By the time a patient gets to stage 4 referrals are made and preparing for dialysis treatment becomes a harsh reality.
Three months ago a local steering group was put together to explore all options and evaluate the best way forward in establishing dialysis treatment in Whanganui.
The group included renal specialist from MidCentral DHB and the Whanganui DHB and some local dialysis patients.
Ms Schiebli said the team narrowed it down to four options that they researched in depth.
"The first was a home support service which is what the Canterbury DHB is doing, the second was a satellite dialysis unit, the third was a renal team and the other option was a community house for independent users," Ms Shiebli said.
She said the team looked at what option would be best for patient experience, health outcomes and cost.
"Our results showed that the renal team scored the highest... it showed the largest number of patients that would benefit and it's a flexible model. And it's affordable."
Project manager Sharon Bevins said if you started with a renal team and built up knowledge locally you got a better understanding of the issues.
"And then maybe that renal team could come up with something," Ms Bevins said.
She said it would require an investment of more than $100,000 to establish and fund the operational shortfall in the first few years.
Whanganui has one nurse practioner specialising in renal services who is contracted to work 20 hours a week under the WDHB.
That position will become full time and a team trained in haemodialysis and peritoneal dialysis and who could also provide pre-dialysis education will be build.
Ms Schiebli said she was unsure at this stage how many staff the board would employ and it was not easy pickings.
"We will probably get one more full-time nurse and then keeping adding from there," she said.