Related Sites

Related Sites

medical news ireland medical news ireland medical news ireland

NOTE: By submitting this form and registering with us, you are providing us with permission to store your personal data and the record of your registration. In addition, registration with the Medical Independent includes granting consent for the delivery of that additional professional content and targeted ads, and the cookies required to deliver same. View our Privacy Policy and Cookie Notice for further details.



Don't have an account? Register

ADVERTISEMENT

ADVERTISEMENT

CKD ‘up there as an equal’ in the community 

By Denise Doherty - 17th Jun 2025

Opening the first session on day two of the Irish Nephrology Society (INS) Annual Scientific Meeting 2025, Chief Clinical Officer of the HSE Dr Colm Henry thanked delegates for their ongoing “commitment to public service and patients”.

Dr Henry pledged his support for building a sustainable renal service amidst ongoing healthcare reform and demographic challenges.

“We want renal disease to be up there with respiratory and cardiac disease, as an equal in the community,” he said.

Dr Henry emphasised that Ireland has the longest life expectancy in the EU and that this rising older population will heavily impact nephrology services in coming years. “People over 65 will double to 1.3 million by 2042,” he said, “and the greatest proportion will be the very elderly.” Dr Henry then presented graphical data illustrating that people over 75 comprise a large proportion of emergency department presentations, hospital admissions, bed and resource utilisation, and delayed discharges.

“This demographic challenge doesn’t belong to geriatricians; this belongs to all of us because it impacts all of our practice and we have to adapt to it,” he added.

Attendees then heard that overall, healthcare “needs to look more and more at disease prevention and secondary prevention” by enhancing care in the community. “We can’t relentlessly invest in high-end interventional care ignoring the fact that it makes more economic and healthcare sense to prevent disease in the first place,” Dr Henry said.

Referencing the chronic disease management and enhanced community care programmes, Dr Henry said that “the promotion of renal disease as a partner in our network of chronic hubs is to be welcomed”, and that “more renal focus in the community is certainly a good thing”. He then described ways to configure renal services within the ongoing healthcare reform system.

 “We want to standardise care as much as possible. We want to make sure we have equal access to healthcare, built around the needs of patients…. We want a workforce that’s trained according to the kind of care we want to deliver, which is of course high-end specialist care, which is of course ANPs [advanced nurse practitioners] for dialysis units and transplantation, but also to deliver care within the community.”

Delegates heard that the substantial increase in in-centre dialysis dependency over recent years is “largely explained by the demographics of the population”, but that building more in-centre haemodialysis units “doesn’t keep pace” with the healthcare reform model. “We have to look at our dependency on dialysis and how we can promote alternatives for this population,” Dr Henry said.

He went on to discuss different strategies, such as transplantation and supportive care, noting that supportive care offers better quality-of-life than dialysis for certain patients, according to some research. Collaborating and working with palliative care to develop conservative management for appropriate patients is “something we need to consider”, Dr Henry said, adding that this also requires discussion with patients and families, as well as back-up support. “It offers an alternative to an ageing population, particularly those with comorbidities,” the conference heard.

Moving on to discuss kidney transplantation, Dr Henry acknowledged that Ireland is “lagging behind” – at both an international level and within the island of Ireland itself – and said that “we need to do better”. He described how the “fragile and vulnerable” Irish transplant system witnessed a sharp drop in organ donation and transplant activity in the early years of the pandemic.

Dr Henry then highlighted the “remarkable story” across the border in Northern Ireland, where transplant services are doing “exceptionally well”.

“What they’ve done [in NI] is lowered the threshold for intervention. Rather than seek the perfect kidney for the candidate, an alternative is to offer a value proposition to patients that an imperfect, or less than perfect, kidney is a better proposition than years on dialysis, for patients who are eligible. We need to consider how we can lower the threshold to allow transplantation wherever possible…. It’s a priority for me and the HSE to drive up transplant activity.”

Newly appointed Clinical Director of the National Renal Office (NRO) Prof Joe Eustace, Professor of Medicine and Consultant Nephrologist, Cork University Hospital, and Director of the Clinical Research Facility, Cork, echoed many of the points made by Dr Henry in his address to delegates.

Beginning with a retrospective account of the “catastrophic challenges” that faced the NRO when it was first established in 2009, Prof Eustace warned that nephrology is “once again facing a catastrophic under-resourcing of dialysis”.

He said that without increased provision for treating the ever-increasing number of people suffering from end-stage kidney disease (ESKD), “we’re going to become more progressively more under-resourced.”

“No amount of building of dialysis units will ever meet the needs of ESKD,” Prof Eustace said, “because by itself, it [dialysis] can never be effective.”

He admitted that increasing in-centre dialysis capacity and building new units is essential in view of the rising trends of ESKD in Ireland.

He also emphasised the importance of multiple other strategic considerations for advancing renal care, such as primary and secondary prevention; expanding home therapies and shared care; developing quality systems and modernised care pathways; improving transplant figures; developing conservative and supportive care; and continuing the development of a renal registry. He also reinforced that “this all requires resourcing to effectively implement”.

“These interventions really need a population-based approach. I think we should have a sense of optimism at the moment, particularly with the development of Sláintecare. If we have the ability to strategically integrate with that appropriately, we can build those pathways that will allow our patients to benefit from those interventions.”

Prof Eustace also advocated for collaboration with, and integration of, palliative care for appropriate, frail, and multi-morbid renal patients, reminding delegates that kidney transplant “is the only way we cure”, and that “everything else, including dialysis itself, is purely palliative”.

He concluded that regardless of whether a strategic or operational approach is adopted by the NRO, “it will not achieve meaningful progress without sufficient resources,” before presenting updates in the epidemiology of kidney disease across each region of the country.

Leave a Reply

ADVERTISEMENT

Latest

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

Latest Issue
Medical Independent 15th July 2025

You need to be logged in to access this content. Please login or sign up using the links below.

ADVERTISEMENT

Trending Articles

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT