Dialysis Options

NEW CAMPAIGN CALLS FOR FAIR TREATMENT FOR ALL KIDNEY PATIENTS

When your kidneys fail you have two options: a kidney transplant or dialysis. Dialysis performs the function of the kidney by artificially filtering the blood. Without one of these treatments your condition will become critical.

Established renal failure (ERF) is a life debilitating illness that dominates every moment of every day for every kidney patient, and affects more than 40,000 people in the UK (1).

Generally Kidney patients will choose transplantation or dialysis depending on which option they and their doctor feel is most appropriate. Some patients choose dialysis whilst waiting for a suitable donor organ, for others dialysis is their preferred choice of treatment. More than half of the kidney patients in the UK currently receive some form of dialysis.

Not all patients, however, are offered the same choice of dialysis treatments according to Dialysis Options, a new campaign launched this month to lobby for fair treatment choice for all kidney patients.

Kidney disease can strike at any time but is most common in the fast growing ‘Golden Age’ group, where the mean age of those impacted is 65 plus (2). This group comprises 10,640 patients (3) which represents a quarter of all registered kidney patients in the UK.

For many older patients, transplantation is not an option owing to coexisting diseases, so the right treatment choice of dialysis becomes even more important for these patients.

According to Dialysis Options, it is this group that is most likely to be restricted in its choice of dialysis treatment options, resulting in significant lifestyle and health inequalities.
There are two clinically effective forms of dialysis treatment: haemodialysis (HD) and peritoneal dialysis (PD). Generally HD is administered by a health care professional in a hospital about three times a week, while the PD patient is trained to perform dialysis for themselves at home to their own schedule.

Home treatment offers many benefits, not least removing the need for the patient to organise their lives around repeated and exhausting journeys to a hospital that may be many miles from their home.

The home based dialysis patient is able to maintain a more normal and active life routine with continuous access to family and friends, availability for work, travel and other leisure pursuits, all of which have a beneficial impact on personal wellbeing.

Yet, despite wide-spread acceptance that home-based treatment is appropriate for most kidney patients, just 14 per cent of older patients aged 65+ are presently receiving their dialysis at home (4).

A recent survey of kidney patients highlighted the fact that of those interviewed who were over the age of 60 years, 63% said that they would prefer a home based treatment (5).

“Quality of life is of primary importance to the patient when being treated for any chronic disease,” says Professor Edwina Brown, a leading Consultant Nephrologist at West London Renal and Transplant Centre.

“Choice of dialysis modality is of particular importance for older patients as transplantation is often not an option. Despite studies to the contrary, it is often assumed that older patients cannot cope with peritoneal dialysis so the option is never discussed with them.

Being on one type of dialysis does not preclude changing to another, so all patients should be given regular information about alternative disease options and therefore the opportunity to change to the type that of dialysis that would give them the best quality of life.”

Dialysis Options advocates the availability of home based dialysis treatment for all kidney patients where clinically appropriate, irrespective of age, gender or background, mirroring directly current health policy relating to the care of older patients.

The Department of Health report ‘A Recipe for Care’ (published February 2007) (6) lists amongst its key objectives for the care of older people: ‘long-term conditions managed in the community’ and ‘partnership built around the needs and wishes of older people and their families.’

Fundamental to the report and Government health strategy is the stated aim to ‘help older people manage their own conditions’ and ‘maintain independence’, through ‘care closer to home’. According to Dialysis Options this ideal has yet to permeate the coordination of kidney treatment.

“Everyone accepts that the quality of life for a non-transplanted kidney patient suffering established renal failure can often be poor,” says Tim Statham OBE, Chief Executive of patient organisation The National Kidney Federation (NKF).

“It is imperative that the existing health system does not restrict still further what is, and is not, possible for these patients, by failing to offer peritoneal dialysis to appropriate cases. This is an issue about patient choice, and patient freedom, not administrative or clinical convenience.

The NKF welcomes the ‘Dialysis Options’ initiative and looks forward to the day when all kidney patients, of whatever age, have as much say about the choice of dialysis treatment offered to them as does the nephrologist providing the treatment.”

The Dialysis Options campaign is developing a database of older kidney patients and their personal experience of the dialysis treatment options they have been offered. If this story has affected you and you would like to share your experience of dialysis with the Dialysis Options team contact 01943 468010 or email info@dialysisoptions.org. ENDS

 

 

References:

UK Renal Registry Report 2005, Chapter 4 UK Renal Registry, Bristol, UK Editors: David Ansell, Terry Feest, Andrew Williams, Chris Winearls
UK Renal Registry Report 2005, Chapter 3 UK Renal Registry, Bristol, UK Editors: David Ansell, Terry Feest, Andrew Williams, Chris Winearls
UK Renal Registry Report 2005, Appendix E Table E.2.2 UK Renal Registry, Bristol, UK Editors: David Ansell, Terry Feest, Andrew Williams, Chris Winearls
UK Renal Registry Report 2005, Appendix E Table E.2.1 UK Renal Registry, Bristol, UK Editors: David Ansell, Terry Feest, Andrew Williams, Chris Winearls
NKF Conference Patient Survey 2006 Data on file
Department of Health A Recipe for Care – Not a single Ingredient Professor Ian Philp, National Director for Older People February 2007

 

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