uk renal registry 15th annual report figure 5.26. one year death rate per 1,000 patient years by uk...
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Death Audit 2012Aled Lewis
Hemakumar Mallappa
Background Audit started with 2010 cohort in North Wales
Aims to assess number of deaths of RRT patients
if death within 1 year, was conservative management more appropriate?
location of death, and palliative care involvement
subjective assessment if death was expected and/or preventable
documentation of cause of death
Extended to all Wales 2011
Difficulty comparing data, and depth of information
Data unadjusted therefore comparisons impossible between units
Definitions Prevalent population
All patients on RRT surviving for >90 days from start of modality during the year in question
But Renal Registry definition All patients aged >18 years, alive and receiving RRT on 31st
December who had been on RRT for at least 90 days at a UK adult centre
UK Renal Registry 15th Annual Report
Figure 5.26. One year death rate per 1,000 patient years by UKcountry and age group for prevalent dialysis patients, 2010 cohort
UK Renal Registry 15th Annual Report
Figure 1.1. RRT incidence rates in the countriesof the UK 1990–2011
UK Renal Registry 15th Annual Report
Figure 2.1. Prevalence rates per million populationby age group and UK country on 31/12/2011
UK Renal Registry 15th Annual Report
Figure 5.24. One year survival of prevalent dialysis patients by centre adjusted to age 60, 2010 cohort
UK Renal Registry 14th Annual Report
Figure 6.24. One year survival of prevalent dialysis patients in each centre adjusted to age 60, 2010
Unit Prevalent Rates 2012South East
South West
Bangor Wrexham
Glan Clwyd
HD 491 357 86 103 90
PD 77 70 15 22 20
Tx 824 275 68 138 83
Total 1392 702 169 263 193
Deaths 113 * 74 14 * 29 19
*transplant deaths not documented
Prevalence figures from November 2012 Wales RRT Capacity Data, Kieron Donovan/WRCN
South East 99 HD, 14 PD =113 deaths
Mean age 72.14 years
Mean length of RRT 4.32 years
20 dialysis withdrawals
16 deaths within 1 year of starting modality
63 patients had previous RRT modality
South West 62 HD, 7 PD, 5 transplant = 74 deaths
Mean age 73.3 years
Mean length of RRT 4.98 years
13 dialysis withdrawals
13 deaths within 1 year of starting modality
17 patients had previous RRT modality
25 deaths predictable
3 preventable
Bangor 10 HD, 4 PD = 14 deaths
Mean age 73.9 years
Mean length of RRT 4.18 years
5 dialysis withdrawals
0 deaths within 1 year of starting modality
7 patients had previous RRT modality
9 deaths predictable
0 preventable
Wrexham 19 HD, 4 PD, 6 transplant = 29 deaths
Mean age 68.9 years
Mean length of RRT 6.91 years
7 dialysis withdrawals
4 deaths within 1 year of starting modality
11 patients had previous RRT modality
16 deaths predictable
2 preventable
Glan Clwyd 12 HD, 3 PD, 4 transplant = 19 deaths
Mean age 70.86 years
Mean length of RRT 8.2 years
10 dialysis withdrawals
3 deaths within 1 year of starting modality
10 patients had previous RRT modality
12 deaths predictable
2 preventable
Deaths Within 1 Year
South East 16 deaths within 1 year- all HD
Mean age 72.01 years
3 previous RRT modalities
9 unknown/unexpected
7 expected, with 4 withdrawal of dialysis
South West 13 deaths within 1 year (12 HD, 1 PD)
Mean age 78.3 years
1 previous RRT modality
5 predictable, 3 withdrawal of dialysis
11 deaths in hospital, 2 at home
Palliative care involved in 3 deaths
1 preventable
Bangor No deaths within 1 year
Wrexham 4 deaths within 1 year (3 HD, 1 PD)
Mean age 76.5 years
No previous RRT modality
All predictable, 2 withdrawal of dialysis
3 deaths in hospital, 1 at home
Palliative care involved in 2 deaths
None preventable
Glan Clwyd 3 deaths within 1 year ( All HD)
Mean age 69.54 years
1 previous RRT modality
2 predictable, 1 withdrawal of dialysis
2 deaths in hospital, 1 at home
Palliative care involved in 1 death
None preventable
Preventable Deaths
South East
South West 3 deaths preventable
1. 60 year old, HD via AVF 27 months
High grade lymphoma and PVD
2. 45 year old, transplant for 58 months
Metastatic carcinoma
3. 76 year old, HD via AVF 3 months
Ischaemic limb, known PVD and DM
Bangor No deaths preventable
Wrexham 2 deaths preventable
1. 84 year old, HD via permcath 19 months
DM and previous CVA
Fall, fractured NOF
CDT+ve, following sepsis
2. 59 year old, HD via AVF 14 months
DM and IHD
Sepsis due to VRE after starting methotrexate (not in dialysis centre)
Glan Clwyd 2 deaths preventable
1. 55 year old, failing transplant with AVF (312 months)
DM- collapse at home with hypoglycaemia
Delayed presentation with hypoglycaemic brain injury
Treatment withdrawn on ITU
2. 84 year old, HD via permcath (42 months)
Severe OA- total hip replacement
Died on ITU post-op, pneumonia and CCF
Summary Difficult to define prevalent RRT population
Impossible to compare death rates between units, but may provide early indication of high death rates in individual units
Allows comparison of RR data, more detailed assessment of comorbidity data, and further feedback if information requested
Importance of ongoing RRT education to inform on conservative management
Action points Move to incident death reporting
Document pre-emptive transplant rate and conservative management numbers
Consider earlier decision on withdrawal of dialysis, and palliative care involvement (?Advance Care Plan for all RRT patients)
Support discharge home if palliative care (55 withdrawals, 13 deaths at home)
Any Questions?