The Department of Renal Medicine is based in Dumfries Infirmary and serves the population of south west Scotland. The medical staffing consists of 2 Consultant Nephrologists, 1 part time consultant nephrologist and 2 Associate Specialists in Nephrology. There is a strong multi-disciplinary approach to care with excellent team working and many nurse led services. In addition to haemodialysis and peritoneal dialysis nurses, the department is supported by a renal dietitian, pre-dialysis nurse, anaemia co-ordinator, palliative care nurse, transplant link nurse and vascular access nurse.
The Renal Unit currently supervises the care of patients on renal replacement therapy including hospital haemodialysis, home haemodialysis, CAPD, APD and transplant patients. The main unit is in Dumfries. We have a 4 station satellite unit in Stranraer 75 miles west of Dumfries and also have 3 station satellite unit in Kirkcudbright. We run two haemodialysis shifts a day in Dumfries on a Monday, Wednesday and Friday and one shift on a Tuesday, Thursday and Saturday. The Stranraer satellite unit currently runs two shifts a day on a Monday, through to Saturday. Kirkcudbright satellite unit currently runs two shifts on a Monday, Tuesday, Wednesday and Friday.
Our community dialysis team are based at Dumfries Infirmary but spend most of their time in the community. They are a group of specialist nurses who provide home haemodialysis care, pre-dialysis care, anaemia management, peritoneal dialysis, transplant assessment and follow up, palliative care and vascular access. Kidney transplants are undertaken at the Queen Elizabeth University hospital in Glasgow and kidney/pancreas transplants at the Royal Infirmary in Edinburgh.
We currently hold 6 - 8 out-patient clinics per week in Dumfries plus 2 clinics per month in Stranraer and 1 at Newton Stewart. Vascular access is undertaken by the Consultant Vascular Surgeons in Dumfries. Peritoneal access is performed by the consultant vascular surgeons in Dumfries. Tunnelled dialysis lines are done by the consultant nephrologist under fluoroscopic guidance. Native renal biopsies are performed by one of the Consultant Radiologists in Dumfries. These are interpreted by a Pathologist with a special interest in renal pathology in Glasgow. Renal imaging by ultrasound, CT and MRI takes place in Dumfries, isotope scanning in Carlisle.
There are too few renal in-patients to justify a renal ward in Dumfries. Patients requiring admission go to Ward 9 which they share with general medical, diabetes and cardiology patients. Patients with acute kidney injury requiring dialysis are treated either in the Renal Unit, the Medical High Dependency Ward or the Intensive Care Unit.
We hold medical renal strategy meetings every week on a Thursday morning and renal business meetings every two months on a Thursday afternoon, the latter supported by the medical General Manager and Finance Director of the Trust. Other monthly meetings include transplant assessments, pre-dialysis, access, anaemia, phosphate, haemodialysis review and PD meetings. Mr Marc Clancy, Transplant Surgeon at the Queen Elizabeth University Hospital, Glasgow visits Dumfries every three months to see and discuss Dumfries patients undergoing both recipient and donor work up which are all undertaken locally and to address difficult access problems.
The Renal Unit undertakes a number of local and national audits, participates in multi-centre studies and encourages all staff to undertake and publish as much research as time will allow. Recent papers have been published in the BMJ, Lancet, QJM and Age and Ageing. We present regularly at the Scottish Renal Association and play an active part in the Scottish Renal Registry.
Major developments of the renal service in Dumfries and Galloway have been completed in 2007. Specifically, we have upgraded the dialysis facility in Dumfries to 18 stations and opened a 4 station satellite unit in Stranraer and more recently a 3 station satellite unit in Kirkcudbright. Both developments have been to a very high standard, guaranteeing all patients and visitors to the region a ‘club class’ experience during treatment.