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  • The Burden, Impact and Costs of Dialysis

    - The Data Viewpoint

    Dr Shona Methven

    Senior Clinical Research Fellow

    UK Renal Registry

  • Aim

    To implement and evaluate a quality improvement programme toidentify patients at high risk of progressive renal decline, usingeGFR graph reports sent to primary care in sites across the UK

    P - Patient populationI - InterventionC - ComparatorO - OutcomeS - Study Design

    Patients with CKD not yet referred to nephrology

    Graph of eGFR over time with individualised advice

    Routine care

    Late referral rate to nephrology

    Step Wedge RCT

  • Improve outcomes

    Reduce avoidable late presentation

    Reduce ESKD

    Improve equity of access

    Reduce costs

    For individuals

    For society

  • Improve outcomes

    Reduce avoidable late presentation

    Reduce ESKD

    Improve equity of access

    Reduce costs

    For individuals

    For society

  • Improve outcomes

    Reduce avoidable late presentation

    Reduce ESKD

    Improve equity of access

    Reduce costs

    For individuals

    For society

  • Comparative audit of all UK Renal Units

    - Quality assurance

    - Dashboard indicators

    - Commissioning data

    - Efficient clinical trials

  • UK Renal Registry 18th Annual Report

    Percentage of people presenting late (2013/2014)

    Inequity of Access

    to Specialist Services

  • Late presentation of ESKD

    Unavoidable

    vs

    Avoidable

    Acute Diagnoses Group

    Crescentic GN/ anti GBM disease

    Cisplatin Nephrotoxicity

    Malignant Hypertension

    Polyarteritis/ GPA/ cryoglobulinaemia

    Myeloma/ LCDD

    Systemic sclerosis

    Cortical necrosis/ irreversible ATN

    Surgery/trauma

  • Late presentation of ESKD

    Unavoidable

    vs

    Avoidable

    UK Renal Registry 18th Annual Report

  • BurdenImpact

    Costs

  • Consequences of late presentation

    Low prevalence of permanent access

    Delayed referral for transplant

    Greater initial hospitalisation rate

    Higher mortality

    Reduced patient choice of RRT modality

    Anaemia and bone disease

    Severe hypertension & fluid overload

    Worse psychosocial adjustment

  • Consequences of late presentation

    Low prevalence of permanent access

    Delayed referral for transplant

    Greater initial hospitalisation rate

    Higher mortality

    Reduced patient choice of RRT modality

    Anaemia and bone disease

    Severe hypertension & fluid overload

    Worse psychosocial adjustment

  • Consequences of late presentation

    Low prevalence of permanent access

    Delayed referral for transplant

    Greater initial hospitalisation rate

    Higher mortality

    Reduced patient choice of RRT modality

    Anaemia and bone disease

    Severe hypertension & fluid overload

    Worse psychosocial adjustment

  • Consequences of late presentation Benefits of early presentation

    Low prevalence of permanent access Greater proportion with permanent access

    Delayed referral for transplant Reduced need for urgent dialysis

    Greater initial hospitalisation rate Reduced hospital LOS and costs

    Higher mortality Improved survival

    Reduced patient choice of RRT modality Greater choice of treatment options

    Anaemia and bone disease Improved nutrition

    Severe hypertension & fluid overload Better CVD and comorbidity management

    Worse psychosocial adjustment Delay need to initiate RRT

    Overall 2-fold increased risk of

    death in group referred late (Chan Am J Med 2007)

  • UK Renal Registry 18th Annual Report

    Survival of incident patients (unadjusted), 19972013

  • Burden

    ImpactCosts

  • Quality of Life with CKD

    0% 20% 40% 60% 80% 100%

    Mobility

    Self-care

    Usual Activities

    Pain or Discomfort

    Anxiety or Depression

    Absent Mild Moderate Severe Overwhelming

    Data from Transforming Participation in CKD

  • Burden

    Impact

    Costs

  • Costs attributable to CKD (to the nearest million), 200910.

    Marion Kerr et al. Nephrol. Dial. Transplant. 2012;27:73-80

  • Estimated annual cost of direct CKD

    care, RRT and non-RRT patients.

    Marion Kerr et al. Nephrol. Dial. Transplant. 2012;27:73-80

  • Do NothingDo Nothing

    DANGER

    Maintain Invest

  • Do Nothing MaintainMaintain Invest

  • Do Nothing Invest

    To Save

    Maintain

  • Estimated annual cost of direct CKD

    care, RRT and non-RRT patients.

    Marion Kerr et al.

    Nephrol. Dial. Transplant.

    2012;27:73-80

  • Evaluation using Mixed Methods Approach

    Quantitative 1y outcome uses routinely collected data

    Efficacy of the intervention

    Balancing measure of OP appt activity

    Qualitative Acceptability

    Barriers and facilitators to spread

  • Advanced Kidney Disease

    Burden

    Impact

    Costs

    By working together we can show the worth of the ASSIST-CKD intervention

  • Thank you to you and your colleagues for taking part in this

    project

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