Roderick, P., Nicholson, T., Armitage, A., Mehta, R., Mullee, M., Gerard, K., Drey, N., Feest, T., Greenwood, R., Lamping, D. and Townsend, J.
An evaluation of the costs, effectiveness and quality of renal replacement therapy provision in renal satellite units in England and Wales , Kent, County of, GB Gray Publishing 178pp.
(Health Technology Assessment, 24, 9).
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The prevalence and annual acceptance rates for renal replacement therapy (RRT) have increased significantly over the past decades and continue to rise. Over 30,000 patients were being treated with RRT in England by 2000, at a cost of about £600 million. The patients now being treated are older with more co-morbidity. Given the continued shortage of kidneys for transplantation, the expansion of RRT in the last decade has largely been in dialysis. Peritoneal dialysis, although popular in the 1980s, has not grown in recent years; most expansion has been in hospital haemodialysis (HD), increasingly delivered in renal satellite units (RSUs). In general these are nurse-run renal units which provide only chronic HD. They are linked to main renal units (MRUs) at which nephrologists, inpatient services and interventional facilities are based. They are more geographically accessible for patients. Previous national surveys have shown them to be of variable size, location (e.g. some are on non-hospital sites) and organisational arrangements (e.g. some are private). However, there are few data on the effectiveness and costs of RSUs or of patients’ experience. This report presents data first from an updated survey of the structure, processes and organisation of RSUs in England and Wales (Phase 1), and then a detailed comparison of the effectiveness, acceptability, accessibility and economic impact of chronic haemodialysis performed in RSUs compared with MRUs (Phase 2).
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