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Dialysis and kidney management in chronic kidney failure

26 September 2011

New research funded by the NIHR HSR programme is undertaking a national study of practice patterns in UK renal units in the use of dialysis and conservative kidney management to treat people aged 75 years and over with chronic kidney failure.

An estimated 50,000 people in the UK have lost more than 85 per cent of their kidney function at stage 5 with chronic kidney disease (CKD5). The majority of these people are elderly and their numbers are increasing as the population of older people grows. Many have other important conditions ('co-morbidity') in addition to kidney disease.

Some chronic kidney disease patients remain stable and asymptomatic but in others kidney function declines and symptoms arise. This raises the issue of whether to consider renal replacement therapy (RRT), or the alternative form of palliative care called conservative kidney management (CKM).

The study, led by Professor Paul Roderick of the University of Southampton and Dr Hugh Rayner from Heart of England Hospitals Trust in Birmingham, has two phases. In the first phase the team will select people aged 75 or over with chronic kidney disease, that have made the decision to start CKM or RRT, from nine renal units and interviewed about the factors that influenced their decision. In addition, key clinical staff in the renal units will be interviewed about how CKM and dialysis is raised with the patients and how both modes of therapy are provided.

Professor Roderick commented; "Currently there is limited evidence to guide patients and doctors when making this important decision. We need to understand better how renal units are developing conservative care, how this varies between units in extent and content, how decisions about treatment are made by clinicians, patients and their families, and the quality of the information."

Based on the findings from these interviews a postal questionnaire will be developed and sent to all UK renal units to survey the extent and nature of their conservative care programmes. Data that are routinely collected on patients with CKD5 in the units will be collated in order to identify what additional information would be needed in a future study. The researchers will also explore a sample of units to find out what proportion of patients with CKD5 are looked after by their GPs in primary care rather than by renal units, and explore why GPs choose this course of action.

The researchers then aim to prepare the way for a much larger prospective study which will compare what happens to patients with kidney failure receiving dialysis with conservative care in several renal units.

Professor Roderick added; "Better evidence is needed of the comparison between dialysis and conservative care in terms of how long people live with CKD5 and their quality of life (and that of their principal carers), for which types of patient conservative care might be most appropriate, and the comparative costs of CKM and dialysis. Such evidence would inform decision making between patients carers and clinicians, and renal service planning."

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The NIHR Health Services and Delivery Research (HS&DR) Programme is managed by the NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC). NETSCC is part of the University of Southampton funded by the NIHR, with specific contributions from the CSO in Scotland and NISCHR in Wales and the HSC R&D Division, Public Health Agency in Northern Ireland.

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