Auckland Hospital’s dialysis service is running at 150 percent capacity and some patients now finish treatment at 11pm

Auckland Hospital’s dialysis service is running at 150 percent capacity, with some patients now finishing their life-sustaining treatment as late as 11pm three nights a week, according to a new national survey that paints the most worrying picture of New Zealand’s renal services in years.

The Australian and New Zealand Dialysis and Transplant Registry, which tracks data through to the end of 2025, found that half of all renal services around the country are operating above capacity. Auckland is the worst affected, running six patients to every machine. Nationally, the average has climbed to 4.53 patients per machine, comfortably past the four-to-one ratio that Kidney Health New Zealand says effectively means a unit is full.

For people on haemodialysis, the numbers translate into long, awkward days that revolve around three sessions a week of four to five hours each. When chairs are scarce and shifts have to be stretched, those sessions get pushed into evenings and weekends. Some Aucklanders are now dialysing overnight and seven days a week, with the city running an extra twilight shift to squeeze more people through the available equipment.

Nephrologist Dr Curtis Walker, who has been one of the country’s most vocal voices on kidney services, told RNZ the deterioration since the previous survey was alarming. “I was frankly shocked when I’d heard how much worse the situation had got than even 2022,” he said. Walker estimates that the country needs roughly 150 additional dialysis machines simply to bring service levels into line with what Australian patients receive.

Dr Andrew Henderson, co-chair of the Renal National Clinical Network, conceded that the system is leaning heavily on patients to absorb the strain. “We acknowledge that some patients have to travel long distances, and others have to receive it at inconvenient times,” he said. Henderson pointed to a forthcoming national plan as the route out, saying the Renal National Clinical Network is developing a nationwide renal dialysis plan to address the current capacity gap.

The geography of the crisis is starkest in the South Island, where only three haemodialysis units serve the entire region. That sparse coverage forces patients to travel for hours, or in some cases relocate altogether, just to access a treatment that keeps them alive. Walker said rural patients have long carried this load and that the situation is not great for them.

Some bright spots have emerged. A new four-chair haemodialysis unit, Tātari Toto, opened recently in Blenheim and initially runs three days a week with room to scale up as demand grows. Health New Zealand is also working to return Auckland to a more orderly two-shift-a-day model, lifting staffing first so the existing chairs can be used more fully before any new bricks-and-mortar expansion.

The pressure is not going to ease on its own. Health New Zealand confirmed that demand for dialysis is rising about four percent every year, driven largely by the steady climb in chronic kidney disease, much of which traces back to New Zealand’s high rates of type two diabetes and high blood pressure. With current capacity already overrun, every year of compounding growth makes the gap harder to close.

Dialysis is not a treatment that tolerates much delay. Once a patient’s kidneys can no longer filter waste from the blood, missing more than a day or two of treatment quickly becomes life-threatening. That is why staff at units around the country spend so much of their time juggling rosters to fit in urgent admissions. In Palmerston North, where Walker works, that kind of scramble has become routine.

It also explains why the late-night shifts in Auckland are not simply an inconvenience. People on dialysis tend to be older, often retired, and frequently have other long-term conditions to manage on top of kidney failure. Finishing treatment at 11pm and then being driven home, exhausted and dehydrated, is not a sustainable rhythm. It also makes ordinary things, like booking a holiday or visiting family on the other side of the country, much harder to organise. 1News reported on Tuesday that Auckland patients are already finishing as late as 11pm three nights a week.

Behind the staffing rosters and the survey numbers sit several thousand New Zealanders for whom three or four days a week of dialysis is the price of staying alive. The Australasian survey suggests that even after years of warnings the system has been slow to invest in the chairs, machines and trained staff needed to keep up. Walker argues that a 150-machine shortfall is not a marginal problem to be tinkered with at the edges, but a multi-year capital and workforce programme.

The Renal National Clinical Network has not yet published its plan, and there is no firm date for when patient experience will start to improve. For people already on dialysis, the message from this survey is that the squeeze is getting tighter and the system’s response is still arriving. For everyone else, it is a reminder that chronic disease prevention, including better management of diabetes and blood pressure, eventually shows up in hospital chairs that are full and corridors that are not big enough.

Have you or a family member been affected by dialysis waiting times, late-night sessions, or long travel to a renal unit? Share your experience in the comments below.