wales and Northern Ireland are described. Methods: Adult patients starting RRT between 2002 and 2007 in centres reporting to the UK Renal Registry (UKRR) and with data on comorbidity (n = 13,293) were included. The association of comorbidity with patient demographics, treatment modality, haemoglobin, renal function at start of RRT and subsequent listing for kidney transplantation were studied. Association between comorbidities and mortality at 90 days and one year after 90 days from start of RRT was explored using Cox regression. Results: Completeness of data on comorbidity returned to the UKRR remained poor. Of patients with data, 52% had one or more comorbidities. Diabetes mellitus and ischaemic heart disease were the most common conditions seen in 28.9% and 22.5% of patients respectively. Comorbidities became more common with increasing age (up to the 65–74 age group), were more common amongst Whites and were associated with a lower likelihood of pre-emptive transplantation, a greater likelihood of starting on haemodialysis (rather than peritoneal dialysis) and a lower likelihood of being listed for kidney transplantation. In multivariable survival analysis, malignancy and ischaemic/neuropathic ulcers were the strongest predictors of poor survival at 1 year after 90 days from start of RRT. Conclusions: The majority of patients had at least one comorbid condition and comorbidity is an important predictor of early mortality on RRT. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

المؤلفون: Ravanan, Rommel¹ rommel.ravanan@cardiffandvale.wales.nhs.uk, Udayaraj, Udaya², Steenkamp, Retha², Ansell, David²

المصدر: Nephron Clinical Practice. Mar2009 Supplement 1, Vol. 111, pc69-c96. 1p. 17 Charts, 22 Graphs.

مصطلحات موضوعية: *KIDNEY diseases, *FILTERS & filtration, *DEATH rate, *HEMODIALYSIS patients, *DIALYSIS (Chemistry)

مستخلص: Introduction: Outcomes following renal transplantation are usually reported as graft or patient survival. However, graft function, haemoglobin and blood pressure are also important measures of quality of care. Methods: Transplant activity and incident graft survival data were obtained from NHS Blood and Transplant (NHSBT), laboratory and clinical variables and prevalent survival data were obtained from the UK Renal Registry (UKRR). Data were analysed separately for prevalent and one year post-transplant patients. Results: Increasing live and non-heartbeating donors were responsible for the increasing transplant activity. Transplant waiting list numbers continued to rise by 8%. Graft failure occurred in 3.2% of prevalent transplant patients. Death rates remained stable at 2.3/100 patient years. Malignancy accounted for 21% of these deaths. There was centre variation in outcomes such as eGFR and haemoglobin in prevalent and 1 year post-transplant recipients. Analysis of prevalent transplants by chronic kidney disease stage showed 16% with eGFR <30 and 2.2% <15. Of those in stage 5T, 26% had Hb <10 g/dl, 27% phosphate ⩾ 1.8 mmol/L and 50% an iPTH ⩾ 32 pmol/L. These patients were less likely to achieve the UK standards in comparison to CKD5 dialysis patients. Conclusion: Wide variations in clinical and biochemical outcomes may be secondary to variations in the care administered to transplant recipients across the UK. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]