Supporting people who need treatment for kidney failure

28 Nov 2014 02:29 PM

The National Institute for Health and Care Excellence (NICE) has published a new quality standard which sets out how best to care for adults who need treatment for chronic kidney disease.

Chronic disease is common in the UK but it is not usually associated with symptoms until advanced stages. In some people their kidney function will continue to deteriorate and they eventually need dialysis or transplantation, collectively known as renal replacement therapy, in order to survive.

Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE said: “For many people with kidney disease, progression can be prevented. However there are instances where the decline in kidney function becomes irreversible and a person will need life-saving dialysis or a transplant. Providing access to renal replacement therapy services prevents thousands of people from suffering avoidable harm or dying prematurely.”

Pre-emptive transplantation should be considered as the treatment of choice if a living donor is available because this provides most adults with the best chance of long-term rehabilitation. Adults who have been on dialysis for only a short time, or have not received it at all, fare better with their kidney transplant.

The standard recommends that adults whose kidney function is progressively getting worse are placed on the national transplant lists within 6 months of their anticipated dialysis start date. Adults who have to start dialysis in an unplanned way, for instance if they do not receive a transplant in time or if they were diagnosed late, should continue to be supported to receive a kidney transplant.

Professor Leng added: “With survival rates better than ever, the number of people receiving treatment for chronic kidney disease continues to increase. Facing a long-term, life-altering condition can be very distressing, which is why it is so important that all those using renal replacement therapy services not only have effective treatments but are also offered comprehensive support to help them best understand and self-manage their condition.”

Other statements cover priorities for NHS services on how to deliver high-quality, cost effective care to enhance quality of life and ensure adults with kidney failure have a positive experience of care, including:

• Renal healthcare professionals perform necessary procedures in advance1to prepare adults with chronic kidney disease for dialysis, such as modifying the blood vessels in the arm to make haemodialysis more straightforward.
• Services provide reliable transport to adults receiving dialysis in a treatment centre, or who are training for home-based dialysis, to ensure that they do not have to wait more than 30 minutes to be picked up or dropped off for dialysis.
• Adults with chronic kidney disease are supported to carry out home-based dialysis if possible.
• Education courses are offered to adults preparing for renal replacement therapy, alongside their family members and carers, to help them with treatment choices and to better understand their condition.

The full standard can be viewed online at /guidance/QS72.

For more information call the NICE press office on 0300 323 0142 or out of hours on 07775 583 813.

Notes to Editors

Further information

1. Adults with chronic kidney disease and established kidney failure start who are starting dialysis have either:

• Arteriovenous fistula, by connecting an artery to a vein, usually in the forearm, or
• Peritoneal dialysis catheter, by inserting a tube into the abdomen.

      2. The 2013 UK Renal Registry reported that:

• 54,824 adult patients received renal replacement therapy in the UK at the end of December 2012, an increase of 3.7% since the previous year.
• Elderly patients aged over 85 accepted onto renal replacement therapy nearly doubled between 2006 and 2011.
• Unadjusted 1 year after 90 day survival for patients starting renal replacement therapy in 2011 increased to 87.5% from 87.3% for those starting in 2010.

      3. The Health Survey for England data suggests that chronic kidney disease has an overall prevalence of 13%.

About the quality standard

1. The quality standard for renal replacement therapy services is available at/guidance/QS72. 
2. The quality standard for renal replacement therapy services partially updates the NICE quality standard for chronic kidney disease. Quality statements 2 to 6 in the new quality standard update and replace quality statements 11 to 15 in the quality standard for chronic kidney disease.

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

Our products and resources are produced for the NHS, local authorities, care providers, charities, and anyone who has a responsibility for commissioning or providing healthcare, public health or social care services.

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