£1.1m research to improve uptake of home kidney dialysis treatments

A study led by Keele University could save the NHS up to £45m over three years by increasing the number of dialysis patients whose treatment takes place at home.

Led by Keele’s Professor Simon Davies, alongside Professor Lisa Dikomitis, Dr Ivonne Solis-Trapala and Dr Mark Lambie with colleagues from the Universities of Sheffield and Birmingham, the NIHR-funded study called Inter-CEPt (“Intervening to eliminate the centre-effect variation in home dialysis use”) will focus on the reasons why home therapies are not used more equally and fairly by kidney centres across the country, as well as designing and testing possible solutions to improve the uptake of home therapies.

Building on previous collaborations, this multidisciplinary project integrates ethnographic and statistical expertise from Keele, health policy researchers from the University of Birmingham, and health economists from the University of Sheffield.

Around 30,000 kidney failure patients in the UK currently manage their condition with dialysis, either at home or by travelling to their local dialysis unit as an out-patient, where it is provided by healthcare staff.

Although national guidelines encourage the use of home dialysis, the uptake is limited and varies greatly by treatment centre. Some centres offer home treatments more than others, with provision varying between two and 28 per cent of patients requiring kidney replacement therapy. Having dialysis at home is associated with improved clinical outcomes, treatment satisfaction and patient autonomy. It has also been safer for patients during the Covid-19 pandemic.

Recent research by the Renal Registry has also found that certain groups in society were less likely to have home therapy, with patients from Black, Asian and Minority Ethnic (BAME) groups and those from poorer or more disadvantaged backgrounds being particularly affected.

This research aims to change the uptake and availability of home dialysis treatments, by using a five-stage approach to assess the main factors affecting home dialysis availability, which will allow the researchers to develop a practical and feasible approach for dialysis centres to make these treatments more accessible.

Professor Simon Davies from Keele’s School of Medicine said: “We will use in depth knowledge of what constitutes a strong and equitable home therapies programme to inform a wider survey of dialysis unit practices linked to patient outcomes; this will allow us to develop a bundle of interventions designed to support inclusion of those patients into home therapies who may not currently benefit from this treatment option.”

Professor Lisa Dikomitis from Keele University added: “I am delighted to be part of this timely and important study, which is underpinned by a robust patient and public involvement and engagement strategy. Ethnographic and qualitative data will provide us with a better understanding of why certain groups in our society are less likely to have home therapy and how we can improve the uptake of such therapies.”

Dr James Fotheringham, from the University of Sheffield’s School of Health and Related Research, is leading the health economics research for the study. He said: “The internationally renowned expertise in health economics which the School of Health and Related Research brings to this project, ensures that the costs and benefits of these important treatments are fully understood so they can inform policy and clinical practice.”

The research team includes Dr Iestyn Williams and Dr Kerry Allen, of the University of Birmingham’s College of Social Sciences, and Dr Sarah Damery, of the University of Birmingham’s College of Medical and Dental Sciences.

Dr Williams, Reader in Health Policy and Management, said: “It is really important that the most effective treatments are accessed by everyone, including marginalised and disadvantaged groups. This study will be crucial in helping us to understand how this can be achieved.”