Renal services deal with patients with kidney failure. Each year, in England, approximately 5,500 people start treatment for kidney failure and there are currently around 43,000 people receiving treatment for kidney failure. Around 4 in 10 people are treated by circulating their blood through a machine which cleans it of toxins (haemodialysis). This can be done either in hospital or at home. About 1 in 10 people are treated using the thin membrane that lines the abdominal cavity (the peritoneum) as a filter. This is called peritoneal dialysis. Approximately half of these patients are treated by having a kidney transplant.
This Clinical Reference Group (CRG) covers:
- services for people with acute kidney injury
- the preparation for and delivery of dialysis, whether in a centre or at home
- people who undergo kidney transplantation.
Chair: Dr Richard Baker, Consultant Nephrologist, Leeds Teaching Hospitals Trust.
Guide to renal transplantation services
NHS England has produced a summary of renal transplantation services and how they are commissioned.
A key part of the CRG’s work is the delivery of the ‘products’ of commissioning. These are the tools used by the 10 Hub Commissioning Teams to contract services on an annual basis.
Service specifications are important in clearly defining the standards of care expected from organisations funded by NHS England to provide specialised care. The specifications have been developed by specialised clinicians, commissioners, expert patients and public health representatives to describe both core and developmental service standards. Core standards are those that all funded providers should be able to demonstrate, with developmental standards being those which may require further changes in practice over time to provide excellence in the field.
The following service specifications fall within the scope of this CRG:
- Centre Haemodialysis ICHD
- Haemodialysis to treat established renal failure in the home
- Peritoneal Dialysis to treat Established Renal Failure
- Acute Kidney Injury (Adult)
- Renal Assessment (Adult)
- Haemodialysis delivering only Dialysis Away from Base (DAFB)
- Renal Transplantation (Adult)
- Encapsulating peritoneal sclerosis treatment service (adults)
A commissioning policy is a document that defines access to a service for a particular group of patients. A NICE Technology Appraisal Guideline on the same topic will replace, or be incorporated into, a commissioning policy as appropriate. These are important documents that are developed to ensure consistency in access to treatments nationwide.
The following policies fall within the scope of this CRG:
- Dialysis Away From Base
- Dialysis Away From Base – Frequently asked questions
- Reimbursement of Expenses for Living Kidney Donors
Not routinely commissioned:
- Eculizumab for the treatment of refractory antibody mediated rejection post kidney transplant
- Bortezomib for the treatment of refractory antibody mediated rejection post kidney transplant
- Rituximab for the treatment of Idiopathic membraneous nephropathy in adults
Policy statements are brief documents that define the current commissioning position to support service contracting. They are interim documents for use while a full commissioning policy is being developed or until a formal NICE Technology Appraisal Guideline has been published.
The following policy statements fall within the scope of this CRG: