It is estimated that there are more than 1.5 million patients with established renal failure who are treated with haemodialysis (HD). Innovations and changes in HD practice have seldom been underpinned by adequately powered randomised trials but day-to-day clinical decisions on HD are required and standards need to be set on the best available evidence. Consequently clinical practice guidelines for HD have been developed in Australasia, Canada, Europe and the USA as well as in the UK. These guidelines serve to identify and promote best practice in the delivery of HD and have set clinical standards to allow comparative audit of the key aspects of the HD prescription, laboratory data and patient outcomes.
This module provides an update of the 2007 RA clinical practice guidelines in HD and, most importantly, modification of the current guidelines whenever indicated by evidence from new studies. The sections on vascular access and planning, initiation and withdrawal of renal replacement therapy in the 2007 version have been removed as two separate new modules have been developed to provide guidance on these key areas in the provision of high quality care in HD. Separate sections are included in this update on anticoagulation, home haemodialysis, frequent and/or extended duration HD and patient safety on HD.
This guideline promotes the adoption of a range of standardized audit measures in HD and the proportions of patients who should achieve clinical and laboratory performance indicators have not been specified for most of the clinical practice guidelines.