Cardiovascular disease profile

Transcription

1 Cardiovascular disease profile Kidney disease Background This chapter of the Cardiovascular disease profiles focuses on kidney disease and is produced by the National Cardiovascular Intelligence Network (NCVIN). The profiles are available for each clinical commissioning group (CCG) in. Each profile is made up of five chapters which look at risk factors, coronary heart disease (CHD), diabetes, kidney disease and stroke. This profile compares the CCG with data for, a group of similar CCGs and the South West Coast strategic clinical network (). Key facts Observed prevalence of CKD Estimated prevalence of CKD 3.4% 6.6% Comparator CCGs 6.8% 4.5% 4.8% 4.3% 6.7% 6.1% Key information August 214 The total population of NHS Wiltshire CCG is 477, and 9,5 of these people are aged 65 and over, a higher proportion than across as a whole. In the CCG, 2.% of people live in the most deprived fifth of areas in. In 212/13 there were 12,78 people over 18 years of age who had been diagnosed with chronic kidney disease (CKD) in NHS Wiltshire CCG. This represents 3.4% of the population aged 18 and over. There was wide variation in achievement of the CKD Quality and Outcomes Framework (QOF) indicators at practice level within the CCG in 212/13. Patients diagnosed with CKD whom the last blood pressure reading is 14/85 or less Number of people on RRT Proportion of people on RRT with transplants 71.% 7.7% 7.6% 3-3, % 53.9% 53.% 71.6% 44,41 5.1% There were 3 NHS Wiltshire CCG residents receiving renal replacement therapy (RRT) in 212. The number of residents receiving RRT between 27 and 212 has increased by 23.%. In in 212 the percentage of people receiving RRT who have had a renal transplant was 59.3%, a further 35.% received haemodialysis and 5.7% received peritoneal dialysis. Produced by the National Cardiovascular Intelligence Network (NCVIN) PHE publications gateway Crown copyright Page 1

2 Prevalence CKD is classified into five stages. This profile describes the prevalence and management of moderate to severe CKD (ie CKD stages 3 5 as defined by the National Institute for Health and Care Excellence). This is consistent with the Quality and Outcomes Framework (QOF) but this simplified grouping misses some important detail within stages. Stage 3 CKD can be sub classified into 3a and 3b with stage 3b experiencing a higher risk of CVD and end stage renal disease (ESRD) than those in 3a. The presence of proteinuria is also important, as it is associated with a higher risk of ESRD and death independent of CKD stage, and may lead to further treatment options being considered. Patients diagnosed with CKD benefit from early treatment which is proven to reduce mortality and slow progressive decline in kidney function. Diagnosis also highlights patients at risk of greater harm due to the side effects of medication and acute kidney injury. The figure below compares diagnosed (observed) CKD to an estimate of total levels of CKD (diagnosed and undiagnosed) in the population. Chronic kidney disease prevalence, 212/13 (percentage) Estimated CKD (16+ years) Diagnosed CKD (18+ years) Source: Quality and Outcomes Framework (QOF), 212/13, Copyright 214, Re-used with the permission of the Health and Social Care Information Centre. All rights reserved. Prevalence estimates unpublished data, G.Aitken, University of Southampton Variation by general practice of chronic kidney disease prevalence, 212/13 (percentage) Diagnosed CKD prevalence (QOF) CCG diagnosed CKD prevalence (QOF) (practices censored at 16%) Page 2

3 Care processes and treatment indicators 212/13 There are four QOF CKD treatment indicators which describe the management of CKD in primary care. The graphs below present achievement against three of the QOF CKD clinical indicators for the CCG as a whole and for the practices within the CCG. Patients on the CKD register in whom the last blood pressure reading, measured in previous 15 months is 14/85 or less CKD-3, 212/13 (percentage) Variation by general practice for CKD- 3, 212/13 (percentage) Patients on the CKD register with hypertension and proteinuria who are treated with angiotensin converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB), CKD-5, 212/13 (percentage) Comparator group of CCGs Variation by general practice for CKD-5, 212/13 (percentage) Page 3

4 Care processes and treatment indicators 212/13 Patients on the CKD register whose notes have a record of a urine albumin: creatinine ratio test in previous 15 months, CKD-6, 212/13 (percentage) Variation by general practice of CKD- 6, 212/13 (percentage) Acute kidney injury Acute kidney injury (AKI) is a common and serious problem amongst hospitalised patients. The NCEPOD report Acute kidney injury: adding insult to injury' highlights the process of care of patients who died in hospital with a primary diagnosis of AKI and takes a critical look at areas where the care of patients might have been improved. Despite AKI representing a significant cause of preventable patient harm, the exact incidence of AKI in hospitals is unclear, as is the quality of care such patients receive. The incidence of AKI in the general population from UK data ranges from 172 per million population (pmp) per year from early data up to 486 to 63 pmp/year from more recent series depending on the definition of AKI which is used. It is estimated that AKI is seen in 13% to 18% of all people admitted to hospital although more recently an English study suggested that AKI was present in 5.4% of all hospital admissions. Some of this variability may be due to differences in the population groups studied. The cost of AKI to the health service was estimated to be approximately 5 million pounds in Research to investigate where AKI is occurring in the care pathways shows that much of it is present in emergency and admitting departments, highlighting that the beginning of the injury is often in primary care, before admission to hospital. A national initiative is underway to improve the diagnosis and management of AKI Analysis of hospital activity data has not been included in this profile as it under estimates the true level of AKI and may be misleading. Information from the national AKI initiative will be included in future profiles. Page 4

5 End stage renal disease (ESRD) This section summarises some indicators of service use and the care delivered to the CCG by kidney centres. The data is taken from the UK Renal Registry (UK RR). People within the CCG may attend different kidney centres and these and other indicators are available at kidney centre level from the UK RR website Variability between these kidney centre indicators can reflect different patterns of service provision, for example, transplant centres or differences in the populations or the geographical areas served by the centres. Data should be interpreted with local knowledge in mind. Preparation for renal replacement therapy (RRT) It is clinically advantageous for people with ESRD to be referred to kidney services early to allow consideration of treatment options and for kidney disease and complications such as anaemia to be managed. Renal Association guidelines recommend that haemoglobin (Hb) levels should be 1g/dl or higher six months after being seen by a kidney doctor (Hb at start of dialysis is used to estimate these levels). It is estimated that 9 days is sufficient time to receive optimum preparation by the kidney team prior to starting RRT. There are several reasons why Hb levels and 9 days of specialist care may not be achieved, due to clinical or service provision issues. For some CCGs the number of patients is low or the data incomplete and information on late presentation and Hb has been suppressed. RRT patients presenting late (less than 9 days before RRT), 211 and 212 combined (percentage) RRT patients with haemoglobin greater than 1, 212 (percentage) Source: UKRR 212. The interpretation and reporting of these data are the responsibility of NCVIN and should not be seen as an official policy or interpretation of the UKRR or Renal Association. Provision of services RRT acceptance rate (per million population) 27/ Ratio of observed / expected number of people accepted onto RRT (27/12) Number of people receiving RRT 3-3,74 44,41 Change in number of people on RRT (percentage) Proportion of patients on home dialysis (home HD and PD combined) (percentage) Source: UKRR 212 Acceptance rates reflect the number of patients commencing RRT. Acceptance and prevalence rates vary between different CCGs. This is due to a number of different reasons reflecting the demography of the local population and demand for and supply of RRT services within local areas. Page 5

6 Proportion of people on RRT by type of dialysis It is important that patients receive enough information to make an informed decision about RRT treatment options, including conservative care. The different types of dialysis are peritoneal dialysis, and haemodialysis which can be either home or unit-based. There are variations in the type of RRT received by patients in different CCGs. RRT by type of dialysis, 212 (percentage) Transplant Haemodialysis Peritoneal dialysis 59.3 Source: UKRR Transport to kidney centres for people requiring RRT Transport issues impact on the quality of life for people requiring RRT. This section summarises some of the findings from the national patient transport audit conducted in 212. The Renal Association Haemodialysis Clinical Practice Guidelines recommend that "except in remote geographical areas the travel time to a haemodialysis facility should be less than 3 minutes or a haemodialysis facility should be located within 25 miles of the patient s home". CCG level data are supressed where the number of survey responses are too low for reliable analysis. Travel times and distances, and satisfaction with transport services Patients living less than 1 miles from their kidney centre, 212 (percentage) Patients living less than 3 minutes travel time from their kidney centre, 212 (percentage) Source: NHS kidney care - patient transport audit 212 Satisfaction with transport to kidney centre, 212 (percentage) Source: NHS kidney care - patient transport audit Source: NHS kidney care - patient transport audit 212 A list of references for each chapter is given in the indicator guide for the profiles. Crown copyright 214 You may re-use this information (excluding logos) free of charge in any format or medium, under the terms of the Open Government Licence v2.. To view this licence, visit OGL or psi@nationalarchives.gsi.gov.uk. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. Any enquiries regarding this publication should be sent to ncvin@phe.gov.uk Page 6