Wednesday, 26 January 2011

NICE Guideline on Peritoneal Dialysis

This short clinical guideline is now out for consultation until 18 February. It makes interesting reading and there are some key recommendations including:

  • The offer to patients, and their families and carers, should include oral and written information about conservative care, pre-emptive transplantation and dialysis
  • The importance of ensuring patients have been informed and understand that chronic kidney disease is a lifelong disease and that during the course of renal replacement therapy they are likely to need to switch between treatment modalities according to clinical and personal circumstances
  • To enable an informed decision, or shared decision making, information about the description of the treatment modalities and as importantly, discussion about how treatment fits into patients’ lives including details of impact on body image, distance and time travelling for treatment, flexibility of the regime and support needed are considered
  • The recommendations flag the importance of decision aids in helping patients make the right choice for themselves and the importance of presenting information to children in a form suitable to their age
  • People who present late for renal replacement therapy need the same information and opportunities to make decisions about their care
  • Consider peritoneal dialysis as a first choice for adults aged under 60 years and children older than 2 years
  • If consideration is been given to switching between modalities, a shared decision process should again be used to decide future treatment options

The guideline also highlights gaps in our knowledge and makes research recommendations about how the process of decision making about the choice of dialysis modality should be supported and what factors determine the effectiveness of any modality of dialysis including what is the most effective sequence of treatment, are they differences in nutritional status between treatment modalities and which outcomes should be used in evaluating effectiveness.

I am sure people with kidney disease , carers , commissioners and clinicians will want to read the draft guideline and make comments

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