There was stated that "Management of renal disease requires a multi-professional team including many other professionals in addition to doctors/nurses. This is often poorly appreciated by those commissioning renal services, leading to shortages of key staff." (CPG, 2003)
Kidneys play an essential role for life. Excretion of toxic products of metabolism, the maintenance of water-electrolyte balance, secretion of rennin and erythropoetin - these functions could be impaired in the cases of the severe renal diseases. Until the late 1950s the diagnosis of established renal failure was a synonym of death sentence. Nowadays advanced medical technologies could extend the lives of the patients and improve their life quality. Older patients having multiple pathologies could be treated effectively. Sick infants and children got chance for life.
The epidemiology of renal diseases is characterised with the prevalence of chronic forms. This fact can be explained by the prolongation of patients' lives and by the association between chronic renal diseases and other nosologies, e.g. cardiovascular diseases or diabetes mellitus. By the official data (DOH, 2005) there are more than 2,500,000 people in England who suffers with chronic kidney diseases. Frankel, Brown & Wingfield (2005) assessed the prevalence of chronic kidney disease as 0.2-0.5% of general population. ...
The incidence and prevalence of terminal stages of kidney diseases continues to grow worldwide. Accordingly to research data (Moeller, Gioberge & Brown, 2002) there were 1,500,000 people receiving renal replacement therapy. Among them the absolute majority (about 69%) received haemodialysis, 23% had transplanted kidney and 9% received peritoneal dialysis. That is interestingly that the highest incidence and prevalence rates are observed in the United States of America and Japan, i.e. in the countries with the highest technological and economical potential. Generally, a number of people receiving specialised nephrological care depend on the various factors including demographic characteristics, responsiveness of health care systems, government funding, reacceptance of treatment, and accessibility of care. Thus in the industrialised countries the number of people who achieve the terminal stages is increased.
This circumstance require urgent actions of health care services, particularly in the development of effective system of palliative care and ensuring that patients will get adequate pain relief and other appropriate treatment and they spend the last days of their lives with dignity. The National Service Framework (NSF) for Renal Services recommended the measures, which should be implemented in three main domains, including early medical interventions in the cases of chronic kidney disease, reducing the incidence of acute renal failure and extending good palliative care practice to patients with terminal stages of chronic renal failure.
There were also developed sets of standards and identified the markers of good practice which "will help the NHS and its partners manage demand, increase fairness of access, and improve choice and quality in dialysis and kidney