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More patients receiving dialysis from comfort of their homes thanks to dedicated renal team

The Home Therapies Team at Royal Derby Hospital

The number of patients in Derby receiving life-changing dialysis from the comfort of their own home has increased – thanks to improvement work carried out by UHDB’s renal team.

Derby previously had one of the highest proportion of patients receiving peritoneal dialysis in the UK in 2016, but the numbers of patients on this form of dialysis nearly halved from July 2016 – August 2020, dropping from 90 to 55.

However, thanks to the hard work and commitment of our renal team, there are now 130 patients receiving dialysis at home, via either peritoneal or haemo dialysis, which eliminates their need to attend hospital, improving their experience and protecting their health.

Dr Nitin Kolhe, Consultant Renal Physician at UHDB, said the difference that this has made to the lives of patients has been huge: “There are two main forms of dialysis: haemodialysis and peritoneal dialysis. Traditionally, haemodialysis is done in the hospital three times a week, but it can also be done at home. The process usually lasts around three hours and needs repeating up to five times weekly.  In a hospital setting, this usually takes a number of hours which not only puts a strain on the patient’s life due to the time it takes, but they have to travel to and from the hospital. Dialysis patients are also immunosuppressed, so having to come to hospital presents an added risk – particularly during the pandemic.

“However, it is well documented that patients on peritoneal dialysis have better results clinically, as well as giving them improved quality of life and reducing their need to come to the hospital. As an added bonus, it is also far more cost effective for the NHS to treat them this way, too.

“This makes a massive difference to the quality of life of these patients as it gives them back control of their lives.”

Peritoneal dialysis involves a catheter being inserted into the patient’s abdomen, through which fluid is added into the peritoneal cavity in the abdomen. This removes waste products and excess fluid from the blood before drawing the fluid back out again in a process which must be done four times every day but only takes around 30 - 40 minutes as opposed to the several hours haemodialysis takes.

So when the number of patients on dialysis at home began to drop, Dr Kolhe and the team decided to take action.

Dr Kolhe continued: “Over a number of years, we noticed a decrease in the number of patients being treated this way, and a rise in the number of patients getting infections in their catheter for example.

“An external company conducted a quality improvement investigation to find the reason behind, but we were unable to pinpoint anything specific, so we decided to make improvements to the service ourselves.”

One of the key changes that was made was to bring in a common nursing lead for both home haemodialysis and peritoneal dialysis patients. Sister Carol Rhodes was brought into the role, with the teams being merged to create the Home Therapies Team to help more effectively manage patients dialysing in the community.

The peritoneal team extended their working hours, implemented new training regimes for both staff and enhanced the educational offering to patients receiving home dialysis, such as taster sessions for patients due to begin dialysis and six-monthly refresher training.

Carol Rhodes, Senior Sister and Home Therapies Lead in the Renal Department at Royal Derby Hospital, said this focus on education has proven extremely beneficial:

“Every patient that requires dialysis is offered the choice of having it at home, so we worked really hard to ensure these patients who opted for the latter were fully supported and could carry out their treatments safely.

“We teach patients how to correctly perform their dialysis which has led to a decrease in the number of peritonitis infections which is fantastic news. Peritonitis can lead to patients having to have their catheters removed and having to move onto haemodialysis in the hospital, so this increase in the confidence and reassurance patients feel because of the enhanced support is a real success.

“Our nurses visit these patients every month to carry out routine tests and checks, but they are also there to answer any questions patients may have and provide the support they need to continue their dialysis at home which is a huge benefit for them.

“This work has been a real success story and UHDB now has one of the highest percentages of patients on home haemo dialysis in the UK which is a great achievement.”

Despite recent success, the team is hoping to increase the number of patients undergoing dialysis in the community further in the coming months.

Dr Kolhe added: “The work that the team has done has been nothing short of incredible, and to see such an increase in the number of patients taking up peritoneal dialysis in our communities is a wonderful achievement in such a short space of time.

“We are now aiming to maintain our current success and want to be treating around 90 patients using home dialysis in the next year to help give them more freedom and improve their lives.”