Dialysis

Purpose

With the end-stage kidney disease population growing we continue to focus on optimising access to the best dialysis option for each person who needs it. This could be dialysis at home (peritoneal dialysis and haemodialysis) or in-centre dialysis and includes the need for the most appropriate vascular access. We will be taking work started by the dialysis at home and vascular access workstreams and developing the next steps to deliver improvement.

LKN Leads

Aims and objectives of the group:

Aims

1. Access to peritoneal dialysis (PD) catheter percutaneous insertion for eligible patients optimised
2. There is equitable access to  home haemodialysis (HHD) across the network by influencing commissioning and procurement decisions, ensuring all renal units have timely access to HHD machines and training. Ensure appropriate access to HHD respite care through in-centre haemodialysis
3. Peritonitis rates in London reduced, meeting international standards and best practice
4. Peer support is embedded within the pathway to support both shared-decision making on kidney replacement modality as well as support for people established on home dialysis
5. There is a resilient and sustainable home therapies service across London, underpinned by expert procurement using a ‘once for London’ approach where possible, minimising risk of reliance on single suppliers
6. Arteriovenous fistulas are recognised the preferred HD vascular access where appropriate, with a reduction in the percentage of people starting dialysis on central venous catheters
7. Long-term AVF outcomes are improved through consistent use of standardised, high-quality needling techniques regardless of place of care, supported by multi-format, patient and staff education 

Objectives

1. Support and training  provided by Units with established percutaneous PD catheter insertion services (Epsom, Imperial, Kings) as regional centres
2. Develop a rolling-programme of training across to future-proof service continuity​ in percutaneous dialysis access
3. Ensure any appropriately qualified healthcare provider can access percutaneous catheter training​, when supported by their unit to develop the service locally. 
4. Agree metrics to monitor impact of percutaneous catheter insertion training and report quarterly
5. Influence home therapy commissioning decisions through collaborative working with the LKN Demand and Capacity Group​
6. Support patients to access HHD machines and training within London-wide agreed timeframe in all renal units
7. In-centre haemodialysis is available as respite from HHD enabling people to remain on HHD longer 
8. Majority of units in London working with using a shared root-cause analysis (RCA) measure  for PD peritonitis
9. Share learning from the RCA methodology across London units​
10. Monitor changes in PD peritonitis rates through the LKN data pack, and take action to address issues as needed
11. Support the implementation of peer support for all dialysis at home modalities, in collaboration with the Peer Support Lead​
12. Pilot peer support pathway, and evaluate impact on uptake, patient experience of shared decision making (SDM) and dialysis at home
13. Assess current supplier landscape in dialysis across London ​
14. Develop a commissioning support group, including ICBs, renal unit Ops leads, procurement leads, and finance leads, to define options and opportunities
15. Develop an LKN training and education programme on vascular access management ​
16. Trial and embed use of N-PREM to monitor impact of training on patient experience​
17. Work with Peer Support Lead and the LKN Patient Experience Group (PEG) to develop accessible, multi-format patient information on vascular access.