Chapter 6 Adequacy of Haemodialysis in UK Adult Patients in 2016: National and Centre-specific Analyses

BACKGROUND Outcome in patients treated with haemodialysis (HD) is influenced by the delivered dose of dialysis. The UK Renal Association (RA) publishes clinical practice guidelines which include recommendations for dialysis dose. The urea reduction ratio (URR) is a widely used measure of dialysis dose. AIM To determine the extent to which patients received the recommended dose of HD in the UK. METHODS All seventy-two UK renal centres submitted data to the UK Renal Registry (UKRR). Two groups of patients were included in the analyses: the prevalent patient population on 31st December 2010 and the incident patient population for 2010. Centres returning data on 65%) increased from 56% in 1998 to 86% in 2010. There was persistent variation observed between centres, with 19 centres attaining the RA clinical practice guideline in >90% of patients and 39 centres attaining the guideline in 70-90%. The overall proportion of prevalent patients with a URR >65% has continued to improve over time. CONCLUSIONS The delivered dose of HD for patients with established renal failure has increased over the last decade. Whilst the majority of UK patients achieved the target URR there was considerable variation between centres in the percentage of patients achieving the guideline.

[1]  A. Davenport,et al.  Comparison of resting energy equations and total energy expenditure in haemodialysis patients and body composition measured by multi‐frequency bioimpedance , 2018, Nephrology.

[2]  W. van Biesen,et al.  Is Kt/V useful in elderly dialysis patients? Pro and Con arguments , 2018, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[3]  A. Davenport Is Hemodialysis Patient Survival Dependent upon Small Solute Clearance (Kt/V)? , 2017, Seminars in dialysis.

[4]  A. Davenport,et al.  Comparison of Estimates of Resting Energy Expenditure Equations in Haemodialysis Patients , 2017, The International journal of artificial organs.

[5]  A. Davenport,et al.  Scaling Hemodialysis Target Dose to Reflect Body Surface Area, Metabolic Activity, and Protein Catabolic Rate: A Prospective, Cross-sectional Study. , 2017, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[6]  T. D. Ivanov KDOQI clinical practice guideline for hemodialysis adequacy: 2015 update , 2016 .

[7]  K. Farrington,et al.  Predicting residual kidney function in hemodialysis patients using serum β-trace protein and β2-microglobulin. , 2016, Kidney international.

[8]  T. Wilt,et al.  KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 update. , 2015, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[9]  Sunny Eloot,et al.  Once upon a time in dialysis: the last days of Kt/V? , 2015, Kidney international.

[10]  A. Davenport Differences in prescribed Kt/V and delivered haemodialysis dose--why obesity makes a difference to survival for haemodialysis patients when using a 'one size fits all' Kt/V target. , 2013, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[11]  A. Davenport,et al.  The Effects of Racial Differences on Body Composition and Total Body Water Measured by Multifrequency Bioelectrical Impedance Analysis Influence Delivered Kt/V Dialysis Dosing , 2013, Nephron Clinical Practice.

[12]  F. Dekker,et al.  Agreement between different parameters of dialysis dose in achieving treatment targets: results from the NECOSAD study. , 2012, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[13]  A. Davenport How best to improve survival in hemodialysis patients: solute clearance or volume control? , 2011, Kidney international.

[14]  C. Tomson,et al.  UK Renal Registry 11th Annual Report (December 2008): Chapter 15 The UK Renal Registry, UKRR database, validation and methodology , 2009, Nephron Clinical Practice.

[15]  F. Collart,et al.  Assessment of urea removal in haemodialysis and the impact of the European Best Practice Guidelines. , 2008, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[16]  C. Basile,et al.  Dialysis time is the crucial factor in the adequacy of hemodialysis. , 2008, Kidney international.

[17]  A. Davenport,et al.  Kt/V underestimates the hemodialysis dose in women and small men. , 2008, Kidney international.

[18]  P. Verdonck,et al.  Impact of hemodialysis duration on the removal of uremic retention solutes. , 2008, Kidney international.

[19]  E. Lowrie The kinetic behaviors of urea and other marker molecules during hemodialysis. , 2007, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[20]  P. Verdonck,et al.  Complex compartmental behavior of small water-soluble uremic retention solutes: evaluation by direct measurements in plasma and erythrocytes. , 2007, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[21]  C. Wanner,et al.  EBPG guideline on dialysis strategies. , 2007, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[22]  P. Kerr,et al.  Associations of hemodialysis dose and session length with mortality risk in Australian and New Zealand patients. , 2006, Kidney international.

[23]  J. Bragg-Gresham,et al.  Longer treatment time and slower ultrafiltration in hemodialysis: associations with reduced mortality in the DOPPS. , 2006, Kidney international.

[24]  Hans Köhler,et al.  Dialysis dose and frequency. , 2005, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[25]  R. Wolfe,et al.  High dialysis dose is associated with lower mortality among women but not among men. , 2004, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[26]  G. Beck,et al.  Dialysis dose and the effect of gender and body size on outcome in the HEMO Study. , 2004, Kidney international.

[27]  J. Traynor,et al.  A new method of post-dialysis blood urea sampling: the 'stop dialysate flow' method. , 2000, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[28]  J T Daugirdas,et al.  The dose of hemodialysis and patient mortality. , 1996, Kidney international.

[29]  T. Depner,et al.  Assessing adequacy of hemodialysis: urea modeling. , 1994, Kidney international.

[30]  E G Lowrie,et al.  The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis. , 1993, The New England journal of medicine.

[31]  J A Sargent,et al.  A mechanistic analysis of the National Cooperative Dialysis Study (NCDS). , 1985, Kidney international.

[32]  C. Courivaud [Incremental haemodialysis]. , 2018, Nephrologie & therapeutique.

[33]  A. Davenport,et al.  Screening for muscle loss in patients established on peritoneal dialysis using bioimpedance , 2017, European Journal of Clinical Nutrition.

[34]  M. Woodward,et al.  Higher convection volume exchange with online hemodiafiltration is associated with survival advantage for dialysis patients: the effect of adjustment for body size. , 2016, Kidney international.

[35]  John T Daugirdas,et al.  Factors that affect postdialysis rebound in serum urea concentration, including the rate of dialysis: results from the HEMO Study. , 2004, Journal of the American Society of Nephrology : JASN.

[36]  rendan,et al.  EFFECT OF DIALYSIS DOSE AND MEMBRANE FLUX IN MAINTENANCE HEMODIALYSIS , 2002 .