On Christmas Eve in 1987, Ewen Maclean was a fit and active 33-year-old with a young family. He played squash and enjoyed hill-walking and had never really been ill. After experiencing headaches on a family holiday, he found himself in a clinic in Glasgow’s old Western Infirmary. It was there he was told that he had end stage renal failure.
“I thought end stage renal failure meant the end of my life,” he says. “It was a hellish Christmas.”
Since then, Ewen, now 67, from Largs has had two life-saving kidney transplants, but for a number of years, waste products and excess fluid were removed from his blood through dialysis.
Treatment is normally for four hours, three times per week, and while lifesaving, can be hugely disruptive. Back in 1988, with travel and waiting, it could be a 10 hour day for Ewen, door-to-door. Ewen had to give up his production job at the Greenock Telegraph. Sometimes, he would have a quick nap in his car before driving home from treatment.
Another key aspect of treatment is the work required to create a fistula, an access point in the arm, where medical teams try to effectively make a “super-vein”, to allow the dialysis machine access to the blood supply.
Despite dialysis dating back to the 1940s, medical procedures to establish a fistula can often have mixed results.
“I’ve had terrible times with my fistula and it’s nobody’s fault, it’s just that they can fail,” explains Ewen. “They scan your arms to see where the veins are and see which ones are suitable. Once they find the right spot it takes anything from a few weeks to a few months for it to ‘mature’ and be of use. You are watching it constantly and praying that it won’t stop working.
“As a new patient, you are constantly checking your arm to make sure the fistula is still working. You’re careful not to lift anything too heavy with your fistula arm in case you damage it.”
Now doctors in Glasgow are launching a UK-wide study to try to maximise the success of fistulas, improve care for patients and, ultimately, increase life-expectancy.
“Fistulas are the best way of getting dialysis, but the big downfall is that not every fistula works and, therefore, many patients need more than one operation,” says consultant transplant surgeon, Dr Emma Aitken.
“You’re essentially trying to turn a vein into an artery and veins don’t like being arteries.”
Glasgow is a world-leader in vascular access research and the team have worked on a number of ways of improving approaches to dialysis access. This trial will compare two different anaesthetic techniques to see if one or other is better for the fistula. The project builds on 10 years of work ongoing in Glasgow and will now happen on a bigger scale across 20 sites around the UK, including several sites in London as well as Oxford, Cambridge, Newcastle, Dundee and Belfast.
Over the next two years, Glasgow will recruit about 300 of the 550 patients required in the study from Stobhill Hospital and the Queen Elizabeth University Hospital. A number of teams will be involved in the study including vascular access surgeons, anaesthetists, nephrologists, specialist nurses, dialysis nurses and radiologists. The study has received £1.2 million in funding from the National Institute for Health Research. Results are expected toward the end of 2024.
About 700 people in the West of Scotland are on haemodialysis – but only about 150 will receive a transplant every year. Not everyone on dialysis is eligible for a transplant and not everyone will get a transplant that easily. So that can mean a long time on dialysis.
By improving dialysis the study could lead to changes being introduced across the world. Emma adds: “We want to make dialysis care better and hopefully make people live longer. That could be globally important and change practice.”
Ewen says he is ‘in awe’ of the teams at the QEUH and before that, the Western Infirmary, who along with his kidney donors have kept him alive. He now works for Kidney Care UK, providing patient support and advocacy for others who face renal failure.
Ewen’s last transplant was five years ago and is eternally grateful to those strangers who provided him with kidneys.
He concludes: “Getting a transplant is life and hope, but while you’re on dialysis a fistula is the best option. Making them better will make a huge difference.”