UK Renal Registry 11th Annual Report (December 2008): Chapter 10 Biochemistry profile of patients receiving dialysis in the UK in 2007: national and centre-specific analyses.
BACKGROUND
The UK Renal Association Clinical Practice Guidelines include clinical performance measures for biochemical parameters in dialysis patients [1]. The UK Renal Registry (UKRR) annually audits dialysis centre performance against these measures as part of its role in promoting continuous quality improvement.


METHODS
Cross sectional performance analyses were undertaken to compare dialysis centre achievement of clinical audit measures for prevalent haemodialysis (HD) and peritoneal dialysis (PD) cohorts in 2007. The biochemical variables studied were phosphate, adjusted calcium, parathyroid hormone, bicarbonate and total cholesterol. In addition longitudinal analyses were performed (2000-2007) to show changes in achievement of clinical performance measures over time.


RESULTS
Serum phosphate was between 1.1-1.8 mmol/L in 53% of HD and 64% of PD patients. Since 2003 there has been annual improvement in phosphate control for both HD and PD patients, largely through a reduction in phosphate >1.8 mmol/L. PD patients this year also showed a reduction in the percentage with a low phosphate. Adjusted calcium was between 2.2-2.6 mmol/L in 73% of HD and 78% of PD patients. Parathyroid hormone was between 16-32 pmol/L in 25% of HD and 27% of PD patients. The audit measure for bicarbonate was achieved in 71% of HD and 50% of PD patients. There was inter-centre variation for all variables studied.


CONCLUSIONS
The UKRR consistently demonstrates inter-centre variation in achievement of biochemical clinical audit measures. Understanding the causes of this variation is an important part of improving the care of dialysis patients in the UK.
Hodsman
Alex
A
UK Renal Registry, Southmead Hospital, Bristol, UK. renalreg@renalreg.com
Lamb
Edmund J
EJ
Steenkamp
Retha
R
Warwick
Graham
G
D000328:Adult; D015415:Biomarkers / Q000097:blood; D002118:Calcium / Q000097:blood*; D002784:Cholesterol / Q000097:blood*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000097:blood*; D012042:Registries; D006435:Renal Dialysis / Q000401:mortality*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
D015415:Biomarkers; D010710:Phosphates; D002784:Cholesterol; D002118:Calcium