Economic evaluation of end-stage renal disease treatment

One of the main functions of the human kidney is the clarification of blood from human waste products, such as ureum and creatinine. Failure of functioning of the kidneys may ultimately lead to death. When the stage of very limited kidney functioning (5 to 10% of norm-al) is reached, renal replacement therapy becomes essential to survive. Chronic renal replacement therapy has been available since the 1960s. At present, three major types of renal :replacement therapy are available: haemodialysis, peritoneal dialysis and kidney transplantation. With haemodialysis, the body is connected to an extracorporeal filter or dialyser, consisting of a semipermeable membrane to which blood is taken and returned. This requires a permanent artificial access to the body (a shunt, fistula or synthetic graft), that usually is created in the forearm. Dialysis fluid, resembling blood plasma, is passed in the opposite direction across the outside of the membrane. Waste products and excess water from the blood diffuse into this dialysis fluid. Several forms of haemodialysis are available in the Netherlands. Most patients receive full care centre haemodialysis which requires the patient to travel to a dialysis centre, usually 3 times a week. The patient is attached to a dialysis machine for 3-4 hours. Limited care or active centre haemodialysis is similar to full care centre haemodialysis, but the patient takes active responsibility for the treatment, implying that the majority of the (nursing) tasks involved are performed by the patient him/herself. Another modality is home haemodialysis whereby the patient has all the necessary equipment at home and takes active responsibility for the treatment; some help from a partner, family member or nursing assistant is usually necessary.

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