UK Renal Registry 12th Annual Report (December 2009): Chapter 9 Anaemia Variables in UK Adult Dialysis Patients in 2008: national and centre-specific analyses

Background: The UK Renal Association (RA) and National Institute for Health and Clinical Excellence (NICE) have published Clinical Practice Guidelines which include recommendations for management of anaemia in established renal failure. Aims: To determine the extent to which the guidelines for anaemia management are met in the UK. Methods: Quarterly data (haemoglobin (Hb) and factors that influence Hb) extracts from renal centres in England, Wales, Northern Ireland (EWNI), and annual data from the Scottish Renal Registry for incident and prevalent renal replacement therapy (RRT) cohorts for 2008 were analysed by the UK Renal Registry (UKRR). Results: In the UK, in 2008 57% of patients commenced dialysis therapy with Hb >= 10.0 g/dl (median Hb 10.2 g/dl). For incident patients the Hb at 3 and 6 months of dialysis treatment was 11.4 and 11.7 g/dl respectively. The median Hb of haemodialysis (HD) patients was 11.6 g/dl with an interquartile range (IQR) of 10.6-12.5 g/dl. Of HD patients 85% had a Hb >= 10.0 g/dl. The median Hb of peritoneal dialysis (PD) patients in the UK was 11.7 g/dl (IQR 10.8-12.6 g/dl). Of UK PD patients 89% had a Hb >= 10.0 g/dl. The median ferritin in HD patients in EWNI was 436 mu g/L (IQR 289-622) and 95% of HD patients had a ferritin >= 100 mu g/L. The median ferritin in PD patients was 246 mu g/L (IQR 141-399) with 84% of PD patients having a ferritin >= 100 mu g/L. In EWNI the mean ESA dose was higher for HD than PD patients (9,166 vs. 6,302 IU/week). Conclusions: Last year for the first time a small fall (from 85.9% in 2006 to 85.6% in 2007) in the % of HD patients with a Hb of >= 10 g/dl which was thought to be related to the implementation of the new Hb Standard which has a target range of 10.5-12.5 g/dl was seen. This year attainment of Hb >= 10 g/dl in HD patients fell again slightly to 85.3%. In HD patients, 54% of patients had a Hb >= 10.5 and <= 12.5 g/dl compared with 53% in the 2008 Report.