Life-saving dialysis at capacity, forcing some patients into nighttime treatment

New Zealand’s life-saving dialysis service is now under strain nationwide, new data shows, with one doctor warning of a "crisis" as hospitals face a rise in kidney disease.

The situation is becoming especially acute in Auckland, where dialysis machines are operating at 150% of their normal capacity, with some patients finishing treatment as late as 11pm.

The revelation comes from a survey released today by the Australia and New Zealand Society of Nephrology.

Tracking the latest data to the end of 2025, the society found many of our hospitals are operating either close to or above 100% of their usual capacity.

That’s a significant concern because dialysis is a life-saving treatment, where machines are used to clean the blood of patients suffering from kidney disease. Without it, patients may die. The treatment takes several hours each time and patients return every few days, meaning that one machine can usually only take around four patients a week on normal hours.

But after tracking all haemodialysis units across the country, the society found New Zealand has exceeded that mark – hitting a national average of 4.53 patients for every one machine.

The new data has caused serious alarm for Dr Curtis Walker, a kidney specialist at Palmerston North Hospital and a board member at Kidney Health New Zealand. The doctor – who arranges treatment for patients daily – believes our health system has not taken enough action to combat kidney disease, telling 1News we are "halfway down a precipice".

"The precipice is only going to get steeper and higher and more dangerous the longer it takes to take action," he said.

Health NZ has accepted the new data is a "concern", with its representative Dr Drew Henderson saying work is underway to improve the situation.

"We recognise that dialysis is a real challenge," he said. "We want to do the best by all our patients. That's why I’m here as a kidney doctor, and that’s why the national network is working so hard to improve capacity across the country."

While many parts of the country have pressure on their dialysis services, the area most under strain is Auckland.

Hospitals there run an extra "twilight shift" to increase capacity, with some patients finishing their treatment as late as 11pm three nights a week.

The latest data released today has found the "ratio" of patients to machines was far worse in Auckland than any other part of the country as of the end of 2025, going far beyond the mark of four patients to a machine.

Auckland Hospital was the worst with six patients to every machine – or 150% capacity – followed by Middlemore Hospital with 5.52, and Waitematā Renal Service at 5.24.

These areas had far higher numbers of patients than other parts of the country, meaning their units pull the whole national average up. Other areas outside Auckland were either at or close to the 100% capacity mark, with Palmerston North Hospital at 4.20, Wellington’s Capital and Coast at 4.00, Christchurch Hospital at 3.41, and Dunedin Hospital at 3.13.

The situation may have changed further in recent months, as that data is to the end of 2025. Health New Zealand accepted that Auckland was the most under strain, saying it was a result of population growth in the city and other "particular pressures".

Henderson said the twilight shift had been set up due to increasing demand and a lack of dialysis space.

"We recognise that that’s not ideal for patients and we recognise that it puts significant challenges on both patients and their whānau, and is not something we undertook lightly," he said.

Henderson, who is based at Hamilton’s Waikato Hospital, is also the co-chair of the Renal National Clinical Network, a body that works to improve care for kidney disease. He said work was underway to get back to a two shift a day model in Auckland, where patients could dialyse in the evenings if they wanted to – but not be forced.

“We have a plan which looks to stabilise the need for the number of dialysis chairs by increasing our staffing to utilise the spaces that we have available at present, and then build infrastructure,” he said.

“We need to stabilise now with more nursing staff and more teams to deliver the dialysis, followed by more infrastructure overtime.”

However, some in the profession are worried that if we continue on the current trajectory, hospitals could be forced to ration dialysis – something which would have a serious impact on patients.

Walker said his unit at Palmerston North has recently gone beyond the 100% capacity mark, something he found "really concerning".

"More than four patients per dialysis chair basically means patients have to dialyse into the evening, overnight and possibly even on things like Sundays," he said. "It's really disruptive to patients' work. It's really disruptive to their family life. It's disruptive to be able to do anything like go away, even if it's just for a few days."

He believed that the new data released by the Society of Nephrology showed that kidney health had not been taken seriously enough.

"We haven't prioritised enough, we haven't planned enough and we haven't put enough investment into dialysis and upstream prevention," he said. "Dialysis capacity is already at crisis, it's been at crisis and if we don't do something it's going to become a worse crisis."

Speaking on behalf of Health New Zealand, Henderson argued that crisis wasn’t the right word – using the three-shift model in Auckland as an example.

"It’s not a crisis in that there’s staffing for those units to deliver the dialysis, so patients will still get dialysis," he said. "That’s an important point to note, and it’s different from us being at crisis."

The doctor added that Health New Zealand was prioritising kidney health, pointing to recent efforts of the national renal network.

"The network has done significant amounts of work looking at dialysis capacity and looking at how we need to increase dialysis capacity to meet the demands of our population," he said. "We are planning with the rest of Health New Zealand on how we deliver that at present."

But from his position in Palmerston North, Walker feared that a dire future was possible.

"It's already bad, and we know it's projected to get worse if we don't invest in dialysis capacity and upstream prevention now," he said.

He feared that rationing was a real possibility if nothing changed, leaving patients with fewer treatments than they needed.

"That's something that no clinician wants to have to do," he said.

Henderson said work was underway to avoid that outcome.

"We really don’t want that to happen for our patients," he replied. "More dialysis facilities are required and that’s recognised by Health New Zealand, we’re working very well to understand where to put those."

However, the doctor acknowledged the challenge ahead was "difficult".

"Building infrastructure for dialysis takes time, it takes money and we need staffing to deliver in that infrastructure as well, so it’s been a challenging time to be able to do that," he said. "But we’re hopeful that coming forward, we’ve got a good plan."