UK Renal Registry, Bristol, United Kingdom.
UK Renal Registry, Bristol, United Kingdom,
Nephron. 2020;144(9):440-446. doi: 10.1159/000508637. Epub 2020 Jul 22.
Diabetes is a major cause of CKD and of mortality in patients on renal replacement therapy (RRT). Auditing the care of patients with diabetes on RRT against published guidelines relies on robust data collection.
This article assesses the completeness of data items collected by the UK Renal Registry (UKRR) that are required to audit the care of patients with diabetes on RRT.
The UKRR receives data on all patients receiving RRT in the UK. Patients with diabetes, diabetes type, and method of renal diagnosis were identified from primary renal disease (PRD) codes and comorbidity data for patients commencing RRT at one of the 57 renal centres in England and Wales between 2010 and 2016. The completeness of demographic and clinical data (blood pressure, cholesterol, glycated haemoglobin [HbA1c], and smoking status) was assessed for the first year of RRT.
Ninety-three per cent of all patients on RRT irrespective of diagnosis had a PRD code, but only 28/57 renal centres had comorbidity data completeness ≥70%; 34.9% of patients with diabetic nephropathy (DN) had type 1 diabetes, but this varied between centres (9.2-100%). Overall, 4.2% of DN diagnoses were by biopsy. Data completeness in the first year of RRT for cardiovascular risk factors ranged between 50.0 and 80.0%, with HbA1c data completeness being 63.0%. Of 57 centres, 20 had HbA1c data for ≥70% of patients in the first year of RRT.
There is persistent variation between renal centres in the completeness of data collected on patients with diabetes on RRT, impacting on the ability to undertake robust audit. Data linkages and expanded data permissions could see registry data play a key role in ongoing audit and research into patients with diabetes and CKD, provided adequate data can be collected.
糖尿病是慢性肾脏病（CKD）和接受肾脏替代治疗（RRT）患者死亡的主要原因。根据已发表的指南，对接受 RRT 的糖尿病患者的护理进行审核，需要依靠可靠的数据收集。
本文评估了英国肾脏登记处（UKRR）收集的糖尿病患者 RRT 数据的完整性，这些数据是审核接受 RRT 的糖尿病患者护理所必需的。
UKRR 接收英国所有接受 RRT 的患者的数据。从主要肾脏疾病（PRD）代码和 2010 年至 2016 年英格兰和威尔士的 57 个肾脏中心开始 RRT 的患者的合并症数据中，确定了糖尿病患者、糖尿病类型和肾脏诊断方法。评估了 RRT 第一年患者的人口统计学和临床数据（血压、胆固醇、糖化血红蛋白[HbA1c]和吸烟状况）的完整性。
无论诊断如何，93%的 RRT 患者都有 PRD 代码，但只有 28/57 个肾脏中心的合并症数据完整性≥70%；34.9%的糖尿病肾病（DN）患者患有 1 型糖尿病，但中心之间存在差异（9.2-100%）。总体而言，4.2%的 DN 诊断是通过活检确定的。心血管危险因素在 RRT 第一年的数据完整性在 50.0%到 80.0%之间，HbA1c 数据完整性为 63.0%。在 57 个中心中，有 20 个中心在 RRT 第一年有≥70%的患者有 HbA1c 数据。
在接受 RRT 的糖尿病患者数据收集的完整性方面，肾脏中心之间仍然存在差异，这影响了进行可靠审核的能力。数据链接和扩展的数据权限可以使登记处数据在对糖尿病和 CKD 患者的持续审核和研究中发挥关键作用，前提是能够收集到足够的数据。
