Effective Delivery: Renal Association
Standards and Continuous Quality Improvement
Haemodialysis should be provided thrice
weekly for >90% of patients.
Haemodialysis adequacy should be assessed
regularly and should achieve either URR >65% or Stable
Kt/V >1.2, in >90% of patients.
Disconnect systems for peritoneal dialysis
should be provided to all PD patients by 2001.
Peritoneal dialysis adequacy should be
measured and the daily fluid volume adjusted regularly
to ensure the combined fluid / natural renal creatinine
clearance exceeds 50l / week / 1.73m2 body surface area
or weekly urea kt/v exceeds 1.7. APD or HD should be available
for patients who cannot achieve these levels of adequacy.
Correction of anaemia: Haemoglobin should
be maintained >10g/dL in all patients unless there
is a specific medical reason. Commissioners should ensure
that adequate mechanisms and funding are in place for
provision of erythropoietin and iron to achieve this goal.
All autonomous renal units and their satellites
should be linked to the UK Renal Registry within 2 years.
Service providers should carry out regular
audits of their compliance with current dialysis standards
and download this data to the UK Renal Registry for national
collation and comparison.
Staffing levels in renal centres should
reflect the time necessary to carry out
systematic audit.
Funding bodies and Trusts should support
renal professionals engaging in peer review through advisory
inspections since they could constitute a powerful aid
to continuous quality improvement.
Wherever possible, Commissioners and Trusts
should support improvement of the evidence base for standards
of clinical care for ESRF patients.
NHS Performance:
• Effective Delivery • Efficiency • Health Outcomes
