Chapter 1 UK Renal Replacement Therapy Adult Incidence in 2016: National and Centre-specific Analyses.

The incidence rate in the UK decreased from 120 per million population (pmp) in 2015 to 118 pmp in 2016 reflecting renal replacement therapy (RRT) initiation for 7,759 new patients. The median age of all incident patients was 64.3 years, but this was highly dependent on ethnicity (66.2 years for White incident patients, 58.7 years for non-White patients). Diabetic renal disease remained the single most common cause of renal failure treated by RRT (28.6%). By 90 days, 66.6% of patients were on haemodialysis (HD), 19.6% on peritoneal dialysis (PD), 9.3% had a functioning transplant (Tx) and 4.6% had died or stopped treatment. The percentage of RRT patients at 90 days who had a functioning transplant varied between centres from 0% to 31% (between 2% and 31% for transplanting centres and between 0% and 19% for non-transplanting centres). The mean eGFR at the start of RRT was 7.4 ml/min/1.73 m(2) by the CKD-EPI method and 8.5 ml/min/1.73 m(2) by the MDRD method, similar to the previous five years. Late presentation continued to fall from 23.9% in 2006 to 15.6% in 2016. Timeline codes indicated that 6,891 first-ever HD sessions were delivered in 2016 across 62 centres in England, Wales and Northern Ireland. Of these, 2,581 (37.5%) were classified as acute HD and the remaining 4,310 (62.5%) as HD for established renal failure (ERF). Data relating to the first HD session were available for 5,373 (78.0%) HD starts. After centre exclusions, 4,191 (79.7%) of 5,257 timeline and sessional HD start dates were on the same day and 97.2% were within two weeks of each other. These low levels of discordance are unlikely to meaningfully influence overall survival data for HD recipients. Of the 2,581 individuals who received acute HD, 790 (30.6%) developed ERF and 1,791 (69.4%) died, stopped RRT or recovered renal function. It is vital that coding is consistent between centres. The UK Renal Registry (UKRR) asks clinicians to use the timeline to record the date of first dialysis and separately, the date on which the patient is deemed to have reached ERF. This allows patients who have an acute start to be distinguished from those whose start on RRT was planned.