UK Renal Registry 10th Annual Report 2007 Fig 9.1 Annual change in percentage of dialysis patients...
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Transcript of UK Renal Registry 10th Annual Report 2007 Fig 9.1 Annual change in percentage of dialysis patients...
UK Renal Registry 10th Annual Report 2007
Fig 9.1 Annual change in percentage of dialysis patients with serum phosphate < 1.8mmol/L and ≥1.1 -≤1.8mmol/L
1999 - 2006 E,W and NI
40
45
50
55
60
65
70
75
8019
99
2000
2001
2002
2003
2004
2005
2006
1999
2000
2001
2002
2003
2004
2005
2006
Year
Per
cena
tge
of p
atie
nts
% w ith P04 < 1.8mmol/L
% w ith P04 =1.1-=1.8mmol/L
Peritoneal DialisysPeritoneal DialysisHaemodialysis
UK Renal Registry 10th Annual Report 2007
Fig 9.2 Annual change in percentage with serum phosphate between 1.1-1.8mmol/L, >1.8mmol/L and <1.1mmol/L
1999 - 2006 UK
0
10
20
30
40
50
60
70
8019
99
2000
2001
2002
2003
2004
2005
2006
1999
2000
2001
2002
2003
2004
2005
2006
Year
Perc
enta
ge o
f pat
ient
s
% w ith phos 1.1-1.8
% < 1.1 mmol/L
% >1.8mmol/L
Haemodialysis Peritoneal Dialysis
UK Renal Registry 10th Annual Report 2007
Fig 9.3 Median serum phosphate mmol/L: dialysis
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
2.2
2.4
2.6
1 L
Wes
t 1
Red
ng13
Wirr
al 4
Tyr
one
0 U
lste
r 0
Che
lms
0 L
Kin
gs 1
Wol
ve 0
Ant
rim 2
Lee
ds11
L G
uys
8 C
lwyd
0 N
ottm
2 S
wan
se 2
Yor
k 4
Liv
Ain
16 M
anW
st 0
Bris
tol
30 C
amb
15 C
arsh
12 L
Rfre
e 2
Oxf
ord
2 E
xete
r 2
Liv
RI
4 N
orw
ch12
Dud
ley
2 B
right
n 1
Ipsw
i 0
Bra
dfd
0 G
louc
1 D
orse
t 4
Bel
fast
2 S
then
d 4
Sun
d 4
L B
arts
2 B
ango
r 0
Che
str
1 B
asld
n 4
B Q
EH 0
Der
ry 3
New
ry 2
Car
dff
1 L
eic
5 S
tevn
g 3
Der
by 1
Mid
dlbr
0 N
ewc
1 S
heff
5 B
Hea
rt 3
Por
ts 1
Ply
mth
1 T
ruro
1 S
hrew
0 P
rest
n 4
Car
lis 4
Eng
land
3 N
Irel
and
12 W
ales
5 E
,W&N
I
Centre
Ser
um p
hosp
hate
mm
ol/L
Upper quartile
Median phosphateLow er quartile
N = 17,319
UK Renal Registry 10th Annual Report 2007
Fig 9.4 Percentage of patients with serum phosphate <1.8mmol/L : HD
Percentage of patients with serum phosphate <1.8mmol/L : HD
40
45
50
55
60
65
70
75
80
85
90
95
100
Centre
Per
cent
age
of p
atie
nts
Upper 95% confidence interval% with P04 < 1.8mmol/LLower 95% confidence interval
UK Renal Registry 10th Annual Report 2007
Fig 9.5 Confidence in centre ranking for percentage of HD patients with phosphate<1.8mmol/L
0
10
20
30
40
50
Centre
Ran
k
Upper 95% Conf idence interval
Median rank
Low er 95% Conf idence interval
UK Renal Registry 10th Annual Report 2007
Fig 9.6 Percentage of patients with serum phosphate ≥1.1-≤1.8mmol/L : HD
20
30
40
50
60
70
80
90
100
0 D
erry
5 W
irral
8 C
lwyd
4 T
yron
e 0
Glo
uc 4
Nor
wch
0 U
lste
r 1
Yor
k 1
Not
tm 4
B Q
EH 0
Red
ng 0
L K
ings
1 S
wan
se 0
Dor
set
4 L
iv A
in13
L G
uys
0 A
ntrim
1 D
erby
2 O
xfor
d 1
Sth
end
0 C
helm
s18
Car
sh16
Dud
ley
4 B
elfa
st 6
Ste
vng
1 B
asld
n 0
Bra
dfd
1 L
eic
2 E
xete
r 0
Bris
tol
36 C
amb
1 S
heff
1 W
olve
2 L
eeds
1 M
iddl
br14
L R
free
3 B
ango
r 5
B H
eart
2 L
iv R
I 1
New
ry 1
Por
ts 3
Brig
htn
18 M
anW
st 0
L W
est
4 S
und
3 C
ardf
f 0
New
c 0
Che
str
0 P
rest
n 1
Tru
ro 0
L B
arts
2 P
lym
th 0
Ipsw
i 1
Shr
ew 5
Car
lis 4
Eng
land
2 N
Irel
and
12 W
ales
5 E
,W&N
I
Centre
Per
cent
age
of p
atie
nts
Upper 95% confidence interval% with P04 =1.1-=1.8mmol/LLower 95% confidence interval
UK Renal Registry 10th Annual Report 2007
Fig 9.7 Percentage of patients with serum phosphate <1.8mmol/L : PD
30
40
50
60
70
80
90
100
9 Y
ork
1 R
edng
0 C
amb
2 W
olve
0 A
ntrim
0 C
helm
s 2
Liv
RI
2 D
orse
t 0
Bas
ldn
2 L
eeds
3 L
Wes
t 3
Sw
anse
0 B
ango
r 0
L K
ings
9 H
ull
5 B
Hea
rt 6
L R
free
1 B
right
n 4
Ipsw
i 1
L G
uys
2 L
eic
2 D
udle
y 0
Ply
mth
2 S
tevn
g 3
Car
sh 2
Nor
wch
11 L
Bar
ts 0
Tru
ro 0
Oxf
ord
10 M
anW
st 5
Bel
fast
0 C
ovnt
0 B
risto
l 0
Exe
ter
1 C
ardf
f 4
Mid
dlbr
0 N
ottm
9 D
erby
0 P
rest
n 2
New
c 0
Shr
ew 0
She
ff 0
Bra
dfd
6 B
QEH
10 P
orts
0 G
louc
4 E
ngla
nd 6
N Ir
elan
d13
Wal
es 5
E,W
&NI
Centre
Per
cent
age
of p
atie
nts
Upper 95% conf idence interval
% w ith P04 <1.8mmol/L
Low er 95% confidence interval
UK Renal Registry 10th Annual Report 2007
Fig 9.7 Percentage of patients with serum phosphate ≥1.1-≤1.8mmol/L : PD
30
40
50
60
70
80
90
100
9 Y
ork
0 A
ntrim
2 D
orse
t 9
Hul
l 2
Wol
ve 0
Cam
b 0
Ban
gor
3 S
wan
se 4
Ipsw
i 0
Che
lms
1 L
Guy
s 0
Not
tm 0
Tru
ro 0
Ply
mth
6 L
Rfre
e 1
Red
ng 1
Brig
htn
2 N
ewc
2 L
iv R
I 0
Bas
ldn
0 B
risto
l 3
Car
sh 2
Dud
ley
2 L
eeds
0 L
Kin
gs 0
Bra
dfd
10 M
anW
st 9
Der
by 0
Shr
ew 5
B H
eart
2 N
orw
ch 2
Lei
c 6
B Q
EH 4
Mid
dlbr
11 L
Bar
ts 1
Car
dff
0 C
ovnt
0 O
xfor
d 5
Bel
fast
0 S
heff
0 P
rest
n 0
Exe
ter
2 S
tevn
g 3
L W
est
10 P
orts
0 G
louc
4 E
ngla
nd 6
N Ir
elan
d13
Wal
es 5
E,W
&NI
Centre
Per
cent
age
of p
atie
nts
Upper 95% confidence interval
% w ith P04=1.1-=1.8mmol/L
Low er 95% confidence interval
UK Renal Registry 10th Annual Report 2007
Fig 9.9 Percentage of patients with serum phosphate divided into bands
0
2
4
6
8
10
12
<0.8 0.8-<0.9
0.9-<1 1-<1.1 1.1-<1.2 1.2-<1.3
1.3-<1.4
1.4-<1.5
1.5-<1.6
1.6-<1.7
1.7-<1.8
1.8-<1.9
1.9-<2.0
2.0-<2.1
2.1-<2.2
2.2-<2.3
2.3-<2.4
2.4-<2.5
2.5-<2.6
2.6+
Serum phosphate band
Perc
enta
ge o
f pat
ient
s
HD patients
PD patients
UK Renal Registry 10th Annual Report 2007
Fig 9.10 Funnel plot for percentage achievement of phosphate <1.8mmol/L:HD
20
30
40
50
60
70
80
90
100
0 100 200 300 400 500 600 700 800 900 1,000 1,100
Number of patients in centre
Per
cent
age
of p
atie
nts
with
P0 4
=1.8
mm
ol/L
% w ith phosphate <1.8mmol/L
Upper 99.9% CIUpper 95% CI
Mean
Low er 95% CILow er 99.9% CI
UK Renal Registry 10th Annual Report 2007
Fig 9.11 Funnel plot for percentage achievement of phosphate ≥1.1-≤1.8mmol/L :HD
20
30
40
50
60
70
80
0 100 200 300 400 500 600 700 800 900 1,000 1,100
Number of patients in centre
Perc
enta
ge o
f pat
ient
s w
ith P
04 1
.1-
=1.8
mm
ol/L
% with phosphate =1.1-=1.8mmol/LUpper 99.9% CIUpper 95% CIMeanLower 95% CILower 99.9% CI
UK Renal Registry 10th Annual Report 2007
Fig 9.12 Funnel plot of percentage achievement of phosphate <1.8mmol/L:PD
30
40
50
60
70
80
90
100
25 50 75 100 125 150 175 200
Number of patients in centre
Per
cent
age
of p
atie
nts
with
P04
=1.8
mm
ol/L
% with phosphate <1.8mmol/LUpper 99.9% CIUpper 95% CIMeanLower 95% CILower 99.9% CI
UK Renal Registry 10th Annual Report 2007
Fig 9.13 Funnel plot of percentage achievement of phosphate ≥1.1-≤1.8mmol/L:PD
30
40
50
60
70
80
90
100
25 50 75 100 125 150 175 200
Number of patients in centre
Per
cent
age
of p
atie
nts
with
P0
4 =1
.1-
=1.8
mm
ol/L
% with P04 =1.1-=1.8mmol/LUpper 99.9% CIUpper 95% CIMeanLower 95% CILower 99.9% CI
UK Renal Registry 10th Annual Report 2007
Fig 9.14 Annual change in percentage of dialysis patients achieving serum corrected Ca ≥2.2-≤2.6mmol/L split by modality 1999-2006
50
55
60
65
70
75
80
85
90
1999
2000
2001
2002
2003
2004
2005
2006
1999
2000
2001
2002
2003
2004
2005
2006
Per
cent
age
of p
atie
nts
Haemodialysis Peritoneal dialysis
– Upper 95% CI¦ % w ith Corrected Ca =2.2-=2.6mmol/L
– Lower 95% CI
UK Renal Registry 10th Annual Report 2007
Fig 9.15 Percentage of patients with corrected calcium ≥2.2-≤2.6mmol/L : HD
40
50
60
70
80
90
100
Centre
Per
cent
age
of p
atie
nts
Upper 95% confidence interval % with corrected Ca=2.2-=2.6mmol/LLower 95% confidence interval
N = 13,960
UK Renal Registry 10th Annual Report 2007
Fig 9.16 Funnel plot of percentage achieving corrected calcium ≥2.2-≤2.6mmol/L:HD
40
50
60
70
80
90
100
0 100 200 300 400 500 600 700 800 900 1,000 1,100
Number of patients in centre
Per
cent
age
of p
atie
nts
with
cor
rect
ed c
alci
um
=2.2
-=2.
6mm
ol/L
% with corrected calcium =2.2-=2.6mmol/LUpper 99.9% CIUpper 95% CIMeanLower 95% CILower 99.9% CI
UK Renal Registry 10th Annual Report 2007
Fig 9.17 Percentage of patients with corrected calcium ≥2.2-≤2.6mmol/L : PD
40
50
60
70
80
90
100
2 D
orse
t 0
Bas
ldn
2 N
orw
ch
2 L
eeds
9 D
erby
0 O
xfor
d
0 G
louc
2 S
tevn
g 9
Por
ts
0 C
helm
s 1
Red
ng 0
Ban
gor
0 S
heff
0 B
radf
d 0
Cam
b 0
Cov
nt
2 W
olve
0 B
risto
l 3
Lei
c
3 L
Wes
t 5
B H
eart
0 P
lym
th
1 L
Guy
s 9
Yor
k 5
Bel
fast
5 B
QEH
0 L
Kin
gs 9
Hul
l
2 D
udle
y 1
Brig
htn
11 L
Bar
ts
0 E
xete
r 1
Car
dff
6 L
Rfr
ee
4 M
iddl
br 2
Liv
RI
3 C
arsh
0 P
rest
n 0
Ant
rim 4
Ipsw
i11
Man
Wst
2 N
ewc
3 S
wan
se 0
Not
tm
0 T
ruro
0 S
hrew
4 E
ngla
nd
6 N
Irel
and
13 W
ales
4 E
,W&N
I
Centre
Per
cent
age
of p
atie
nts
Upper 95% confidence interval
"% w ith corrected Ca =2.2-=2.6mmol/L"
Low er 95% confidence interval N = 3,366
UK Renal Registry 10th Annual Report 2007
Fig 9.18 Median calcium*phosphate product: Dialysis
2.0
2.5
3.0
3.5
4.0
4.5
5.0
5.5
Centres
Cal
cium
*pho
spat
e pr
oduc
t
Upper quartileMedian Ca*P 04 productLower quartile
N = 17,307
UK Renal Registry 10th Annual Report 2007
Fig 9.19 Percentage of patients with calcium*phosphate product <4.4mmol²/L² : Haemodialysis
40
50
60
70
80
90
100
Centre
Per
cent
age
of p
atie
nts
Upper 95% confidence interval% with Ca*Phos product <4.4mmol²/L²Lower 95% confidence interval N = 13,945
UK Renal Registry 10th Annual Report 2007
Fig 9.20 Funnel plot of percentage achieving Calcium*Phosphate product <4.4mmol²/L²:HD
30
40
50
60
70
80
90
100
0 100 200 300 400 500 600 700 800 900 1,000 1,100
Number of patients in unit
Per
cent
age
with
Ca*
P04
pro
duct
<4.4
mm
ol²/L
²
% w ith Ca*Phos product<4.4mmol²/L²
Upper 99.9% CI
Upper 95% CI
Mean
Low er 95% CI
Low er 99.9% CI
UK Renal Registry 10th Annual Report 2007
Fig 9.21 Percentage of patients with calcium*phosphate product <4.4mmol²/L²: Peritoneal dialysis
40
50
60
70
80
90
100
Centre
Per
cent
age
of p
atie
nts
Upper 95% conf idence interval% w ith corrected Ca*Phos product <4.4mmol²/L²Low er 95% conf idence interval
N = 3,362
UK Renal Registry 10th Annual Report 2007
Fig 9.22 Percentage of patients with Calcium*phosphate product <4.8mmol²/L²: Dialysis
50
55
60
65
70
75
80
85
90
95
100
Centre
Perc
enta
ge o
f pat
ient
s
Upper 95% confidence interval% with Ca*P04 product<4.8mmol²/L²
Lower 95% confidence interval N = 17,307
UK Renal Registry 10th Annual Report 2007
Fig 9.23 Change in percentage of patients achieving serum corrected calcium*phosphate product ≤4.4 mmol²/L²
1998 - 2006
50
55
60
65
70
75
80
85
90
95
100
199
8
199
9
200
0
20
01
20
02
20
03
20
04
20
05
20
06
199
8
199
9
200
0
200
1
200
2
200
3
20
04
20
05
20
06
Pe
rce
nta
ge o
f pa
tie
nts
Upper 95% CI
% w ith Ca*P04 produc t =4.4 mmol²/L²
Low er 95% CI
HD P D
UK Renal Registry 10th Annual Report 2007
Fig 9.24 Median iPTH in dialysis patients
0
10
20
30
40
50
60
70
80
Centre
iPTH
pm
ol/L
Upper quartileMedian iPTHLower quartile
N = 14,641
UK Renal Registry 10th Annual Report 2007
Fig 9.25 Percentage of patients on dialysis with iPTH < 32 pmol/L
30
40
50
60
70
80
90
100
Centre
Perce
ntage
of pa
tients
Upper 95% confidence interval
% with iPTH<32pmol/L
Lower 95% confidence intervalN = 14,641
UK Renal Registry 10th Annual Report 2007
Fig 9.26 Percentage of patients on dialysis with iPTH 16-32 pmol/L
0
10
20
30
40
50
60
Centre
Per
cent
age
of p
atie
nts
Upper 95% confidence interval
% w ith iPTH =16-=32pmol/L
Low er 95% confidence interval
N = 14,641
UK Renal Registry 10th Annual Report 2007
Fig 9.27 Median serum bicarbonate : Haemodialysis
17
19
21
23
25
27
29
31
33
Centre
Ser
um b
icar
bona
te m
mol
/L
Upper quartileMedian bicarbonateLower quartileN= 11,621
UK Renal Registry 10th Annual Report 2007
Fig 9.28 Percentage of patients with bicarbonate ≥20-≤26mmol/L : Haemodialysis
30
40
50
60
70
80
90
100
Centre
Per
cent
age
of p
atie
nts
Upper 95% confidence interval
% w ith bicarb 20-26mmol/L
Low er 95% confidence interval
N = 11,621
UK Renal Registry 10th Annual Report 2007
Fig 9.29 Percentage with serum bicarbonate ≥20-≤26mmol/L: HD
30
40
50
60
70
80
90
100
0 50 100 150 200 250 300 350 400 450 500 550 600 650
Number of patients in centre
Per
cent
age
with
bic
arbo
nate
=20
-=2
6mm
ol/L
% w ith bicarb =20-=26mmol/L
Upper 99.9% CI
Upper 95% CI
Low er 95% CI
Low er 99.9% CI
UK Renal Registry 10th Annual Report 2007
Fig 9.30 Median serum bicarbonate : Peritoneal dialysis
19
21
23
25
27
29
31
33
35
Centre
Ser
um b
icar
bona
te m
mol
/L
Upper quartileMedian bicarbonateLower quartile
N = 2,862
UK Renal Registry 10th Annual Report 2007
Fig 9.31 Percentage of patients with bicarbonate ≥25-≤29mmol/L :
Peritoneal dialysis
0
10
20
30
40
50
60
70
80
90
100
0 Sh
eff
2 N
ewc
0 B
asldn
11 H
ull
4 M
iddlbr
0 Gl
ouc
0 B
ristol
0 Sh
rew
5 B
Hear
t 0
Chelm
s 1
Redn
g15
Pre
stn 2
Wolv
e 6
Leic
9 De
rby
5 Yo
rk10
Tru
ro 2
Leed
s 0
Plym
th 2
Ste
vng
0 E
xeter
0 An
trim
0 Do
rset
2 No
rwch
12 L
Barts
5 Be
lfast
3 Ca
rdff
10 B
QEH
4 L
Wes
t 4
Ipswi
3 Sw
anse
4 D
udley
0 Ca
mb 0
Brad
fd23
Por
ts 4
Brig
htn
2 Liv
RI
6 B
ango
r22
Oxfo
rd 1
L Gu
ys 3
Cars
h20
Eng
land
8 N
Irela
nd15
Wal
es19
E,W
&NI
Centre
Perce
ntage
of pa
tients
Upper 95% confidence interval
% with bicarb =25-=29mmol/LLower 95% confidence interval
N = 2,862
UK Renal Registry 10th Annual Report 2007
Fig 9.32 Percentage with serum bicarbonate ≥25-≤29mmol/L:PD
10
20
30
40
50
60
70
80
90
0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180 190 200
Number of patients
Per
cent
age
with
bic
arb
=25
-=29
mm
ol/L
% with bicarb =25-=29mmol/LUpper 99.9% CIUpper 95% CIMeanLower 95% CILower99.9% CI
UK Renal Registry 10th Annual Report 2007
Fig 9.33 Median serum total cholesterol: Dialysis
2.5
3.0
3.5
4.0
4.5
5.0
5.5
15 H
ull
10 Y
ork
21 C
arsh
16 D
orse
t24
Liv
Ain
37 B
Hea
rt10
Bra
dfd
9 B
risto
l 1
Mid
dlbr
1 S
hrew
5 C
arlis
1 B
asld
n12
Sth
end
9 E
xete
r12
L G
uys
4 N
orw
ch13
Oxf
ord
17 C
lwyd
6 L
Kin
gs 3
Tyr
one
7 B
ango
r13
Car
dff
12 Ip
swi
3 C
helm
s35
Cam
b 6
L B
arts
10 L
Rfre
e 5
Lei
c 3
Not
tm 3
Red
ng 3
New
ry 0
Pre
stn
8 G
louc
46 S
tevn
g 4
B Q
EH13
L W
est
6 L
eeds
9 S
heff
2 S
wan
se 3
Tru
ro 9
Wol
ve 5
New
c 0
Der
ry17
Che
str
21 M
anW
st15
Wirr
al 9
Bel
fast
44 D
udle
y 4
Sun
d 0
Uls
ter
0 A
ntrim
13 P
lym
th20
Eng
land
5 N
Irel
and
16 W
ales
19 E
,W&N
I
Centre
Med
ian
chol
este
rol m
mol
/L
Upper quartileMedian total cholesterolLower quartile
N = 14,754
UK Renal Registry 10th Annual Report 2007
Fig 9.34 Median serum cholesterol: transplant
3.5
4.0
4.5
5.0
5.5
6.0
26 A
ntrim
30 H
ull
7 B
risto
l11
Cam
b40
Por
ts10
Exe
ter
40 B
Hea
rt31
Glo
uc26
Oxf
ord
9 S
hrew
8 C
arlis
19 Ip
swi
19 T
ruro
11 B
QEH
0 B
asld
n17
Mid
dlbr
12 W
olve
9 D
orse
t12
She
ff15
New
ry43
Brig
htn
8 L
Guy
s 3
Nor
wch
21 C
arsh
16 D
udle
y26
Sth
end
10 P
rest
n 2
L W
est
5 T
yron
e10
L R
free
12 N
ottm
32 S
tevn
g12
Yor
k 3
Bel
fast
11 C
ardf
f 9
L K
ings
11 L
eic
1 S
und
8 B
radf
d18
L B
arts
5 L
eeds
4 P
lym
th 3
New
c 3
Red
ng 2
Sw
anse
9 M
anW
st20
Eng
land
7 N
Irel
and
10 W
ales
19 E
,W&N
I
Centre
Med
ian
chol
este
rol m
mol
/L
Upper quartile
Median total cholesterol
Low er quartile
N = 12,729
UK Renal Registry 10th Annual Report 2007
Fig 9.35 Serum cholesterol distribution by modality 31/12/2006
0
5
10
15
20
25
30
35
40
45
1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 10 -11 11-12 12-13
Cholesterol mmol/L
Per
ecen
tage
of p
atie
nts
HD
PD
Tx
UK Renal Registry 10th Annual Report 2007
Fig 9.36 Percentage of patients with cholesterol ≤5mmol/L, 1997 - 2006, England, Wales and Northern Ireland
10
20
30
40
50
60
70
80
90
10019
97
1998
1999
2000
2001
2002
2003
2004
2005
2006
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Year
Per
cent
age
of p
atie
nts
Upper 95% CI% with cholesterol = 5 mmol/LLower 95% CI
Haemodialysis Peritoneal dialysis Transplant