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Preparing for renal replacement therapy

Quality statement

People with progressive CKD whose eGFR is less than 20 ml/min/1.73m2, and/or who are likely to progress to established kidney failure within 12 months, receive unbiased personalised information on established kidney failure and renal replacement therapy options.

Quality measure

Structure

a) Evidence of local arrangements to ensure that people with progressive CKD whose estimated glomerular filtration rate (eGFR) is less than 20 ml/min/1.73m2, and/or who are likely to progress to established kidney failure within 12 months, receive unbiased personalised information on established kidney failure and renal replacement therapy options.

b) Evidence of local procedures to document the outcome of discussions with people with CKD about renal replacement therapy options, with reasons for the uptake of a particular modality.

c) Evidence of local arrangements to collect, analyse and act upon patient feedback on whether they felt that informed choice was available to them.

d) Evidence of local arrangements for provision and distribution of written materials on established kidney failure and renal replacement therapy options.

Process

a) Proportion of people with progressive CKD whose eGFR is less than 20 ml/min/1.73m2, and/or who are likely to progress to established kidney failure within 12 months, known to renal services with progressive CKD for 3 months or more, who receive unbiased personalised information regarding established kidney failure and renal replacement therapy options.

Numerator - the number of people in the denominator receiving unbiased personalised information regarding established kidney failure and renal replacement therapy options.

Denominator - the number of people with progressive CKD whose eGFR is less than 20 ml/min/1.73m2, and/or who are likely to progress to established kidney failure within 12 months, known to renal services with progressive CKD for 3 months or more.

b) Proportion of people on long-term dialysis who started dialysis in an unplanned way who receive unbiased personalised information regarding established kidney failure and renal replacement therapy options at the earliest opportunity.

Numerator - the number of people in the denominator receiving unbiased personalised information regarding established kidney failure and renal replacement therapy options at the earliest opportunity following dialysis start.

Denominator - the number of people on long-term dialysis who started dialysis in an unplanned way.

Outcome

a) Proportion of people who start long-term renal replacement therapy via the modality which they initially selected.

Numerator - the number of people in the denominator receiving renal replacement therapy via the modality which they initially selected.

Denominator - the number of people starting long-term dialysis.

b) Proportion of people on long-term dialysis who are on peritoneal dialysis.

Numerator - the number of people in the denominator on peritoneal dialysis.

Denominator - the number of people on long-term dialysis.

c) Proportion of people on long-term dialysis who are on home haemodialysis.

Numerator - the number of people in the denominator on home haemodialysis.

Denominator - the number of people on long-term dialysis.

Transplantation uptake is addressed in quality statement 11 - ‘Transplantation - pre-emptive' and 12 - ‘Transplantation - on dialysis'.

Description of what the quality statement means for each audience

Service providers ensure they provide people with progressive CKD whose eGFR is less than 20 ml/min/1.73m2, and/or who are likely to progress to established kidney failure within 12 months, with unbiased personalised information on established kidney failure and renal replacement therapy options.

Healthcare professionals provide unbiased personalised information on established kidney failure and renal replacement therapy options to people with progressive CKD whose eGFR is less than 20 ml/min/1.73m2, and/or who are likely to progress to established kidney failure within 12 months.

Commissioners ensure they commission services that provide unbiased personalised information on established kidney failure and renal replacement therapy options to people with progressive CKD whose eGFR is less than 20 ml/min/1.73m2, and/or who are likely to progress to established kidney failure within 12 months.

People with advanced CKD that is getting worse and/or whose kidneys are likely to fail within 12 months receive information specific to their situation about their condition and possible treatment options.

Source clinical guideline references

The Renal Association clinical practice guideline: planning, initiating and withdrawal of renal replacement therapy, recommendation 3.1.

Data source

Structure

Local data collection.

Process

Local data collection. Contained within The Renal Association clinical practice guideline: planning, initiating and withdrawal of renal replacement therapy, audit measures 7-9.

Outcome

Local data collection. Hospital Episode Statistics (HES) contains data on compensation for renal failure. The Office of population censuses and survey classification of surgical operations and procedures (OPCS-4)code for this is X40, with subcategories 0-9. The UK Renal Registrycollects data on renal treatment modality.

Definitions

People with progressive CKD whose eGFR is less than 20 ml/min/1.73m2, and/or who are likely to progress to established kidney failure within 12 months, includes people who start dialysis in an unplanned way and people with failing kidney transplants. All people in these groups should have access to unbiased personalised information on established renal failure and renal replacement therapy options.

Information should, as part of a care plan, include:

  • transplantation
  • home haemodialysis
  • peritoneal dialysis
  • haemodialysis
  • conservative management.

It should also enable patients to make an informed decision about their treatment. A care plan is defined in quality statement 3 - ‘Planning care'.

Equality and diversity considerations

All information about treatment and care should be culturally appropriate. It should also be accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English. People with CKD should have access to an interpreter or advocate if needed.

Chronic kidney disease
Identification
Specialist referral
Planning care
Cardiovascular risk
Blood pressure control
Progression
Acute illness
Anaemia treatment
Preparing for renal replacement therapy
Psychosocial support
Transplantation - pre-emptive
Transplantation - on dialysis
Dialysis access
Best possible dialysis
Patient transport

This page was last updated: 10 March 2011

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.