When Mark Moore had to start dialysis in his early 30s due to polycystic kidney disease, he felt he lost the battle in an inheritance condition diagnosed as a child.
“Very scary” is a way to remember the outlook that he had his first dialysis treatment in Dublin on May 26, 2021 Tallaght University Hospital. It was a process he knew well, as his late father, aunt, and his uncle all needed dialysis for the illness. Clusters of cysts affected kidney function. However, he had to meet the conditions very quickly, with the recognition that it was “my turn,” when a decision was made regarding treatment during the appointment of the clinic on Friday, and he had his first session the following Tuesday.
“But it was actually one of the best things that happened to me. I didn't realize how sick I was and how I was under pressure. After my first dialysis, I was running down the corridors of Taragut and made everyone hear how good I felt.
Due to a family history of kidney disease, the 36-year-old was tested at age 11 when he received treatment for something else. His parents weren't doing much with him at the time, so it was only when he began to develop problems in his early 20s that he began to develop symptoms. “I played a lot of GAA football and used to get a lot of bangs. I was a goalkeeper. I ruptured a cyst and bleed.” He also had to deal with high blood pressure. This is “just one thing that comes with illness.”
The initiation of the dialysis regimen included taking a return trip to Taragut Hospital three times a week from his home in Baltingras, Wicklow, to treat him for three hours each time. The HSE provides transportation to dialysis patients, but in addition to the time actually spent in the hospital, it meant up to 1 hour on the street, depending on the traffic.
What you can do is great [home dialysis] In my sleep, it doesn't take away my time for my work or my time with my kids
– Mark Moore
“It really had an impact on my workplace schedule,” says Moore, a pharmaceutical manufacturing process technician who works 12-hour or night shifts with a 24-hour operation at Pfizer's Grange Castle factory in Dublin. Having to go on dialysis meant he could no longer do that shift pattern. So when he was given the option to dialysis at home, he jumped at it.
He was on hemodialysis at the hospital, during which time the blood was pulled out of his body, filtered by a machine, and returned to his body. Filtering removes waste and excess liquid from the blood. This is one of the tasks that is usually done by healthy kidneys, which produce urine to be expelled from the body.
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The home treatment Moore has been doing since the end of 2021 is peritoneal dialysis, with cleansing fluid inserted while sleeping through a tube inserted inside the abdomen.
“I took it into the water like a duck,” he says. After about three training sessions at Tallaght and the team visited at home to set up at home, everything went smoothly and there were no issues with teething. At first, you can experience a bit of drainage pain as the liquid flows and then drains after living there, he explains. The one-night session consists of five cycles of this and lasts for 8 hours.
“I started with seven nights and they dropped me to six because my blood was so good.”
If he works night shifts, he will do the steps when he sleeps during the day. Peritoneal dialysis should be performed more frequently than hemodialysis, but it is gentle on the body. He feels he doesn't feel any aftereffects at all, but more intense hemodialysis often makes him tired, drained and very hungry by the time he gets home from the hospital.
The convenience of home dialysis is also a major advantage for Moore, who has two young sons, Noah (5) and Ollie (3), along with his wife Michelle.
Michelle, who he describes as “surprising,” plays a major role in making the home dialysis work for him, so that he can leave for work at 5:45am the next day, and be ready by 9pm, so that he can get home from his day shift at 8pm. She then cleans the machine and disposes of the waste bags.
“It's great to be able to do that while I sleep because I don't take away time to work, work with my kids or go to soccer with my kids. I can live my life with this.”
He is one of more than 300 patients in Ireland and is doing his own dialysis at home. This represents approximately 12% of dialysis patients. Professor George Mellotte, consultant kidney scientist at HSE National Clinical Lead for Renal Services and Tallaght Hospital, is determined to oversee the increase in that percentage.
He says it benefits both patients and the health system.
Home dialysis patients often avoid 150 long hospital visits per year, often accompanied by extremely long commutes, but also have the flexibility to decide when to treat them (for example at night), with low risk of infection, and can continue this important treatment by bringing in equipment during the holidays. For health services, annual cost savings for all patients who can manage dialysis at home range from 30,000 to 50,000 euros.
At the time, both parties benefited, but in recent years, home dialysis had not been revived, and the numbers had hardly grown. Peritoneal methods began in the 1980s, and hemodialysis was introduced into home therapy programs more than a decade ago. “But there was nothing I would call structure,” says Professor Mellott. “I don't make any sense to criticize this, but it evolved organically. Sometimes I was forced onto people because the hospital system wasn't capable.”
Despite the time-saving and convenience aspects, dialysis clearly brings more work from home for patients. Professor Mellotte compares it to his own equipment and hotel experience. Those using centre-based dialysis are driven there and come back from home. The machine is ready and trained dialysis nurses will perform the treatment, while light snacks are available during this time. Specialist doctors and nutritionists are available if necessary.
With domestic dialysis, “patients do all their jobs and bring illness to the home,” he says. Patients must arrange delivery, store supplies, set up machines, then clean and dispose of waste. However, the advantages of this approach were clearly increased during the Covid-19 pandemic when patient demand for patient dialysis accelerated due to fear of visiting hospitals.
Unless patients receiving domestic treatment are better supported, they return to centrally based treatment, and Professor Melott argued that he insisted on developing and funding modernized care pathways. The purpose of this is that out of 2,500 people, people have undergone dialysis from central treatment. According to HSE figures issued in March, 1,461 people received the HSE hospital-based unit in 2,502 patients, 736 people received the HSE contract dialysis unit and 305 patients at home.
Improved support for home dialysis patients includes providing more specialized nurses in community units to support training and occasional home visits. These patients also require the same access to a nutritionist, usually six times a year, when they visit a hospital clinic, and enter the dialysis unit three times a week.
Professor Mellotte also advocates for nursing or health care assistant support for older, frail patients. They may not have a family to help them, or they may not want to impose on them.
We have kept records since 2009 and have a very detailed record, with 3% growth annually over the last 15 years
– Professor George Mellott on the incidence of chronic kidney disease
Other barriers to home dialysis include electricity costs. Electricity costs must be employed by most people to benefit from the available tax credits of income. Hemodialysis at home requires a change of house and essentially requires a dedicated room to accommodate the machinery and equipment you need. As of April 1st this year, there were 63 people on hemodialysis at home, and they are usually experienced every two days.
Individual circumstances and medical complications mean that home dialysis is not an option for many, but Professor Melot says that embraces moving towards a national rate of 20% of patients, a target already filled by the kidney unit in Taragut. The incidence of chronic kidney disease and failure continues to increase in aging populations. Two of the main causes are diabetes and high blood pressure. People who died years ago from heart disease are now alive due to stent insertion, Professor Melot explains, but the same vascular factors affecting the kidneys are still there.
“We have kept records since 2009 and have a very detailed record, with 3% growth annually over the past 15 years.”
According to HSE, approximately 5,257 people with chronic kidney disease or failure were treated in 2023 by dialysis or kidney transplant. This is an increase of 109 from the previous year.
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Approximately 191 kidney transplants were performed last year. They are “another way to treat kidney failure,” explains Professor Melott. Transplants should significantly improve recipient health and quality of life, but that is not a treatment. These individuals may have many original complications, such as diabetes. “We still need to take a lot of pills. There's a risk that the disease might return to our new kidneys.”
Mark Moore has been on the transplant list for over two years, but he's temporarily removed it as he prepares to keep a right kidney, which has many infections that were removed in July. This will cause his body to have a better shape and undergo a transplant.
However, after this mid-summer nephrectomy, he will have to return to hospital-based hemodialysis for 8-10 weeks. “Gives a little help to one kidney.”
After the period of recovery after surgery, he should be able to resume peritoneal dialysis at home.
Moore says he was always happy to experience hemodialysis in the hospital and was able to see that side of it.
“It humbled me so badly…and I'm really grateful that I had the opportunity to participate in peritoneal dialysis now. [at home]. Highly recommended. ”
