Outcomes and management in renal replacement therapy
The treatment of end-stage renal disease (ESRD) by dialysis and transplantation (renal replacement therapy - RRT) imposes major social and economic burdens on the patient, the family and society. Data obtained from 2 Scottish and 4 European renal units indicate that non-renal comorbid illness significantly increased patient mortality. Furthermore, application of a simple risk stratification method based on age and comorbidity divided patients into groups which carried different survival rates. Multivariate analysis showed that even after adjustment for comorbidity and age, an apparent "centre effect" persisted which ranked the centres. A further study examined factors influencing early mortality on RRT. The method of risk stratification described can be used for comparative survival studies by national and international registries. The generic health status questionnaire (the SF-36) which has been validated in the UK was administered to patients receiving all 3 modalities of RRT and their health status compared with a large sample of the general population. Patients' quality of life was influenced by mode of treatment and like survival was also shown to relate to comorbidity. Further studies of the incidence and prevalence of chronic renal failure in Grampian showed that advancing age and comorbidity significantly influenced the decision by non-nephrologists to refer a patient to the renal service. The results of this study have manifest resource implications for the provision of renal services. A protocol for the use of erythroprotein in the Aberdeen renal unit was developed and implemented. Its efficacy was monitored by studying defined outcome measures. This study showed that formal implementation of the protocol led to an increase in the proportion of patients with haemoglobin concentrations in the acceptable range and a fall in the number of blood transfusions.