The National Kidney Federation has today released its Manifesto 

Increasing Home Dialysis in England for the Benefit of Patients and the NHS.

The manifesto is presented in the form of a report with recommendations that has been prepared for the Secretary of State for Health and Social Care, the NHS and the kidney community following a five-year campaign. 

The manifesto outlines the charity’s vision to prioritise home dialysis as a treatment option, empowering kidney patients to advocate for their own care and makes it clear that the NHS is under growing pressure. Home dialysis offers a practical, cost-effective and patient-centred solution. 

What is dialysis?

Dialysis is a daily lifesaving treatment that helps to clean your blood when your kidneys are unable to do so, when kidneys fail, they can’t properly filter the blood which can lead to a build-up of harmful waste and excess fluid. Some patients dialyse in hospital, others have equipment installed at home, this depends on what facilities the hospital can offer, your medical condition and your own personal preference.

What is home dialysis?

Home dialysis is a clinically safe and effective alternative to ‘in-centre’ dialysis. It offers patients and their carers greater independence, flexibility and quality of life, with lower infection risk and fewer hospital visits. Studies show it can reduce cardiovascular risk, support employment and family life, and improve long-term wellbeing. During the COVID-19 pandemic, patients on home therapies had significantly lower mortality than those receiving in-centre dialysis. If home dialysis is chosen, initial treatment and training is given at a renal unit in hospital.

What are the barriers of home dialysis?

Stark findings revealed that many people in disadvantaged areas, including within our communities, face significant barriers to accessing home dialysis. Only 16% of patients in the UK were on home therapies in 2023 - a decline from previous years. Just 12 of 67 centres exceed the recommended 20% threshold, while 52 are below it.

National progress is inconsistent, the main barriers include:

• Workforce shortages and lack of specialist staff
• Limited protected time for clinical leadership
• Inadequate pre-dialysis education
• Uneven funding for training and support
• Variability in utility cost reimbursement
• Structural inequality in access across ethnic and socioeconomic groups.

What is being done to help support and improve home dialysis care?

The NHS Long Term Plan commits to moving care into the community, digitising services, and focusing on prevention. Home dialysis supports all three aims. It frees hospital capacity, enables remote monitoring, and promotes self-management, resilience and wellbeing.

Many centres across the UK are working hard to increase access to home dialysis through innovation, patient and carer education, staff development and peer support.

Now is the time for us to make improvements with clear national backing, local leadership, and patient involvement, home dialysis can become a more accessible, equitable and sustainable option for many more people across the UK. With collaboration, commitment and accountability, we can achieve and exceed the recommended 20% home dialysis target and in doing so transform lives.

The All-Party Parliamentary Kidney Group Summit in May 2025, brought together patients, clinicians, NHS leaders and policymakers to explore progress and challenges in increasing home dialysis across the UK.

The summit showcased inspiring work from renal units and revealed areas of ongoing variation, and the reason behind the variation and highlighted where political and structural support

is urgently needed.

To accelerate and sustain improvement the APPKG makes the following recommendations within the manifesto:

1. For the Secretary of State of Health and Social Care to respond to this report by December 2025, demonstrating his support and agreeing a target date by which at least 20% of adult dialysis patients are dialysing at home.

2. The APPKG recognises the work being done by the NKF, NHSE, UKKA, Regional Kidney Networks and DAYLife in promoting home dialysis and urges them to work collaboratively to publish and share the impact of their work annually from 2025.

3. That the patients’ voice for home dialysis is strengthened through the work of the main kidney

charities - NKF, KCUK, Kidney Research UK - using the information in this Manifesto to ensure

progress towards meeting the 20% target, along with a reduction in inequality of access by ethnicity and social deprivation, and that each charity publishes its impact in their annual report.

4. That the NKF provides support and guidance to those Kidney Patient Associations, which are

members of the NKF, to influence change and improvement in home dialysis rates by raising the issue with trust chief executives and boards along with the support of local clinical directors, from September 2025.

5. That Regional Kidney Networks be requested to use the manifesto as a driver for change to increase home dialysis and reduce inequality and to publish their plan of action by January 2026.

6. The APPKG acknowledges the importance of peer support in increasing home dialysis and recommends that kidney charities collaborate with Clinical Directors to ensure all patients requiring Advanced Kidney Care (AKC), formerly known as low clearance clinics, have access to peer support by the end of 2027. This to be provided through well-established peer support by services, such as the NKF’s National Peer Support Service and regional services.

7. That NHS England requests Integrated Care Boards, through the evidence provided in this

report, to set home dialysis targets annually in their region, thereby ensuring home therapies

are prioritised in local planning and investment decisions from 2026.

8. That Regional Kidney Networks request trust CEOs, through the evidence provided in this report, to ensure there are sufficient staff appointed for home dialysis services, to provide funding for staff training and protected time for home dialysis leads, and to fund peer support infrastructure by the end of 2025.

9. The APPKG recognises the research done through the Inter-CEPt study and recommends that the key outcome regarding local cultural change, including strong leadership from Clinical Directors within the renal departments and their trusts, along with a commitment to continuous improvement are essential to increase and sustain high levels of home dialysis. It recommends all trusts to adopt this approach.

10. Regional Kidney Networks to work with their Clinical Directors to ensure that all patients are

suitably reimbursed for utility costs, removing financial barriers that deter patients from choosing home treatment. It must be recognised that prompt payment by trusts is essential for disadvantaged groups.

National Kidney Federation Chair, David Coyle said; “I spent 8 years on home haemodialysis (HHD) whilst waiting for my second kidney transplant. Dialysing at home provided greater autonomy and better health outcomes. This enabled me to remain in work, and maintain an active family and social life, manage my kidney failure on my own terms. Our aim at the National Kidney Federation is to continue to promote home dialysis and the benefits it can have for patients and their families. I was delighted to hear the speakers at the Summit in May talk about the work being done to enable more patients to do dialysis at home, but there is still lots of work to do.”

Nicholas Pape chose to do Peritoneal Dialysis (PD) which is home dialysis treatment and received a kidney from a deceased donor in July 2022. Nicholas has worked with his hospital to determine the best ways to support others going through similar experiences. He said “My success and independence have been closely tied to the control and autonomy home dialysis provides. While a transplant marks a new chapter, it still requires the same self-discipline and personal responsibility. I’m thankful to have chosen a path that supports this way of life and secures my future.”

Christine Price, a renal nurse since the 1970s, offers a rare and deeply personal insight into the long term benefits of home haemodialysis. Her late husband, Bob, began dialysis in 1981 and continued for more than 40 years – almost entirely at home. Together they built a life shaped by flexibility, resilience and a determination to live fully in the face of chronic illness. Reflecting, Christine said; “He stayed well because he was in control. And being in control gave him dignity. The greatest takeaway,” she says, “is that being in control leads to a better quality of life. With the right support, more people could benefit. It takes courage – but it’s worth it.”

The next three years are critical. With collaboration, commitment and accountability, we can achieve - and exceed - the 20% home dialysis target, and in doing so, transform lives.

To read the manifesto in full visit:
www.kidney.org.uk/home-dialysis-campaign-manifesto