The Canterbury Renal Unit provides a renal service for the population of East Kent and the Medway and Maidstone districts of West Kent, a total population of 1.25 million. The unit is based at the Kent and Canterbury Hospital which was first established in April 1793 and supported by a list of wealthy subscribers including the local nobility, gentry and clergy. In 1937 it moved to its current site in Ethelbert Road immediately adjacent to Kent County Cricket Club. The renal unit was subsequently built in 1971, welcoming its first patient in February 1972.
About the service
Dialysis was first provided in Canterbury in 1972. Early in the unit's history there were some innovative developments, such as the establishment of GP led minimal care dialysis units. However, the majordevelopments in the service have largely taken place since 1996. Now we care for over 400 patients on dialysis and over 250 patients who have functioning renal transplants. The renal centre is based at Canterbury, where there is a 39 bed inpatient ward, a home therapies unit and a 30 station centre haemodialysis unit. Satellite dialysis services have been established in Ashford, Dover, Margate, Medway Hospital and Maidstone. Outreach services are currently provided in Ashford, Dover, Folkestone, Margate, Maidstone and Medway. Home and community outpatient services are now well established.
Acute Kidney Injury and In-patient Nephrology
The acute service is based on the in-patient ward and has 6 beds. All forms of treatment for acute kidney injury are available including haemodialysis, haemofiltration and plasmapharesis. The care of patients with acute kidney injury in ITUs in East and West Kent is overseen by the renal consultants and patients are transferred to the acute service for continuing care when no longer ITU dependent. At any one time there are 2 teams responsible for in-patient care comprising consultant,specialist registrar and a mixture of GP ST2/F2/F1 junior docotrs . All practical procedures involved in renal medicine are undertaken and taught, including temporary and tunnelled central venous access, peritoneal access and renal biopsy. The ward has its own portable ultrasound machine for diagnostic ultrasound and echocardiography. Central venous access is placed under ultrasound control on the ward and by direct imaging in the endovascular suite. Patients cared for include those admitted briefly for investigation or treatment of kidney disease, patients with pre-existing kidney disease complicated by intercurrent illness, and dialysis and transplant patients with problems related or unrelated to their kidney failure or renal replacement therapy.
Vascular access and PD catheters
Vascular access surgery and placement of PD catheters under GA is provided both by the visiting transplant surgeons from Guys Hospital and by local vascular surgeons. Percutaneous PD access is undertaken and taught in the ward procedures room, as is temporary and semi-permanent central venous access. Complicated semi-permanent lines and percutaneous interventions to salvage or modify vascular access are carried out in the endovascular suite.
Transplantation is provided through the transplant centre at Guys Hospital. Patients are worked up for transplantation locally, including living donation, and all patients are assessed by the transplant surgeons in the transplant assessment clinic at Canterbury. About 30-40 kidney transplants are performed annually, and Guys Hospital also undertakes combined kidney and pancreas transplants. Currently patients return for local follow up approximately 2 months post-transplantation, but it is planned to reduce this to 2 weeks by the end of 2009.
Haemodialysis for outpatients is performed in the centre unit at Canterbury and in five other units in East and West Kent. The units are: The Alan Squirrel Dialysis unit at the Kent and Canterbury-this has 30 stations operating 2 shifts daily, with a limited twilight shift 3 days per week. Patients are supervised by consultants and training grades.
The Alan Squirrel Satellite Dialysis Unit at Queen Elizabeth the Queen Mother Hospital, Margate- 11 stations operating 2 shifts daily. QEQMH is a fully functional District General Hospital located at the South East tip of the county,about 19 miles from Canterbury. Patients are supervised by 2 visiting consultants and a visiting nephrology SpR.
The Alan Squirrel Satellite Dialysis Unit at Medway Hospital - 12 stations operating 2 shifts daily and one twilight shift of 10 patients. Medway Hospital is a busy DGH located in the Medway Towns, about 35 miles from Canterbury. Patients are supervised by 2 visiting consultants.
Maidstone Kidney Care Centre - 24 stations operating 2 shifts daily. The Maidstone Kidney Care Centre is located at Maidstone Hospital, about 32 miles from Canterbury. Patients are supervised by 3 visiting consultants
Buckland Satellite Dialysis Unit - 10 stations operating 2 shifts daily located in a cottage hospital in Dover. Ashford Satellite Renal Unit - 15 stations operating 2 shifts daily located in the grounds of the William Harvey Hospital, Ashford.
Home haemodialysisis gradually building up again and remains a very good treatment for those patients who can manage it, but numbers are low, as most of the patients best suited to it are also suitable for renal transplantation. Like home peritoneal dialysis, it is managed through the Home Therapies Team.
Peritoneal dialysisis undertaken by patients at home supervised by the Home Therapies Team. Most patients are receiving automated PD at night but a significant number are also on CAPD. The srvice is led by Dr Mohammed Al-Hasani
General outpatient nephrology
More than 14 outpatient sessions are provided each week in general nephrology (ie excluding care of dialysis and transplant patients), more than two thirds by consultant staff. Clinics take place at the Kent and Canterbury,QEQMH Margate, Royal Victoria Hospital Folkestone, William Harvey Hospital Ashford, Maidstone Hospital and Medway Hospitals.
Working on the Kent and Canterbury Renal Unit
Medical staff include 9 consultant nephrologists, and 1 associate specialist. Canterbury has 4 training posts for middle-grade staff from the South Thames rotation. Each registrar spends 12 months based in Canterbury but during this time will gain experience in outreach clinics and inthe satellite dialysis units. The other units in the South Thames rotation include Guys and St Thomas Hospitals, Kings College Hospital,St Georges Hospital, St Helier Hospital and the Royal Sussex CountyHospital in Brighton. There are also additional G(I)M posts in Lewisham, Greenwich, Croydon and Worthing. There is a very strong and burgeoning clinical research interest developing a very good track record in Canterbury. The director of the research programme is Dr Edmund Lamb, Consultant Clinical Chemist. Collaborations have been developed in this country with Guys and St Thomas, St Georges and St Helier Hospitals in London, with the Department of Epidemiology in Guildford University, the departmentof computing in the University of Kent, and with Salford Royal HospitalTrust in Manchester. International collaboration with St Paul's Hospital in Vancouver, British Columbia has been recently developed.
Over 100 nurses are involved in the care of patients attending the Unit. There are 3 senior charge nurses (Home therapies,Haemodialysis & Ward/outpatients areas)and 1 nurse consultant. Each clinical area has one senior charge nurse responsible for day to day care and supervision. Links have been established with Christchurch Nursing College in Canterbury to improve education and training of renal nurse practitioners. The Unit provides a high level of education and training for all levels of staff. Nursing vacancies are advertised in various ways but some at least are available via east kent trust recruitment
Working in Canterbury
Canterbury is an ecclesiastical and business centre and the University of Kent is based in the city. There are many surrounding areas of unspoilt countryside and a wide variety of quiet secluded beaches. The countryside is mainly arable farmland, but in the immediate vicinity of Canterbury fruit and hop farming predominate. The Stour valley runs through the area and there are areas of great natural beauty and charm. The Thanet coast is on a list of best wildlife sites in Europe. Places of historic interest include Canterbury Cathedral and Dover, Deal and Walmer castles. There are excellent schools, both private and state. Regular train services and the M2 and M20 motorways provide easy access to London, and the Continent is within immediate reach through the Channel ports and Channel Tunnel. Manston airport (20 minutes drive from Canterbury) has recently been developed to serve Kent and flies to a variety of destinations. There are also outstanding sporting facilities, both indoor and outdoor. The Kent County Cricket ground is immediately adjacent to the Kent and Canterbury Hospital. Sports associated with the coast such as sailing and windsurfing are well served and golfers can enjoy many courses,including championship golf courses.