NINEWELLS HOSPITAL’S renal unit is again feeling the squeeze as demand for dialysis shows a rising trend, writes Marjory Inglis, health reporter.

More and more people are attending the Dundee unit for lifesaving treatment, that cleanses the blood when kidneys fail, and bosses are poised to make alterations to the unit and install extra dialysis stations at just a few days notice.

For months now hospital chief executive Gerry Marr has been openly stating that current capacity for dialysis in Dundee is unlikely to cope ahead of the planned development of a satellite unit in Perth next year and a short-term measure will have to be put in place to ease the pressure.

The latest statistics show that demand for dialysis in the Ninewells unit rose by 10.2% over the three years to March 2005.

In the year 2002/03 a total of 18,708 sessions of dialysis were delivered in the unit. In the 12 months to the end of March 2005, the numbers of sessions had risen to 20,624.

The rise in the unit’s activity is tracked by dialysis sessions delivered rather than numbers of patients treated.

The unit is currently treating over 130 patients, offering three “shifts” a day on dialysis machines.

However, the patient population is ever changing, as new patients come into the programme and others leave it, either because they receive transplanted organs or because they die.

As a result, the numbers receiving treatment fluctuates, though the overall trend is rising inexorably.

Demand for treatment of patients with kidney failure is something that shows sudden peaks and relative recessions in an overall rising trend.

One of the unpredictable factors that adds to the difficulty in plotting likely demand is that patients do die.

The vast majority of patients who attend several times a week for dialysis are pensioners, with a significant proportion aged over 80. Not only do these patients depend on dialysis to keep them alive, but many have a complex mix of other illnesses and diseases that contribute to a poor prognosis.

But as drugs and other treatments improve more people are being kept alive longer and the rising demand for dialysis is expected to continue, though estimating requirements is problematic.

Last week finance director Colin Masson said, “There remains a requirement for increased dialysis capacity in order to satisfy the projected increase in patients requiring dialysis in forthcoming years.”

A major investment planned for next year will see the transformation at Perth Royal Infirmary of the stand-alone women’s clinic on the site, earmarked for the satellite dialysis unit development.

One of the benefits of that location, on what is an otherwise inhospitable site for disabled people with steep gradients, is that the women’s clinic is on one level with accessible parking close by.

However, there have been delays in that project, meaning pressure will remain on Ninewells to continue to deliver services to renal patients from all over Tayside in the short-term.

Kidney specialist Dr Iain Henderson, who heads the renal unit at Ninewells, said a private company was ready to step in “at short notice” to make the alterations and install the equipment to create two extra dialysis spaces, which gives the capacity to treat an extra six patients a day over three “shifts.”

The system was just coping at present but he expected the extra spaces to be necessary soon.

“My guess is we will need them later on in the summer, probably about a year before we move in to Perth.

“At present, much to my surprise, the pressure is off a wee bit just now but that can change at any moment. For once we have got the money put aside (to create the two extra spaces at Ninewells) and I think it can literally be done for the asking over a weekend. It’ll be a bit of a tight squeeze but that should see us through to the opening of Perth.

“The only reason we are having to do this is we are expanding rapidly but Perth is taking slightly longer than we would have liked getting off the drawing board.”

Provision at Perth is not “absolutely decided,” but Dr Henderson said he thought there would be 10 communal dialysis spaces with two side rooms fitted with dialysis machines to treat people with infection.

“It really will be a good spec and that will see us through for a few years.”