Home dialysis, or CAPD, was referred to. There was also a question on whether we should take people out of the hospital environment. I spent a long time in Canada and in the UK. One of the models of dialysis we had was a home therapies unit where patients would come for three to six weeks' training, depending on the modality of dialysis chosen. The choice was between peritoneal dialysis, which requires a tube in the tummy and fluid being instilled several times a day, seven days a week. It is a continuous form of dialysis treatment.
On average, these patients come to hospital once a month or once every two months. Deliveries are made directly to their homes. They are in charge of their therapy, although sometimes family members do it for them if they are incapacitated. Blind patients, patients with one hand and people in their 80s have done this treatment. As a unit, we have particular expertise in delivering this therapy. It started in our unit in the late 1970s and early 1980s.
That said, we have just audited our peritoneal dialysis figures and we have a very good take on rates and a very low rates of infection. We can tell this to our patients. However, only 20% to 25% of our patients take up the option of dialysis.
The ethos when one delivers renal care is that the patient must make an educated and informed choice. Education must begin from the first time one encounters that patient, ideally in the primary care setting. To that end, over the past two years, we have had two very successful GP training days where we have brought people from the community into the hospital to introduce them to the concept of renal replacement therapy. Many people had never seen peritoneal dialysis before. For them to go away and counsel their patients on its availability was a very good start.
We believe in dialysis in the community. The other link would be the therapy of home haemodialysis, which was particularly strong in Canada. Interestingly when haemodialysis was introduced, it started off as a home based therapy and not a hospital therapy. Then it became economically more viable to bring patients to the institution because we were taking on much fewer patients.
In the UK, there was a consensus group and a NICE guideline was published to try to bring haemodialysis into the community again in the form of satellite units which are minimally staffed and where patients put themselves on machines or where there are healthcare technicians with perhaps one nurse supervising the unit. One is bringing care to the community, reducing the burden on the hospital and empowering the patient.
The next step up from that is the concept of dialysis in the patient's home. We already have that with peritoneal dialysis but one is talking about putting a haemodialysis machine in the patient's home. The patient would dialyse more frequently for more hours, very frequently at night time. Studies in Canada and in the UK have shown that these patients return to work, there is a restoration of fertility, they come off anaemia drugs and blood pressure tablets and some even choose not have a kidney transplant because their quality of life improves so dramatically.
If I had the choice of the modality I was offering a patient, or if I was educating a patient, I would say home therapy first. I would like the patient to have a choice between home haemodialysis and peritoneal dialysis. I would say hospital therapy second.
In terms of home haemodialysis, a very specific infrastructure is required and one needs a minimum of 20 patients on a programme before it irons out the kinks. There is a very significant cost requirement for the set up of that programme, certainly in the first one year to two years of initiating it. There is a home training unit set up in the Beacon renal facility, so there are facilities already in Ireland. If we were allowed to tap into those facilities working with industry, we could see the development of a home haemodialysis service here within one to two years.
It is expertise many nephrologists returning to Ireland carry with them and it would be one of our goals. We had actually envisaged setting up a home haemodialysis training house in the community in Tallaght to look at training the local population and keeping them out of hospital entirely. That is a very long answer to a short question.
