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Dialysis Capacity - What's needed in your patch in the next 3 years?

Posted Oct 24 2011 12:00am
The census date for the Dialysis Capacity Survey is fast approaching. The survey now, in it's 3rd year, will be conducted on the 31st of October 2011.

Nationally we seem to be moving from the inexorable year on year l growth phase towards steady state. For the past 4 years, the acceptance rate onto our renal replacement therapy programmes has been stable at 109 per million of the population. No doubt that is due to a range of factors including better detection and early management of CKD, and a recognition that the 'no dialysis choice' isn't a no treatment choice. Although we don't yet have national data on conservative kidney care, I am encouraged by the high profile choice has in advance kidney care and the passion of the conservative kidney care teams up and down the country to provide high quality care and when the time comes a dignified death .

The sustained increase in live donor transplants also offers the prospect of moving from a dialysis and transplant paradigm to a transplant first model for many people with end stage renal failure. There are still a lot of variability in live donor rates and even more in pre-emptive transplant rates which suggests that our focus on timely transplant listing will deliver further quality improvements.

Mark Brady, formerly clinical advisor to Kidney Care, and now specialist registrar in renal medicine in the northern region presented MORRIS, the model for optimising renal replacement investment and services at the joint Renal Association and British Renal Society meeting in June. The model is freely available at NHS Kidney Care , so you can put your own network figures in and play with the assumptions to see the impact. MORRIS suggests that if the acceptance rate stays flat, as it has done for the last 4 years, and if transplantation continues along the same trajectory, then with the next 3-5 years the total number of people needing dialysis may fall.

There are a lot of ifs and buts and assumptions in that the total number of people needing dialysis may fall statement, but when considered alongside the reemergence of home haemodialysis, the variation in Peritoneal dialysis and the anecdotal stories of capacity led demand, the importance of good data to ensure adequate future planning is clear.

The national picture based on the 50 million population off England tells a aggregated story built from the national demographics, Renal Registry returns and UK Blood and Transplant data. It's very helpful for macro level planning but doesn’t tell the local story where individual populations may have very different needs, different capabilities maybe in place for historic reasons
and there maybe unique factors that must be borne in mind in developing local services at the unit and network level. That's why the dialysis capacity survey, which this year also begins to capture aspects of nursing capacity is so important. During the transition period as specialist commissioning of dialysis migrates to the National Commissioning Board I would say that this survey is vital.

I am pleased that we have always had a very comprehensive return and look forward to a similar response this year.

The previous surveys have been very useful in a range of areas including;

• Identifying current pressures on capacity and the varied potential growth in dialysis numbers within existing capacity across the country,
• understanding the balance of centre, satellite and home dialysis nationally and regionally,
• quantifying the plans to increase home dialysis in the future.

The survey aims to capture the national profile of dialysis service across England to help ensure kidney services can be prioritised at a national level. But using the maxim 'collect data once, use it many times' I do hope that the national collection will feed into local planning at network level. To see the details of last years survey and check out your capacity and plans compared to other networks go to
http://www.kidneycare.nhs.uk/Library/DialysisCapacitySurveyResultsOctober2010.pdf
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