“There are approximately 21,000 patients currently receiving dialysis treatment in England. The number of patients requiring renal replacement therapy (dialysis or transplantation) is increasing at around 4% per year.

It is estimated that around one third of dialysis patients (7,000+) may choose to opt for dialysis at home. In particular NICE have previously suggested that 10 to 15% of dialysis patients may opt for home haemodialysis (whereas currently 2% do so). In theory, more than one third of patients could choose home therapies provided it was clinically appropriate for them.

Work by NHS Kidney Care on reference costs for dialysis showed the annual costs of home haemodialysis to be up to 25% less than in-centre dialysis, based on data returns from 16 units.

However, releasing savings in practice will depend on a range of factors including the set up costs, treatment regimen, and training and support needs in any individual case. As referenced by NICE, previous studies have demonstrated that initial costs of home haemodialysis are recouped within a period of approximately 14 months. ”

Now this makes very interesting reading. The fact that the potential that has been identified is so large, and with the long term costs savings as a benefit, there is clearly a need for a more focused recruitment of patients for home therapies. I’ve gone on about this before, and suggested that a more co-ordinated programme of recruitment should be developed, but certainly locally, I don’t see the relative volume of recruitment going on. In fairness, the local unit is very busy and short staffed, so most of the time it’s ‘heads down’ and crack on with the job in hand to get the patients through door. All understood and I don’t envy their daily task. BUT… there is material around that talks about the real and valuable benefits to patients and the NHS alike, but in truth, you have to rummage around on the web to find it.

How about a simplified brochure that gives guidance and answers basic questions, or a well thought through web site, that can be used to recruit new and ‘eligible’ patients? (The NHS Kidney Caresite is a good start) Give them something to read while on dialysis on their unit, and let them ask questions. Make use of, and develop more patient advocates that can talk to potential home patients so they can engage and help with the recruitment process, nothing better than a chat with somebody who’s been there, done it and got the t-shirt!

Overall, and above all, widen and raise the volume of the debate, information, benefits and more. With the advent of smaller and easier to manage dialysis machines, the opportunities to recruit are increasing.

Here’s some useful links:

NHS Kidney Care
NHS Kidney Care Matters
Improving choice for Kidney Patients – a report produced in February 2010

Then there is the less than useful view:

NICE press release about patient choice for dialysis treatment – 27th July 2011 – very focused on how much money can be saved by promoting PD more strongly –  The document is supposed to be about choice? Could do with an equally weighted document about the benefits of home haemo!