2014 Annual Report highlights and new directions for the UK Renal Registry UK Renal Registry 2015 Annual Audit Meeting Dr Fergus Caskey Medical Director, UK Renal Registry

Setting the

Jo Partington Keith Simpson Outline Core work – New dataset: PD, CKD4+ and dialysis/ Pex for AKI – Linkage – UKRDC National Programmes – AKI – Patient participation Research

Core work

UKRR Dataset v4.0 PD dataset Dashboard information CKD4+ Dialysis and plasma exchange for AKI

Developing a PD data set

Dialysis for AKI Acute haemodialysis Hospital Southmead Haemodialysis Hospital Southmead

Plasma exchange for AKI The example of plasma exchange for AKI “Report every dialysis or plasma exchange session for acute kidney injury to the UK Renal Registry” Sept 2014 Plasma exchange (performed in a renal unit) Non-renal patient e.g. neurology or haematology Renal patient AKI (stage 1, 2 or 3) CKD e.g. HLAi or ABOi pre transplant Nephritic e.g. vasculitis or aHUS Nephrotic e.g. FSGS Green = covered by s251 permissions and mandate Orange = covered by s251 permissions but not mandated Red = not covered by mandate or s251 permissions

UKRR Dataset v4.0 PD dataset Dashboard information CKD4+ Dialysis and plasma exchange for AKI Effective from Jan 2016 Jan 2015 in England

RRT incidence and prevalence

eGFR at start

Dialysis survival

Survival Adjusting for comorbidity with HES data “The addition of a combination of 16 comorbid conditions present at the start of RRT reduced the number of centres with worse than expected survival to one.” Fotheringham NDT outliers 4 outliers 1 outliers

Prevalent survival by centre To publish or not? Patient council RIGB and Exec Committee -> Must publish and escalate as before Don’t stress variation in patient summaries this year Use co-morbidity data where available Work towards routine HES linkage in all 4 countries

Infections

PHE Infection data MRSA, MSSA, Cdiff and E Coli – mandatory reporting Renal flag NOT mandatory – Some patients not identified as renal – Some incorrectly identified as renal Validation time consuming and variable Plan: Link all UKRR data with all PHE infection data Receive linked data set and send to renal units for validation

National Programmes

AKI National Programme Board RiskEducationDetectionImplementationInterventionMeasurement NHS England Patient Safety Steering Group Hydration Sub- Group Software Implementation Sub-Group Algorithm Sub- Group Best Practice in E- alert Group Expert Reference Group Advisory Group National Programme 1. AKI

NHSBT BAPN RaDaR UK Renal Data Collaboration SRR UK RR RPV Patient Research and Audit Renal Units LABS Primary care – prescribing etc HES, RGOS etc meta data

NHSBT BAPN RaDaR UK Renal Data Collaboration SRR UK RR RPV Patient Research and Audit Renal Units LABS Primary care – prescribing etc HES, RGOS etc meta data AKI data Primary and secondary care Direct from labs

National algorithm and mandate to report By 9 th March 2015

Research

Study Groups Dialysis: chair Simon Davies Transplant: chair Iain McPhee CKD: incorporated into UKKRC SG Research methods: chair Fergus Caskey Patient council: chair Fiona Loud Research fellows Retha Steenkamp PhD awarded Tony Wing fellow (BKPA & KRUK) – Alex Hamilton – commenced Current PhD fellows – Rishi Pruthi (ATTOM) – Catriona Shaw (MINAP) – Ani Rao (EQUAL) New ACF call Non-clinical fellows (doctoral/ pot-doctoral) adverts

Late referral (2012/2013) 5% 30% Chapter 1. UKRR Annual Report 2014

ASSIST CKD eGFR graph generated in high risk patient in labs Sent to GP with information Aim to reduce late referral Stepped wedge roll out to gather evidence of effectiveness (or not) Michael Nation at KRUK Hugh Gallagher at St Heliers Scaling up Hugh Rayner’s work at Birmingham Heartlands In collaboration with Prof Stephen Walters in ScHARR and Dr Erik Lenguerrand at UoB

Research: grants awarded Health Foundation – ASSIST-CKD (St Heliers with KRUK) – AKI Care Bundle (Derby) NIHR HTA – SIMPLIFIED (Cambridge) NIHR RfPB – UK PDOPPS-catheter (Sheffield) Other – NIHR HS&DR (ICNARC) – NIHR HTA (Oxford) – NIHR SBRI D4D x2 (UKRR and Atlantis HC) Stepped wedge CRCT Registry RCT IV analysis

Acknowledgements Thank you to all the UK renal centres for providing data to the UK Renal Registry. And thank you to all those who contributed to the writing of the 2014 annual report or participated in the Registry’s National Programme initiatives and Study CROSS TALK IN RENAL EPIDEMIOLOGY UKRR & ERA-EDTA Registry Thursday 28 th May, London 13:15 – 16:45 1. Selection bias in renal research 2. Missing data 3. Linkage to achieve big data 4. IV analysis 5. Propensity scores 6. Time dependent confounding