Life and Death in a Welfare State: End-Stage Renal Disease in the United Kingdom

Objective: Renal replacement therapy (RRT) is essential for maintenance of life for those with end-stage renal disease. However, there remain many areas of uncertainty about which method of RRT should be chosen. This paper reports an economic model based on a systematic review that attempts to determine which method of dialysis, continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis, a patient should have as the initial method of RRT.Methods: A systematic review and a costing exercise carried out in a Scottish hospital were used to populate a Markov model. Scenario analysis was used to model plausible variations in variables included in the model.Results: In 8 of the 16 scenarios developed hemodialysis dominated CAPD. In a further eight scenarios, the cost per life-year displayed considerable variability, ranging from between £5,000 to £51,000. The higher costs per life-year were associated with minimum estimates of additional survival for a patient starting RRT on hospital hemodialysis.Conclusion: It may be more cost-effective to manage patients starting on RRT with hospital hemodialysis than CAPD. This has particular implications for the United Kingdom, given that up to 50% of new patients receive CAPD.

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Pre-emptive Renal Transplantation: Optimum Treatment for End-Stage Renal Disease?

Journal of Nepal Medical Association ◽

10.31729/jnma.221 ◽

2008 ◽

Vol 47 (169) ◽

Author(s):

B M Shrestha

Keyword(s):

Kidney Transplantation ◽

Renal Transplantation ◽

Renal Disease ◽

End Stage Renal Disease ◽

Clinical Evidence ◽

Renal Allografts ◽

The United Kingdom ◽

Recent Emergence ◽

Stage Renal Disease ◽

End Stage

Renal transplantation (RT) prior to having dialysis or pre-emptive renal transplantation (PRT) hasbeen controversial because of the paucity of clinical evidence to clarify the benefi ts and risks of PRT.The recent emergence of evidences from major transplant centres in the United Kingdom and UnitedStates have confi rmed the survival advantages for both renal allografts and RT recipients. Hence anincreasing number of transplant centres are adopting the practice of PRT. This article discusses theadvantages and disadvantages of PRT and highlights the clinical evidences in support of PRT.Key Words: Dialysis, kidney transplantation, pre-emptive renal transplantation

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Attitudes of Caregivers to Management of End-Stage Renal Disease in Infants

Peritoneal Dialysis International ◽

10.3747/pdi.2009.00265 ◽

2011 ◽

Vol 31 (4) ◽

pp. 459-465 ◽

Cited By ~ 33

Author(s):

Jun Chuan Teh ◽

Michelle L. Frieling ◽

Julianna L. Sienna ◽

Denis F. Geary

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Pediatric Nephrology ◽

Mail Survey ◽

The United States ◽

Influential Factor ◽

The United Kingdom ◽

The Right ◽

Stage Renal Disease ◽

End Stage

Objectives To characterize the attitudes of pediatric nephrologists caring for infants with end-stage renal disease (ESRD) compared with attitudes from a survey published in 1998. Nephrology nurses and social workers were included. Methods An e-mail survey was distributed to pediatric nephrology teams in Canada, Germany, Japan, the United Kingdom, and the United States. Results Survey responders totaled 270. Renal replacement therapy (RRT) is offered by all nephrologists to some children 1 – 12 months, and by 98% to some less than 1 month of age (93% in 1998). Of responding nephrologists, 30% offer RRT to all children less than 1 month of age (41% in 1998), and 50%, to all children 1 – 12 months. Among respondents, 50% indicated that parents can never refuse RRT for children aged 1 – 12 months, compared with 27% for younger infants. The most influential factor in rejecting RRT for infants was the presence of a co-existing abnormality. Nurses were more likely to believe that parents have the right to refuse RRT for infants. Conclusions Attitudes of pediatric nephrologists have changed since 1998. Also, nurses have opinions that are different from those of the nephrologists on some issues, and a consensus should be reached before speaking to families.

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