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
Top Related