§ Mr. Carter-Jonesasked the Secretary of State for Social Services if he will give the percentages of kidney 513W sufferers in each of the European Economic Community countries treated by transplant, home dialysis, hospital dialysis and continuous ambulatory peritoneal dialysis techniques; and if he will make a statement.
§ Dr. VaughanThe following table gives the percentages of patients being treated by different methods
Patients receiving treatment on 31 December 1979* Percentage of Patients Country On Peritoneal dialysis On Haemodialysis With Functioning Transplant Hospital Home Hospital Home Belgium 0.6 2.2 59.9 4.3 24.0 Denmark 1.7 3.9 31.7 9.6 50.2 Federal Republic of Germany 1.2 0.4 67.7 17.7 8.5 France 1.5 2.9 66.2 13.9 12.3 Greece 1.4 — 78.3 0.4 10.8 Ireland 0.9 — 34.8 17.2 44.8 Italy 1.8 0.9 76.4 10.1 7.3 Luxembourg — — 83.0 — 1.7 Netherlands 0.2 0.2 57.7 6.1 31.6 United Kingdom 1.0 2.1 18.4 32.9 43.4 * Totals include patients known to be alive on treatment but whose mode of treatment was uncertain.
§ Mr. Carter-Jonesasked the Secretary of State for Social Services (i) if his Department has made an assessment of continuous ambulatory peritoneal dialysis; if he will publish the result in the Official Report; and if he will make a statement;
(2) what is the attitude of his Department to various form of portable dialysis; what advice his Department hives to area health authorities on portable dialysis; and if he will make a statement.
§ Dr. VaughanThe Department keeps in close touch with developments in the treatment of chronic renal failure and welcomes any advances which improve the range of choice available. The choice of treatment for any patient is, however, a matter for the individual clinician concerned.
The term "portable dialysis" may include the use either of continuous ambulatory peritoneal dialysis (CAPD) or of a portable haemodialysis machine. CAPD is at present the most widely used of these methods and is recognised as having a valuable place in the treatment of some patients. However, it has certain disadvantages which include the risk of peritonitis. Further, the technique is not suitable for all patients suffering from chronic renal failure.
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Patients under treatment on 31 December 1979 Region Hospital haemodialysis Home haemodialysis Hospital Peritoneal Dialysis Home Peritoneal Dialysis Functioning Transplant Total Northern 122 78 9 21 193 423 Yorkshire 91 91 8 0 101 291 Trent 63 262 6 8 113 452 East Anglia 53 49 0 1 156 259 North-West Thames 64 140 2 6 240 452 North-East Thames 83 259 8 33 264 647 South-East Thames 133 191 4 2 383 713 South-West Thames 16 40 1 1 24 82 Wessex 12 72 0 0 68 152 Oxford 39 104 1 5 139 288 in each member State on 31 December 1979. Information on the total number of people suffering from kidney failure is not available. Figures for continuous ambulatory peritoneal dialysis are not available separately; it is probable that most of those on home peritoneal dialysis, and a few of those on hospital peritoneal dialysis, were being treated by this method.
For patients treated by haemodialysis, there are at present very few fully portable haemodialysis machines and their use for more than short periods may have disadvantages. The Department is prepared to evaluate any new equipment which becomes available and would make the results of such evaluation known to the medical profession and to health authorities.
No advice on the various forms of portable dialysis has so far been issued to health authorities.
§ Mr. Carter-Jonesasked the Secretary of State for Social Services what is the method of selection of patients for various types of kidney failure treatment; if he will breakdown the figure by area health authority; if he will give the relative costs of each form of treatment; and if he will publish success rates in the Official Report.
§ Dr. VaughanSelecting the treatment appropriate to a particular patient is a matter for the clinical judgment of the consultant concerned. Figures for patients receiving different types of treatment are not available by area health authority but are given below for regional health authorities.
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Region Hospital haemodialysis Home haemodialysis Hospital Peritoneal Dialysis Home Peritoneal Dialysis Functioning Transplant Total South Western 54 161 7 16 93 331 West Midlands 78 95 5 1 215 394 Mersey 48 78 7 10 97 240 North Western 44 105 1 5 136 291 An estimate of the annual cost of treating a patient by different methods was made in 1976. Revalued to November 1979 levels the figures are:
Transplant and one year's follow-up (with no major complications) — £5,000 Hospital haemodialysis — up to £15,000 Home haemodialysis — up to £9,700 (initial capital cost about £7,500) However, their validity as estimates of present-day costs is questionable and the Department is putting in hand work to obtain up-to-date figures (including those for peritoneal dialysis).
The two-year survival rates for patients who started different types of treatment in 1977–78 are 82 per cent. for hospital haemodialysis, 87 per cent. for home haemodialysis, 90 per cent. for those receiving a transplant from a live—related—donor and 76 per cent. for those receiving a cadaver transplant. 50 per cent. of the kidneys transplanted in 1977–78 were still functioning satisfactorily two years later; most of the other patients would have returned to dialysis or had a second transplant. Survival rates for patients on peritoneal dialysis are not yet available.