Mark Moore found himself starting dialysis in his early 30s due to polycystic kidney disease, an inherited disorder he had been living with since childhood. The experience, as he recollects, was frightening as he embarked on his first treatment on 26th May 2021, at Dublin’s Tallaght University Hospital. This was a familiar journey as his late father, aunt, and an uncle had all undergone dialysis for the same disease, characterised by cyst clusters affecting kidney functionality. He had to come to grips speedily with the fact that it was now his turn, as this reality dawned on him during a Friday clinic appointment, with his first session scheduled for the following Tuesday.
Unexpectedly, this medical intervention turned out to be a blessing in disguise. He had been unaware of the extent of his ailment and the accompanying strain. Following the initial dialysis, he felt invigorated, sharing his newfound energy with those around him enthusiastically. He declared it astounding.
Diagnosed with the kidney disorder at 11 while being treated for another health issue, Mark, now 36, didn’t attach much attention to the diagnosis initially as his parents downplayed the situation. The disease started to become a concern only in his early 20s when symptoms began to manifest. Mark, a keen GAA football player and goalkeeper, often experienced severe injuries that triggered cyst ruptures and bleeding. Hypertension was another struggle he was forced to manage, a common side effect of this kidney disease.
Starting dialysis required him to make frequent trips from his residence in Baltinglass, Co Wicklow, to Tallaght hospital, thrice weekly for three-hour-long treatment each time. The Health Service Executive provides transportation but this meant spending approximately an hour on the road, each way, traffic-dependent, plus the actual hospital time.
Mark appreciates home dialysis, which allows him to undergo treatment while asleep, thereby preserving his working hours and quality time with his children.
The requirement for dialysis had been imposing on Moore’s work routine, creating challenges for his role as a process technician in pharmaceutical production, where he participated in day-long or overnight shifts at the Dublin-based Grange Castle facility of Pfizer. This came to an end when he was provided the chance to conduct his dialysis treatments at home.
Previously, he was subjected to haemodialysis at the hospital, a procedure that wrests blood from the body for machine filtration before releasing it back, removing excess fluid and waste products, functions typically performed by healthy kidneys.
Since the culmination of 2021, Moore has adopted peritoneal dialysis, a home treatment that cleanses the blood by flushing a cleaning agent in and out of his abdomen through a tube inserted into the abdomen’s lining, performed while he sleeps.
In Moore’s words, he embraced the new method seamlessly. After roughly three training meetings in Tallaght and a home visit for equipment setup, the process encountered no initial difficulties. He conveys that at first, there may be minor discomfort as fluid fills up and subsequently empties from the abdomen. A typical nightly session comprises of five repetition cycles, spanning eight hours.
Initially, he underwent seven treatment nights, and was later reduced to six following favourable blood tests. If his work schedule necessitates night duty, he undergoes the process while sleeping in the day. Peritoneal dialysis, while requiring more frequency compared to haemodialysis, is less strenuous on the body. He experiences absolutely no ill-effects post-treatment, unlike the intense haemodialysis that frequently resulted in exhaustion and excessive hunger upon his return from the hospital.
The ability to perform dialysis from home is an immense convenience for Moore, a father to two young sons, Noah and Ollie, and married to Michelle.
In referring to Michelle as “incredible”, he acknowledges her crucial role in making it possible for him to perform kidney dialysis at home. After a long day at work ending at 8pm, she readies the machine so he can start his dialysis by 9pm, ensuring he has ample time on it before he has to leave for his job at 5.45am the following day. Michelle is also responsible for cleaning the apparatus and getting rid of the waste bag.
He greatly values the ability to undergo this procedure while sleeping, which allows him to keep up with his work schedule, spend quality time with his children, and attend their football matches. His condition doesn’t stop him from living a normal life.
He is one of only slightly more than 300 people in Ireland who undergo home dialysis treatment. They make up about 12% of individuals undergoing dialysis treatments in the country. Prof. George Mellotte, HSE’s national clinical lead for renal services and a consultant renal physician at Tallaght hospital, is committed to seeing a rise in the number of home dialsysis patients.
He believes that home dialysis offers advantages to both the patients and the healthcare system overall. A person who undergoes dialysis at home can avoid making 150 exhausting hospital trips each year. Furthermore, it often saves them from long journey times, gives them the flexibility to choose when to undergo the treatment, such as during the night, lowers the risk of contracting infections, and allows them the option to carry the essential equipment on holiday with them. The health service also benefits, as each patient who manages their own dialysis at home saves between €30,000 to €50,000 per year.
Despite these obvious benefits, growth in the number of people opting for home dialysis has been slow, largely due to lack of resources. The peritoneal method was introduced in the 1980s, and haemodialysis became a part of the home treatments program just over 10 years ago. Reflecting on this, Mellotte mentions, “There was no structured plan for its implementation. It expanded organically, and in some cases, was forced upon people simply because the hospital system lacked capacity.”
Prof Mellotte makes a comparison between home dialysis and receiving treatment at a dialysis centre, to that of cooking at home versus eating at a hotel. A centre-based dialysis treatment sees patients getting rides to and from the premises where a dialysis machine is prepped and operated by a professional nurse. They also have the luxury of enjoying light meals during the treatment and access to specialised medical personnel if needed.
On a contrary, home dialysis requires substantial effort from the patient. They will need to manage delivery and storage of supplies, set-up and cleaning of the machine, as well as waste disposal. Prof Mellotte suggests that this can increase the sense of illness within a domestic setting. Despite this, more and more home dialysis treatments were being requested during the Covid-19 pandemic due to avoidance of hospital visits.
According to Prof Mellotte, without adequate support, patients could revert back to centre-based treatments. He argues for enhanced development and funding for a modernised care system to ensure more of the 2,500 people currently on dialysis, don’t have to rely on in-centre treatment. Reports from the Health and Safety Executive (HSE) in March show that out of the 2,502 patients on dialysis at the time, 1,461 were in HSE-accredited hospital units, 736 in HSE-contracted dialysis units, and 305 were undergoing treatment from home.
Prof Mellotte encourages increased support for patients opting for home dialysis, with the introduction of more specialist nurses in community based units to aid with training and planned home visits. These patients also demand equal access to dietitians during their usual six hospital visits every year, similar to those seen three times a week at dialysis units.
For elderly patients who are weaker, nursing support or that from a healthcare assistant could inspire them to initiate home dialysis or sustain it, particularly when it becomes physically exhausting to handle fluid and drain accompanying up to 14 litres of liquid. They might not be able to count on family support, or not want to be a burden.
Prof Mellotte noted that records have been kept since 2009 which confirm a yearly growth of 3 per cent in chronic kidney disease cases for the past 15 years.
Managing the costs of electricity, required to run home dialysis, often proves a hindrance for some, as they need to be working to take advantage of available income tax relief. Home-based haemodialysis necessitates alterations to the home, primarily the need for a special room to house vital equipment and machines. There were 63 individuals utilising home haemodialysis as of 1st April this year, typically every alternate day.
Despite each patient’s unique medical challenges potentially ruling out home dialysis as a feasible option, Prof Mellotte aspires for a national goal of 20 per cent patient participation, a standard already achieved by the renal unit he leads in Tallaght. As the population continues to age, there’s a upwards trend in the prevalence of chronic kidney illnesses and failures, primarily due to diabetes and hypertension. The rise may be attributed to the successful treatment of heart disease through stent installations, which, however, don’t address vascular issues affecting the kidneys.
“We’ve been maintaining comprehensive records since 2009, observing a steady three per cent annual increase over the last 15 years”, reports Prof Mellotte. In 2023, the HSE reported that there were 5,257 individuals suffering from chronic kidney disease or failure, marking an increase of 109 patients from the prior year.
Last year, a total of 191 kidney transplants were conducted. “These serve as an alternative treatment method for kidney failure”, explains Prof Mellotte. Although the transplant can dramatically improve the patient’s health and standard of living, it’s not a cure-all. Recipients are susceptible to the same complications, like diabetes. “Recipients will need to maintain a heavy medicinal regimen, and there’s a chance the disease could reoccur in the transplanted kidney.”
Mark Moore has been on the waiting list for a transplant for over two years, but has been temporarily removed from the list as he prepares for a surgery in July to remove his infection-ridden right kidney. This should optimise his body to accept a transplant. However, after the upcoming nephrectomy, he will need to undergo hospital-based haemodialysis for approximately two to three months to aid his remaining kidney.
Following some time for convalescence post-surgery, he is predicted to recommence peritoneal dialysis within his residence. Moore voiced his contentment in having undergone haemodialysis in the health centre, appreciating the exposure to this perspective. Alluding to his humbling experience, he expressed deep gratitude for now being able to conduct peritoneal dialysis within his home setting. Moore speaks highly of this method and would wholeheartedly endorse it.