An update on the HSE’s modernised care pathways for home dialysis therapy has been presented at the Irish Society of Nephrology’s 2024 Winter Conference.
The speech was given by Professor George Melotte, National Clinical Lead for the HSE's Renal Services. The conference was informed that the National Kidney Programme prioritises early detection of chronic disease and appropriate and timely referral to a nephrologist. The HSE has also set a minimum target to increase the number of home dialysis patients in Ireland to 20%, up from the current 12%.
In his speech, Professor Mellotte highlighted the number of kidney failure patients on dialysis and those undergoing kidney transplants in Ireland, which he said would see 5,190 people with end-stage kidney disease in 2023, up from 5,077 in 2022, an increase of 113.
“This growth has been consistent over the past 15 to 20 years, increasing by about 3 percent each year,” Professor Melotte said.
“Pre-COVID, it was around 55% transplants and 45% in-center dialysis. The figures for home dialysis were pretty stable at 195 people on peritoneal dialysis and 50 people on home hemodialysis.”
“We saw a big surge during COVID, mainly dialysis and transplants stopped, which slowed recovery. As you know, we've seen a surge in people receiving transplants this year, with nearly 200 transplants announced. That's helped contain the increase in dialysis.”
He said more than 340,000 in-centre haemodialysis patients would be treated at 24 centres in 2023, with 60 new dialysis stations having been installed in the past four years, adding there were geographic gaps in the location of dialysis units, such as in Roscommon and parts of Kerry.
The meeting was informed that demand for dialysis is expected to increase, with the population aged 65 and over predicted to almost double over the next 25 years.
“We expect to see a significant increase in the number of people needing dialysis and transplants,” Dr. Melotte said.
However, demand for dialysis is uneven and local access is limited, leading some patients to travel to central Dublin to receive in-centre haemodialysis.
In 2022, 222 new positions have been approved in end-stage renal disease programs to accommodate the 30 percent increase in dialysis activity experienced over the past decade, but the pace of hiring has been slow, it was reported at the meeting.
And despite policies to expand community-based care, 88% of patients were treated in centers and only 12% at home.
Prof Mellotte said home dialysis patients needed support. Barriers included electricity and cleaning costs and staff training costs covered by the HSE. He said there were also the logistical challenges of setting up equipment in people's homes.
“In other countries, home dialysis is subsidised,” Professor Melotte said, adding that the operating costs of home dialysis are between €600 and €1,200. In contrast, the cost of expanding dialysis capacity in a parent renal unit within a hospital is estimated at €100,000 per patient. And the capital costs of building a dialysis station in an HSE hospital renal unit are in the region of €500,000 to €1 million per station bed, the conference explained.
“We need to support patients. We are asking them to take medical treatment from the hospital to their home. They are bringing the disease home,” he said.
“And they feel isolated.”
He added that the number of home dialysis patients in Ireland was low at 12%.
“In some countries it's 25-30%. We've set 20% as a minimum standard and I think it's achievable,” Professor Melotte concluded.
