The Edinburgh Renal Unit 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 Liver Transplant 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 patients who 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) which currently occupies Ward 115 and has 6 in-patient beds. Patients looked after on the Unit have a high level of dependency and a need for close monitoring, and can have continuous or intermittent dialysis or haemofiltration performed. The acute service also looks after patients in ITU, HDU and ward areas all over the Trust, and lower dependency patients on the Renal wards. Numbers on the books at one time may vary from 10-25. In any one month, medical input to the service is provided by a consultant and a member of the middle grade medical staff with oneof the SHOs. Nursing staff on the acute unit also provide renal replacement therapies on intensive care units and HDUs elsewhere in the hospital.
Consultants and trainees rotate to the Transplant Unit where they share care of inpatients with transplant surgeons, usually for one month at a time. There is a joint medical/ surgical ward round every morning. Responsibilities here are truly joint, and the success of these arrangements is a major advantage for patients and staff, and anattraction to working on the unit. About 60-70 renal transplants are performed annually, and the Unit also undertakes liver and pancreas transplants. A rotating SHO manages renal transplant patients during the day; in evenings and weekends cover of renal and liver transplant patients is shared with the liver transplant SHOs. Middle-grade cover for day to day matters is the responsibility of the nephrology registrar attached to the unit, and out of hours, of the on-call nephrology registrar. Outpatient clinics are managed separately to maintain long-term continuity, run by three consultant nephrologistsand two consultant surgeons, with middle-grade staff. Nursing staff on the Unit are separate from those covering the rest of Nephrology, although the Unit is one of the areas involved as part of the two major nephrology nursing courses in Edinburgh (see below).
General inpatient nephrology
25 inpatient beds provide the inpatient area for general nephrology on ward 206 at the Royal Infirmary. Patients cared for on these wardsinclude those admitted briefly for investigation or treatment of renal disease, patients with pre-existing renal disease complicated by intercurrent illness, and dialysis patients with problems related or unrelated to their renal failure or dialysis. In-patient care is supervised 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 and around Edinburgh. A fourth will open during 2004. The units are:
Dialysis unit at the Royal Infirmary - this has 26 stations operating 3 shifts daily, supervised by staff grade doctors,middle grade doctors in training, and four consultant nephrologists.
Western General Hospital satellite unit - 9 stations operating 3 shifts daily. WGH is a major hospital on the other side of Edinburgh. Patients are supervised by a consultant nephrologist and by middle grade staff.
Borders General Hospital satellite unit - BGH is locatedin Melrose, about an hour's travel south from Edinburgh, in the Borders region. Patients are supervised by a consultant nephrologist at regular clinics at BGH. Medical emergencies can be dealt with at the hospital in Melrose before transfer. (see the BGH Unit webpage)
St John's Hospital satellite unit - at Livingston, West Lothian (see the SJH Unit webpage).
Home haemodialysis remains a very good treatment for those patients who can manage it, but numbers are now 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 Community DialysisTeam.
Peritoneal dialysis is undertaken by patients at home supervised by the Community Dialysis Team. Most patients are receiving CAPD but many carry out automated PD at night. About 25% of the long-term dialysis patient population are receiving peritoneal dialysis.
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 half by consultant staff. Clinics take place at the Royal Infirmary, Western General Hospital, and at St John's Hospital in West Lothian. Proposals to provide further clinics at the Borders General Hospital are under discussion.
Vascular access and PD catheters
Surgery to provide vascular access is provided by either the vascular surgical team or by the transplant team. Many semi-permanent lines and percutaneous interventions to salvage or modify vascular access are carried out in the Department of Radiology. PD catheters are inserted 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 and teaching responsibilities. Edinburgh has seven training posts for middle-grade staff, who are often also training in General Internal Medicine (GIM). The dual training programme takes at least 5 years, some of which usually takes place outside Edinburgh. Training in nephrology as a single specialty takes 4 years (at least 3 of clinical nephrology) - this is increasingly popular. Six months of nephrology training is likely to be in Dunfermline, Fife (30-40 minutes from Edinburgh), where there are four consultant nephrologists, all of whom also undertake general medicine. While in Edinburgh trainees rotate through the first four major clinical areas described above. The service provided by these trainees is supplemented by a staff grade and an associate specialist, who have major responsibilities on the dialysis unit. There is a very strong research interest and track record in Edinburgh. Many of our trainees have either come from, or goon to, substantial research posts supported by major research bodies such as the Medical Research Council, Wellcome Trust, or the National Kidney Research Fund. Immediate care for inpatients is provided by agroup of rotating SHOs (senior house officers), junior doctors with 1 to 3 years of experience who are training in general medicine. Their attachments to the unit are commonly for 4 months before they rotate to another speciality. Vacancies are advertised through the Postgraduate Dean's offices at NES.
Over 120 nurses are involved in the care of patients attending the Unit. Each clinical area has one 'G grade' senior charge nurse responsible for day to day care and supervision. At a senior level there is also an anaemia coordinator, and two education coordinators. Plans for a course to train advanced nurse practitioners are under consideration. The Unit provides a high level of education and training for all levels of staff. An in-house programme 'Nephrology and Renal Transplantation' has been developed for junior staff on the Renal and Transplant Units. Two modules are accredited through Napier University, contibuting to a BSc. The first is a 15 week Theory module, which is combined with clinical work. Assessment includes an essay. The second module of 48 weeks is practical, involving rotation through all areas of the unit, and assessed in clinically defined competencies. The Edinburgh Critical Care Course is run within the NHS Trust in two modules. The first is an update on critical care, lasting 6 months. Itis followed by six-week placements in three of six critical care areas within 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 a Certificate in Critical Care Nursing, but is also accredited through Edinburgh University and can contribute to an MSc. For more information on 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 here want to move away. The city is spectacular, and there's lots happening all year round, not just during the famous Festivals that take place during 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 to spectacular countryside and beaches. If you are interested, get in touch using one of the contacts above.