Haemodialysis
HD requires considerable forward planning, especially if requested at units close to popular holiday destinations. Requests should be in writing, include relevant patient and dialysis provision details and, if possible, propose alternative dates. Only dialysis centres judged unlikely to infect patients with HepB/HIV/HepC are acceptable. Dialysis requests to foreign centres should, therefore, explicitly request confirmation that the unit conducts virus surveillance and segregates infected patients. When the risk of infection exists, or is uncertain, patients must be made aware of risk and upon return to Edinburgh unit treated as HepB positive (segregated) and suspended on transplant list for six months.
CAPD
Dialysis at destinations in the developed world can usually be organised, provided a holiday address is available for delivery and storage of PD fluid.
Patients should
- carry a supply of antibiotics and diluents
- know how to assemble and administer in case of peritonitis
- carry a letter for Customs - and -
- know how to contact local Nephrology Service
Infection prophylaxis
Patients with renal failure make relatively poor antibody responses to immunisation but should still be offered immunisations as recommended for the geographical area of travel, with one or two particular exceptions.
Immunosuppressed patients should not receive live virus vaccines - these include yellow fever, conventional oral (Sabin) polio vaccine, and oral typhoid vaccine. If polio cover is required obtain the killed (Salk) polio vaccine.
Hepatitis B All patients should have been immunised. Check current immune status and discuss with Department of Virology. If negative and travelling to a high risk area, immunoglobulin may be required.
Malaria prophylaxis is difficult because Proguanil is contra-indicated (potential marrow toxicity). No ideal regime is available. Up to date information should be sought from renal pharmacist or medicines information.
Insurance
Dialysis patients travelling abroad must buy adequate health insurance, particularly if travelling to the USA. The National Kidney Federation website www.kidney.org.uk is one possible source of information about suitable insurance companies.
Acknowledgements: Richard Phelps was the main author for this page. It was reviewed in July 2002 November 2006, last amended Thursday, November 30, 2006.
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