Chapter 13: The UK Renal Registry Advanced CKD Study: frequency of incorrect reporting of date of start of RRT

Abstract

Background: A preliminary review of the UK Renal Registry (UKRR) pre-RRT study data revealed results suggesting that, for some patients, the date of start of renal replacement therapy (RRT), as reported to the UKRR, was incorrect and often significantly later than the true date of start. A more detailed study then aimed to validate a set of criteria to identify patients with an incorrect start date. Methods: Pre-RRT laboratory data were electronically extracted from 8,810 incident RRT patients from 9 UK renal centres. Any patient with a low urea (<15 mmol/L) at the start of RRT or with a substantial improvement in kidney function (either a fall in urea >10 mmol/L or rise in eGFR >2 ml/ min/1.73 m) within the two months prior to RRT were considered to potentially have an incorrect date of start. In 4 selected centres, the electronic patient records of all patients flagged were reviewed to validate these criteria. Results: Of 8,810 patients, 1,616 (18.3%) were flagged by the identification criteria as having a potentially incorrect date of start of RRT, although a single centre accounted for 41% of the total flagged cohort. Of these flagged patients, 61.7% had been assigned an incorrect date of start of haemodialysis (HD), 5.7% had evidence of acute RRT being given before the reported date of start of HD and 9.2% had evidence of starting peritoneal dialysis exchanges prior to the reported date of start. Of those flagged, 10.7% had a correct date of start of RRT. Conclusions: Accurate reporting of RRT episodes is vital for the analysis of time dependent studies such as survival or time to transplantation. A proportion of patients starting RRT were assigned an incorrect start date. In order to improve the accuracy of this reporting the UK Renal Registry must work with renal centres and clinical staff on improving data input for the start of RRT.

UK Renal Registry 18th Annual Report: Chapter 6 Comorbidities and Current Smoking Status amongst Patients starting Renal Replacement Therapy in England, Wales and Northern Ireland from 2013 to 2014

“…Many UKRR analyses, including those presented here, rely on the accuracy of the date of start of RRT. A discussion of the issues around the definition of the start date is included in chapter 13 of the 2009 Annual Report [15].…”

UK Renal Registry 15th Annual Report: Chapter 5 Survival and Causes of Death of UK Adult Patients on Renal Replacement Therapy in 2011: National and Centre-Specific Analyses

“…However, adherence to this require- Steenkamp/Shaw/Feest ment was very variable, with some clinicians entering a code for established renal failure only once a decision had been made to plan for long-term RRT [6]. All UK nephrologists have now been asked to record the date of the first haemodialysis session and to record whether the patient was considered to have acute kidney injury (acute renal failure) or to be in ERF at the time.…”

Chapter 1 UK RRT Incidence in 2010: National and Centre-Specific Analyses

“…In these patients, the eGFR used for analysis in some patients may have been taken whilst they were already receiving RRT and thus be artificially high. The details of this analysis and a subsequent validation study were described in detail in the 12th Annual Report chapter 13: The UK Renal Registry Advanced CKD Study 2009 [5].…”