Dialysis space running out at Middlemore Hospital

By REBECCA WALSH, health reporter

Ballooning demand for kidney dialysis in South Auckland will see Middlemore Hospital run out of space to treat patients by as early as June.

The hospital is planning additional night-shift dialysis to cope with the influx of people needing treatment but new facilities will be needed by the end of the year.

Management says that long term the growth is unsustainable and they are calling for national guidelines on rationing treatment.

The number of people requiring kidney dialysis in the Counties-Manukau area is almost double the national average - a figure largely attributable to the fact the area has a high number of Maori and Pacific people who have higher incidence of diabetes.

Dr Sharad Ratanjee, clinical head of the renal department, said there were 204 new dialysis patients per million people in the Counties Manukau area in 2002, compared to a national average of 115 per million.

Dr Ratanjee said the hospital would run short of spaces for haemodialysis patients by June. The dialysis centre at Middlemore and two satellite units, one at the Manukau Surgery Centre, had the capacity to cope with 248 patients but the hospital was expecting 260 patients by July and up to 300 by July next year.

Additional night dialysis shifts, starting at 7pm and finishing after midnight were being considered but were not popular among patients.

By December the hospital would need to look at new facilities. Dr Ratanjee estimated at least another 20 dialysis machines would be needed to keep up with demand by July 2006.

The hospital has 63 dialysis machines. Thirty people undergo dialysis at home.

Chris Mules, the board's chief planning and funding officer, said in the medium term continuing to pump more money into dialysis treatment was not sustainable.

The health board spends about $13 million a year on kidney dialysis (excluding costs such as theatre time).

It costs about $50,000 a year per patient, including in-patient time.

Mr Mules said the issue was one for the wider community and the board would raise the idea of national guidelines with the Ministry of Health.

Dr Ratanjee said rationing care for renal patients would pose an ethical problem for doctors unless there were structured guidelines and criteria set up by the Government and health boards.

At the moment, patients who had a reasonably good quality of life and did not have advanced diseases such as Alzheimers, cancer, heart or lung disease, received treatment.

Dr Ratanjee said although programmes were under way to slow the growth in people needing dialysis, by targeting diabetes, it would take 15-20 years before there was any impact on figures.

About half those on dialysis had end stage renal failure as a result of diabetes and two-thirds of Maori on dialysis had diabetes.

A Ministry of Health spokesperson said a National Renal Advisory Board existed and would possibly look into setting up national guidelines.