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Centre variation in home dialysis uptake: A survey of kidney centre practice in relation to home dialysis organisation and delivery in England

Damery, Sarah, Lambie, Mark, Williams, Lestyn, Coyle, David, Fotheringham, James, Solis-Trapala, Ivonne, Allen, Kerry, Potts, Jessica, Dikomitis, Lisa, Davies, Simon J. and others. (2024) Centre variation in home dialysis uptake: A survey of kidney centre practice in relation to home dialysis organisation and delivery in England. Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, . ISSN 0896-8608. (doi:10.1177/08968608241232200) (KAR id:105279)



Disparities in home dialysis uptake across England suggest inequity and unexplained variation in access. We surveyed staff at all English kidney centres to identify patterns in service organisation/delivery and explore correlations with home therapy uptake, as part of a larger study (‘Inter-CEPt’), which aims to identify potentially modifiable factors to address observed variations.


Between June and September 2022, staff working at English kidney centres were surveyed and individual responses combined into one centre-level response per question using predetermined data aggregation rules. Descriptive analysis described centre practices and their correlation with home dialysis uptake (proportion of new home dialysis starters) using 2019 UK Renal Registry 12-month home dialysis incidence data.


In total, 180 responses were received (50/51 centres, 98.0%). Despite varied organisation of home dialysis services, most components of service delivery and practice had minimal or weak correlations with home dialysis uptake apart from offering assisted peritoneal dialysis and ‘promoting flexible decision-making about dialysis modality’. Moderate to strong correlations were identified between home dialysis uptake and centres reporting supportive clinical leadership (correlation 0.32, 95% Confidence Interval (CI): 0.05–0.55), an organisational culture that values trying new initiatives (0.57, 95% CI: 0.34–0.73); support for reflective practice (0.38, 95% CI: 0.11–0.60), facilitating research engagement (0.39, 95% CI: 0.13–0.61) and promoting continuous quality improvement (0.29, 95% CI: 0.01–0.53).


Uptake of home dialysis is likely to be driven by organisational culture, leadership and staff attitudes, which provide a supportive clinical environment within which specific components of service organisation and delivery can be effective.

Item Type: Article
DOI/Identification number: 10.1177/08968608241232200
Projects: UK National Institute for Health and Care Research (NIHR) Health Services & Delivery Research (HSDR) Programme (project reference 128364).
Uncontrolled keywords: home dialysis; home haemodialysis; kidney centre; kidney failure; peritoneal dialysis; survey; uptake
Subjects: R Medicine
R Medicine > RZ Other systems of medicine
Divisions: Divisions > Division of Natural Sciences > Kent and Medway Medical School
Depositing User: Manfred Gschwandtner
Date Deposited: 11 Mar 2024 11:09 UTC
Last Modified: 18 Mar 2024 14:52 UTC
Resource URI: (The current URI for this page, for reference purposes)

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