The National Institute for Health and Social Care (NICE) has launched new guidance on ‘renal replacement 
therapy and conservative management ’which describes good practice when considering options for kidney failure. The guidelines group included, among others, kidney doctors, nurses, transplant surgeons and 3 other members, including Kidney Care UK Policy Director Fiona Loud; it took 2 years to review the evidence and make the recommendations.
The guidelines apply to adults and children and we welcome the emphasis on patient choice and timely preparation to support people with kidney failure.
Key points:
- Review patients a year before it is likely they'll need a transplant or to start dialysis or conservative management to increase opportunities for supporting patient choice and reduce the frequency of unplanned starts
- Start treatment guided by patient symptoms or at 5-7% egfr (kidney function), whichever comes sooner
- Ensure that decisions about renal replacement therapy (RRT) choices or conservative management are made jointly with the person (or with their family members or carers)
- Offer regular opportunities to review treatment decisions
- Suitability for transplantation should not be guided by BMI alone
- Include living donor transplantation in the full informed discussion of options for RRT