For Kidneys Sake podcast

Dialysis: Let's Clear Things Up

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The For Kidneys Sake podcast series is brought to you by Imperial College Healthcare NHS Trust and North West London Integrated Care Board (NWL NHS)

How much do GPs really need to know about dialysis – and could better understanding of the options make a real difference to patients' lives? 

Dialysis has changed considerably over recent decades, offering patients with advanced kidney disease more choice, flexibility and independence than ever before. Yet for those working in primary care, understanding the different treatment options and knowing when to intervene can be challenging. In this episode of For Kidneys Sake, consultant nephrologists Prof Jeremy Levy and Dr Andrew Frankel from Imperial College Healthcare NHS Trust explore what GPs and other non-renal healthcare professionals need to know about modern dialysis care. From the importance of early preparation and informed decision-making to the benefits of home-based therapies, they explain why dialysis is far more than simply connecting someone to a machine three times a week.

The discussion explores the practical differences between haemodialysis and peritoneal dialysis, the growing opportunities for patients to receive treatment at home, and why timely planning is essential to avoid emergency dialysis starts. Jeremy and Andrew also highlight several important responsibilities for primary care, including protecting veins for future dialysis access, ensuring appropriate vaccinations, accurately coding patients receiving dialysis and recognising the complexities of diabetes management. They emphasise the importance of close communication between GP practices and specialist dialysis teams, particularly when managing intercurrent illnesses or patients who miss dialysis sessions. Above all, this episode reinforces the value of collaborative, patient-centred care, ensuring that people with kidney failure are supported to make informed choices and receive coordinated care both inside and outside the dialysis unit.

5 Key Takeaways

  1. Early planning is essential for successful dialysis care. Patients approaching kidney failure need time to understand their options, prepare psychologically and undergo necessary procedures, such as fistula formation. Early referral and ongoing discussions with specialist kidney teams help avoid unplanned dialysis starts and support informed decisions.
  2. Dialysis offers more choice than many people realise. In-centre haemodialysis is only one option. Home haemodialysis and peritoneal dialysis can offer greater independence, flexibility and improved quality of life for suitable patients. Primary care professionals should understand these alternatives and avoid inadvertently discouraging patients from considering them.
  3. Protect vascular access and prioritise vaccinations. Preserving veins, particularly in the non-dominant arm, is important for patients who may require haemodialysis. Once a fistula is established, blood sampling and blood pressure measurements should be avoided in that arm. Patients approaching or receiving dialysis should also receive appropriate vaccinations, particularly against hepatitis B, alongside influenza, pneumococcal, shingles and COVID-19 vaccination as recommended.
  4. Dialysis patients still need comprehensive primary care. Although specialist renal teams manage dialysis-related treatment, GPs remain essential in managing other health conditions and intercurrent illnesses. Diabetes requires particular attention because HbA1c becomes less reliable, hypoglycaemia is a significant concern and routine complication screening must not be overlooked. Close collaboration with specialist diabetes and renal teams is vital.
  5. Communication between primary care and dialysis units is critical. Accurate coding, including recognising CKD G5D in patients receiving dialysis, helps ensure appropriate records and alerts. GP practices should maintain direct contact details for their patients' dialysis units and seek specialist advice when needed. A patient who becomes unwell and misses dialysis may require urgent assessment, making timely communication especially important.

Resource Links:
NICE GUIDELINES [NG203] chronic kidney disease: assessment and management Overview | Chronic kidney disease: assessment and management | Guidance | NICE

Northwest London CKD guidelines for primary care Chronic kidney disease (nwlondonicb.nhs.uk)

The purpose of this podcast is to inform and educate health care professionals working in the primary care and community setting. The content is evidence based and consistent with NICE guidelines and North West Guidelines available at the time of publication.

The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement.

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