Background

End Stage Renal Disease (ESRD) is a condition in which the kidneys permanently cease to function at a level which will support life.  The two types of treatment for ESRD are transplantation and maintenance dialysis.  

The onset of renal failure, the irreversible reduction of renal function to levels incompatible to maintenance of life without dialysis or transplantation, can be sudden (acute) or develop over months or years (chronic). Ideally, patients with ESRD will have a successful kidney transplant.  However, the availability of this intervention is limited by a shortage of suitable donor organs.  The use of Maintenance Dialysis (MD) treatment prolongs life for these patients and restores quality of life by allowing sufficient independence with minimal support.  There are two types of MD (see Modality Definitions for detailed definitions):

• Haemodialysis
• Peritoneal dialysis

MD can be undertaken at a facility (most frequently a hospital) or at home.  The different dialysis modalities are hospital (in-centre) haemodialysis, satellite haemodialysis and the following home dialysis modalities: home haemodialysis, nocturnal home haemodialysis, continuous ambulatory peritoneal dialysis and automated peritoneal dialysis.  Decisions regarding choice of type of dialysis and the location of service provision are usually decided by the patient and their physician subject to clinical and other considerations (e.g. availability of a carer).

Dialysis Services in Victoria

In 2008-09, the Victorian Government has allocated an additional $5.7 million for maintenance dialysis (MD) services, and will spend over $110 million treating around 2,500 MD patients.  The number of patients requiring MD is expected to grow between four and five per cent per annum over the next 10 years. 

At present, Victoria has a two tier service system with most clinical care being provided at one of seven hub hospitals and MD being provided by a network of satellite services.  A new level of service provider, called a ‘node’, is to be introduced that will provide clinical care at the regional level.  Rural patients will benefit by not having to travel to the Melbourne based hubs as frequently to receive their care.

Service Planning

Regular reporting through the Victorian Dialysis Registry will continue to facilitate a state-wide planning process to assist with the planning of services through early identification of demand priorities.

In 2006-07 Rosebud Hospital was expanded from three to nine chairs, the Peter James Centre from 12 to 20 chairs and Moorabbin Hospital from 12 to 15 chairs.  In 2007-08, Werribee Mercy Hospital was expanded from 6 to 12 chairs, Echuca Regional Health from 3 to 6 chairs and Central Gippsland Health Service from 6 to 8 chairs.

On 1 July 2008, Western Health commenced operations as a level 3 (non-transplanting) hub hospital.  In 2008-09, as part of the Stage 1 of the Box Hill Hospital re-development announced in the May 2006 state budget, Box Hill Hospital will commence as a level 3 (non-transplanting) hub. In addition, a new 16-chair satellite dialysis unit will be operational at Box Hill and a 12-chair satellite centre will be operational at the Maroondah Hospital.