This guideline covers renal replacement therapy (dialysis and transplantation) and conservative management for people with chronic kidney disease stages 4 and 5. It aims to improve quality of life by making recommendations on planning, starting and switching treatments, and coordinating care.
NICE has also produced a guideline on chronic kidney disease.
This guideline includes recommendations on:
- indications for starting dialysis
- planning and choosing treatments
- switching or stopping treatments
- recognising symptoms
- diet and fluids
- information, education and support
- coordinating care
Who is it for?
- Healthcare professionals
- Providers of renal replacement therapy and conservative management
- People with chronic kidney disease stages 4 and 5, their families and carers
Is this guideline up to date?
August 2023: We have found no new evidence that affects the recommendations. For more information, see the surveillance decision.
Guideline development process
This guideline updates and replaces NICE guideline CG125 (July 2011) and NICE technology appraisal guidance 48 (September 2002).
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and 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. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
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.