Doubling dialysis demand, screening gaps and unfunded drugs: Inside the kidney disease crisis

Saturday, 30 May 2026

In the album of treasured parental memories, the 18th birthday of your eldest child must rank up there with births and weddings.

But Rebecca Bisman spent son Riley’s coming of age 160km away, watching on virtually as her partner and three kids enjoyed a family dinner without her.

For her first two months as a dialysis refugee in Christchurch, the 40-year-old Timaru mum cried every day. She’s lucky to be able to bunk with her parents, but that’s an extra burden on her mum, who is already dealing with her dad’s health issues.

“My poor parents, I must have made them feel like I didn’t love them, because I just was so upset the whole time, because I just wanted to be with my family.”

Bisman found out in September that her kidneys were only working at 12% of normal function. She’s had diabetes for six years, but that wasn’t the cause. She was belatedly diagnosed with autoimmune condition IgA nephropathy, which causes kidney inflammation and failure.

Like many Kiwis in smaller centres with no dialysis unit, she was told she’d have to travel two hours each way, three times a week, to Christchurch for the life-saving treatment.

“I was pretty devastated.”

She doesn’t drive, so the only realistic option was to leave her family and stay Monday to Friday in Christchurch.

“It’s been a lot on my partner - he’s had to basically do everything, and work, and be running around, bringing me up here. He’s broken down quite a few times, and he’s not the type to cry. But he has, because being separated has just made life so, so difficult.”

The Christchurch dialysis unit was so slammed in March, they sent patients, including Bisman, a letter warning they might have to ration the number of dialysis sessions per patient. That’s a symptom of the national capacity crisis flagged in a November report to the minister. But look out a decade and the news gets much worse.

The capacity crisis

The word crisis is generally excised from bureaucratese, so when it appears in an official report, you know things are bad.

A Health NZ November 2025 briefing to Health Minister Simeon Brown, from the national clinical renal (kidney) network, states unequivocally that “dialysis provision has reached a capacity crisis”.

A survey of haemodyalisis units earlier this month reinforced that, finding that New Zealand has 4.5 patients to every dialysis machine, compared with Australia’s 3.3 patients. Auckland was worst off, with 6 patients per dialysis chair, necessitating an extra shift that can see patients finishing their five-hour treatment late at night.

That, says Australian and New Zealand Society of Nephrology president-elect Drew Henderson, is not good enough.

“Going home at midnight or 11 o’clock at night is awful … That’s not patient-centric care. That level of care would not be OK for cancer patients, so why is it OK for dialysis patients?”

Kidney Health NZ board member, and Palmerston North kidney specialist, Curtis Walker says over-full units other than Christchurch are avoiding limiting sessions only through staff and patient gymnastics, which takes a huge toll on both.

“It’s because of patients having to juggle their lives, and it’s because of staff bending over backwards and working extra hours and extra shifts to make sure that hasn’t had to happen, because that's the last thing anyone working in dialysis would accept, is rationing. But at some point, if things don’t change, I fear that’s an inevitable consequence.”

And modelling suggests that point might not be far off. The ministerial briefing paper predicts demand for dialysis chairs will more than double nationwide by 2033, from 551 to 1126.

In the South Island, demand is forecast to quadruple, from 48 chairs to 199.

That, says Kidney Health NZ general manager Madi Keay, is heartbreaking.

“We know that dialysis is so gruelling for patients, so it makes me really sad. But I also just do not think we are being proactive in planning for this need. Dialysis is life-sustaining - people will not be able to live without this access.”

Keay says the idea of rationing dialysis is “horrific” and worries health professionals will quit if it comes to that.

Henderson says the projected demand growth is partly due to the changing way dialysis is delivered. While having haemodialysis at home is the best option for patients who can manage it, the increasing number of elderly, frail and sicker people getting dialysis means more people need the added support of a dialysis unit.

The proportion of patients receiving in-unit dialysis jumped from 46% in 2006 to 64% in 2022.

That’s also the reason the South Island needs to quadruple its dialysis chairs by 2033, Henderson says. It’s traditionally relied more on home dialysis, so has a bigger gap to bridge.

And while some places avoid rationing sessions by adding extra shifts, over-full units mean some patients stay too long on a form of home dialysis, called peritoneal dialysis, which loses effectiveness over time. And that can shorten their lives, Henderson says.

“Doctors across New Zealand are choosing to keep patients on a treatment which is not the right treatment for them, because there’s no space in a local dialysis unit for them.”

Increasing capacity isn’t just about machines. Depending how sick the patients are, you need about one nurse for every three patients on each shift.

Health NZ director funding hospital and specialist services, Rachel Haggerty, says the agency is “very aware” that dialysis services are not meeting access needs and they are “working to strengthen renal care, increase capacity and improve early detection”.

In the past 18 months, a new $40 million renal centre was established in Waikato to support central North Island patients, 35 upgraded dialysis machines were installed in Waitākere and a new dialysis facility was set up in Blenheim to reduce travel for Marlborough patients.

A nationwide renal dialysis plan will also help address the “current capacity gap” and improve patient-to-machine ratios, Haggerty says.

Everyone agrees urgent investment is needed to increase access. But the experts argue it shouldn’t just be more of the same.

Not just more, but better

When Henderson set up a new Hawke’s Bay renal service in 2007, the area’s dialysis rates doubled in four years. Not because the number of people with failing kidneys suddenly soared, but because people sought treatment who had previously decided dying was a better option than spending their last years driving for hours to get treatment.

Others don’t even have the luxury of that decision. Pharmacist prescriber Leanne Te Karu works with patients around Taupō and the central plateau - often Māori, often poor. She had one woman in a wheelchair, who couldn’t even get a bus to travel the two hours to her nearest dialysis centre.

“Either you become a refugee in another town, outside of your normal whānau setting … or you stay where you are, and you’re doing immense travel. It’s a huge thing just to dialyse, let alone to have to travel for 2½ -3 hours one way.

“Some people think there are choices. Often, there aren’t choices.”

So what’s needed, says Henderson, is not just more dialysis chairs, but fairer access. Especially for rural patients, who are often Māori, often disadvantaged, and may not have the safe running water supply needed for home dialysis.

Public health doctor and University of Sydney PhD student Johanna Birrell mapped where Kiwi dialysis patients come from, to work out how long they had to travel for the life-saving treatment, and where new services would be most efficient.

Using data from 2006-2019, she found the median travel time for rural patients was 45 minutes, on top of their five hours in the chair. Urban patients had an 11-minute trip.

If the dialysis network remains unchanged, by 2028, 2,395 Kiwis will collectively travel 10.1 million km and 197,640 hours annually for treatment, her latest research found.

But she has now pinpointed 10 locations where new services could reduce that travel time by 21% - Kaikohe, South Auckland, Pukekohe, Te Kuiti, Tokoroa, Whanganui, Masterton, Blenheim, Timaru and Invercargill. (Blenheim and Invercargill have opened new units in the past six months)

Extra services could include community-based dialysis houses, which provide safe, clean spaces for patients to self-dialyse; and small but staffed satellite units in rural areas. Australia also runs mobile dialysis buses, which drive to patients instead of them having to travel.

“It’s doable, but it’s going to take time to adapt to that,” Birrell says. “We really need to have a long-term vision for implementing this, and also meeting the urgent needs.”

Her supervisor, epidemiology professor, nephrologist and transplant physician, Angela Webster, says the research flips the focus, from what works for the system, to what works for patients.

“Doing more of the same is not tackling the root problem - that there’s unfair access. So we’ve got to do something different.”

Turning the tide

At roughly $100,000 per patient, per year, haemodialysis is an expensive ambulance at the bottom of the cliff. Much better value, says National Hauora Coalition clinical director Nina Bevin, is stopping them falling in the first place.

“Prevention and early intervention - it's a no-brainer to me. We absolutely still need to deliver high quality dialysis to people who need it, but we've got to get serious about prevention.”

Three things could reduce the need for dialysis, and experts say we’re not doing brilliantly at any of them.

The first is getting in early. Because kidney disease is silent, by the time people get symptoms, they have often already lost 80% of their kidney function.

So the key is to pick it up early, through screening. Often, that’s via GPs, which already leaves many Māori out in the cold, says Bevin.

Of the 300,000 Kiwis not enrolled with a GP clinic, half are Māori. And more than two-thirds are under 45.

“We know that to get in early for kidney disease, we need to start screening tane Māori at age 30, so a lot of the people in that unenrolled group are missing out on that screening and early prevention, so that’s a big problem.”

But there’s another gap identified in the ministerial briefing paper - the underuse of a screening test called ACR which looks for protein in the urine, which is a great early warning for both kidney and cardiovascular risk.

About half of dialysis patients have diabetes, and we’re pretty good at screening for ACR as part of annual diabetes checks. Where we fall down, says Henderson, is not routinely using it in cardiovascular risk assessments.

“So we’re not only under-treating people’s kidney disease, but we’re underestimating their cardiovascular risk, and their ability to benefit from other medications, such as cholesterol-lowering medications.”

As pharmacist prescriber Te Karu puts it, “we’re missing people who don’t have diabetes, who do have renal failure”. And that means missing the opportunity to slow the march of decline towards dialysis.

“The benefit of being able to identify and manage and delay is untapped and unexplored, and it’s certainly something that we need to be putting a focus on.”

Kidney Health NZ’s Keay also advocates taking testing to people, rather than expecting them to go to a clinic. They have a mobile finger-prick and blood pressure testing service which they take to events, which costs about $25 per test, including nurse time.

“It’s so cost-effective, in comparison to dialysis.”

Palmerston North kidney specialist Walker wants kidney disease put on the long-term conditions list, alongside heart disease and diabetes, and a national screening programme to identify the half million Kiwis who have it.

“It’s a simple blood test and urine test. Hold your arm out, pee into a cup, and a blood pressure check…If we do that, we can slow progression of the disease and reduce the people coming on for dialysis by up to 60 or 70%. That’s massive.”

GPNZ chairman Bryan Betty says the ACR is a pretty standard test in general practice, especially for diabetes, which remains a critical driver of dialysis demand.

“Younger onset type two diabetes is devastating in terms of what it's doing - these are patients in their late teens, twenties, and they're galloping towards end stage renal failure.”

More targeted education for GPs around kidney disease outside of diabetes would help, Betty says. But there also needs to be medication available to treat it. Which brings us to the second wobbly pillar of prevention.

Health NZ’s Haggerty agrees the best hope of reducing dialysis demand is to improve early detection and treatment, especially for Māori and Pasifika, who are often diagnosed later.

“We are committed to improving dialysis service to all those who need it and have work under way to explore the benefits of targeted screening in high-risk populations.”

A drug access outlier

Several types of drugs can help delay kidney decline.

GLP-1s - from the same family as diet drugs Wegovy and Ozempic - help people with diabetes lose weight, which reduces their risk of further health problems. They’re funded for diabetics, and so are SGLT-2 inhibitors like Empagliflozin, which help the kidneys remove excess sugar and reduce blood pressure.

But unlike in Australia, you can’t get both funded together, Henderson says.

And for non-diabetics with chronic kidney disease, SGLT-2s are not funded at all, despite the fact they can double the time it takes those patients to need dialysis. Self-funding Empagliflozin costs about $500 a year, which, given poverty is a common driver of dialysis, is out of reach for many patients.

“So we’re denying half of our patients who are going to reach dialysis, drugs which reduce their risk of reaching dialysis,” Henderson says.

Pharmac is currently consulting on those access criteria, and the Nephrology Society has sent a letter saying it’s “deeply concerned” at the continued lack of access.

Then there’s another drug, called Finerenone, that’s not even available in New Zealand, Henderson says.

“So it's really frustrating. This is where kidney doctors get upset and angry because we feel that we're being limited in what we can do to prevent kidney failure.”

The third wobbly pillar of prevention is access to kidney transplants. That’s a whole other story, but Walker says more theatre time could help increase the number of live donor transplants, allowing more people to come off dialysis.

Bisman hopes a transplant will be in her future. She’s dropped 25kg but needs to lose more to be eligible. For now, she’s excited to be learning to dialyse at home, so she can go back to being a mum to her kids.

But at some stage, she’ll probably need in-unit dialysis again. And she hopes by then, there will be a lower stress option closer to home.

“Life’s just been on hold, while I’ve been here. So I’m looking forward to going back home - I can actually find my life again.

“The amount of stress I’ve had, on top of coming to terms with my own illness and my future … knowing that things could change and be better would be awesome.”