Renal replacement therapy · UK
Kidney dialysis in the UK, every modality on the table.
Haemodialysis, peritoneal dialysis, HDF, home therapies, transplant workup and the honest option of conservative care — laid out by a consultant nephrologist, so the choice is really yours.
Why patients choose us
- 01
A consultant nephrologist, from day one
Not a generalist and not a clinic coordinator. A named renal consultant leads the decision — modality, access, timing — with you.
- 02
Every modality on the table
In-centre HD, home HD, PD (CAPD or APD), high-volume HDF, and the honest option of conservative care. Not one house pathway.
- 03
Independent, and free
We are paid by no unit, so the recommendation is impartial — and it costs the patient nothing.
Indicative pricing
What dialysis actually costs — NHS-funded, or private.
Almost all UK dialysis is NHS-funded. Private figures below are annual costs to give a realistic sense of what the therapy consumes across a year.
In short
In-centre HD runs ~£26k/year. A transplant is much cheaper long-term — and gives far better quality of life.
| Modality | Indicative cost | Schedule | Duration |
|---|---|---|---|
| In-centre haemodialysis (per year, private) | ~£26,000 | 3× weekly, 4h | Ongoing |
| Home haemodialysis (per year) | ~£20,000 | 4–6× weekly | Ongoing |
| Peritoneal dialysis — CAPD or APD (per year) | £15,000–£20,000 | Home, daily | Ongoing |
| Kidney transplant (year 1) | ~£17,000 | One-off surgery | Long-term |
| Transplant (each subsequent year) | ~£5,000 | Follow-up | Ongoing |
| Nephrology consultation only | £250–£450 | 45 min | Same visit |
Prices vary by unit, geography, and whether erythropoietin, phosphate binders and access procedures are included. Most patients pay nothing directly — dialysis is NHS-funded. We help navigate private capacity, insurer cover, or holiday dialysis if needed.
The problem
The right modality, the right access, the right timing.
Most patients meet dialysis via whichever pathway their local unit runs by default. NICE NG107 says the modality decision should be shared and informed — we make sure it actually is.
-
Not sure it is time?
Numbers alone rarely start dialysis. Symptoms, potassium, fluid status and quality of life matter — we help you and your consultant read them together.
-
Not sure HD or PD?
Neither is superior for most patients. Home vs unit, working life, hand dexterity, carer support and preferences decide — not the local house pathway.
-
Want the transplant option kept alive?
For suitable candidates, transplant is the long-term goal. Living-donor workup runs in parallel — nothing about starting dialysis rules it out.
The journey
From enquiry to steady state — what happens, in order.
One nephrologist coordinating access, first sessions, home training and transplant workup — so it feels like a plan, not a chase.
Phase 1 · Before you start
Assessment, decision, access
Phase 2 · First sessions
Supervised start and training
Phase 3 · After
Monitoring, transplant workup
- 01
Before
You tell us where you are
A confidential form. Latest eGFR, symptoms, comorbidities, whether this is planned CKD 5 or acute kidney injury.
- 02
Before
We come back with a plan
Within one working day: modality options that fit your life, indicative pricing, and where dialysis vs transplant vs conservative care sits for you.
- 03
Before
Access is arranged
AVF for HD (created 8–12 weeks before start where possible), Tenckhoff catheter for PD (placed ~2 weeks before start), or tunnelled line if starting urgently.
- 04
First sessions
First sessions, supervised
HD begins in-centre so the team can dial in dry weight, ultrafiltration and dialysate. PD begins with a home training block of 1–2 weeks.
- 05
First sessions
Home training (if suitable)
Home HD or APD training runs 4–8 weeks. A community nurse visits, and the unit is on call 24/7 for problems.
- 06
After
Steady state and monitoring
Monthly bloods (URR/Kt/V, phosphate, PTH, Hb), quarterly access reviews, annual peritoneal membrane test for PD patients.
- 07
After
Transplant workup in parallel
If you are a candidate, listing and living-donor workup runs alongside dialysis — transplant remains the long-term goal for suitable patients.
Typical planned start: 8–12 weeks from decision (allow time for AVF maturation). Home training: 4–8 weeks.
When it helps
When dialysis is the right step.
The clinical situations that lead to dialysis, plus the one red flag that means an emergency rather than a clinic booking.
-
CKD stage 5 (eGFR <15)
Chronic kidney disease at end stage — usually with uraemic symptoms, fluid overload, or resistant hyperkalaemia and acidosis.
-
Uraemic symptoms
Nausea, itch, restless legs, poor appetite, fatigue and cognitive change — the clinical trigger that tips CKD 5 into starting dialysis.
-
Acute kidney injury needing RRT
AKI with refractory hyperkalaemia, pulmonary oedema, severe acidosis or uraemic encephalopathy — usually CRRT or SLED in ITU.
-
Fluid overload not responding to diuretics
Breathlessness and oedema in a failing kidney that no longer clears sodium and water — dialysis removes the excess directly.
-
Refractory hyperkalaemia
Potassium climbing despite diet, binders and medical therapy — a common tipping point in advanced CKD.
-
Failed transplant
A previous graft that has lost function — returning to dialysis while relisting or considering living-donor options.
-
Modality switch
Peritoneal membrane failure, access problems on HD, or a change in home circumstances — moving between HD, PD and HDF.
-
Red flag: hyperkalaemia with ECG changes
Peaked T waves, wide QRS or new arrhythmia at high potassium is a same-day A&E problem — not a clinic booking.
Modality options
Dialysis is not one thing.
Every option — HD, PD, HDF, home therapies, transplant and conservative care — with an honest description of what it is and who it suits.
-
In-centre haemodialysis (HD)
Thrice-weekly 4-hour sessions in a satellite or hospital unit. Nurses run the machine — the standard UK starting modality.
-
Home haemodialysis
More frequent (4–6× weekly) or nocturnal sessions at home. Better BP, phosphate and quality-of-life outcomes per the FHN Trial.
-
CAPD (Continuous Ambulatory PD)
Four manual bag exchanges a day through a Tenckhoff catheter. No machine, fully portable — good for independent patients.
-
APD (Automated PD)
An overnight cycler runs 8–10 hours; days are free. Suits working patients and those wanting minimal daytime interruption.
-
Haemodiafiltration (HDF)
High-flux HD with added convective clearance. High-volume HDF improved survival in the CONVINCE trial (2023) vs conventional HD.
-
CRRT (CVVH, CVVHDF)
Continuous renal replacement in ITU for critically ill patients — slower fluid shifts, better haemodynamic tolerance than intermittent HD.
-
Kidney transplant
Best long-term survival and quality of life for suitable candidates. Living-donor pre-emptive transplant is the ideal pathway — see /treatments/kidney-transplant.
-
Conservative (supportive) care
A legitimate choice for frail elderly patients with heavy comorbidity — symptom control, psychology and palliative input without dialysis. Life expectancy varies.
Our vetted UK network
A small panel of nephrologists, we picked them.
Consultant nephrologists with substantive UK renal unit posts — introductions are made privately, once we understand your case.
Selection criteria
How we choose every nephrologist in our network.
-
Consultant nephrologists with substantive UK renal unit posts
-
Full modality choice offered — HD, home HD, PD, HDF, transplant workup
-
Vascular access surgeons and interventional radiology on the same site
-
Conservative care pathway discussed openly, not treated as failure
Safety and complications
What actually goes wrong on dialysis — honestly.
Dialysis is major life-changing therapy. The complications worth knowing about — and the survival numbers your consultant should also be discussing with you.
-
Intradialytic hypotension and cramps
The commonest HD complication — dry-weight and dialysate adjustments usually settle it, and the team is trained to intervene mid-session.
-
Access complications
AVF thrombosis, stenosis, infection or aneurysm. Regular surveillance and prompt fistulography or angioplasty keep the access working.
-
PD peritonitis
Roughly one episode per patient-year is typical — cloudy fluid and abdominal pain need same-day antibiotics, occasionally catheter removal.
-
Cardiovascular disease
The leading cause of death on dialysis. BP, lipids, phosphate and volume control are as important as the dialysis prescription itself.
-
Anaemia and bone-mineral disease
EPO deficiency is treated with darbepoetin or epoetin per NICE NG8; phosphate binders, alfacalcidol and cinacalcet manage the mineral axis.
-
Peritoneal membrane failure over years
Ultrafiltration capacity declines with time on PD — an annual peritoneal equilibration test flags when conversion to HD is coming.
-
Depression is very common
A major life change with restricted diet, fluid limits and time on the machine. Psychology support is part of a good renal service, not an extra.
-
Realistic survival framing
5-year survival on RRT in older UK patients is roughly 40–50% (UKKA/UK Renal Registry). Transplant remains the long-term goal where feasible.
-
Red flags
Fever with a line or PD catheter, chest pain, breathlessness, or hyperkalaemia ECG changes — same-day A&E or your unit’s on-call, not a clinic booking.
Reading your dialysis notes
Your dialysis clinic letter in four parts. Read the last one first.
Whichever modality you are on, the clinic letter your nephrologist sends keeps to the same shape.
A quiet reminder
Renal medicine leans on acronyms and numbers — we translate them for you.
If you would like us to talk you through the letter before your review, just ask.
- 01 Header
Modality, access and start indication
Which modality was chosen — HD, PD, HDF — the access used, and the clinical reason dialysis was started (CKD 5 vs AKI).
- 02 Technique
Prescription and adequacy
Session length, blood/dialysate flow, dialyser or PD regimen, ultrafiltration target, and Kt/V or URR for adequacy.
- 03 Findings
Bloods, access surveillance, membrane
Haemoglobin, phosphate, PTH, potassium, bicarbonate; access flow and recirculation; PD peritoneal equilibration where relevant.
- 04 Impression
Plan, transplant status, next review
Read this first: any modality change, transplant listing status, symptoms to watch for, and when you are seen next.
Recognised by major UK insurers
Most UK dialysis is delivered by NHS renal units. Private cover for RRT is limited — we help navigate insurer position, private capacity and holiday dialysis where relevant.
Frequently asked
Everything patients ask about dialysis.
Timing, HD vs PD, home therapies, HDF evidence, cost, conservative care, transplant and travel.
-
When do I actually need to start dialysis?
Usually when eGFR falls below 15 and uraemic symptoms appear — nausea, itch, restless legs, fluid overload or resistant hyperkalaemia and acidosis. A pure number alone rarely starts dialysis; it is the number plus symptoms. NICE NG107 mandates shared decision-making about timing and modality.
-
HD or PD — which is better?
Neither is medically superior for most patients. HD suits people who want the machine work done in a unit; PD suits those wanting home-based, more flexible therapy that preserves residual kidney function longer. Lifestyle, home suitability, comorbidities and preference decide — not a house rule.
-
Can I have dialysis at home?
Yes — home HD (usually 4–6 sessions a week, sometimes overnight) and PD (both CAPD and APD) are both home therapies. Home HD in particular showed better BP, phosphate and quality-of-life outcomes in the FHN Trial vs standard in-centre HD.
-
Is haemodiafiltration (HDF) worth it?
For patients who can tolerate the higher flows and volumes, yes. The CONVINCE trial (2023) showed high-volume post-dilution HDF improved all-cause mortality vs conventional high-flux HD. Not every centre delivers high-volume HDF — worth asking specifically.
-
How much does private dialysis cost in the UK?
Roughly £26k/year for in-centre HD, £20k/year for home HD, £15–20k/year for PD, and £17k first year then £5k/year for a transplant. Almost all UK dialysis is NHS-funded — we can help navigate private capacity or holiday dialysis if needed.
-
What is conservative care and is it giving up?
No. Conservative (supportive) kidney care is a legitimate choice — usually for frail elderly patients with heavy comorbidity — that focuses on symptom control, medication optimisation, psychology and palliative input, without dialysis. Some patients live years on this pathway. Shared decision-making, not surrender.
-
Should I be listed for a transplant?
For most fit patients under ~70 with limited comorbidity, yes — transplant offers the best long-term survival and quality of life. Living-donor pre-emptive transplant (before dialysis starts) is the ideal pathway. Workup runs in parallel with starting dialysis.
-
What if I want to travel or work full time?
APD (overnight PD) suits full-time workers with minimal daytime disruption. Home HD gives schedule flexibility. Holiday dialysis units across the UK and abroad accept guest patients — see /treatments/holiday-kidney-dialysis for the travel-focused pathway.
Related treatments