Doctors say they may be forced to choose who lives or dies in dialysis crisis

A group of renal specialists say they being forced to ration dialysis through shorter or reduced sessions as services struggle to meet demand.

Dozens of senior clinicians have sounded the alarm on western Sydney’s lack of capacity to provide basic haemodialysis treatments, saying they will soon have to choose who lives or dies.

“We continue to see patients develop life-threatening complications of under-dialysis or delayed dialysis,” the 45 clinicians from across the region wrote in a letter to NSW Minister for Health Ryan Park.

“Soon we may be forced to deny these life-sustaining treatments to patients who need them to stay alive, or to choose patients who can stay on haemodialysis while others die.

“We are not prepared to do this.”

The crisis was the result of years of underinvestment in infrastructure and resources, and meant they were “in essence providing haemodialysis treatments at levels seen in the developing world”.

Incredibly, one in six of Australia’s dialysis patients receive treatment in one of the three local health districts where the specialists worked.

Demand means that each year more than 300 new patients in the region are also starting regular dialysis treatments.

But lack of capacity has meant that this May some 127 patients were on twice-a-week haemodialysis instead of the standard three sessions a week, while 52 patients were receiving shorter than recommended treatments.

“Lack of capacity has [seen clinicians ration] life sustaining dialysis to many patients who require it — by reducing the number of treatments or by shortening the duration of each dialysis session, thereby compromising the strongest determinant of patient survival,” the doctors wrote.

The shortage was causing health and emotional impacts for not only patients, but also for healthcare workers who were under “immense stress” due to being hindered by resource constraints.

One of the doctors who signed the letter, Blacktown Hospital’s head of renal department Associate Professor Lukas Kairaitis, said: “When you shorten the number of treatments per week, or the number of hours per treatment, you’re compromising the one major determinant of that patient’s survival.

“Patient wellbeing is significantly impacted when you provide just the bare minimum, or not even that,”

Mr Park said the state government was undertaking immediate as well as long-term measures to alleviate the waitlist.

“It’s important that this issue has been brought to my attention — it’s serious and we must do better, and while the challenge is structural, we are working to rectify it as quickly as possible,” Mr Park said.

He said he had asked NSW Health to optimise shift patterns to allow more patients to receive dialysis, as well as expand capacity by engaging with private providers.

He added there would be an additional 10 dialysis treatment chairs as part of the Nepean Hospital stage 2 redevelopment, due to open in 2026.

“The Nepean Hospital renal dialysis unit has also been trialling an additional shift per day for 10 dialysis chairs to treat up to an additional 18 patients every day, or an additional 2800 dialysis therapies each year,” Mr Park said.