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Practice Guidelines

Renal replacement therapy: summary of NICE guidance

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4303 (Published 19 October 2018) Cite this as: BMJ 2018;363:k4303
  1. James Gilbert, senior research fellow1,
  2. Kate Lovibond, health economics lead1,
  3. Andrew Mooney, consultant renal physician2,
  4. Jan Dudley, consultant paediatric nephrologist3
  5. on behalf of the Guideline Committee
  1. 1National Guideline Centre, Royal College of Physicians, London, UK
  2. 2Leeds Teaching Hospitals NHS Trust and Honorary Clinical Associate Professor, University of Leeds
  3. 3Bristol Royal Hospital for Children
  1. Correspondence to: J Gilbert James.Gilbert{at}rcplondon.ac.uk

What you need to know

  • Start exploring the options of dialysis, transplantation, or conservative management with patients at least a year before they are likely to need it

  • Recommend patients start dialysis at an estimated glomerular filtration rate (eGFR) of 5-7 mL/min/1.73 m2 or sooner if symptoms of their chronic kidney disease are affecting their daily life

  • Haemodiafiltration is a form of haemodialysis with additional convection and is more effective than standard haemodialysis with a similar patient experience

  • Transplantation has better outcomes than any form of dialysis, with pre-emptive transplantation being more effective than transplantation after dialysis

  • Patients should not be excluded from receiving a kidney transplant based on body mass index alone

Approximately 8000 people a year start renal replacement therapy in the UK.1 Box 1 describes the options available for people approaching the need for renal replacement therapy. Around 60 000 people are currently living with a kidney transplant or are receiving dialysis. Transplant is the most common form of renal replacement therapy (approximately 54% of prevalent renal replacement therapy patients), followed by haemodialysis (40%), and then peritoneal dialysis (6%).1 The number of new transplants was around 3000 in 2016; this has gradually increased more recently. Some people will receive a kidney from a living donor, but those who have to join the waiting list for a kidney donation can expect to wait for 2.5-3 years.2 Among those receiving dialysis, most people opt for haemodialysis or haemodiafiltration done at hospital or in a satellite centre rather than at home.

Box 1

Renal replacement therapy explained

Renal replacement therapy comprises either transplantation or dialysis. Some people decide not to receive renal replacement therapy but choose conservative management, which comprises full supportive management (including advance care planning and control of symptoms and complications).

Transplantation

  • Can be from living or deceased donors

  • Can be done pre-emptively (before the point at which dialysis …

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