National kidney care audit findings

The main aims of the audit are to determine the performance of renal centres across England, Wales and Northern Ireland in the use of optimal vascular access for haemodialysis, to measure the burden of vascular access and to explore operational issues in providing access. Sixty out of sixty-three renal centres in England, Wales and Northern Ireland took part in the audit, submitting 2,404 records. The median age of the patients in the sample was 68 years old, and 62% of the patients were male. Late referrals, less than 90 days from seeing a renal physician to dialysis, accounted for around 25% of patients nationally, although this varied across networks. The audit showed that, at first dialysis, 39% cent of patients had a tunnelled line, 20% had a non-tunnelled line, 1% an arteriovenous graft (AVG) and 40% an arteriovenous fistula (AVF). After three months, there was little change in the provisions of AVG and AVF. Key findings include the fact that late referrals (less than 90 days from seeing a renal physician to dialysis) were less likely to have had definitive access at first dialysis and late referrals were less likely to have been referred to a surgeon (7%) compared to patients with longer waits for dialysis, although this may be linked to organisational factors and uncertainty around the need for dialysis. The median bed day utilisation for haemodialysis patients within three months of the start of dialysis was six days overall. This ranged from 14 days for non-tunnelled line patients to one day for arteriovenous fistula patients. 7% of haemodialysis patients had a bacteraemic episode in the six months following first dialysis. After adjusting for sample size, bloodstream infections were more common in patients with catheters compared to definitive access, six episodes/100 patients for an AVF, 13 for a non-tunnelled venous catheter and eight for tunnelled catheters. The audit also identified that, while age is often associated with higher rates of infections in a healthcare setting, this did not appear to be a significant factor in dialysis patients. When examining Hospital Episodes Statistics data for patients in the audit, patients on venous catheters were found to have a higher rate of general infections and cardiovascular even

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