Renal Units in IrelandWhat do they do……………….?

IKA AGMDublin July 2014

Cardiac-Renal CentreCork University Hospital

Renal Services in 6 Hospital Groups(*/^ – shared access contracted Units; [] planned Units)

Hospital Group Renal Units Contracted Satellite HD Unit

Home Programme

Dublin North East BHCGH

[fmc Northern Cross*][Beacon Drogheda*]

PD/HHD

Dublin Midlands AMNCH/SJHMRHT

[Beacon Tallaght^][Portlaoise]

[Beacon Sandyford^]

PD/HHD

Dublin East SVUHMMUH

[Beacon Sandyford^][fmc Northern Cross*]

[Beacon Tallaght^]

PDPD

South/South West CUH/KGHWRH

fmc Kilkenny[Wexford]

PD/HHDPD/HHD

LUHG MWRHD fmc Limerick PD

WNWHG GUH/MGHLGH/SGH

Wellstone Galway PD/HHD

Programmes in SW Renal Unit

• ESKD Programme

• General Nephrology Programme

• Acute & Consultative Programme

• Special Populations Programme

Patients with Kidney Disease

• ESKD 0.09% of population (4000)

• CKD 21.5% of those >45y

• AKI 20% of hospitalised patients

Clin J Am Soc Nephrol. 2013 Sep;8(9):1482-93.World incidence of AKI: a meta-analysis.

2004-12 154 studies 3,585,911

KDIGO definition of AKI• Adults: 21.6 (19.3,24.1) %• Children 33.7 (26.9,41.3) %

AKI-affected Mortality• Adults: 23.9 (22.1,25.7) %• Children 13.8 (8.8,21.0) %

Work in progress at CUH(Plant SF, Clarkson MR)

August 201371 Cases present to ED with AKI

• Age (median, IQR) 74 (65,84) years

• ACKD 34%

• Renal Consult 9%

564 ESKD Patients in SW

335142

41

1333

TransplantCentre HDSatellite HDHome HDHome PD

Summary Activity 2013

• ESKD 22,150 HD Day Cases 6,400 Satellite HD Day Cases12,050 Home PD Treatments 2,700 Home HD Treatments

2,100 TX OPD Visits

• CKD 3,600 OPD Visits

• AKI 1,000 Consultations

Common Partners

Common

• Intensive Care• Cardiology• Vascular Surgery• Cardiothoracic• Haematology• Urology• Obstetrics• Diabetes Care

Regular

• General Surgery• General Medicine• Rheumatology• Oncology• Infectious Diseases• Dermatology• Geriatric Medicine• Palliative Medicine

ESKD Patients in Ireland

54%

26%

14%

6%

TransplantCentre HDSatellite HDHome Therapies

Prevalent ESKD patients (n)

31/12/2007

31/12/2008

31/12/2009

31/12/2010

31/12/2011

31/12/2012

31/12/2013

0

500

1000

1500

2000

2500

3000

3500

4000

1623 1728 1824 1891 2007 2079 2156

13291401

14731554

1557 1560 1556191

200188

195191 209 204

211

2028 44

HHDPDHDTX

3960 patients39.3% HD 6.2% PD/HHD 54.5% TX

862 p.m.p.339 HD

54PD/HHD 469TX

Incident adult ESKD patients (n)

2008 2009 2010 2011 2012 20130

50

100

150

200

250

300

350

400

450

500

6 22 9 20 22 22

377

422

307330 330 327

63

42

56

63 71 56

HomeHDTX

405 patients81% HD14% PD

5% TX

88 p.m.p.

ESKD Patients 31/12/13(total patients under governance of 6 Hospital Groups)

Dublin North East

Dublin East

Dublin Midlands

South

LUHG

WNWHG

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

760

210

320

480

115

271

233

161

196

233

65

122

67

77

86

37

73

45

42

32

45

50

16

19

20

3

18

3

41

97

TXcHDsHDsHDcPDHHD

ESKD Patients 31/12/13(total patients under governance of 11 Parent Units)

CGH

Beaumont

MMUH

SVUH

AMNCH/SJH

MRHT

WRH

CUH/KGH

LUHG

GUHG/MGH

LGH/SGH

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

10

750

98

112

280

40

145

335

115

195

76

64

169

79

82

90

106

91

142

65

59

63

67

30

47

86

37

73

45

9

3

1

5

3

2

42

19

13

45

17

33

16

19

20

3

5

13

3

41

57

40

TXcHDsHDsHDcoHDNIPDHHD

HD Patients 31/12/13(HD patients per facility/PD and HHD also illustrated)

PD/HHDBeaumont

c.BeaconCUH

MRHTc.fmc Northern X

WRHAMNCH

SVUHMMUH

c.fmc LimerickLUHGCGHLGH

GUHGMGH

c.WellstoneKGHSGH

c.fmc Kilkenny*Newry

*Omagh

0 20 40 60 80 100 120 140 160 180 200 220 240 260 280204 44

169

142106

9190

8279

656463

59

133

97

73

45

37

13

82

57

4140

cHDsHDsHDcoHDPDHHD

Staffing (Consultants)

• 11 per 1000 ESKD patients

• 0.06 per 1000 CKD patients

DNEG DEG DMG SSWG LUHGWNWG0

1

2

3

4

5

6

7

5.5

2.23.4

5.9

1.8

3.2

Renal Units in IrelandWhat do they do……………….?

IKA AGMDublin July 2014