Salford Royal Hospital, Northern Care Alliance, Manchester And University of Manchester

ILD157

“Late presentation” is a term used when people with chronic kidney disease are first seen by kidney services less than 3 months before they start renal replacement therapy (RRT) (either starting dialysis or having a kidney transplant). UK renal registry reports show that late presentations accounted for 16.4% of RRT starts in 2020, 18.2% in 2021 and 18.6% in 2022. Patients who present late to renal services are likely to have worse outcomes. They may miss the opportunity to receive treatments that may delay progression to requiring RRT, and may not have the opportunity to receive adequate preparation for RRT such as preparation for home therapies, or pre-emptive transplantation listing. This study will help to assess the value of timely referral to specialised renal care in the UK. We will build on the Renal Services Transformation Programmes (RSTP) Health Equity Baseline Assessment which analysed the demographic factors of age, sex, ethnicity, socioeconomic status and geography in patients presenting late from 2017-2019. We will update this analysis by using UKRR data to assess the same factors in all patients older than 18 who presented late (<90 days and <12 months prior to commencing RRT) in 2021, 2022 and 2023 (if available) in the UK. This would be an estimated 4,500 patients. We will also look at co-morbidities data. We will also collect 12-month follow-up data. Note that this analysis will also consider patients presenting within 12 months pre-RRT whereas the RSTP assessment only considered presentations within 90 days. This study will provide up-to-date demographic factors associated with late presentations. This will help to inform the development of interventions improving equitable access to timely renal care. It will also provide information on specific groups requiring additional focus and targeted interventions. We aim to publish our findings in a peer-reviewed journal. As a complimentary piece of research, we are conducting a study locally via the Northern Care Alliance, examining the pathways and phenotypes of patients presenting late (we have data on 398 patients since 2017). This will include assessment of missed opportunities for detection in primary and secondary care, the role of acute kidney injury and the underlying disease process (such as rapidly progressive glomerulonephritis), immigration, change in circumstances amongst other factors.