Hospitals treating patients in end-stage renal failure are failing to hit national clinical targets, the first detailed study of treatment has discovered.
In its first annual report, the UK Renal Registry, set up to monitor the quality and quantity of care, concludes that 'in many areas, current practice is adrift from the recommended standards'.
It also reports wide variation between centres, with some more than twice as likely as others to meet standards for biochemical measures of the effectiveness of renal dialysis.
But it adds a cautionary note about the targets set by the Renal Association, and about data collection. And it warns that comparative data 'must be considered with great care and without judgment at this stage'.
Registry general manager David Ansell says that despite these reservations, there is some evidence that centres which meet the clinical targets are doing so by offering more effective treatments.
In the case of data on urea reduction ratios, he says, one centre - referred to throughout the report as 'B' - has 90 per cent of its patients reaching the national standard, while another - centre 'C' - achieves just 43 per cent.
'I have spoken to centre B and they have told me that all their patients are on a minimum of four hours of dialysis three times a week, they are using big dialyser membranes and high flow rates,' says Dr Ansell.
'It is more expensive to do and it takes a lot more time. But I know some centres have had to step patients down to twice-a-week dialysis, which is inadequate, just so they can keep other people alive.'
Some centres, says Dr Ansell, have been able to use data from the Registry to argue for greater resources from their purchasers. 'They can say, 'this is how we are doing, and this is what others are doing to get better results'.'
But he adds that it is not just a question of short-term money. 'There is a great shortage of suitably qualified nurses.'
The report, which draws on data from nine major renal units, is the first of its kind in this country, and Dr Ansell hopes its work will feed through into clinical governance initiatives.
The 11 centres currently contributing to the registry's database cover a combined population of 13 million people, and a further half dozen are in the process of joining.
In future, reports will be able to make comparisons both between centres and over time. Work is also under way with the Association of Clinical Biochemists to try to harmonise data, ensuring that comparisons are more meaningful.
The Renal Registry is just one of a small number of similar initiatives in this country - similar work is under way in intensive care and cardiac care - and is unique internationally for the speed with which it provides data.
'The US registry and other groups produce a report, but it is two years out of date. By that time, the data is not very useful for audit, and not at all useful for contracting,' says Dr Ansell.
His concern, however, is that smaller units, which do not collect their data on computer, will be unable to join. 'We are just not a paper-based system,' he says. 'We couldn't handle the volume of data in the time.'
And though the Department of Health has made clear that data audit will not be an optional extra, some sites lack the necessary IT and won't get resources to put it in place. 'It is a question of money again,' says Dr Ansell.
First Annual Report of the UK Renal Registry, 1998. The Renal Registry, Southmead Hospital, Southmead Road, Bristol BS10 5NB. 9.95 plus 2 postage.