Home Haemodialysis the advantages for suitable patients
Whilst some Haemodialysis patients live for many years on dialysis, it is a sad truth that Haemodialysis patients have an average life expectancy of just eight years - as under the current model of NHS renal care they only receive up to 12 hours dialysis per week. This is inadequate as a healthy kidney would dialyse around the clock. Home care provides undoubted clinical benefits to patients as it allows for longer and slower dialysis, improving kidney function and life expectancy.
Patients usually receive their hospital haemodialysis each week spread over three, four hour sessions. Home care reduces this unnecessary burden on patients but very few patients currently receive home dialysis. Through home care, patients can also be trained for nocturnal dialysis, which reduces the disruption to their daily lives still further and can raise kidney function to around 40% of normal levels. In 2010 however, only 5 patients in the entire UK are trained for nocturnal dialysis.
The current centralised model of kidney care represents a serious drain on NHS resources. Despite representing just 0.1% of the population, 2% of the NHS budget is spent on services for dialysis and transplantation patients. In the 52 hospitals in England that offer dialysis services, up to 50% of their patient transport service costs are accounted for by dialysis.
In its 2002 guidance NICE advocated home dialysis as a more cost effective treatment than hospital dialysis and its expansion as an opportunity to ease the capacity burden on hospitals. NICE have stated that up to 30% of patients (HD and PD) would be suitable for, and should recieve, home dialysis but this has not been implemented at a local level due to the objections of renal units and nephrologists.
(Quality, Innovation, Productivity and Prevention)
The expansion of home dialysis services met the objective of the previous NHS Chief Executive David Nicholson’s when he posed a challenge to the NHS to make major efficiency savings whilst improving the quality of a patient-focussed health service. For too long, renal care has benefited hospitals, not patients, but home dialysis is exactly the kind of cost-effective innovation that will represent a major step forward both for patients and the NHS itself. David Nicholson stood down in April 2014 and was succeeded by Simon Stevens.
In 2010 the Secretary of State for Health, Andy Burnham MP, said “...but the NHS needs to do more to plan services around patients - even taking services into their homes. Dialysis at home is a perfect example, which can mean patients no longer have to worry about long trips to their nearest hospital three times a week while also enjoying better clinical outcomes.”
Not every patient will be suitable for Home Dialysis; however every suitable patient should be offered this choice. If you think Home Dialysis might be beneficial (Haemodialysis or Peritoneal Dialysis) then ask to discuss these options with your clinical team.