Questions and Answers - UKRR

Why is HDP04 different between the schema and V5?

This was a typo. Access used should be HDP20

GS

Should Dialysis Prescriptions be sent when the Dialysis Session records are available.

Yes

JM

Should PD prescriptions be included with the Dialysis Prescription information?

No. There is no current audit requirement for collecting this data and past experience leads us to believe it is not widely recorded.

JM / FB

What are the symptoms of Peritonitis and how do we submit them?

The role of this item is to improve the interpretation of any PDfluid microscopy and culture result that we receive. The definition of PD peritonitis is classically 2 from 3 possible features (symptoms, WCC > 100, positive culture). A practical approach to this data item therefore is simply to record a ‘Y’ or ‘N’ every time a PD sample is sent to the microbiology department. In the case of a blank answer to this question the assumption will be that the patient did have symptoms (the most common reason for sending a sample after all).

JM

Is there a SNOMED code for “symptoms of peritonitis” ?

Because this is a composite of multiple symptoms defined by the UKRR there is not a SNOMED code. To record this use the CodingStandard of ‘UKRR’ and the Code of ‘QBLKU'.

GS

Should we send patients that have a high EGFR (50), that drop to a low EGFR briefly (<30) then go back to an EGFR 50?

In practice the only group of people which are likely to be included in an audit measure in the foreseeable future are people with advanced CKD (eGFR <20ml/min) under the care of a renal centre. These people need assessment for kidney replacement therapy, kidney transplantation, and symptom control. So this is the group of people we need reliable information about.
It is not always easy to separate out people with AKI and CKD – so historically we have pragmatically just requested the results on any patient who ever had an eGFR < 30. Some will indeed have had AKI and recovered, but others will hover around an eGFR of 30 and it would be unhelpful to include/not-include them.
So yes – do please continue to include people regardless of whether their eGFR improves.

JM

How do we identify & provide data for patients with an EGFR between 20-30 that are cared for by non-renal staff as they are not on renal systems?

This is a similar challenge to the ‘what to do if a patients eGFR improves above 30’ question above. As the above answer – it is those with CKD and an eGFR < 20 under follow-up by a renal centre we are most interested it for comparative audit and improvement.Some centres will be able to distinguish people under follow-up by a renal centre, and those who are not (perhaps discharged or lost-to-followup). If it is possible to limit the group to just those under care – that is ideal. If that is not possible then we will attempt to do the same using likage to hospital episode statistics.

JM

Care plan – No option for unpredicted. On the care plan – we do have undecided patients – what to do with them?

There is always be people who cannot make a decision about KRT until the moment that they need it – either because they present late with symptoms, or they struggle to decide. So ‘best’ care will never be 100% of people with a care-plan at KRT start.However – even after KRT start it is not unreasonable to think that every patient still has an assessment about whether they could do dialysis at home.

JM

Care Planning - How would a patient be classified if they would be suitable for transplant if they lost weight? How to classify unsuitable patients for RRT.

This is a very good question – to which the first answer should be – ‘the priority of the clinical and operational team locally should take precedence in this decision’. So if a local service continues to keep people under the care of the transplant assessment service whilst they lose weight then the assessment is ongoing.Much more commonly though is that people are ‘referred back to their nephrologist’ and in practice the transplant assessment is finished until the person becomes suitable and is re-referred. A patient will then have two or more care-planning episodes.

JM

Dialysis sessions - Blood flow rate. The dialysis interface could return multiple of these within one session, do you want the first, last or something else?

This has been removed from V5 of the UKRR dataset so is no longer required. Were it to be needed in the future a value from the middle of the session is likely to be best.

FB