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Renal replacement therapy and conservative management: NICE guideline (NG 107) October 2018
  1. Zainab Arslan1,
  2. Muhammad A Khurram2,
  3. Manish D Sinha3,4
  1. 1 Department of Paediatric Nephrology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
  2. 2 Department of Renal Transplantation, Barts Health NHS Trust, London, UK
  3. 3 Department of Paediatric Nephrology, Evelina London Children’s Hospital, London, UK
  4. 4 Department of Education and Professional Studies, King’s College London, London, UK
  1. Correspondence to Dr Zainab Arslan, Paediatric Nephrology, Great Ormond Street Hospital For Children NHS Foundation Trust, London SE1 7EH, UK; zainab.arslan{at}

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In 2017, 966 children in the UK received long-term renal replacement therapy (RRT) for established end-stage kidney disease (ESKD); 76% of whom had functioning renal transplants while 24% were on dialysis (13% on haemodialysis (HD) and 11% on peritoneal dialysis (PD)).1 The National Institute for Health and Care Excellence (NICE) published its guidance ‘Renal replacement therapy and conservative management’ in October 2018 (NG 107, 2018).

Information about the clinical guideline

The guideline caters to both adult and paediatric populations with stages 4 and 5 chronic kidney disease (CKD) (defined as an estimated glomerular filtration rate (eGFR) between 15–29 and <15 mL/min/1.73 m2 2) and provides recommendations on initiation, preparation, choice, switching or stopping modalities for RRT. It also provides information for patients and coordinating care when commencing RRT. The guideline mainly targets healthcare professionals looking after the patients and their families with CKD stages 4 and 5.

Previous guidelines

The British Association for Paediatric Nephrology3 4 and more recently the Renal Association (2017)5 have produced guidance for HD and PD, respectively, in children. This guidance replaces previous NICE guidance CG125 and TA48 (NICE, 2011) (box 1).

Box 1


  • NICE (NG 107) (2018). Renal replacement therapy and conservative management. Accessed online

  • NICE (CG 125) (2011). Chronic kidney disease (stage 5): peritoneal dialysis. Accessed online

  • NICE (TA48) (2011). Improving Choice for Kidney Patients and Carers - Increasing access to home dialysis. Accessed online

Key points

Joint decision-making involving the child/young person, their parents and the multidisciplinary team (MDT) is recommended at all the stages. The key points highlighted in this guideline relating to paediatric population are:

  1. Indications for starting dialysis

    1. Consider starting dialysis when indicated by …

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  • Twitter @Zainab_arslan_

  • Contributors ZA conceived, wrote and reviewed. MAK wrote and reviewed. MDS wrote and reviewed.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.