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Developing a renal service for patients opting not to dialyse
  1. Helen Noble, Senior Clinical Nurse Specialist,
  2. Alistair Chesser, Nephrology Consultant and
  3. Jaryn Go, Clinical Nurse Specialist
  1. Renal Supportive Care, Barts and The London NHS Trust, London. Email: Helen.noble{at}


In the UK, there has been a significant rise in the number of patients treated with renal-replacement therapy. By 2010, this number will have increased from approximately 30,000 in 2000 to between 42,000 and 51,000 (900–1000 per million population), consistent with an average annual growth rate of 4.5–6%. Alongside this growth is an increase in the average age of patients developing renal failure, often with many comorbidities, leading to increased recognition that not everyone will benefit from dialysis. Renal supportive care services are being developed to manage those who make the decision not to undergo dialysis and, by implication, die. This article describes the implementation of such a service in the East End of London, UK, and how the need for the service was identified. It discusses the aims of the service, patient activity and goals for the future. Conflicts of interest: none

  • Dialysis
  • Renal failure
  • Supportive care
  • Palliative care
  • Active treatment withdrawal

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