Home dialysis patients in UK face “postcode lottery of care”, new report finds

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Kidney failure patients who wish to receive the choice of home dialysis face an unequal struggle across the UK to access such care, according to the Bridging the Gap report, which was released today by Quanta Dialysis Technologies. The failure to offer such treatment is “wasting NHS [National Health Service] money and reducing quality of care for patients”, the report states.

A significant proportion of the 30,000 UK patients currently living with kidney failure are not offered the choice of dialysing at home, meaning they spend hours per day travelling to hospitals. This leads to potentially worse clinical outcomes, according to Quanta. In some areas, the company claims, more than one in three patients (37%) have access to such therapy—but, in others, this rate drops to just one in 25 (4%), as per the 2021 Getting It Right First Time (GIRFT) report on renal medicine.

Kidney patient Maddy Warren, one of the authors of the report who has been on home dialysis for 23 years, said: “Patients face a de-facto postcode lottery in accessing home dialysis, with still too many not properly informed that they have the option of such treatments.

“Where I and other home dialysis patients can dialyse as frequently as we wish, patients who dialyse in-centre do so only three times a week. This treatment is more intense over a shorter time period, which can be very draining, and often patients only feel slightly better for a short time before their toxin and fluid levels build up again and they still face a wait before their next dialysis session.

“They have to adhere to strict fluid and diet restrictions and must also travel to and from the centre, which is a time consuming and often exhausting experience. Dialysis on the hospital’s schedule can prevent people from getting a job, seeing family and enjoying a good quality of life.”

The new report points to research showing that the NHS spends in excess of £50 million a year on transport costs getting kidney patients into and out of hospitals, with usually three sessions of dialysis being offered per week for three-to-five hours at a time—meaning more than 3.3 million such journeys are carried out each year, a Quanta press release notes.

Apart from access to care itself, there is also a lottery in whether patients given home dialysis receive financial help with water and electricity bills. Some do, but others are denied this, the company adds. The Bridging the Gap report highlights studies showing that home dialysis can provide equal or better care for between £4,000 and £6,000 less per patient each year, and bring improved physical and psychological wellbeing.

The report also states that, currently, only 33 in 52 renal treatment centres in England are meeting the NHS target of getting 20% of patients to dialyse at home. In addition, this new report makes five key recommendations on how the NHS can move more dialysis treatments to patients’ homes and reduce hospital admissions. These include:

  • Information for patients about transitioning to home therapies should be standardised and include details on practical and financial support available. This should include a consistent approach to utility bill contributions from the NHS to ensure nationwide equity. The government should ensure that educational resources are also provided to local authorities, enabling them to respond appropriately to the needs of people in their area who want to choose home therapies.
  • Renal units should proactively and universally offer support to people undergoing dialysis, at all stages in their journey. The goal should be to gradually build their knowledge, skills and confidence, and ensure they are dialysing in the right way for them at the time.
  • All renal unit staff should receive updated training to build their home dialysis knowledge to enable positive discussions with patients, and conversations should focus on finding solutions, not highlighting the barriers.

Commenting on the report findings, Yasmin Qureshi, who sits on the All-Party Parliamentary Kidney Group, said: “It is unthinkable that patients up and down the country are still facing such drastically different levels of care depending on where they live. This is about more than cost saving in the NHS—it is about giving everyone, regardless of ethnicity, gender or postcode, the equal right to choose the treatment. The government must urgently act upon the recommendations in this report, and ensure that NHS staff and patients are given the right education and tools to make empowered decisions at every stage in their dialysis journey.”

John Milad, CEO of Quanta, added: “It is heart-breaking to see what dialysis patients are still undergoing, but we hope this report will shine a light on what needs to be done to help. It is only through collaboration between patients, charities, healthcare teams and industry that we can transform patient care in this way to ensure everyone gets equal access to testing and treatment.”

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