NHS Dialysis Choices: Hospital vs. Home Care for Kidney Patients

Every week, thousands of individuals in the United Kingdom with chronic kidney disease undergo life-sustaining dialysis treatments in hospitals. This routine often requires patients to travel to kidney units three times weekly, dedicating hours to each session. While hospital dialysis is viewed as the standard method of treatment, an alternative exists: home dialysis, which offers flexibility and potential cost savings for the National Health Service (NHS). Despite these advantages, a significant number of patients still prefer hospital-based treatments.

A parliamentary summit held in May 2025 highlighted the pressing need to facilitate access to home dialysis options for patients. Research led by Leah McLaughlin, a Research Fellow in Health Services at Bangor University, in collaboration with various stakeholders, including patients, healthcare providers, and dialysis charities, sought to identify barriers to the uptake of home dialysis. According to McLaughlin and her team, many patients perceive hospital dialysis as the default option, primarily due to the way healthcare providers present it.

The study, which included discussions with 50 individuals across Wales, revealed that patients often experience hesitation regarding home dialysis. Concerns about the need for home modifications and the potential responsibilities placed on family members as caregivers were prevalent. Additionally, the social interactions and routine provided by hospital visits can make patients reluctant to change their treatment environment.

"For many, hospital dialysis represents the path of least resistance, particularly for those who have not fully accepted the need for treatment," McLaughlin stated.

Notably, the research team discovered that healthcare professionals might unintentionally reinforce the preference for hospital treatments by expressing comfort in managing patients within clinical settings. In some instances, the lack of infrastructure in local areas to support home dialysis further complicates patients' choices.

In a related study published in 2022, McLaughlin’s team analyzed the financial implications of different dialysis modalities. Home dialysis was found to cost between £16,000 and £23,000 per annum per patient, whereas hospital dialysis expenses ranged from £20,000 to over £30,000, particularly when factoring in ambulance transportation. This discrepancy suggests that promoting home dialysis could yield considerable savings for the NHS, especially in regions like Wales, where services are more centralized. However, in England, fragmented service provision can significantly hinder access to home options.

Despite the potential benefits of home dialysis, systemic challenges persist. Patients often begin their dialysis journey at facilities that may not be the most convenient, leading to long-term attachment to those units. This creates a complex emotional and social web that can obscure the practicalities of their treatment decisions. According to Dr. Gareth Roberts, a Consultant Nephrologist and Associate Medical Director at Aneurin Bevan University Health Board, "The emotional connection patients develop with their dialysis units can significantly influence their treatment preferences and decisions."

To address these challenges, the research team has proposed a new service plan aimed at redesigning kidney services to support a greater number of patients in choosing home dialysis. This plan emphasizes the importance of early discussions about treatment options, ideally starting at least a year before initiating dialysis. Furthermore, it highlights the need for comprehensive training for both healthcare professionals and patients to ensure all parties are well-informed about available choices.

McLaughlin’s findings underscore the essential role of social care in supporting patients with complex needs, such as those living alone or facing financial difficulties. The proposed model aims to integrate social care more effectively into the kidney treatment pathway, thereby enhancing patient autonomy and satisfaction.

As the NHS grapples with increasing pressures and limited resources, the need for a shift towards patient-centered care has never been more critical. By prioritizing the lived experiences of individuals with kidney disease, the system can evolve to offer treatment that aligns more closely with patients’ needs and aspirations, ultimately fostering a healthcare environment where patients can thrive.

In conclusion, while the preference for hospital dialysis remains prevalent among kidney patients, the potential for home dialysis to provide a more tailored and cost-effective solution is evident. The challenge lies in overcoming the systemic and emotional barriers that influence patient choices. By enhancing education, training, and support systems, the NHS can work towards a future where more individuals with kidney disease can choose the treatment option that best suits their lifestyle and health needs.

Leah McLaughlin receives funding from Health and Care Research Wales and is affiliated with the Wales Kidney Research Unit. Dr. Gareth Roberts is recognized for his leadership in the Dialysis Options and Choices study within the Welsh Renal Clinical Network.