Since Bermuda's first dialysis unit opened in 1977, the number of people requiring treatment have steadily risen.

What started out as a treatment centre for only three patients with chronic kidney failure has become a hive of activity, which starts with dialysis sessions at 5 a.m. each day and ends as late at 8 p.m.

On some days, up to 50 people receive dialysis at the unit.

Some are awaiting transplants, which could take as long as five years to arrive, and others will use dialysis as their treatment option for the rest of their lives.

In total, there are 67 people who must use the unit or face the fatal consequences.

The unit resembles a hospital ward, with high-tech machinery and equipment in every corner. With 16 dialysis machines, the 14 nurses have their work cut out.

It is busy, yet relaxed, and is the location where many life-long friendships are formed.

Glenda Simmons, from Pembroke, has been receiving dialysis for three months after being diagnosed as suffering chronic kidney failure earlier this year. She is not on a transplant list.

Last week, The Royal Gazette spoke to her while she went through one of her three-hour sessions. With her man-made kidney beside her - otherwise known as a dialysis machine - the senior's job was just to sit there and wait while the toxins and fluids were removed from her body by a pump, and fed through the intricate filtering device.

"I have been on dialysis for three months and must come here three times a week," said the 65-year-old.

"I was very upset when I was told I had to come here for dialysis, but I am getting used to it now.

"My kidneys were very bad and I didn't know. I was feeling sick, but didn't know why. Now I feel much better after dialysis."

Dialysis Nurse Marianne Herbert, who is also the Islands' kidney transplant coordinator, said there were only two treatments for kidney failure in Bermuda: a transplant or dialysis.

Some 16 people are currently on the kidney transplant list.

She said a lot of people mistakenly believe that a transplant is a quick fix, but this is not so. Even after a successful operation, patients must continue to take medication for the rest of their lives to prevent rejection, and keep to a sensible diet and state of fitness.And in order to choose the transplant route, they must first undergo a series of extensive tests to ensure they are suitable and able.

Once they have been completed and the patient accepted, they must visit the Brigham and Women's Hospital in Boston, which is Bermuda's kidney transplant centre, where they are officially added to the waiting list of the New England Organ Bank.

After that it is a waiting game.

A family member may step forward and offer to be kidney donor, or, alternatively, the patient has to wait for a suitable cadaver donor, where somebody has been certified brain dead.

Ms Herbert said: "During the time they are waiting for an organ donor, they have to take very good care of themselves to ensure they are physically ready should the call come. Dental and physical exams have to be completed regularly, they must exercise and try to keep their weight down.

"Waiting lists are very very long, so it can take some time, even up to five years, but every couple of years we might get a surprise and someone will get called very quickly."

When the call does arrive, often patients only have a few hours to actually get to the hospital in Boston. That might mean getting to Bermuda's International Airport within an hour. But, Ms Herbert said it was always worth while. She said the success rate for kidney transplants was getting better and better all the time.

She said sometimes, after kidneys had been removed and preserved for up to 72 hours in preparation of a transplant, they did not immediately begin to work.

She added: "If that happens then the recipient will have to have dialysis for a couple of days until it starts working properly again.

"But it's very rare that they don't work. Over the 23 years I have worked here, I can think of only two people who had a very acute rejection and they lost the kidney. Medication and technology are improving all the time. So, the more donors we have the more successful operations we will have."