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Article History

Received: 6 March 2025

Accepted: 19 February 2026

First Online: 4 March 2026

Declarations

:

: This study was classed as a service evaluation and used de-identified, functionally anonymous, data recorded as part of routine patient care by healthcare providers. This data was accessed by regional analysis sites with appropriate ethics approvals informed by Data Protection Impact Assessments and Caldicott Guardians. In South Yorkshire, ethical approvals were granted by the University of Sheffield (reference number 050058). In Birmingham (PIONEER), ethical approvals were provided by East Derby Research Ethics Committee (reference 20/EM/0158) and Health Research Authority (reference number 279353). Bristol Biomedical Research Centre sought advice and guidance from the Health Research Authority and Calidcott Guardians, utilising anonymous patient information collated by the Trust’s direct care team members for service evaluation purposes. At Imperial, access to patient level data within the ICHT iCARE SDE was approved by the NIHR Imperial BRC data Access and Prioritisation committee (covered by database ethics - South West - Central Bristol Research Ethics Committee reference 21/SW/0120; IRAS project ID 282093). In Lancashire access to data for this project was approved as a service evaluation by Lancashire Teaching Hospital NHS Foundation Trust. For Southampton, the Wessex Secure Data Environment holds Sect.  251 ethics. Wherever patient identifiable data were shared by the collecting healthcare provider, this was done within the context of an existing data sharing arrangement approved by an NHS Research Ethics Committee and authorised by the NHS HRA under The Health Service (Control of Patient Information) Regulations 2002 Section “Conclusions”. Only aggregated anonymised summaries were shared with the lead site. Accordingly, in line with the NHS evaluation toolkit for service evaluations using anonymised data, and following a risk-benefit assesment concluding extremely low risk to individual patients, individual patient consent was not required for this service evaluation. Notwithstanding this exception regarding individual patient consent, this study is in compliance with the Helsinki Declaration.

: Not applicable.

: For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising from this submission.

: AD, FE, MG, QD, RC, RD, SiC, and SW have no competing interests to declare. CG Received additional funding from the Barts Charity and is the Chair of the Data Access Committee and the Chief Clinical Information Officer for Barts Health NHS Trust, and has received fees from SNOMED international for advice on the use of clinical terminology.EM, ES, JK, JL, MH, RJ, RS, SG, SM, and SuC received funding from the NIHR.ES received additional funding from HDRUK and UKRI Innovate UK.MS received funding from the Data for R&D program and DARE UK. SG received additional funding from HDRUK and MRC. TP Received funding from Kidney Research UK.