Ireland lagging behind international best practice in area of dialysis, says expert

Irish kidney failure patients undergoing haemodialysis are highly dependent on central venous catheters, which could be leading to higher rates of hospitalisation, infection and mortality, new research has found.

A team of doctors at the University of Limerick School of Medicine discovered that 77 per cent of Irish patients starting dialysis were reliant on central venous catheters, involving the insertion of a plastic tube into a large vein, to connect to dialysis machines.

That less than a quarter of patients were connecting to dialysis through arteriovenous fistulas, which involves surgically connecting a vein and an artery, is “very concerning”, according to the researchers.

After three months on dialysis a third of Irish patients were using fistulas, compared to 56 per cent in Germany and 53 per cent in the United Kingdom. A year into treatment, fistula use among Irish patients only rose to 41 per cent.

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Patients who develop kidney failure depend on dialysis machines to clear waste and excess fluid from their blood. The research, published in the American journal Kidney360, points to international studies that have shown that fistulas lead to better clinical outcomes.

Professor Austin Stack of University of Limerick School of Medicine and Consultant Nephrologist at University Hospital Limerick, a senior author of the study, said Ireland “lags behind international best practice” in this area.

The high dependency on catheters at the start of dialysis is “very concerning and need[S] to be tackled at a national level,” he said. Catheters predispose patients to “higher rates of infection, clotting problems, hospitalisations and even death,” he warned.

The proportion of patients with fistulas varied widely across major Irish dialysis centres, from nine per cent at one clinic to 37 per cent at another. A patient’s age or health were not attributable to the variations, the researchers note.

The study followed 610 patients over the years 2015 to 2017. Prof Stack believes practices have likely not changed significantly since the research period.

Greater investment in the national haemodialysis programme with dedicated vascular surgical support, specialist nurses and access to theatre time could assist with improving Ireland’s record, Prof Stack said.

Catheters can be inserted within a day, but the “more complex” fistulas need to be made by vascular surgeons and take three months to mature, he explained.

Each year more than 500 people in Ireland develop kidney failure and require dialysis, while more than 2,000 patients undergoing dialysis annually. The national programme for dialysis must be “resourced and empowered to deliver for our patients”, Prof Stack added.

The Health Service Executive was approached for comment.