Haemodialysis

Haemodialysis is the most common treatment for end-stage renal failure. Blood is shunted through an extracorporeal circulation in which waste products and excess fluid are removed by the physical processes of diffusion and ultrafiltration.

Notes:

• home haemodialysis (HD) has the best patient outcomes (1,2) and is the most cost-effective of any dialysis modality, but its use has been declining in many countries
  • prevalence of home HD varies from 0 to 58.4 per million population, and varies between countries, more than any other renal replacement therapy (RRT) modality
  • variation cannot be explained by the variation in the use of other RRT modalities, nor by prevalence of diabetic nephropathy, national wealth or population density
    
    
• according to the 19th annual report by the UK Renal Registry (2016), on 31 December 2015 there were 61,256 adults in the UK receiving RRT
  • of these, 53.1% had received a transplant, 41.0% were receiving haemodialysis (21.2% in satellite units, 17.8% in hospitals, 2.0% at home), 2.5% were receiving continuous ambulatory peritoneal dialysis and 3.4% were receiving automated peritoneal dialysis
  • in addition, 769 children and young people under the age of 16 years were receiving RRT
    • most had received a transplant (41% live, 34% deceased), with 13% on haemodialysis and 12% on peritoneal dialysis
  • median age of all people newly requiring RRT was 59.0 years; 22.7% of people were from minority ethnic groups

Reference:

1. MacGregor MS et al. Home haemodialysis-international trends and variation. Nephrol Dial Transplant. 2006 Jul;21(7):1934-45.
2. Mowatt G et al. Systematic review of the effectiveness of home versus hospital or satellite unit hemodialysis for people with end-stage renal failure. Int J Technol Assess Health Care. 2004 Summer;20(3):258-68
3. NICE (October 2018). Renal replacement therapy and conservative management