Quality standard


This quality standard covers renal replacement therapy services for kidney failure in adults. For more information see the renal replacement topic overview.

Why this quality standard is needed

Renal replacement therapy is a life‑long treatment for people with end‑stage kidney disease. For adults who wish to progress with renal replacement therapy, treatment choices include:

  • dialysis (either haemodialysis or peritoneal dialysis)

  • kidney transplantation (from a living or deceased donor).

Two main types of dialysis are available: haemodialysis and peritoneal dialysis. The main factors that determine the choice of dialysis type are patient preference to suit their lifestyle, individual clinical factors and contraindications, and the local availability of treatment within a service. Kidney transplantation is not suitable for all people receiving dialysis.

The quality standard is expected to contribute to improvements in the following outcomes:

  • preventing adults from dying prematurely

  • enhancing quality of life for adults with long‑term conditions

  • ensuring that adults have a positive experience of care

  • treating and caring for adults in a safe environment and protecting them from avoidable harm.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable quality improvements within a particular area of health or care. They are derived from high‑quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following outcomes framework published by the Department of Health and Social Care:

Table 1 shows the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2014/15


Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicator

1a Potential Years of Life Lost (PYLL) from causes considered amenable to healthcare

i Adults

1b Life expectancy at 75

i Males ii Females

2 Enhancing quality of life for people with long‑term conditions

Overarching indicator

2 Health‑related quality of life for people with long‑term conditions**

Improvement areas

Ensuring people feel supported to manage their condition

2.1 Proportion of people feeling supported to manage their condition

Reducing time spent in hospital by people with long‑term conditions

2.3 i Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults)

4 Ensuring that people have a positive experience of care

Overarching indicator

4b Patient experience of hospital care

Improvement areas

Improving hospitals' responsiveness to personal needs

4.2 Responsiveness to in‑patients' personal needs

Improving people's experience of accident and emergency services

4.3 Patient experience of A&E services

5 Treating and caring for people in a safe environment and protecting them from avoidable harm

Overarching indicator

5a Patient safety incidents reported

5b Safety incidents involving severe harm or death

5c Hospital deaths attributable to problems in care

Improvement areas

Reducing the incidence of avoidable harm

5.4 Incidence of medication errors causing serious harm

Alignment across the health and social care system

** Indicator complementary with Adult Social Care Outcomes Framework (ASCOF)

Patient experience and safety issues

Ensuring that care is safe and that people have a positive experience of care is vital in a high‑quality service. It is important to consider these factors when planning and delivering services relevant to renal replacement therapy.

NICE has developed guidance and an associated quality standard on patient experience in adult NHS services (see the NICE Pathway on patient experience in adult NHS services), which should be considered alongside this quality standard. They specify that people receiving care should be treated with dignity, have opportunities to discuss their preferences, and be supported to understand their options and make fully informed decisions. They also cover the provision of information to patients and service users. Quality statements on these aspects of patient experience are not usually included in topic‑specific quality standards. However, recommendations in the development sources for quality standards that impact on patient experience and are specific to the topic are considered during quality statement development.

Coordinated services

The quality standard for renal replacement therapy services specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole renal replacement therapy service care pathway. A person‑centred, integrated approach to providing services is fundamental to delivering high‑quality care to adults receiving renal replacement therapy services.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high‑quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high‑quality renal replacement therapy service are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating adults receiving renal replacement therapy should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development sources on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting adults receiving renal replacement therapy. If appropriate, healthcare professionals should ensure that family members and carers are involved in the decision‑making process about investigations, treatment and care.