Joint statement from professional and patient societies on Dialysis Away from Base (DAFB) in the UK - May 2022

As restrictions have been lifted, patients are keen to make travel plans, but concerns continue about rates of COVID-19 infection across the UK. We support DAFB and provide the following guidance irrespective of DAFB type (Haemodialysis or Peritoneal Dialysis).

This guidance only applies if shielding or local lockdown is not in place in base or destination units and will be reviewed and updated as required.

Opening up DAFB is a local decision based on capacity, resources, and the COVID-19 situation in each unit, but equal access to DAFB for all UK patients is desirable. We recommend that all units actively consider this question and ensure their DAFB status is communicated so that patients are aware.

Patients receiving dialysis remain clinically extremely vulnerable to COVID-19 compared with the general population and transmission has occurred in dialysis units. We recommend that dialysis away from base (DAFB) should be discussed on an individualised basis between the patient and their clinical team using the principles stated below.

1. Assess risk based on the following:

a) Current incidence of COVID-19 in the base unit/locality

b) Current incidence of COVID-19 in the designated unit/locality for DAFB.

c) DAFB unit IPC precautions in place

d) Base unit IPC precautions

1. Ensure

a) There is a documented discussion between the clinical staff at the base unit and the DAFB centre for shared awareness of COVID-19 rates and confirmation of number of recent COVID-19 infections in the base unit or receiving service

b) The patient is aware in advance of the local protocols that they will need to follow including any requirements for PCR or lateral flow tests.

c) Requirements are completed for the both the home and accepting DAFB unit – including medical paperwork, bloods, swabs and COVID-19 testing within the required time frame

1. Vaccination – we recommend that patients should be up to date with their COVID-19 vaccine schedule before travelling. Travel should ideally be at least 2 weeks after the last dose to ensure an immune response. However, if a patient has refused vaccination or been unable to be vaccinated this should not exclude them being considered for DAFB. Management of unvaccinated patients should be consistent with recommended IPC policies.
2. COVID-19 testing

a) Before travel – PCR or lateral flow test 3 days before travel; follow DAFB unit policy

b) On return – either an NHS COVID-19 PCR or lateral flow test should be performed at the first dialysis session. Asymptomatic surveillance testing should be resumed as per renal unit policy

1. Isolation requirements on return to the base unit

a) Travel within the UK – patients do not need to dialyse in isolation

b) Travel to non-UK countries – patients should dialyse in isolation for 10 days. If this is not possible, renal units may choose to follow a frequent testing regime using PCR or lateral flow tests

Depending on where they have visited, patients may need to isolate for a longer period for enhanced surveillance for blood borne viruses as per BBV guidance.

Patients should not travel if they

• Are a close contact of any individual with COVID-19 infection
• Have symptoms of COVID-19 with a positive LFT / PCR or are awaiting COVID-19 PCR test result
• Have a planned surgery date occurring during the isolation period on return from DAFB.

Further information

1. Patients should follow local guidance in the DAFB locality (likely to vary with time and between areas) and government guidance on isolation on return home.
2. Patients should take out travel insurance before making any bookings due to the risk of sudden cancellations. Check what is covered by travel insurance in the event of an infection with COVID-19 just before or during the holiday.
3. Patients should get an up to date GHIC card if travelling to countries with reciprocal healthcare arrangements so they can receive their dialysis free of charge or at the same rate as local people at public hospitals. Apply for a GHIC card online or by calling 0300 330 1350 from the UK or +44 191 279 0575 from abroad.
4. Dialysis Freedom offers a DAFB swap service within the UK.

Updated May 2022

Travelling with CKD: additional resources

• Kidney Care UK Holiday grant support
• Travelling with kidney disease: everything you need to know to plan worry-free time away from home