UK Renal Registry 23rd Annual Report

Introduction

The UK Renal Registry (UKRR) plays a vital role in monitoring and reporting on kidney disease treatment across the United Kingdom. The 23rd Annual Report provides comprehensive data on renal replacement therapy (RRT) including dialysis and transplant outcomes. This report serves as a cornerstone for healthcare professionals, policymakers, and researchers working to improve kidney care standards and patient outcomes across the UK.

Established in 1995, the UK Renal Registry has consistently collected and analyzed data from renal centres throughout England, Wales, Scotland, and Northern Ireland. The 23rd report continues this tradition of excellence, offering insights into trends, treatment patterns, and outcomes that inform clinical practice and healthcare policy. Despite the challenges posed by the COVID-19 pandemic during the reporting period, the registry continued to gather essential data that paints a comprehensive picture of renal services in the UK.

Methods and Data Collection

The UKRR utilises standardised data collection protocols across all participating renal centres. Data entered includes patient demographics, primary renal diagnosis, treatment modality (haemodialysis, peritoneal dialysis, or transplantation), laboratory results, complications, and survival outcomes. This systematic approach ensures consistency and allows meaningful comparison between centres and countries within the UK.

For the 23rd report, analysis included adult patients receiving renal replacement therapy between 1st January 2020 and 31st December 2020, with some trends analyzed over longer timeframes. The registry employs various statistical methods to account for patient heterogeneity and ensure robust analysis of outcomes across different patient groups and treatment modalities.

Epidemiology of Kidney Disease

The report provides updated figures on the incidence and prevalence of established renal failure requiring renal replacement therapy in the UK population. These statistics help healthcare services plan resource allocation and identify high-risk populations that may benefit from targeted intervention strategies.

Geographical and Demographic Variations

The 23rd Annual Report highlighted significant variations in both incidence and prevalence of kidney disease across different regions of the UK and between different demographic groups. These variations have important implications for service planning and understanding of risk factors for kidney disease.

There were notable differences between countries within the UK, with Scotland reporting higher acceptance rates for renal replacement therapy compared to England and Wales. Urban areas generally demonstrated higher prevalence rates of kidney disease compared to rural areas, potentially reflecting differences in population demographics, accessibility of healthcare services, and prevalence of risk factors such as diabetes and hypertension.

Significant ethnic disparities were evident, with patients from South Asian and Black populations having substantially higher rates of kidney disease compared to White patients. These disparities were observed in both incidence of renal failure and outcomes following commencement of renal replacement therapy. Socioeconomic deprivation also correlated with higher incidence rates of kidney disease and poorer outcomes, highlighting the importance of addressing social determinants of health in kidney disease prevention and management.

Dialysis Outcomes

The report provides comprehensive analysis of dialysis outcomes including survival rates, technique failures, and achievement of clinical performance targets. For patients receiving dialysis, the one-year survival rate was 87.6%, while five-year survival was 42.8%. These figures remained relatively stable compared to previous years, despite the challenges posed by the COVID-19 pandemic.

Clinical Performance Targets

Assessment against established clinical performance targets showed varying levels of achievement across renal centres:

• Approximately 72% of dialysis patients achieved the recommended haemoglobin range (100-120 g/L).
• Serum phosphate levels were within target range in 58% of haemodialysis patients and 65% of peritoneal dialysis patients.
• Achievement of calcium and parathyroid hormone targets showed modest improvement compared to previous years.
• Vascular access outcomes remained a focus area, with 78% of prevalent haemodialysis patients using an arteriovenous fistula.

Home Dialysis Growth

The report highlighted continued growth in home dialysis therapies, a trend that accelerated during the COVID-19 pandemic. Many centres reported increased adoption of peritoneal dialysis and home haemodialysis as patients and clinicians sought alternatives to facility-based dialysis. This shift toward home therapies represents an important development that may have lasting impacts on dialysis service delivery models.

Transplantation Activity and Outcomes

Kidney transplantation continues to offer patients with established renal failure superior survival and quality of life compared with dialysis. The 23rd Annual Report provides detailed analysis of transplant activity and outcomes across the UK.

Waiting Times and Access

The median waiting time for a deceased donor transplant remained approximately 2.5-3 years, with substantial variation between different regions of the UK. Ethnic disparities in access to transplantation persisted, with White patients generally having shorter waiting times and higher transplantation rates compared to patients from minority ethnic groups. These disparities reflect complex interactions between biological factors, distribution of blood groups in donor populations, and potentially healthcare system factors.

Impact of COVID-19 on Renal Patients

The COVID-19 pandemic had profound implications for patients receiving renal replacement therapy. The 23rd Annual Report included dedicated analysis of the impact on this vulnerable population.

Mortality Impact

Patients receiving dialysis demonstrated particularly high mortality from COVID-19, with a case fatality rate of approximately 20% among those who contracted the virus. Transplant recipients also experienced elevated mortality compared to the general population, though at lower rates than dialysis patients. This excess mortality contributed to an overall increase in mortality among the renal replacement therapy population during 2020.

Service Delivery Changes

Renal services rapidly adapted to the pandemic through implementation of telemedicine, reorganization of dialysis units to enable social distancing, and temporary suspension of transplantation activities during peaks of COVID-19 prevalence. These changes necessitated significant adjustments in clinical practice and had both positive and negative impacts on patient care.

Vaccination Response

Renal patients were identified as a priority group for COVID-19 vaccination. Early data suggested that while most dialysis and transplant recipients developed antibody responses to vaccination, these were generally at lower levels than in the general population. This highlighted the need for continued protective measures even after vaccination and consideration of additional booster doses in this vulnerable population.

Children and Young People

The report included a dedicated chapter on renal replacement therapy in children and young people. The outcomes in this population continued to be excellent, with one-year survival of 97.2% and ten-year survival of 89.1% for patients commencing dialysis. The prevalence of children receiving renal replacement therapy increased slightly, with approximately 1,000 children and young people (age <18 years) in the UK receiving renal replacement therapy at the end of 2020.

For children with kidney disease, growth and educational outcomes remain important quality of life indicators in addition to medical outcomes. The report highlighted that approximately 65% of children on dialysis achieved acceptable height parameters when compared with age-matched controls, indicating improved management of growth-related complications.

Quality Improvement Initiatives

The UK Renal Registry continues to support quality improvement through benchmarking of clinical performance indicators between centres. The 23rd Annual Report demonstrated significant variation between centres in achievement of clinical targets, highlighting opportunities for improvement through sharing of best practices.

Participation in clinical audit remains a cornerstone of quality improvement in renal medicine. Over 95% of UK renal centres contributed data to the registry, demonstrating strong engagement with this process. The report highlighted several centres that had shown particular improvements in clinical outcomes year-on-year, illustrating the value of audit and feedback in driving quality improvement.

Future Directions and Recommendations

Based on the findings from the 23rd Annual Report, several key recommendations for future development of renal services were identified:

• Addressing persistent health inequalities through targeted interventions for high-risk populations and communities.
• Continuing to expand access to home therapies including peritoneal dialysis and home haemodialysis.
• Developing more integrated models of care that span primary and secondary care to enable earlier identification and management of kidney disease.
• Enhancing transplantation rates through increased utilization of marginal donor organs and expansion of living donor programs.
• Implementing and evaluating digital innovations in renal care that were accelerated during the COVID-19 pandemic.
• Developing personalised approaches to kidney care based on individual patient characteristics and preferences.

Conclusion

The UK Renal Registry 23rd Annual Report provides a valuable comprehensive overview of renal replacement therapy across the United Kingdom. Despite the challenges posed by the COVID-19 pandemic, the report demonstrates the continued resilience and quality of renal services throughout the UK. The data collected and analyzed by the registry continues to support clinical practice improvement, healthcare planning, and research into kidney disease.

The findings highlight both strengths of the UK renal system and areas requiring continued attention, particularly in addressing disparities in access and outcomes between different population groups. As the UK renal community looks forward to the future, the UK Renal Registry will continue to play an essential role in monitoring progress, identifying challenges, and supporting the delivery of high-quality, equitable care for all patients with kidney disease.