The Edinburgh RenalUnit provides a renal service for the population of the Lothian and Borders region, about 850,000 people. In addition, from the Royal Infirmary a Renal Transplant service is provided to the East and North of Scotland, and a LiverTransplant service for the whole of Scotland. Pancreatic transplantation has been undertaken in Edinburgh since 2000.
At www.edren.org you can find a large amount of information about kidney diseases, the protocols we use, and more about the unit and its history.
The Royal Infirmary of Edinburgh was established in 1729. In 2003 it moved to a new site at Little France, near Craigmillar Castle.
About the service
Dialysis was first provided in Edinburgh in 1959 (read more about history).Now we care for about 300 patients on dialysis, over 250 local patientswho have functioning renal transplants, and 150-300 patients each year(depending on definition) who have developed acute renal failure.
Acute renal failure
The acute service is based on the HDU (high dependency unit) whichcurrently occupies Ward 115 and has 6 in-patient beds. Patients lookedafter on the Unit have a high level of dependency and a need for closemonitoring, and can have continuous or intermittent dialysis orhaemofiltration performed. The acute service also looks after patientsin ITU, HDU and ward areas all over the Trust, and lower dependencypatients on the Renal wards. Numbers on the books at one time may varyfrom 10-25. In any one month, medical input to the service is providedby a consultant and a member of the middle grade medical staff with oneof the SHOs. Nursing staff on the acute unit also provide renalreplacement therapies on intensive care units and HDUs elsewhere in thehospital.
Consultants and trainees rotate to the Transplant Unit where theyshare care of inpatients with transplant surgeons, usually for onemonth at a time. There is a joint medical/ surgical ward round everymorning. Responsibilities here are truly joint, and the success ofthese arrangements is a major advantage for patients and staff, and anattraction to working on the unit. About 60-70 renal transplants areperformed annually, and the Unit also undertakes liver and pancreastransplants. A rotating SHO manages renal transplant patients duringthe day; in evenings and weekends cover of renal and liver transplantpatients is shared with the liver transplant SHOs. Middle-grade coverfor day to day matters is the responsibility of the nephrologyregistrar attached to the unit, and out of hours, of the on-callnephrology registrar. Outpatient clinics are managed separately tomaintain long-term continuity, run by three consultant nephrologistsand two consultant surgeons, with middle-grade staff. Nursing staff onthe Unit are separate from those covering the rest of Nephrology,although the Unit is one of the areas involved as part of the two majornephrology nursing courses in Edinburgh (see below).
General inpatient nephrology
25 inpatient beds provide the inpatient area for general nephrologyon ward 206 at the Royal Infirmary. Patients cared for on these wardsinclude those admitted briefly for investigation or treatment of renaldisease, patients with pre-existing renal disease complicated byintercurrent illness, and dialysis patients with problems related orunrelated to their renal failure or dialysis. In-patient care issupervised by one of the consultant nephrologists each month, with amiddle grade member of staff and two or three SHOs.
Haemodialysis for outpatients is performed at three Units in andaround Edinburgh. A fourth will open during 2004. The units are:
Dialysis unit at the Royal Infirmary - this has 26stations operating 3 shifts daily, supervised by staff grade doctors,middle grade doctors in training, and four consultant nephrologists.
Western General Hospital satellite unit - 9 stationsoperating 3 shifts daily. WGH is a major hospital on the other side ofEdinburgh. Patients are supervised by a consultant nephrologist and bymiddle grade staff.
Borders General Hospital satellite unit - BGH is locatedin Melrose, about an hour's travel south from Edinburgh, in the Bordersregion. Patients are supervised by a consultant nephrologist at regularclinics at BGH. Medical emergencies can be dealt with at the hospitalin Melrose before transfer. (see the BGH Unit webpage)
St John's Hospital satellite unit - at Livingstone, West Lothian (see the SJH Unit webpage).
Home haemodialysis remains a very good treatment for those patientswho can manage it, but numbers are now low, as most of the patientsbest suited to it are also suitable for renal transplantation. Likehome peritoneal dialysis, it is managed through the Community DialysisTeam.
Peritoneal dialysis is undertaken by patients at home supervised bythe Community Dialysis Team. Most patients are receiving CAPD but manycarry out automated PD at night. About 25% of the long-term dialysispatient population are receiving peritoneal dialysis.
General outpatient nephrology
More than 14 outpatient sessions are provided each week in generalnephrology (ie excluding care of dialysis and transplant patients),more than half by consultant staff. Clinics take place at the RoyalInfirmary, Western General Hospital, and at St John's Hospital in WestLothian. Proposals to provide further clinics at the Borders GeneralHospital are under discussion.
Vascular access and PD catheters
Surgery to provide vascular access is provided by either thevascular surgical team or by the transplant team. Many semi-permanentlines and percutaneous interventions to salvage or modify vascularaccess are carried out in the Department of Radiology. PD catheters areinserted surgically by the transplant team.
Working on the Edinburgh Renal Unit
Medical staff include five full-time consultant nephrologists, andfive consultant academic staff, who also have major research andteaching responsibilities. Edinburgh has seven training posts formiddle-grade staff, who are often also training in General InternalMedicine (GIM). The dual training programme takes at least 5 years,some of which usually takes place outside Edinburgh. Training innephrology as a single specialty takes 4 years (at least 3 of clinicalnephrology) - this is increasingly popular. Six months of nephrologytraining is likely to be in Dunfermline, Fife (30-40 minutes fromEdinburgh), where there are four consultant nephrologists, all of whomalso undertake general medicine. While in Edinburgh trainees rotatethrough the first four major clinical areas described above. Theservice provided by these trainees is supplemented by a staff grade andan associate specialist, who have major responsibilities on thedialysis unit. There is a very strong research interest and trackrecord in Edinburgh. Many of our trainees have either come from, or goon to, substantial research posts supported by major research bodiessuch as the Medical Research Council, Wellcome Trust, or the NationalKidney Research Fund. Immediate care for inpatients is provided by agroup of rotating SHOs (senior house officers), junior doctors with 1to 3 years of experience who are training in general medicine. Theirattachments to the unit are commonly for 4 months before they rotate toanother speciality. Vacancies are advertised through the PostgraduateDean's offices at NES.
Over 120 nurses are involved in the care of patients attending theUnit. Each clinical area has one 'G grade' senior charge nurseresponsible for day to day care and supervision. At a senior levelthere is also an anaemia coordinator, and two education coordinators.Plans for a course to train advanced nurse practitioners are underconsideration. The Unit provides a high level of education and trainingfor all levels of staff. An in-house programme 'Nephrology and RenalTransplantation' has been developed for junior staff on the Renal andTransplant Units. Two modules are accredited through Napier University,contibuting to a BSc. The first is a 15 week Theory module, which iscombined with clinical work. Assessment includes an essay. The secondmodule of 48 weeks is practical, involving rotation through all areasof the unit, and assessed in clinically defined competencies. TheEdinburgh Critical Care Course is run within the NHS Trust in twomodules. The first is an update on critical care, lasting 6 months. Itis followed by six-week placements in three of six critical care areaswithin the trust, followed by 12 weeks in the home unit with study daysand an elective placement (often overseas) to study an area in detail.This is accredited by NHS Education for Scotland and leads to aCertificate in Critical Care Nursing, but is also accredited throughEdinburgh University and can contribute to an MSc. For more informationon training opportunities contact firstname.lastname@example.org
Nursing vacancies are advertised in various ways but some at least are available via the SHOW website.
Working in Edinburgh
Edinburgh is a great place to live, few people who have worked herewant to move away. The city is spectacular, and there's lots happeningall year round, not just during the famous Festivals that take placeduring August/September. The new Royal Infirmary is to the South Eastof the city, easy to get to from the ring road, or by public transport(or bike) from the centre of town. From Edinburgh it is also not far tospectacular countryside and beaches. If you are interested, get in touch using one of the contacts above.