This renal unit is part of Altnagelvin Area Hospital, Derry/Londonderry. This hospital serves the second-largest city in Northern Ireland, with the most comprehensive services outside of Belfast. The unit was first opened in December 2005 and has subsequently undergone rapid expansion. It now has 18 dialysis stations with facilities for acute dialysis.
It shares the catchment population of close to half a million with its sister unit at Tyrone County Hospital, Omagh. Together the two units provide haemodialysis access at two loci for a large geographical region.
• It provides supportive care in conjunction with the local high dependency unit/intensive care unit towards the management of patients with acute kidney injury.
• Outpatients’ service for nephrology, home therapies and transplant patients, as well as providing a comprehensive consultative service for the many specialties based at Altnagelvin Hospital.
• Specialist clinics include Joint renal-diabetic clinic with the locally based diabetologists and joint renal obstetric clinic
• Plasma exchange services are provided for all renal and non-renal indications.
• Research and special expertise: Participating in multicentre collaborative clinical trials.
Team : Mrs Gillian Crawford, Renal Unit Manager
Mrs Benacy Joseph, Renal Unit Nursing Sister
Mr Sean Tracey, Senior Medical Technical Officer
Mrs Carmel Kilpatrick, Home Therapies Unit Manager
Ms Mandy McGerty, Renal Pharmacist
Mrs Twyla Moffitt, Lead Dietitian
Mrs Julie McCusker, Lead Dietitian
Mrs Noela Mullan, Renal Podiatrist
The Renal team in the Western Trust continues to expand maintaining its ethos of patient centred care and strong multi-disciplinary approach. Through a dedicated team involving doctors, dialysis and specialist nurses, dietitians, pharmacists, dialysis technicians, podiatrist, psychologist and social workers; we continue to provide a holistic care to our patients.
The Altnagelvin renal unit (AAH) along with its sister renal unit in Tyrone county hospital (TCH) facilitates renal replacement therapy to patients with end stage renal disease (ESRD) covering a catchment population of close to half a million over a wide geographical region. The renal unit in TCH is quality accredited under ISO 9001:2000.
Through the quality assurance mechanism, we have monthly multi-disciplinary meeting focusing on continually improving renal services in the trust. As a result, we have robust medical and nursing protocols for the management of most renal conditions. We continue to update the existing protocols and formulate new ones as per clinical need, incorporating the latest medical evidence.
We maintain a very close link with the tertiary transplant centre in Belfast and the rest of our renal colleagues in other HSC trusts. This includes twice a year Nephrology meetings and audit meetings discussing issues of importance across the province.
• Haemodialysis: Both hospital and home based.
Chronic hospital haemodialysis in Altnagelvin and Tyrone county hospital.
Acute haemodialysis in Altnagelvin and south west acute hospital (SWAH).
We also facilitate home based haemodialysis on select patients.
• Peritoneal Dialysis: Dedicated team on both sites providing a patient-centred care across a wide geographical area.
Exponential growth in transplant numbers in the last few years.
Include kidney only and kidney-pancreas transplant patients.
Dedicated transplant nurses at both sites.
Open (“phone-in” and “walk-in”) access to transplant patients at both sites leading to earlier detection and treatment of transplant related pathologies.
Support transplant patients with their shared care and self-care like providing access to renal-patient view, organising “fitness days” and close links with renal patient support group.
• Plasma Exchange: Only centre outside Belfast to provide plasma exchange for both renal and non-renal conditions. This is performed in the Altnagelvin renal unit.
• Out-patient clinics: Robust out-patient based service covering all 4 hospitals in the trust. Clinics include
General Nephrology clinics based at AAH, TCH, SWAH & Roe Valley (RV) monitoring chronic kidney disease (CKD) patients. This includes “hot-clinics” both at AAH & TCH where urgent new referrals are seen at very short notice.
Low clearance clinics at AAH, TCH & SWAH providing a multi-disciplinary review to patients approaching ESRD. This involves dialysis counselling, transplant work-up including pre-emptive transplant (if possible) and also supporting patients (and families) who have chosen conservative management of ESRD.
Haemodialysis clinic at AAH, TCH: Holistic approach to haemodialysis patients including vascular access surveillance, transplant work-up and dealing with acute non- renal related issues.
Peritoneal dialysis clinic at AAH, TCH providing a holistic approach to PD patients.
Transplant clinics at all 4 sites in the trust dealing with transplant and related issues.
Specialist Renal-Diabetic Clinic at AAH, TCH: This specialist clinic jointly run by Dr McCarroll and Dr Black (Consultant Diabetologist) provides an excellent holistic approach to diabetic patients with CKD.
Specialist Renal-Obstetric Clinic at AAH: This clinic jointly run by Dr Bolton and Dr Cartmill (Consultant Obstetrician) likewise provides a holistic approach to the management of high risk pregnant women with pre-existing or new renal pathology.
Vascular access clinic at AAH and TCH by Mr Mzimba and Mr Grannell respectively: Assessing patients for new dialysis access and monitoring high risk fistulae.
“Telerobot” reviews of renal patients in TCH via remote access from AAH.
• Email Consultations: All primary care doctors in the Trust have access to a generic renal consultant trust email. This email is checked on a daily basis by one of the renal consultants and queries dealt with appropriately. This has proved a huge success with the GPs’ as it provides timely advice, potentially avoiding out-patient review and in-patient stay. It also leaves evidence trail in the form of written documentation thereby enhancing clinical governance.
• In-patient activity: We provide a very consultant led in-patient service to our renal patients.
A dedicated renal ward in Altnagelvin Hospital which has a healthy mix of renal pathology, renal patients with medical/surgical issues and medical patients.
Renal consults elsewhere in the hospital with AKI/renal pathology.
Twice weekly in-patient review for patients’ with renal pathology at SWAH.
Close liaison with HDU/ICU (on both acute sites AAH & SWAH) reviewing patients with AKI and taking over their care if single organ renal damage.
Monitoring AKI e-alerts and proactively getting involved in patients’ care with AKI.
Regular interface with allied specialties including urology, vascular surgery, rheumatology, radiology and acute medicine.
Weekly clinical governance meetings with emphasis on quality improvement thereby enhancing patient care. These meetings include formal teaching, journal club, M&M, audit/QI meetings, sharing of the clinically difficult cases among consultants and agreeing on a best evidence practice.
Regular bedside and formal teaching to junior doctors and MDT. This includes formal teaching to medical students.
Renal ward is one of the few enhanced clinical areas in the hospital. This means it is formally audited every fortnight for trust anti-microbial concordance. There is a joint microbiology-renal round every fortnight on renal ward which helps in efficient anti-microbial management of our patients.
Plasma exchange for both renal and non-renal conditions.
Dedicated interventional nephrology session in radiology. This helps in inserting timely tunnelled dialysis lines for patients needing dialysis both in our trust and beyond.
Making good use of elective procedure unit (EPU) for day case renal biopsies, renal related IV infusions and tunnelled dialysis lines.
Mechanism in place to access most renal medications in house including Rituximab, Eculizumab.
Providing leadership and logistical support to the critical outreach team in AAH.