The recommendations NICE has made concern only where haemodialysis is carried out (that is, in the home or in a renal unit).They do not deal with other issues concerning haemodialysis, such as how often it should be carried out, or how it compares with other ways of treating kidney failure. And these recommendations only apply to individuals who have had a detailed assessment of their treatment options and for whom haemodialysis is considered to be a suitable treatment.
NICE has recommended that all patients who are suitable for home haemodialysis should be offered the choice of having haemodialysis in the home or in a renal unit. In general, patients who are suitable for home haemodialysis are those who:
- are able and willing to learn to carry out the procedure and to continue with the treatment
- have remained in a stable condition while on dialysis
- don’t have particular problems associated with their kidney disease or don’t have other diseases that would make it too difficult or unsafe to carry out haemodialysis at home
- have blood vessels that are suitable for inserting the catheters (tubes) that carry the blood to and from the dialysis machine
- have a carer (or more than one carer) who has decided, after discussing all the issues, to help with the haemodialysis (this doesn’t apply to patients who can carry out the haemodialysis on their own)
- have a home that already has enough space and facilities to set up and use the kidney machine, or whose home could be adapted to provide the space and facilities needed.
Before it is decided whether home haemodialysis is a suitable option for an individual, there should be a full assessment of the patient’s healthcare needs and social and home circumstances. The team responsible for the patient’s care should give the patient, and anyone who might be a carer, full information about what is involved in carrying out haemodialysis in the home or in a renal unit, and what impact it could have on their lives and the life of the rest of the household. Potential carers should be given the chance to tell the doctor what they think on their own, when the patient isn’t there.
Patients having haemodialysis in a renal unit who haven’t previously been offered the option of having home haemodialysis but who would like to consider the possibility should be reassessed, provided that their clinical condition does not rule out home haemodialysis.
Whenever it is decided to go ahead with home haemodialysis, there should be an opportunity to reconsider the decision later if there is any change in the patient’s circumstances.
Patients and their carers should receive training before starting to carry out haemodialysis at home. They also need the support of a team of healthcare professionals they can contact easily and who respond rapidly. Because sometimes patients can’t carry out dialysis at home as usual (for example, because the carer is ill or away from home), there should be facilities available for them to have the dialysis in a renal unit when necessary.
The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.