Epidemiology of ESKD in Ireland

Data from the 2018 NRO Census

Professor George Mellotte Pat O’Connor Eileen McBrearty

HSE National Renal Office

Renal Replacement Therapies (RRT)

• Transplant (TX)

• Haemodialysis (HD) Parent Renal Unit HD (cHD)

Satellite HD HSE (sHD)

Contracted Satellite HD (sHDc)

Northern Ireland HD (NI)

• Home Dialysis Therapy (PD/HHD)

2018 PREVALENT ESKD PATIENTS ATTENDING ADULT UNITS

Prevalent adult ESKD patients (n)

4572 patients (2018) 41% HD 6% PD/HHD 53% TX

941 p.m.p. 384 HD 50 PD/HHD 507 TX

CSO population estimate April 2018 - 4,857,000

1623 1728 1824 1891 2007 2079 2156 2211 2245 2307 2388 2464

1329 1401

1473 1554

1557 1560

1556 1628

1757 1803

1805 1863

191

200 188

195 191

209 204

202 186

195 196

190

2 11

20 28

44 48

55 57

54 55

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

HHD

PD

HD

TX

Change in 2018 (Adults)

• ESKD +129 2.8% Increased by 26.5 pmp 16.9 pmp (2017) • HD +58 3.1% • PD/HHD -5 -2%

• Dialysis +53 2.5% Increased by 11.0 pmp 0.0 pmp (2017) • TX +76 3.1% Increased by 15.6 pmp 16.9 pmp (2017)

ESKD PATIENTS ATTENDING PAEDIATRIC UNITS

Prevalent Paediatric ESKD patients (n)

80 patients (2018) 12.5% HD 7.5% PD 80% TX

16.4 p.m.p. 2.1 HD 1.2 PD 13.1 TX

63

1

10

2

4 0

10

20

30

40

50

60

70

80

Childrens Health Ireland - Temple St Childrens Health Ireland - Crumlin

PD

HD

TX

National Treatment Modalities 4652 patients (Adult & Paediatric)

54%

25%

4%

12%

0%

4%

1%

Transplant

Centre HD

Satellite HD

Satellite HD Contractuals

Northern Ireland

Peritoneal Dialysis

Home HD 2528

1144

561 160

National Dialysis Modalities 2124 patients (Adult & Paediatric)

54%

8%

26%

0% 9%

3%

CHD

SHD

SHDc

NI

PD

HHD

196

1154 561

160

REGIONAL ANALYSIS ESKD PATIENTS ATTENDING

ADULT UNITS

Adult Renal Services in 6 Hospital Groups

Hospital Group Renal Units /Satellite Units

Contracted Satellite HD Units

Home Therapies

RCSI Hospitals Group

BH CGH

Beacon Drogheda Fmc Northern Cross Beacon Sandyford

Daisy Hill/Altnagelvin

PD/HHD

Ireland East Hospitals Group

SVUH MMUH

Beacon Sandyford Fmc Northern Cross Beacon Drogheda

PD PD

Dublin Midlands Hospitals Group

THKC (TUH) MRHT

Beacon Tallaght Beacon Sandyford

PD/HHD

South/South West Hospitals Group

CUH/UHK UHW

Fmc Kilkenny Wellstone Wexford

PD/HHD PD/HHD

University of Limerick Hospital Group

UHL Fmc Dock Road PD/HHD

Saolta University Healthcare Group

MPUH/GUH/UHM LUH/UHS

Wellstone Galway Omagh/Altnagelvin

PD/HHD

ESKD Adult Patients 31/12/18 (Total patients under governance of 6 Hospital Groups)

782

280

386

551

120

345

232

159

209

289

112

133

54

106

117

107

110

84

89

54

2

6

54

20

33

51

20

12

23

4

18

6

4

0 200 400 600 800 1000 1200 1400

RCSI HG

Ireland East HG

Dublin Midlands HG

SSWHG

ULHG

Saolta UHG

TX

cHD

sHD

sHDc

NI

PD

HHD

Change in Adult ESKD Patient numbers 2018 (+129) (Total patients under governance of 6 Hospital Groups)

13

21

22

15

-2

7

4

-15

-6

7

19

-3

9

-9

12

5

36

-4

-1 4

-3

-1

-1

4

-12

-1

4

-1

-3

2

-1

-30 -20 -10 0 10 20 30 40 50 60 70 80

RCSI HG

Ireland East HG

Dublin Midlands HG

SSWHG

ULHG

Saolta UHG TX

cHD

sHD

sHDc

NI

PD

HHD

HD Patients (+58 increment in HD patients 2018)

4

-15

-6

7

19

-3

9

-9

12

5

36

-4

-1 4

-20 -10 0 10 20 30 40 50 60

RCSI HG

Ireland East HG

Dublin Midlands HG

SSWHG

ULHG

Saolta UHG

cHD

sHD

sHDc

NI

Net affect +58

Saolta UHG

-9

UL HG +15

SSWHG +52

DML -1

IE -3

RCSI +4

Home Therapies Adult Patients (-5 increment in HT patients 2018)

-3

-1

-1

4

-4

-1

4

-1

-3

2

-1

-5 -4 -3 -2 -1 0 1 2 3 4 5

RCSI HG

Ireland East HG

Dublin Midlands HG

SSWHG

ULHG

Saolta UHG

PD

HHD

Net affect -5

Saolta UHG

-2

UL HG -2

SSWHG +1

DML -2

IE -1

RCSI +1

Transplant Follow Up Adult Patients (+ 76 increment in HD patients 2018)

13

21

22

15

-2

7

-5 0 5 10 15 20 25

RCSI HG

Ireland East HG

Dublin Midlands HG

SSWHG

ULHG

Saolta UHG Net affect +76

Saolta UHG

+7

UL HG -2

SSWHG +15

DML +22

IE +21

RCSI +13

4572 Adult ESKD Patients 31/12/18 (Total patients under governance of 11 Parent Units)

17

765

118

162

335

51

168

383

120

240

105

69

163

84

75

96

113

120

169

112

65

68

54

56

50

117

50

57

110

84

89

54

2

6

54

5

15

33

29

22

20

12

23

4

3

15

6

4

0 100 200 300 400 500 600 700 800 900 1000 1100 1200

CGH

Beaumont

MMUH

SVUH

THKC

MRHT

UHW

CUH/UHK

UL

MPUH/UHM

LUH/SUH

TX

cHD

sHD

sHDc

NI

PD

HHD

2108 Adult Dialysis Patients 31/12/18 (Total patients under governance of 11 Parent Units)

69

163

84

75

96

113

120

169

112

65

68

54

56

50

117

50

57

110

84

89

54

2

6

54

5

15

33

29

22

20

12

23

4

3

15

6

4

0 25 50 75 100 125 150 175 200 225 250 275 300 325 350 375 400

CGH

Beaumont

MMUH

SVUH

THKC

MRHT

UHW

CUH/UHK

UHL

MPUH-UHM

LUH/SUH

cHD

sHD

sHDc

NI

PD

HHD

2528 Adult Transplant patients in 11 OPD Facilities 2018

17

765

118

162

335

51

168

320

120

180

73

63

60

32

0 100 200 300 400 500 600 700 800

CGH

Beaumont

MMUH

SVUH

THKC

MRHT

UHW

CUH/UHK

UHL

MPUH-UHM

LUH/SUH

TRANSPLANT ACTIVITY

Transplants 2009-18

146

90

158

131 136

112 120 122

136 122

18

23

27

32 38

40 33

50

51

40

8

8

7

1

11

6 0

0

5

5

3

5

3

3

5

4

2

2

0

20

40

60

80

100

120

140

160

180

200

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

UK Other

UK PKE

K/LoH

SPK

LDK

DDK

Snapshots of Activity

• NRO – 1st March 2019

– How many inpatient adult chronic HD patients in your hospital?

• For any reason – not necessarily HD related

– 108 dialysis patients : 5.6% of total HD population (3.3 % - 7.5% by group)

– Implications

• Planning for inpatient bed requirements

• Need for “Fall back” capacity in PRU

• HIPE - Invisible to system.

Bed Occupancy Adult HD Patients* By Hospital Group 1/3/19

20 20 19

29

7

13

0

5

10

15

20

25

30

35

RCSI HG Ireland East HG Dublin Midlands HG SSWHG ULHG Saolta UHG

Includes cHD, home HD and satellite HD

8

6

5

12

6

10

17

9

6

3

3

1

2

6

3

3

2

1

3

1

1

0 2 4 6 8 10 12 14 16 18 20

Beaumont

CGH

SVUH

MMUH

THKC

MRHT

CUH/UHK

UHW

UHL

GUH -MPUH/UHM

LUH/SUH

cHD Centre

sHD Satellite

sHD Contractuals

Other Hosp