UK Renal Registry 12th Annual Report (December 2009): Chapter 3 UK ESRD Incident Rates in 2008: national and centre-specific analyses

Introduction: This chapter describes the characteristics of adult patients starting renal replacement therapy (RRT) in the UK in 2008 and the acceptance rates for RRT in Primary Care Trusts and Local Authorities (PCT/LAs) in the UK. Methods: The basic demographics and clinical characteristics are reported on patients starting RRT from all UK renal centres. Late referral, 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 PCT/LAs were calculated. Results: In 2008, the acceptance rate in the UK was 108 per million population (pmp). Acceptance rates in Scotland (103 pmp), Northern Ireland (97 pmp) and Wales (117 pmp) have all fallen although Wales still remains the country with the highest acceptance rate. There were wide variations between PCT/LAs with respect to the standardised ratios, which were lower in more PCT/LAs in the North West and South East of England and higher in London, the West Midlands, Scotland, Northern Ireland, and Wales. The median age of all incident patients was 64.1 years and for non-Whites 56.1 years. Diabetic renal disease remains the single most common cause of renal failure (24%). By 90 days, 67.7% of patients were on haemodialysis, 19.8% on peritoneal dialysis, 5.9% had had a transplant and 6.6% had died or had stopped treatment. By 90 days, 77.4% of all dialysis patients were on HD. The geometric mean eGFR at the start of RRT was 8.6 ml/min/1.73 m(2) which was similar to the eGFR of those starting in 2007. The incidence of late presentation (<90 days) has fallen from 28% in 2003 to 22% in 2008. There was no relationship between social deprivation and referral pattern. Conclusions: Acceptance rates have fallen in Northern Ireland, Scotland and Wales whilst they have plateaued in England over the last three years. Wales continued to have the highest acceptance rate of the countries making up the UK.