Rise in diabetes to put strain on demand for dialysis services
National clinical director Dr Liam Plant, a consultant renal physician at Cork University Hospital (CUH), said the health service had been able to meet demand for dialysis to date but that they were now “very close to maximum”.
“We need to plan going forward. Obviously it is a very challenging situation now,” Dr Plant said.
He said the immediate priorities of the National Renal Office were:
* Expansion of capacity to meet demand.
* Provision of services closer to patients’ homes.
* Improvement in patient-centred care with the closure of night-time shifts.
Currently, patients undergoing dialysis at Beaumont Hospital, CUH and Waterford Regional Hospital are being treated in the middle of the night because of capacity problems. Dr Plant said the situation is set to improve at CUH next year when a new cardiac renal unit is scheduled to open.
“CUH will have 35 haemodialysis stations, up from 22, which means people won’t have to travel in the middle of the night anymore. We will be able to treat 175 patients, up from 150 at the moment.
Dr Plant said the Health Service Executive (HSE) had acknowledged the shortage of haemodialysis capacity and, as part of an effort to address the problem, had contracted services from a number of private providers since 2004. At the end of December 2008, 226 patients were being treated in contracted units, 16% of all haemodialysis patients.
Between 2003-2008 the total number of dialysis patients increased from 1,013 to 1,601, up 58%. Dr Plant said the increase did not so much reflect a growth in the incidence rate as the fact that people with ESKD are surviving longer due to greater availability of dialysis or a functioning transplant. Of 3,329 patients with ESKD in 2008, 1,728 (52%) had a functioning transplant and the remainder were on dialysis. In Cork and Kerry, the number of patients with a functioning transplant outnumbers those on dialysis.
However Dr Plant said an increase in diabetes and an ageing population is expected to push up the number of people with ESKD by between five and 10% and that the HSE needs to plan for an additional dialysis 85-170 patients each year.
Dr Plant said transplant was the optimum treatment for ESKD but while Ireland has a relatively high rate of deceased organ donation, transplantation had not kept pace with the increased number of dialysis patients.
For every 10 patients in need of dialysis the cost is approximately €500,000. Dr Plant said after transplant, the cost of treatment for the first year is high, but subsequently, the cost goes down and the outlook is better for the patient and the economy.
In terms of kidney specialists, Dr Plant said Ireland has “proportionately less than other EU countries” but the numbers are increasing slowly.
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