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Seeing the independence that home dialysis gives patients makes our job worthwhile

A renal nurse explains the challenges and rewards of running a home haemodialysis service

A renal nurse explains the challenges and rewards of running a home haemodialysis service

I have worked in renal nursing since I completed my nurse training more than 30 years ago.

After starting in peritoneal dialysis, I worked in the community before taking up posts in haemodialysis and home haemodialysis at Royal Derby Hospital, where I have worked for more than 25 years.

I am now senior sister and home haemodialysis lead of the renal unit at Royal Derby, one of the UK’s leading providers of home dialysis. I have stayed in renal nursing because it is always changing, with advances in technology enabling us to implement services such as home dialysis, which can significantly improve the patient experience.

More than 25,000 people with end-stage kidney failure in the UK rely on dialysis to survive. It is a time-consuming and life-changing process, often done at a dialysis centre, which can wear patients down physically and emotionally.

Leading change

In 2011, I helped set up the home haemodialysis unit at Royal Derby Hospital. Change isn’t always easy to lead, but it is possible if you have the right environment, goals and attitude – in just eight years, my team has more than doubled the number of patients dialysing at home.

We now have 51 patients on home dialysis, meaning more than 13% of the hospital’s dialysis patients are benefitting from the life-transforming effects of the treatment. This is three times higher than the UK average of just 4.4% of patients receiving dialysis at home. A third are not even given the option.

‘Home dialysis enables us to treat more patients, freeing up other in-centre dialysis services for those who need them’

Patients with end-stage renal disease require a range of treatments. The treatment patients receive can make a huge difference to individuals' quality of life, and while home dialysis isn’t for everyone, all patients should have access to the treatment that is right for them.

Home dialysis enables us to treat more patients, freeing up other in-centre dialysis services for those who need them, and the benefits to patients are clear. It is simpler and more practical for patients requiring frequent treatment to have it at home, and patients also benefit from health improvements and better quality of life.

Patients on home haemodialysis have shorter recovery times, are less reliant on additional medication and have lower levels of anxiety and depression. They also have an increased chance of undergoing a kidney transplant due to overall better health.


Carol Rhodes (second from right) with fellow members of the home haemodialysis team. 

Training for home dialysis is nurse-led and takes place at the renal department of the hospital rather than at satellite centres across the trust. The highly skilled and enthusiastic team - three nurses and one support worker -  teach patients how to self-cannulate, monitor their own blood levels and use the machine, which is small and easy to install in the home. 

When we are confident the patient will be able to manage home dialysis, we make home visits that become less frequent, the more experienced and comfortable the patient gets.

Service for new and long-term patients

Implementing a home dialysis service is not without challenges. For example, educating non-clinical managers about better patient outcomes when dialysing at home can be difficult, but we have found that the best way to overcome barriers is through education and training.

‘Don’t wait around for people to say yes, just get on with it. Gather a team of keen nurses, start informing people about what you are doing and banish any misconceptions’

You can then begin to shake up care pathways, offering home dialysis to long-term patients and those who are just starting out. Involving patients in their care from the outset of dialysis treatment also helps break down barriers between administered and self-care.

At Derby Royal Hospital, the drive, passion and resilience of an amazing team of clinical staff has been instrumental to the success of the service. A positive team culture is essential, and every member is engaged, enthusiastic, and believes in our work.

We also interact with healthier and happier patients, seeing the benefits of independence really makes our job worthwhile and we are always keen to learn and share best practice.

How you can achieve change

In an often-siloed NHS, we have a duty to share our knowledge and expertise with others. We facilitate visits from other renal teams interested in increasing the uptake of home dialysis across their units, which often inspires them to push for change in their own teams.

To any nurse interested in setting up a similar service, I would say be the change you want to see. Find out about home dialysis, contact those who have already set up home dialysis training to ask for advice, and see if you can visit them at their centres to see how it works.

Don’t wait around for people to say yes, just get on with it. Gather a team of keen nurses, start informing people about what you are doing and banish any misconceptions.

With the NHS Long Term Plan focusing on patient choice and self-care, I’m hopeful this will allow us to continue on the path of better patient-centred care.


Carol Rhodes is senior sister and home haemodialysis lead of the renal unit, Royal Derby Hospital

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