{"id":33934,"date":"2023-11-30T09:01:08","date_gmt":"2023-11-30T09:01:08","guid":{"rendered":"https:\/\/www.theisn.org\/?page_id=33934"},"modified":"2026-09-29T07:46:16","modified_gmt":"2026-09-29T07:46:16","slug":"dialysis-toolkit-page","status":"publish","type":"page","link":"https:\/\/www.theisn.org\/initiatives\/toolkits\/dialysis-toolkit-page\/","title":{"rendered":"Dialysis Toolkit"},"content":{"rendered":"

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Dialysis Toolkit<\/h2>\n

Toolkit to support implementation of the ISN framework for developing dialysis in low-resource settings<\/a><\/strong><\/p>\n

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Welcome to this toolkit. In 2021, in recognition of the growing need for kidney failure treatment in low resource settings, the ISN published a framework<\/a> providing guidance to policy makers and healthcare providers wishing to develop dialysis programs.<\/p>\n

[\/vc_column_text][vc_column_text]Endorsed by the WHO, this technical package drew attention to several key elements, including affordability, sustainability, scalability and equity. The purpose of this toolkit is to provide materials that support the ISN framework through educational videos, webinars and links to online resources. They are primarily intended for policy makers and healthcare providers but will undoubtedly be of use to people in need of kidney replacement who wish to be better informed about treatment options and how services can be structured. The patient voice is key for service development, and we hope that this toolkit will empower people with kidney failure, their families and carers, to advocate for improved services.<\/p>\n

The components of the toolkit are shown here in overview, organised according to the key components of the framework. Starting with an explanation of what is meant by integrated kidney care, it covers approaches to growing dialysis provision that have proved useful in low resource settings, proceeds to guidance on the ethical and moral concerns that should be considered and finally focusses on the individual with the development of a person-centred dialysis plan. It does not cover the requirements for delivery of dialysis, including quality, standards and resources, topics that will be covered elsewhere in the ISN Kidney Failure (KF) Strategy. Equally the section on conservative or supportive care, an essential component of any kidney failure service, links to ISN KF strategy<\/a> which is still in the process of development.<\/p>\n

This toolkit was developed by: <\/span>Simon Davies, Niang Abdou, Brett Cullis, Ana Elizabeth P L Figueiredo, Arpana Iyengar, Valerie Luyckx, Henriette Nyg\u00e5rd, Jordan Parsons, Irma Tchokhonelidze, Isaac Teitelbaum and Tushar Vachharajani <\/span>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Integrated Kidney Failure Care:” tab_id=”integrated-kidney-failure-care”][vc_row_inner][vc_column_inner width=”1\/2″][vc_column_text]Integrated Kidney Failure Care: Combining dialysis modalities with transplantation and supportive care to achieve optimal efficiency and outcomes<\/strong>[\/vc_column_text][vc_column_text]Watch this short video that explains what is meant by \u2018integrated kidney failure care\u2019[\/vc_column_text][\/vc_column_inner][vc_column_inner width=”1\/2″][vc_video link=”https:\/\/www.youtube.com\/watch?v=MU5LCrQgXWY” el_width=”90″][\/vc_column_inner][\/vc_row_inner][\/vc_tta_section][vc_tta_section title=”Growing dialysis provision: Pros and Cons of different approaches” tab_id=”growing-dialysis-provision”][vc_row_inner css=”.vc_custom_1701941186423{margin-bottom: 10px !important;border-top-width: 2px !important;border-right-width: 2px !important;border-bottom-width: 2px !important;border-left-width: 2px !important;padding-top: 10px !important;padding-right: 10px !important;padding-bottom: 10px !important;padding-left: 10px !important;background-color: #ffffff !important;border-left-color: #578fbf !important;border-left-style: solid !important;border-right-color: #578fbf !important;border-right-style: solid !important;border-top-color: #578fbf !important;border-top-style: solid !important;border-bottom-color: #578fbf !important;border-bottom-style: solid !important;border-radius: 15px !important;}”][vc_column_inner el_class=”box-shadow” width=”1\/2″][vc_column_text]Watch the ISN webinar on the role of Private Patient Partnership<\/strong> (PPP) in growing dialysis services.[\/vc_column_text][vc_video link=”https:\/\/youtu.be\/fys3GKAfneQ” css=”.vc_custom_1701941208756{margin-bottom: 5px !important;}”][vc_column_text css=”.vc_custom_1701941290828{margin-bottom: 0px !important;}”]<\/p>\n

Webinar Recording<\/a><\/p>\n

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Growing dialysis services in any setting can be a challenge but especially so when resources are limited. One way of achieving the capital investment required to develop dialysis services is through public private partnership (PPP). This webinar is focused on what such partnerships can achieve, providing participants with an in depth understanding of both the benefits and the potential disadvantages and how to mitigate against these. Starting with a description of a successful PPP implementation from Georgia, the panel shares experiences from around the world and attempt to define PPP, recognizing that this definition will differ by jurisdiction. Key aspects of the discussion includes standards, costs, contracts, scope of the service (what should, must or must not be included), ethics, management of uncontrolled growth and third-party costs (e.g. out of pocket expenses).<\/em><\/p>\n

[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_row_inner css=”.vc_custom_1701941192560{margin-bottom: 10px !important;border-top-width: 2px !important;border-right-width: 2px !important;border-bottom-width: 2px !important;border-left-width: 2px !important;padding-top: 10px !important;padding-right: 10px !important;padding-bottom: 10px !important;padding-left: 10px !important;background-color: #ffffff !important;border-left-color: #578fbf !important;border-left-style: solid !important;border-right-color: #578fbf !important;border-right-style: solid !important;border-top-color: #578fbf !important;border-top-style: solid !important;border-bottom-color: #578fbf !important;border-bottom-style: solid !important;border-radius: 15px !important;}”][vc_column_inner el_class=”box-shadow” width=”1\/2″][vc_column_text]Watch the presentation on the role of Peritoneal Dialysis First<\/strong> (PD-first) in growing dialysis services.[\/vc_column_text][vc_single_image image=”33941″ img_size=”full” css=”.vc_custom_1701941215933{margin-bottom: 5px !important;}”][vc_column_text css=”.vc_custom_1702997149012{margin-bottom: 0px !important;}”]<\/p>\n

Download as audio PPT presentation<\/a><\/p>\n

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Introducing a national policy by which all new people with kidney failure start their treatment with peritoneal dialysis, \u201cPD-first\u201d, has proved an effective way of introducing a universal healthcare programme for renal replacement. This approach was first adopted in Hong Kong and remains highly effective and is associated with excellent outcomes. It requires effective government negotiation for competitive pricing of dialysis fluids and reduces the infrastructure costs associated with building and staffing haemodialysis units. It does however lead to a restriction in choice and over time there will be the need to invest in haemodialysis services.<\/em><\/p>\n

[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_tta_section][vc_tta_section title=”Kidney conservative care in low resource settings” tab_id=”kidney-conservative-care-in-low-resource-settings”][vc_row_inner][vc_column_inner width=”1\/2″ css=”.vc_custom_1701939515543{border-top-width: 10px !important;border-right-width: 10px !important;border-bottom-width: 10px !important;border-left-width: 10px !important;padding-top: 15px !important;padding-right: 15px !important;padding-bottom: 15px !important;padding-left: 15px !important;background-color: #ffffff !important;border-left-color: #f8f8f8 !important;border-left-style: solid !important;border-right-color: #f8f8f8 !important;border-right-style: solid !important;border-top-color: #f8f8f8 !important;border-top-style: solid !important;border-bottom-color: #f8f8f8 !important;border-bottom-style: solid !important;border-radius: 15px !important;}”][vc_column_text]<\/p>\n

What do we mean by “conservative” or “supportive” care?<\/strong><\/p>\n

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Download publication<\/a><\/p>\n

[\/vc_column_text][\/vc_column_inner][vc_column_inner width=”1\/2″ css=”.vc_custom_1701939521563{border-top-width: 10px !important;border-right-width: 10px !important;border-bottom-width: 10px !important;border-left-width: 10px !important;padding-top: 15px !important;padding-right: 15px !important;padding-bottom: 15px !important;padding-left: 15px !important;background-color: #ffffff !important;border-left-color: #f8f8f8 !important;border-left-style: solid !important;border-right-color: #f8f8f8 !important;border-right-style: solid !important;border-top-color: #f8f8f8 !important;border-top-style: solid !important;border-bottom-color: #f8f8f8 !important;border-bottom-style: solid !important;border-radius: 15px !important;}”][vc_column_text]<\/p>\n

What are the requirements for choice-restricted supportive care?<\/strong><\/p>\n

[\/vc_column_text][vc_single_image image=”34367″ img_size=”full” alignment=”center” onclick=”link_image”][\/vc_column_inner][\/vc_row_inner][\/vc_tta_section][vc_tta_section title=”Ethical and moral policy considerations” tab_id=”ethical-and-moral-policy-considerations”][vc_row_inner equal_height=”yes” css=”.vc_custom_1701939824154{margin-bottom: 10px !important;border-top-width: 2px !important;border-right-width: 2px !important;border-bottom-width: 2px !important;border-left-width: 2px !important;padding-top: 15px !important;padding-right: 15px !important;padding-bottom: 15px !important;padding-left: 15px !important;background-color: #ffffff !important;border-left-color: #8b9bbf !important;border-left-style: dotted !important;border-right-color: #8b9bbf !important;border-right-style: dotted !important;border-top-color: #8b9bbf !important;border-top-style: dotted !important;border-bottom-color: #8b9bbf !important;border-bottom-style: dotted !important;border-radius: 15px !important;}”][vc_column_inner width=”1\/2″][vc_video link=”https:\/\/www.youtube.com\/watch?v=_WnHChoy2BQ” css=”.vc_custom_1701939749069{margin-bottom: 10px !important;}”][vc_column_text el_class=”smaller-text” css=”.vc_custom_1701939742799{margin-top: 0px !important;margin-bottom: 0px !important;}”]Watch this video on the moral dilemmas faced when providing dialysis to a child in a resource-limited setting.[\/vc_column_text][\/vc_column_inner][vc_column_inner width=”1\/2″][vc_column_text el_class=”smaller-text” css=”.vc_custom_1701939736361{margin-bottom: 0px !important;}”]As clinicians navigate through pathways of kidney failure care, from conservative management to dialysis and transplantation, one is faced with a combination of medical, social and ethical issues. Addressing such issues demands a sound understanding of the principles of bioethics by the clinician to maintain the right conduct and standard of behaviour. In this presentation, using real life examples we discuss key ethical challenges in the care of adults and children with kidney failure. In the context of under-resourced settings where lack of accessible dialysis therapies and insufficient resources prevail, ethical dilemmas can lead to moral distress. There is a need to increase awareness of ethical issues, understand its implications and provide strategies for shared decision making in the management of patients with kidney failure<\/em>.[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_row_inner equal_height=”yes” css=”.vc_custom_1701939948589{margin-bottom: 10px !important;border-top-width: 2px !important;border-right-width: 2px !important;border-bottom-width: 2px !important;border-left-width: 2px !important;padding-top: 10px !important;padding-right: 10px !important;padding-bottom: 10px !important;padding-left: 10px !important;background-color: #ffffff !important;border-left-color: #8b9bbf !important;border-left-style: dotted !important;border-right-color: #8b9bbf !important;border-right-style: dotted !important;border-top-color: #8b9bbf !important;border-top-style: dotted !important;border-bottom-color: #8b9bbf !important;border-bottom-style: dotted !important;border-radius: 15px !important;}”][vc_column_inner width=”1\/2″][vc_video link=”https:\/\/www.youtube.com\/watch?v=sw1fo4te_4Q” css=”.vc_custom_1701939888396{margin-bottom: 10px !important;}”][vc_column_text el_class=”smaller-text” css=”.vc_custom_1701939894051{margin-bottom: 0px !important;}”]Watch this video on the ethical duties of clinicians and service providers when faced with nonadherence.[\/vc_column_text][\/vc_column_inner][vc_column_inner width=”1\/2″][vc_column_text el_class=”smaller-text” css=”.vc_custom_1701939902405{margin-bottom: 0px !important;}”]This video explores some of the key ethical considerations when a patient\u00a0does not adhere to an agreed treatment plan. Highlighting various examples of nonadherence, it examines and applies important ethical principles. These range from respect for patient autonomy and justice to proportionality and respect for dignity. Finally, i<\/i>t provides practical advice on navigating such situations whilst upholding professional ethical duties.<\/i>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_row_inner equal_height=”yes” css=”.vc_custom_1701939995434{margin-bottom: 10px !important;border-top-width: 2px !important;border-right-width: 2px !important;border-bottom-width: 2px !important;border-left-width: 2px !important;padding-top: 10px !important;padding-right: 10px !important;padding-bottom: 10px !important;padding-left: 10px !important;background-color: #ffffff !important;border-left-color: #8b9bbf !important;border-left-style: dotted !important;border-right-color: #8b9bbf !important;border-right-style: dotted !important;border-top-color: #8b9bbf !important;border-top-style: dotted !important;border-bottom-color: #8b9bbf !important;border-bottom-style: dotted !important;border-radius: 15px !important;}”][vc_column_inner width=”1\/2″][vc_video link=”https:\/\/www.youtube.com\/watch?v=zxWJz3hmNmU” css=”.vc_custom_1701939923436{margin-bottom: 0px !important;}”][vc_column_text el_class=”smaller-text” css=”.vc_custom_1701939917299{margin-bottom: 0px !important;}”]Watch this video on the principles\u00a0 of priority setting that policy makers need to consider in resource-limited settings.[\/vc_column_text][\/vc_column_inner][vc_column_inner width=”1\/2″][vc_column_text el_class=”smaller-text” css=”.vc_custom_1701939909829{margin-bottom: 0px !important;}”]When budgets are constrained, governments have the obligation to set priorities for health and determine which services will be provided under universal health coverage and which will be \u201cleft out\u201d, meaning the patient will have to pay out of pocket. This talk discusses the process of priority setting around provision of care for kidney failure, focusing not only on cost-effectiveness, but also on the importance of considering equity in the priority setting process, to promote fairness in resource allocation. It is unlikely that universal health coverage can be extended soon to cover the needs of all patients with kidney failure in lower resource settings, but the commitment to progressive expansion of coverage over time is important, and must begin with transparency and accountability in the priority setting process today.<\/em>[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][\/vc_tta_section][vc_tta_section title=”Developing a person-centred dialysis plan” tab_id=”developing-a-person-centred-dialysis-plan”][vc_column_text]Watch these short videos that describe what adults and children and their caregivers should take into consideration when choosing their preferred dialysis modality.[\/vc_column_text][vc_row_inner][vc_column_inner width=”1\/2″][vc_video link=”https:\/\/youtu.be\/2rs5eZ1UdMk”][\/vc_column_inner][vc_column_inner width=”1\/2″][vc_video link=”https:\/\/www.youtube.com\/watch?v=SChiRH9GWgI”][\/vc_column_inner][\/vc_row_inner][vc_column_text]Watch this video to hear what patients have to say about the choices they made their experiences of coping with kidney failure.[\/vc_column_text][vc_row_inner][vc_column_inner width=”1\/2″][vc_video link=”https:\/\/www.youtube.com\/watch?v=6-GcR-BfcHg”][\/vc_column_inner][vc_column_inner width=”1\/2″][vc_video link=”https:\/\/www.youtube.com\/watch?v=TxJXa9jiwGw”][\/vc_column_inner][\/vc_row_inner][vc_column_text][\/vc_column_text][\/vc_tta_section][vc_tta_section title=”Resources” tab_id=”resources”][vc_column_text css=”.vc_custom_1701937463743{padding: 10px !important;background-color: #ffffff !important;border: 2px solid #578fbf !important;border-radius: 15px !important;}”]Developing a person-centred dialysis plan \u2013 resources for patients, their relatives, carers and their healthcare professionals<\/strong><\/p>\n

There are a number of non-commercial online resources designed for patients to help them understand more about kidney failure and the treatment options available. In general these are not primarily aimed at people living in low\/low-middle income countries so patients from these countries should be made aware that the choices discussed, which may include variations on the main modality \u2013 such as home haemodialysis or automated peritoneal dialysis may not be available. Despite this the group developing the toolkit found them valuable and educational. Remember, when using YouTube it is possible to change the language of the subtitles\u00a0https:\/\/youtu.be\/ZnoxutAvyaI?si=_XOLDVjnq16Sj58z<\/a>[\/vc_column_text][vc_column_text css=”.vc_custom_1701937491909{border-top-width: 2px !important;border-right-width: 2px !important;border-bottom-width: 2px !important;border-left-width: 2px !important;padding-top: 10px !important;padding-right: 10px !important;padding-bottom: 10px !important;padding-left: 10px !important;background-color: #ffffff !important;border-left-color: #578fbf !important;border-left-style: solid !important;border-right-color: #578fbf !important;border-right-style: solid !important;border-top-color: #578fbf !important;border-top-style: solid !important;border-bottom-color: #578fbf !important;border-bottom-style: solid !important;border-radius: 15px !important;}”]<\/p>\n

Failing Kidneys and Different Treatment Options<\/strong><\/p>\n

This Canadian Video by Mike Evans starts with an excellent summary of the functions of the kidney and what can go wrong in kidney failure \u2013 and how to recognise the symptoms. It discusses the options for treatment including transplantation (0.52 mins), conservative care (2.10 mins), getting a kidney from a living donor (3.11 mins), haemodialysis (4.05 mins) and peritoneal dialysis (4.50 mins).<\/p>\n

https:\/\/www.youtube.com\/watch?v=mi34xCfmLhw<\/a>[\/vc_column_text][vc_column_text css=”.vc_custom_1705930122448{border-top-width: 2px !important;border-right-width: 2px !important;border-bottom-width: 2px !important;border-left-width: 2px !important;padding-top: 10px !important;padding-right: 10px !important;padding-bottom: 10px !important;padding-left: 10px !important;background-color: #ffffff !important;border-left-color: #578fbf !important;border-left-style: solid !important;border-right-color: #578fbf !important;border-right-style: solid !important;border-top-color: #578fbf !important;border-top-style: solid !important;border-bottom-color: #578fbf !important;border-bottom-style: solid !important;border-radius: 15px !important;}”]<\/p>\n

The UK National Kidney Federation Website presents unbiased information pages about:<\/strong><\/p>\n

Peritoneal Dialysis<\/strong><\/p>\n