Renal Association Clinical Practice Guideline on Haemodialysis

The basis for the management of advanced chronic kidney disease is the seamless integration of renal replacement therapy (HD, peritoneal dialysis, and transplantation) with evidence based medical treatment of its complications. The National Service Framework Part 1: Dialysis and Transplantation has stressed the need for a patient-centred approach in the planning and provision of renal replacement therapy with an emphasis on patient education and choice as well as the provision of adequate resources for elective access surgery, dialysis and transplantation [1]. It also identified that a small proportion of patients after counselling may opt for optimal conservative medical therapy without planning to initiate dialysis. It is estimated that there are more than 1.5 million patients with established renal failure who are treated with HD. Innovations and changes in HD practice have seldom been underpinned by adequately powered randomised trials. Nevertheless, day-to-day clinical decisions on HD are required and standards need to be set on the best available evidence. Consequently clinical practice guidelines for HD have been developed in Australasia, Canada, Europe and the USA [2–5] as well as the UK. These guidelines serve to identify and promote best practice in the delivery of HD and have set clinical standards to allow comparative audit of the key aspects of the HD prescription, laboratory data and patient outcomes. The reports of the UK Renal Registry, Scottish Renal Registry and NHS Quality Improvement Scotland have demonstrated the benefits of performing regular audit to improve clinical standards in HD. This module provides an update of the 2007 RA clinical practice guidelines in HD and, most importantly, modification of the current guidelines whenever indicated by evidence from new studies. In preparation of this update the authors performed a Medline and Pubmed search of all articles published on HD since the