Kidney Research UK

Background

Founded in 1961, Kidney Research UK (formerly the National Kidney Research Fund) is the largest funder of research into the prevention, treatment and management of kidney disease. Our mission is to improve the quality of life of those with kidney disorders and to increase public awareness of kidney health.

Patients with established renal failure (ERF) rely on transplantation or lifelong dialysis treatment to survive. ERF occurs when the kidneys cease to function properly, which is why, without a transplant, an artificial substitute in the form of dialysis is required to replace the lost function and so maintain life.

Transplantation is the treatment of choice for many patients, but given that around 30% of them are not suitable for a transplant, and that available organs are very short in supply, around half require dialysis. We are therefore committed to raising awareness of the need to ensure that patients have timely and appropriate access to dialysis treatment.

Peritoneal Dialysis v. Haemodialysis

However, there may be a number of clinical factors that decide which form of dialysis is most suitable for a patient. For example, peritoneal dialysis may not be feasible in patients that have had extensive abdominal surgery, and the stage at which they present for dialysis may also restrict them to certain methods.

Moreover, the differences in the way these two forms of dialysis are provided need to be taken into account. Some patients may not be able to tolerate the frequency of hospital visits required for haemodialysis, yet peritoneal dialysis can carry a risk of patients developing peritonitis and their ability to manage their dialysis to minimise this risk is important.

However, despite these clinical factors, the National Service Framework for Renal Services states that there is no robust evidence to show that one form of dialysis has better outcomes than the other. In a 2004 study of available research into this issue, it was found that no significant difference was measured in either survival rate or quality of life between patients on CAPD and haemodialysis.

In the specific case of home v. hospital haemodialysis, patients generally tend to report a better quality of life when receiving their treatment at home. For a start, it reduces the need to travel to and from the dialysis unit- a journey that is often made several times a week. There is also more flexibility in receiving treatment at home, as it can be built around a patient's day- to-day regime, allowing them to live a more normal life.

However, it can also be the case that patients prefer hospital treatment, as home dialysis can be quite isolating, stressful to manage alone- even with the help of a carer- and the equipment may take up a lot of space.

Tailoring dialysis to patient needs

In our view, the key consideration in providing dialysis services is to ensure that where possible, patients are offered the choice between different modalities, based on an assessment of their suitability.

In terms of home v. hospital haemodialysis, for example, we would support the result of the 2002 NICE appraisal, which found that patients should be offered the choice of home treatment if they are stable on dialysis; are free of complications and significant concomitant diseases; have access to care and the space to receive dialysis at home; and are capable and motivated to maintain their treatment themselves.

We therefore welcomed the rationale behind the Government's proposal in its Our health, our care, our say: a new direction for community services White Paper to improve the flexibility and convenience of dialysis for kidney patients by enabling more of them to receive treatment at home, in GP surgeries or in more local community settings. This would improve quality of life, as well as limiting travel and time lost to treatment.

However, we do have concerns that any shift in expenditure away from hospitals to primary care and local community services could have a considerable impact on availability of hospital-based dialysis services. There continue to be inequalities of access to dialysis treatment in the UK, and one of the main reasons for this is a shortage of dialysis places in hospitals. For this reason, extending dialysis to new settings should only be done if there is a commitment to improve the overall standard of renal services in the UK to ensure a full range of choice for patients.

Dialysis facilities are expensive to set up, maintain and staff and there is a national shortage of trained dialysis nurses. If dialysis services are set up in primary care or local community settings, the standard of care would either need to be provided by visiting consultants or local health professionals would need to be thoroughly trained. Either way, the issues of staffing, travelling and training need to be made a priority, and adequate funding must be given to ensure the best service for patients.

Kidney Research UK

April 2007