Information for the public

Renal replacement therapy

The kidneys remove harmful substances from the blood by making urine. When the kidneys fail, people need renal replacement therapy to do this job – this means either a kidney transplant or a treatment called dialysis, which artificially removes unwanted substances from the blood. More than 60,000 adults in the UK are having renal replacement therapy. Some people choose not to have renal replacement therapy and instead are offered ongoing support with their symptoms to give them a good quality of life for as long as possible. This is called supportive treatment, palliative or conservative care, or conservative management.

We want this guideline to make a difference to children, young people and adults with kidney failure by making sure:  

  • discussions about possible treatment options, including supportive treatment, start at least a year before your kidneys fail completely, giving you and your care team time to think, get prepared and plan for it
  • your care team explains the risks and benefits of a kidney transplant and whether it could be a suitable option for you
  • your care team helps you understand the pros and cons of different types of dialysis and what they involve so you and your family can decide what’s right for you
  • your care team explains what supportive treatment involves and what to expect if you choose this option
  • your care team supports you to explore and plan for changing treatment, including switching to supportive treatment, if this is your choice.

Making decisions together

Decisions about treatment and care are best when they are made together. Your healthcare professionals should give you clear information, talk with you about your options and listen carefully to your views and concerns.

To help you make decisions, think about:

  • What matters most to you – what do you want to get out of your treatment and care?
  • How will treatment affect your day to day life?
  • What do you need to know about the treatments and their effects – which options are available to you and how do you feel about these?
  • What happens if you don’t want to have renal replacement therapy?

If you can’t understand the information you are given, tell your healthcare professional.

Read more about making decisions about your care.

Where can I find out more?

The NHS website has more information about chronic kidney disease, dialysis and kidney transplant.

The organisations below can give you more advice and support.

NICE is not responsible for the content of these websites.

To share an experience of care you have received, contact your local Healthwatch.

We wrote this guideline with people who have been affected by kidney disease and staff who treat and support them. All the decisions are based on the best research available.

ISBN: 978-1-4731-3108-8

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