This guidance has been incorporated into the chronic kidney disease NICE Pathway, along with other related guidance and products.
At any one time in the UK, 400–800 people per million of the population need renal replacement in the form of dialysis. The prevalence of dialysis in the UK is highly age dependent – for adults aged 70–80 years it is between 1600 and 2000 people per million. Dialysis is needed to sustain life for patients with chronic kidney disease (CKD). For about 40% of adults on dialysis a kidney transplant is the treatment of choice; this percentage is higher in children. If patients do not have a kidney transplant, dialysis is needed for the rest of the patient's life.
Two main types of dialysis are available, haemodialysis and peritoneal dialysis. The main factors that determine what type of dialysis people with chronic kidney disease have are patient preferences about which treatment fits best within their lifestyle, availability of options within a service and clinical contraindications. Factors patients and carers may need to consider about peritoneal dialysis are: the ability to carry out dialysis themselves; the support services they need to carry out dialysis; integration of dialysis with work, school, hobbies, and social and family activities; opportunities to maintain social contacts; possible modifications to their home; the distance and time travelling to hospital; flexibility of daily treatment, diet and medication regimens; and possible changes to body image and physical activities because of dialysis access points.
Peritoneal dialysis can be delivered safely and effectively at home or at another location of the patient's choice. Patients administer it themselves although children, and some adults, might need help from their families or carers. Patients must have a clean and hygienic place to exchange dialysis fluid and/or set up dialysis delivery devices either to have dialysis throughout the day (continuous ambulatory peritoneal dialysis [CAPD]) or overnight while they are asleep (automated peritoneal dialysis [APD] and assisted automated peritoneal dialysis [aAPD]). A small room or shed will be needed to store deliveries of dialysis fluid.
The proportion of people with chronic kidney disease (CKD) starting treatment on home- or hospital-based dialysis, and peritoneal or haemodialysis treatment, varies considerably. The proportion of people with chronic kidney disease using peritoneal dialysis ranges from 0–30% in adults, possibly because of variation in local practice and resources, and is as high as 56% in children.
There is currently no national guidance in England and Wales on supporting people to make informed decisions about renal replacement therapy, specifically peritoneal dialysis. Nor is there guidance on the role of aAPD in an integrated dialysis or renal replacement programme or individual patient pathway.
This short clinical guideline aims to improve the care of people with stage 5 CKD who need and want to receive dialysis, by making evidence-based recommendations on the role of peritoneal dialysis.