NICE: Give balanced information on dialysis options to kidney failure patients

Patients with kidney failure should be given balanced advice so that they can make informed decisions about their choice of dialysis treatment, says the National Institute for Health and Clinical Excellence (NICE).

Kidney failure (known as Stage 5 chronic kidney disease), is a condition where a person’s kidneys have lost most of their ability to function.

This condition is treated by dialysis, which filters the waste products and excess fluid from the blood that cannot be filtered by the person’s kidneys.

Current figures suggest 400-800 people per million of the population require dialysis. This rises to 1,600-2,000 people per million for those aged 70-80 years old.

There are two main types of dialysis available for people with kidney failure – haemodialysis and peritoneal dialysis. As both treatments are effective, the choice of treatment frequently depends on a person’s lifestyle and individual circumstances.
Peritoneal dialysis is usually performed at home. With this treatment, blood is cleaned inside the body using a special fluid via a tube inserted into a small space in the abdomen.

Haemodialysis is normally performed in hospital. Here, blood is cleaned by taking blood out of the body and passing it through a machine.

Some patients prefer peritoneal dialysis as this can be performed at home, as opposed to in a hospital or dialysis centre.

The new Guidance published by NICE is the first in England and Wales to help people with kidney failure make informed decisions about which choice of dialysis treatment to have.

The NICE guideline on peritoneal dialysis recommends that doctors and nurses should offer balanced and accurate information to patients about all dialysis options, so that patients can make informed decisions about their treatment.

This includes information on how the treatment will impact on their working lives, daily routines and social activity.

The guidance recommends that most people with kidney failure should be offered a choice between the two dialysis treatment options, even if they have to start dialysis quickly.

However, peritoneal dialysis should be considered as a first choice for children 2 years old or younger, people whose kidneys still make some urine and adults without other significant illnesses.

Dr. Damien Longson, Chair of the independent Guideline Development Group says: “There are currently far more people receiving haemodialysis than there are who are on peritoneal dialysis. This is despite both forms working equally well and the possible benefits that peritoneal dialysis can offer, such as greater independence and fewer hospital visits. With the right training, peritoneal dialysis can be delivered safely and effectively at home or at another location of the patient’s choice.”

Dr. Fergus Macbeth, Director of the Centre for Clinical Practice at NICE, says that since “dialysis is such a long-term commitment, it’s very important that people are able to make informed decisions about their choice of treatment and understand how it will affect their daily routines.”

Dr. Macbeth adds that if the patients don’t receive a kidney transplant then they will need to remain on dialysis for the rest of their lives. “We have published this guideline to encourage doctors and nurses to consider the individual circumstances of their patients alongside their clinical requirements,” Dr. Macbeth says. “There may be people out there who could benefit from peritoneal dialysis but aren’t currently receiving it.”

Estimates from NICE reveal that peritoneal dialysis can result in significant savings for the NHS if it is considered for the patient groups where it is recommended as a first choice of treatment.

Figures suggest that more than £7.6 million could be saved from the NHS budget each year, after five years. This is based on a conservative rise in the number of people on peritoneal dialysis, rather than haemodialysis, of 1 per cent each year.

NICE has produced a number of support tools to help with the implementation of this guidance. This includes podcasts, a set of clinical case scenarios, a slide set, a costing report and a costing template.