Using geographical information systems to plan dialysis facility provision.
Explore the source record for details and available documents.
Health Planning↗
Biomedical subjects
Scottish Renal Registry
Publications and source records attributed to Scottish Renal Registry.
End-stage renal disease in Scotland: outcomes and standards of care.
BACKGROUND: The number of patients starting renal replacement therapy (RRT) for end-stage renal disease (ESRD) in the United Kingdom rises annually. Patients are increasingly elderly with a greater prevalence of comorbid illness. Unadjusted survival, from the time of starting RRT, is not improving. The United Kingdom Renal Association has published recommended standards of treatment, which all United Kingdom nephrologists strive to attain. This study was devised to define the impact of attaining recommended treatment standards, adjusting for patient age and comorbid illnesses, upon survival on RRT in the United Kingdom population. METHODS: A prospective, registry based, observational study of all patients starting RRT in Scotland over a 1-year period, followed for the first 2 years of RRT. RESULTS: Of the 523 patients who were studied, 217 (41.5%) had died by 2 years of follow-up, 32% excluding deaths within the first 90 days. Age, comorbidity, weight when starting RRT, and attaining the recommended standards for albumin and hemoglobin had a significant impact upon survival. CONCLUSION: This study has emphasized the very high mortality of patients starting RRT in Scotland. By paying close attention to the attainment of recommended standards of care for patients with ESRD, it may be possible to improve upon current mortality figures. The monitoring of such success is only possible if correction is made for age and comorbidity.
Adolescent↗
Derived equations are not precise enough to predict the adequacy of creatinine clearance in peritoneal dialysis patients.
BACKGROUND: Most renal units assess dialysis adequacy in peritoneal dialysis (PD) patients by formal 24-hour collections of urine and effluent dialysate. We sought a reliable method of predicting dialysis adequacy that allows a decrease in the frequency of these formal and cumbersome measurements. METHODS: We created a formula for estimating total creatinine clearances, then assessed the clinical utility of this formula and other published formulae in predicting adequate and inadequate dialysis in PD patients. We collected data over a 6-month period in 2001 from 288 PD patients from 9 centers in Scotland. Four out of every 5 patients were selected at random to create a formula for estimating total creatinine clearance per week, and the fifth patient was used to form a validation group. We plotted creatinine excretion against age, and the resultant linear regression equation was transformed to produce a formula for predicting total creatinine clearance per week, based on patient sex, weight, and serum creatinine. We used the data from the validation subgroup to calculate predictive values for our derived formula and data from all of the patients to calculate predictive values for the Cockcroft and Gault, Jones, and Modification of Diet in Renal Disease Study formulae. RESULTS: Neither our derived formula nor the three published formulae were sufficiently powerful to predict accurately either adequate or inadequate PD clearance. Receiver operator characteristic curves showed that no significant improvement in these predictive values could be achieved by altering either the sensitivity or the specificity. CONCLUSION: Prediction formulae are not accurate enough to detect underdialysis in PD patients.
Adolescent↗
Acute renal failure requiring renal replacement therapy: incidence and outcome.
BACKGROUND: Renal replacement therapy (RRT) for acute renal failure (ARF) may be provided in many settings within the hospital. Such patients require a high level of care and often have a poor prognosis. No prospective studies have accurately defined this population, making the prediction of necessary resources and the planning of services difficult. AIM: To ascertain the incidence, causes and outcomes of acute renal failure requiring renal replacement therapy in Scotland. DESIGN: A prospective observational census of all clinical areas providing renal replacement therapy in three Scottish health boards (Grampian, Highland, Tayside). METHODS: Patients were identified by liaison with each unit providing RRT. Factors precipitating renal failure and reasons for RRT were recorded at the time of initiation. Comorbid disease burden was scored using the Charlson index. Patient status at 90 days was assessed from case-notes, contacting general practitioners where necessary. RESULTS: 375 patients per million population per year received RRT; 203 per million per year for either ARF or acute-on-chronic renal failure. 73.5% of patients receiving RRT for ARF died within 90 days, 23.5% became independent of RRT. The median duration of hospital admission was 19 days. DISCUSSION: The annual incidence of ARF requiring RRT is just over 200 per million population, almost twice that of end-stage renal disease requiring RRT. Such treatment places high demands upon health care resources.
Acute Kidney Injury↗
Fulminating varicella despite prophylactic immune globulin and intravenous acyclovir in a renal transplant recipient: should renal patients be vaccinated against VZV before transplantation?
We describe a case of fulminating varicella despite prophylactic immune globulin and intravenous acyclovir in a renal transplant recipient. This promoted a survey of all 383 adult patients awaiting a renal transplant in Scotland, which showed a low level of Varicella zoster virus (VZV) awareness but a willingness to consider vaccination if non immune. 359/363 serum samples tested were seropositive for VZV antibody giving a susceptibility to VZV of 1.2%. Although data on vaccination in adults with chronic kidney disease are limited, expert opinion is of the view that the benefits of vaccinating immunocompetent seronegative patients before transplantation are likely to outweigh the risks. We believe that adult patients awaiting a transplant in the UK should be tested for their susceptibility to VZV and that early vaccination should be offered to those who are both immunocompetent and seronegative.
Acyclovir↗