Dialysis Units Fail to Cope As Kidney Failure Rises 40% Patients Treated ‘Through the Night’ As Hospitals Struggle to Meet Demand

THE number of patients in Scotland needing hospital dialysis for kidney failure has risen by almost 40% in the past six years, leaving renal units struggling to cope.

New figures show that 1505 people received the treatment in hospitals across the country last year, compared to 1097 in 1999.

The increase in conditions such as diabetes and obesity as well as a growing elderly population are factors in the rise in prevalence of kidney failure. A lack of donated organs also means that many patients who would benefit from transplantation are forced to rely on dialysis instead.

Yet despite a predicted “relentless rise” in the number of people needing treatment, experts warn that patients are already being failed by overstretched services.

Professor Andy Rees, Regius Professor of Medicine at Aberdeen University and immediate past president of the Renal Association of Great Britain, said many patients endured long delays through having to travel to dialysis units and waiting to get onto machines.

“There is a lot of inflexibility about when patients are treated, ” he said. “What could be a half-day treatment actually turns into a full-day treatment. That is a direct consequence of dialysis units being too full.”

Rees added that the situation severely restricted patients’ lives as they are often unable to travel far from home because they can’t find units to treat them on a temporary basis.

He said: “It is often flagged up in the context of having a holiday, but we could be talking about someone who is operating a business and needs to have a business meeting. Or you are talking about things which are absolutely essential, such as bereavement.

“Being a haemodialysis patient is in some ways really a little bit like being a criminal who has been tagged, who has been allowed into the community but can’t go a certain distance from their home base.”

He added: “We’re concentrating (in the UK) almost exclusively on providing dialysis stations, rather than enabling patients to live their optimal lives with treatment.

“That would be regarded as unacceptable in the United States and as unacceptable across almost all of continental Europe, where there are far larger numbers of facilities.”

Tim Statham, chief executive of the National Kidney Federation, said his organisation had been calling for greater investment in dialysis units for “many years”.

“Unfortunately, the renal services in Britain are overstretched. If you look at dialysis services, most of them are offering twilight dialysis services, in other words, through the night, and that is because most of them can’t cope with the demand, ” he said.

“Dialysis is an appalling quality of life – three days a week you spend the whole day tied to a machine. The day leading up to it you feel ill because your blood is poisoned and the day following it, you are recovering because it is such an aggressive treatment, so at no time do you feel well.

“If you are told that your only chance of getting on to a machine to keep you alive is through the night, it is pretty grim. It should not be happening.”

The figures were revealed in an answer to a parliamentary question asked by Christine Grahame, SNP MSP for South of Scotland.

She said: “I have had several constituents from the Borders who are having to travel for dialysis into Edinburgh.

“Compounded with having to go for dialysis, it is the fact that they are having to travel 40 or 50 miles some of them, which is a 100-mile round trip for dialysis, which is absolutely exhausting.”

A major report into renal services in Scotland, published two years ago by a cross-party Parliamentary group, made 38 recommendations to improve the treatment of patients suffering from kidney failure.

Rees, who chaired the advisory panel to the group, said while some progress had been made, a national plan to integrate services still needed to be drawn up.

He added that more also had to be done to identify and treat those with chronic kidney disease – which affects an estimated 5% of the population – who are at risk of progressing to kidney failure.

“The bottom line is that there is going to be a relentless rise in the numbers of patients needing treatment and what we really need to do is focus on treating those patients better, but also on preventing people in future from developing established kidney failure and needing dialysis, ” he said.

“We think of treatment for kidney failure as a triumph of modern medicine, because it was the first example where you could replace an essential organ – the kidney – with treatment.

“But the fact that we need it is a reflection of the complete failure of modern medicine, as really what we want to be doing is treating effectively those diseases that will eventually cause kidney failure.”

Health minister Andy Kerr claimed systems were being developed to help GPs identify chronic kidney disease as early as possible.

He added: “NHS boards are developing facilities to meet the needs of patients on renal dialysis. In line with the Kerr report, care is being provided as locally as possible through new satellite dialysis units.

“There has also been a major investment recently between NHS Borders and NHS Lothian to allow Borders patients to dialyse at Borders General Hospital so they don’t need to travel to Edinburgh for treatment.”

CASE STUDY

DONALD McIntosh, 52, has had to undergo regular dialysis since suffering kidney failure a year ago.

A councillor with Argyll and Bute council, he has to travel from his home in Oban three times a week to have the treatment at the Vale of Leven Hospital, Alexandria in Dunbartonshire.

It involves getting up at five o’clock in the morning to drive approximately 76 miles. After five hours of dialysis, he usually returns home by around three o’clock in the afternoon.

He said: “Everything ties up round about that; it is a lot of travelling. Any facility in Oban would help me tremendously. It also means anyone coming on holiday from England or Wales or anywhere at all, can’t come to Oban and get dialysed on a holiday.

“So apart from it having a negative impact on the people of Argyll and Bute, it has an impact worldwide.

“I can go to any part of the world – France, Germany, Spain, Holland, all different places, and get dialysis in all of these. There is a great lack of services in Scotland.”