Campaign for increased Home Dialysis
It is recognised across the country that dialysis carried out at home brings significant benefits, and this was particularly true during the Covid lockdowns where home dialysis patients were significantly better protected than those attending in centre.
It was because of this that the NKF undertook their five year campaign to increase the proportion of home dialysis patients to at least 20% in each of the renal centres. LAKPA has also been very involved in this with considerable input into the annual reports on progress. It is unfortunate that although there have been some successes, the substantial increase in patients with renal failure has meant that the percentages remain stubbornly low.
The latest report from the NKF can be accessed here.
Kidney Dialysis
There are 2 main types of dialysis: haemodialysis and peritoneal dialysis, both of which can be carried out at home with the proper training and support.
Haemodialysis (HD) involves diverting blood into an external machine, where it’s filtered before being returned to the body.
At dialysis centres, this is usually carried out 3 days a week, with each session lasting around 4 hours. It can also be done at home where the timing and frequency of dialysis can be more flexible.
Peritoneal Dialysis (PD) involves pumping dialysis fluid into the space inside the abdomen through a permanent catheter to draw out waste products from the blood passing through vessels lining the inside of the abdomen.
Like the kidneys, the peritoneum contains thousands of tiny blood vessels, making it a useful filtering device. The fluid is changed and replaced with fresh fluid around 4 times a day, or overnight by machine. Peritoneal Dialysis is virtually always carried out at home. Not all patients are suitable for PD and there is a risk of infection or other problems that can mean that the PD patients have to move to HD.
Home dialysis versus in centre dialysis
Although the great majority of Peritoneal Dialysis patients carry out this procedure at home, this is not true of Haemodialysis patients, who generally attend the hospital, or local dialysis centre up to 3 times a week for up to 4 hours at a time.
Dialysis centres are very resource hungry, requiring physical space, capital equipment and human resources to enable them to operate. In addition, there are transport costs in delivering patients to and from their dialysis sessions. It is possible for haemodialysis to be home based and there are significant advantages in promoting this:
- It enables patients to fit dialysis in around their lifestyle and gives greater autonomy.
- It gives greater protection from infection as patients do not have to travel to hospital or centre several times a week.
- It saves resources for the NHS and mitigates the problems caused by the increasing incidence of chronic severe kidney disease.
However, this cannot happen without the necessary resources being put in place to train and equip patients to undertake their own dialysis and this is the case for both PD and HD patients. It is important to recognise that this is a life prolonging treatment that requires access to the patient’s body – either through a stomach catheter for PD, or a fistula or line for HD.
Inevitably this means that rigorous training is necessary to ensure that the patient and their carers fully understand the processes and the need to follow faithfully strict infection control procedures.
Over the past months there has been a very significant increase in patients with renal failure to the extent that all 5 in centre dialysis units are full and we know that improving the take up of dialysis at home will be an important factor in managing this increase.
However, the training provision for dialysing at home is not meeting the demand so LAKPA has been involved in discussions with the Trust on improving and expanding this for a number of years.
The national target for the percentage of patients who should dialyse at home is at least 20%. The Trust’s at present is 12-13%. Additional provision of home dialysis, both PD and Home HD, is a priority because:
- It is better for patients who are able to take the responsibility for dialysing at home.
- It is cheaper for the NHS compared to dialysing at a centre.
- It will alleviate the pressure on the need to accommodate new dialysis patients.
The training and support for home dialysis for all patients served by the Trust is based at Lister Hospital. This provides training for patients and carers before they start dialysing at home and also offers services to patients undergoing dialysis at home, as needed.
The current accommodation is too small and limits the capacity for training new patients and carers. The Trust has accepted the need to relocate the provision for a number of years and although funding this purpose was identified in the last two financial years, severe pressures in other areas of the Trust and the need to work through the new role of Integrated Care Boards, means that progress has been slow.
However there is now a real impetus behind this project, and it is hoped that it will start before the end of this financial year.
LAKPA is campaigning to ensure that this project goes ahead quickly as it brings savings in capital and resources, and it significantly improves the quality of life of those who can train to dialyse at home.
We have written to all local MP’s as well as the chairs of the ICB’s and Trusts that cover the area and have generated real interest across the community.
We are determined to continue the fight until the necessary resources are in place. Look out for updates on this important campaign.