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Home Dialysis ambitions

urea molecule Statement of Home Dialysis ambitions

The National Kidney Federation is vigorously campaigning to ensure the widest possible range of Dialysis options are offered to Kidney patients. The Federation has in mind the development of more user friendly and more portable dialysis machines which it anticipates will become available in the near future and the needs patients have for dialysis closer to home with more flexible and possibly more frequent time slots. As part of this campaigning work the NKF has endorsed the following statement produced by the Kidney Alliance:-

The Kidney Alliance believes that patients should have a choice of dialysis therapies, including those which can be undertaken in their home. There treatments enable patients to care for their own dialysis and can be delivered either in the form of haemodialysis or peritoneal dialysis.

Haemodialysis has been established as a successful life sustaining treatment in patients with renal failure for over 40 years. Through a mix of financial pressures and convenience for patients, the number of hours patients spent dialysing has fallen gradually. Thrice weekly treatment for approximately 4 hours carried out in renal centres has now become the normal experience for the vast majority. Clinical and laboratory measures to ensure patients receive an adequate dose of dialysis are in place in the UK.

It is increasingly recognised that conventional thrice weekly haemodialysis, which totals 12 hours per week, ‘replaces’ only approximately 10% lost kidney function, and has limited impact on quality of life and survival probably due to the chronic exposure of patients to the effects of renal failure. More frequent treatment, particularly if the 2-day ‘long break’ is avoided, not only allows for a relaxation of dietary and fluid restrictions it can also deliver much more dialysis. Impressive improvements in wellbeing and measurable clinical outcomes are being reported with enhanced, frequent haemodialysis. In practice, this therapy is best carried out in the home or in a community setting by patients trained in self-care. Recently, the introduction of mobile, patient-friendly machines has provided new opportunities for dialysis ‘on the move’ and independence from rigid treatment schedules. After many years of decline, the number of patients opting for self care haemodialysis is now growing in several countries, with most patients who have opted for self-care dialysing more frequently than thrice weekly.

The Kidney Alliance recognises that the NICE guideline (2002), which envisaged up to 15% haemodialysis patients at home, has created little movement and, while there are occasional examples of success, less than 2% HD patients in the UK are currently self-caring. Equally the Alliance recognises this guideline predated the benefits of enhanced dialysis now being reported from other countries. The Alliance anticipates enthusiastic uptake of frequent treatment among some patient groups, particularly using new mobile machines. With peritoneal dialysis (PD) being already established in the UK we envisage a complementary synergy with HD carried out in the community, as those already doing a self care dialysis therapy such as PD are often more comfortable moving to self care haemodialysis.

The Alliance calls on Specialised Commissioners to ensure that all patients are provided with the education and the opportunity to take up this choice in keeping with a patient centred health service. An important component of success will be for the NHS to recognise that the PbR(Payment by Results) haemodialysis tariff should include set-up costs of community/home care and re-imbursement for up to 6 sessions of dialysis per week in those patients motivated to optimise their health prospects to remain well and to stay out of hospital.