Dialysis shortage exposes failings of NHS

Hard-pressed kidney units admit turning away patients and offering inadequate treatment

Kidney disease claims the lives of 7,000 people in Britain every year, many of whom die prematurely because they cannot get the treatment available in the rest of Europe and the United States.

Once the kidneys fail, a patient must start on a kidney machine within three months or they will die. The shortage of kidney machines exposes the failings of the health service with grim finality.

A survey of the 71 renal units providing dialysis in the UK by the National Kidney Research Fund (NKRF) and Sheffield University revealed there were 19,307 adults receiving dialysis, a rate of 328 patients per million population.

In the five European countries of Germany, France, Spain, Italy and the Netherlands the average dialysis rate is 537 per million population, 63 per cent higher than in Britain. In America, 267,327 adults were receiving dialysis in 2000, a rate of 1,000 per million, three times the British rate.

The discrepancy means that patients with kidney failure in Britain are not being diagnosed or are unable to find a kidney unit to accept them.

That has now been confirmed by the renal units, which have admitted turning away patients in the NKRF survey. If the doctors responsible for those patients cannot find a unit to take them, then the only option is for the doctors to keep them comfortable in hospital until they die.

Callers to the helpline for patients and their families run by the National Federation of Kidney Patient Associations reveal a similar picture. In one case, staff spent eight days trying to secure a critically ill patient a space on a kidney machine in one renal unit and only succeeded after "a lot of hard work and harassment of clinical staff," according to an internal report.

Tim Statham, chief executive of the federation, said: "Our helpline receives calls from people who say their relatives are not being offered kidney treatment. In addition, there are many thousands who do not know they have kidney problems. GPs don't even recognise it – they might see one or two cases in a lifetime."

Most renal units try to accommodate extra patients by reducing dialysis sessions to two a week instead of the normal three, offering the treatment out of hours or using inpatient facilities to care for outpatients.

At Addenbrooke's Hospital, Cambridge, where more than 300 patients are receiving dialysis, no patients are turned away. John Bradley, director of renal services, said: "We would tend to take everybody but we probably compromise their care because we have some on dialysis twice a week. The evidence suggests that if you don't provide adequate dialysis the patient has a higher risk of dying and their well-being is less good."

He added: "It is estimated that one quarter of units in the UK do not provide optimum care to all patients because of the pressure on services."

A kidney machine takes over the function of the kidneys, which are vital life-sustaining organs. Their main job is to cleanse the blood of toxins and transform the waste into urine. When a kidney is not working properly, harmful waste and salts build up in the body, causing high blood pressure and the symptoms of kidney failure, such as tiredness. The first sign of the disease is traces of blood or protein in the urine.

The simplest way to protect the kidneys is to drink plenty of water and avoid becoming overweight. The National Kidney Research Fund recommends that people drink two litres (three and a half pints) of water a day.

Although the kidneys can function on less than one litre a day this produces concentrated urine and leads to the build-up of harmful toxins. Together the kidneys filter about 200 litres of fluid every 24 hours.

The NKRF survey says that although services have expanded in recent years, most units are already operating at maximum capacity and will be unable to cope with any increase in patients.

"There is cause for considerable concern that the existing limited facilities will be insufficient to provide patients with optimal care in the future without some form of expansion of the service," it says.

Long wait for treatment - 'drugs were cheaper'

Doreen Allingham was a lively 60-year-old who ran a B&B from her home in Winchester, Hampshire, and doted on her five grandchildren. But in the past five years declining health forced her to give up the business and spend more time confined at home.

She had high blood pressure but the drugs prescribed by her GP made her feel worse. "She always wanted to get on with life but she felt sick, she couldn't climb the stairs and she wasn't eating well," said her son, Roger Savill, 41. Mrs Allingham was referred to a kidney specialist who prescribed more drugs and plotted her progress on a computer, but her condition deteriorated further. "She was feeling so poorly but his attitude was either take the tablets or don't take them and die."

Mr Savill asked the specialist if dialysis would improve his mother's condition. "I pressed him. I spent 55 minutes with my mother in his office and I said there must be something else that could be done. He said no – dialysis would make no difference."

Last November, Mrs Allingham was admitted to hospital as an emergency after contracting a kidney infection and put on dialysis. The transformation in her condition was immediate.

Mr Savill said: "She is much better. A whole cloud has lifted from her. Every day she is improving. What I want to know is, 'Why wasn't she given dialysis sooner? Was it because it was cheaper to treat her with drugs?'

"I got the feeling they didn't want to put her on dialysis because that was the last resort. She didn't need dialysis, not yet. But I think it was because of financial concerns, not what was best for the patient. She feels better every day now. In six months I would say she is going to be fighting fit."