Sailing the Mediterranean, exploring the fjords of Norway or visiting fabled sites of ancient civilization -- these are dream vacations that can shatter when kidney disease strikes.
"The day the doctor told me I would need dialysis, I thought I wouldn't be able to travel any more," said Josette Georgin, 72, from the French city of Metz. "To have dialysis, it's like being in a prison without bars."
Then she discovered dialysis cruising.
Dialysis cruises, organized by the Gerard Pons Voyages travel agency in Bordeaux in partnership with the luxury line Costa Cruises, offers 15 trips a year with an onboard fully-equipped dialysis clinic, providing rare mobility and precious freedom for the ever-growing population of dialysis patients.
According to the UK Renal Registry, over 20,000 patients receive dialysis every year in Britain. The figures are slightly higher in France and Italy. Across the world, as people live longer, the number of dialysis patients increases by eight percent a year.
The average age for starting dialysis is 65, just when many retirees begin travelling. But there are also many younger people on dialysis who will never know the freedom of travel.
One family took their 16-year-old on dialysis for a dream family vacation. A young couple, the husband on dialysis, celebrated their honeymoon, and another couple feted their five-year wedding anniversary.
The nature of the disease makes travel potentially dangerous. People undergo dialysis when their kidneys fail, and cannot purify their blood. Functioning kidneys purify blood every day, all day long.
A patient typically undergoes dialysis three times per week, each session lasting several hours. Without dialysis, they will die.
Should they travel, the logistics of arranging for dialysis in a different hospital, let alone a foreign country, are daunting enough to keep them at home. To travel, they need complete faith in the people overseeing their logistics and healthcare.
Gerard Pons, the industry leader in dialysis cruises, and Anne-Caroline Leurent, his dialysis cruise expert, inspire such confidence.
Pons came up with the idea of onboard dialysis over 20 years ago when talking to a friend who is a nephrologist. On the one hand, he wanted to offer luxury travel, and on the other, he needed an irreproachable dialysis service.
Costa Cruises offers some of the most popular itineraries in the industry -- and three ships that have onboard hospitals spacious enough to host a temporary dialysis clinic.
The clinics are managed by Fresenius, known for manufacturing dialysis units, operating dialysis centres and coordinating dialysis sessions for travelers. Fresenius supplies top-of-the-line equipment and a medical team, including a nephrologist and three nurses. There are four dialysis units on each cruise, allowing for 12 patients.
Despite the economic crisis, Leurent reported that places are fully booked on cruises scheduled for the first half of 2009. She has had one cancellation from a Briton whose bank crashed, but someone on the wait list quickly snapped up his spot.
The lure of secure medical care in the morning followed by a jaunt to Mt. Vesuvius in the afternoon keeps demand high.
"When I'm onboard, it's very luxurious," said Georgin, who has already taken all of the offered cruises and plans more. "I forget that I have dialysis. I am on vacation and the dialysis is only a small part of the trip, four hours, three times per week."
Extra care is taken to schedule the treatment around excursions, and the onboard crew also takes care to integrate the dialysis patients into the regular crowd. "Onboard, no one knows I'm dialyzed, apart from the medical staff," said Georgin.
This is important as vacations provide an escape from daily life, and these cruises allow dialysis patients to enjoy a holiday like everyone else.
Health insurance is naturally an issue. The final cost to the customer for onboard dialysis depends on their national health service.
For the French, the cost normally falls within the limits covered by the French national health service, making it no more costly to dialyze on a cruise ship headed to Helsinki than back at home in Lyon.
For British customers, the NHS (National Health Service) does not always cover the cost of private care dialysis, and each hospital has its own policy.
When Pons saw that 30 percent of his dialysis clients came from Britain, he formed a partnership with Lisa Parnell, owner of Dialysis Holidays in Boston, England.
Parnell began her business after working several years in a hospital haemodialysis unit. "It's really nice to make dreams come true for people who have a medical condition," she said.
Travel insurance presents another challenge.
Dialysis patients have a pre-existing disease so are not covered by regular travel insurance policies. Pons overcomes this obstacle by offering a policy that covers dialysis travelers and their families and costs just 20 euros more than a regular policy.
Meeting the needs of his special clients has paid off for Pons. The niche market generates 800,000 euros for his 6.5 million-euro travel agency.
With Fresenius scheduled to open a dialysis clinic in Dubai, Pons hopes to offer a dialysis cruise to the United Arab Emirates in 2010.
What is the reaction from their clients? "They're excited," said Leurent. "They want to go to new places."