NxStage Medical, Inc. (Nasdaq: NXTM), a leading medical technology company focused on advancing renal care, has published a report, 'Home haemodialysis: Tackling unequal access in the UK'. The report, developed by NxStage in collaboration with renal health professionals, kidney patients, and patient charities including Kidney Care UK and the National Kidney Foundation, highlights significant disparities over patient access to the life changing benefits possible with home haemodialysis, and makes urgent recommendations towards improving access across the country. It also discusses opportunities for home haemodialysis to reduce costs associated with dialysis treatment for the NHS.
The National Institute for Health and Clinical Excellence (NICE) recommends that all patients who are suitable for home haemodialysis should be offered the choice of home therapy, but this is far from the case. Just 4.4% of the 28,000 patients on dialysis in the UK are on home haemodialysis - approximately 10% lower than NICE's recommendation. As a global comparison, compared to the UK's 4.4%, New Zealand has more than 17% of its dialysis patients dialysing at home and Australia has 9%.
The report identifies lack of patient awareness and education of home haemodialysis as primary reasons for low penetration of the therapy. Independent polling of kidney haemodialysis patients found that 27% were not educated on all types of dialysis that would be beneficial to them, and 31% of in-centre patients cite never being offered home haemodialysis as a treatment option.
The report shows that, city to city, it is a postcode lottery as to who has access to the potential benefits of home haemodialysis. Derby has the highest uptake in the UK, with 13.2% of dialysis patients on home haemodialysis, three times higher than the national average. Portsmouth and Manchester are the only other cities hitting recommended targets, with an uptake over 10%. Where patients live in the UK has a significant impact on their ability to access home haemodialysis as a therapy option.
This lack of access to home haemodialysis denies many patients the opportunity for improved health and a better quality of life - the home is the most practical setting for patients to perform haemodialysis at the frequency and duration that bests suits their clinical needs. More frequent haemodialysis has been shown to lead to better clinical outcomes, including improved survival, reduced risk of cardiovascular morbidity, reduced need for blood pressure medications, improved physical and mental quality of life, and more energy. Improved health can also increase a patient's likelihood of receiving a kidney transplant.
More frequent haemodialysis can also dramatically reduce recovery time. The average in-centre patient reports eight hours of post-dialysis recovery time, compared to just one hour for those dialysing more frequently at home. Compared to home haemodialysis patients, in-centre haemodialysis patients lose 52 days per year to recovery time, travelling to appointments , and waiting at the hospital.
Increasing the uptake of home haemodialysis has potential benefits for the NHS, especially considering the need for haemodialysis may double across the world by 2030. A large cost of in-centre haemodialysis is transport, with patients travelling to and from the hospital for therapy. According to the National Kidney Federation, in the 52 hospitals across England that offer dialysis, 50% of their patients transport costs are accounted for by dialysis.
The report urges healthcare professionals and the government to take action towards increasing patient access to home haemodialysis. Recommendations include strengthened patient education programs, dedicated staff responsible for supporting home programmes, and better patient-to-patient interactions.
Other key data from independent polling of kidney haemodialysis patients mentioned in the report include:
- 77% of home haemodialysis patients report an improvement in their health since dialysing at home and 26% relied less on medication.
- 62% of in-centre haemodialysis patients want more flexibility on how often they dialyse, with 63% spending less time with friends and family and 52% not being able to go on holiday.
- Since beginning home haemodialysis, 58% of patients report being happier, 52% witness decreased anxiety levels, and 71% have more leisure time.
- Taking into account additional costs that otherwise wouldn't be spent, such as travel, parking food, and childminding, the average in-centre patient also spends £1,019 of their own money each year on their own life-saving treatment.
Dr. Natalie Borman, Care Group Director for Renal and Transplantation, Wessex Kidney Centre, Portsmouth, which has one of the largest home haemodialysis departments in the UK, says:
"Queen Alexandra's home haemodialysis programme was established in response to increasing evidence that more frequent haemodialysis is associated with improved survival, better patient outcomes and improved quality of life. It's important for patients to have the right to choose which treatment is best for them and their life. Of course, it is not right for everyone, but patients should not be excluded based on their medical conditions alone."
Matt Walker of NxStage Medical UK, Ltd., provider of home haemodialysis machines says:
"Dialysis is a life-saving treatment for patients with kidney failure and access to it should not be impacted by differences across NHS trusts, a person's financial circumstances, or geographical location. With the number of people needing dialysis continuing to rise, now is the time for government and healthcare professionals to focus on improving the uptake of home haemodialysis. Whether dialysing in hospital or at home, all patients should have access to the treatment that is right for them."
Matt Herbert, current home haemodialysis patient, says:
"Because I dialyse more frequently, my overall health has improved. I found it to be really difficult to rely on hospital visits, especially for my mental health. It was really tricky to juggle all aspects of my life - my dialysis appointments, my job, and my family. Moving to home haemodialysis has really helped to have the freedom to choose when and where I dialyse. I can now travel abroad for holidays, be more focused at work, exercise, and spend quality time with my new-born child and family.
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