UK Renal Registry 17th Annual Report: Chapter 7 Haemoglobin, Ferritin and Erythropoietin amongst UK Adult Dialysis Patients in 2013: National and Centre-specific Analyses

Background: The diagnosis and management of anaemia in chronic kidney disease and the standards to be achieved have been detailed in the UK Renal Association Anaemia of CKD guidelines. Aims: To determine the attainment of standards for anaemia management in the UK. Methods: Quarterly data were obtained for haemoglobin (Hb) and factors that influence Hb from renal centres in England, Wales, Northern Ireland (EW&NI) and the Scottish Renal Registry for the incident and prevalent renal replacement therapy (RRT) cohorts for 2013. Results: In the UK, in 2013, 50% of patients commenced dialysis therapy with Hb >= 100 g/L (median Hb 100 g/L). Of patients presenting early, 53% started dialysis with Hb >= 100 g/L compared to 36% of patients presenting late. The UK median Hb of haemodialysis (HD) & peritoneal dialysis (PD) patients was 112 g/L (inter-quartile range (IQR) 103-120 g/L) and 113 g/L (IQR 103-122 g/L) respectively with 83% of patients having Hb > 100 g/L for both treatment modalities. The median ferritin in HD and PD patients was 424 mu g/L (IQR 280-616 mu g/L) and 285 mu g/L (IQR 167-473 mu g/L) respectively with the majority of patients achieving ferritin >= 100 mu g/L. In EW&NI the median ESA dose was higher for HD than PD patients (7,333 vs. 4,000 IU/week). The percentage of patients treated with an ESA and having Hb >120 g/L ranged between centres from 3-29% for HD and from 0-26% for PD. Conclusions: There continues to be significant variation between centres in the use of iron and ESA in order to achieve the target Hb (100-120 g/L).