News from Northern Ireland

Contact Prof Peter Maxwell, Lead Renal Clinician: peter.maxwell@belfasttrust.hscni.net

January 2014 Update

Renal Services Commissioning. Northern Ireland has a combined Health and Social Care budget and renal services are commissioned on a regional basis for the entire 1.8 million population. It is the devolved government’s policy to transform as much healthcare as possible to local community providers. Renal services for adults have been decentralised and are provided by six renal units throughout the country. Commissioners have recognised the importance of investing in a high quality renal transplant programme and have funded the appointment of additional renal failure and transplant surgical staff in 2013.

Haemodialysis: There is now sufficient haemodialysis capacity to provide dialysis for adults and children in Northern Ireland. The incidence of ESRD has fallen from the peak of almost 140 patients per million (ppm) five years ago to just under 100 ppm in 2013.  Pressure on dialysis space has also been reduced by some patients having pre-emptive renal transplant procedures whilst others with ESRD have opted for conservative care. Two of the six adult haemodialysis units provide dialysis sessions three times per day and the other four units provide dialysis twice daily.  .

Home haemodialysis – Continued efforts are being made to expand home therapies including peritoneal dialysis, assisted PD, home haemodialysis and a new dialysis service of “involved care”. A dedicated dialysis facility was opened away from hospitals in Belfast (beside a shopping centre) for those patients who want to have flexibility around the timing of their haemodialysis sessions and are willing to be involved in their own care e.g. lining the dialysis machine and self-needling their fistula. This “involved care” facility will also provide training for those patients who opt for home haemodialysis

Transplantation. Northern Ireland now has an enviable track record in provision of live kidney donor transplant procedures (~30 patients per million population). Two new consultant renal failure and transplant surgeons have been appointed in 2013 ensuring sustainability of surgical capacity for transplantation. In 2013, Northern Ireland also began ABO incompatible and donation after circulatory death (DCD) transplant procedures.  The combined efforts

Acute kidney injury. Electronic alerts for acute kidney injury (e-Alert for AKI) will be introduced by clinical chemistry laboratories to all hospital Trusts in 2014. This should improve recognition for AKI and coupled with sustained educational initiatives (e.g. AKI training by nephrologists for all Foundation Year 2 doctors) should help to improve management of AKI. NICE guidance for AKI (CG169) will be supplemented by the publication in Northern Ireland of updated GAIN guidelines for AKI in 2014.

Manpower. There will interviews for one consultant nephrologist post in 2014 to replace a retiring colleague. No further expansion in the consultant workforce is planned in 2014-15. The size of renal medicine training programme was reduced several years ago to match the workforce plan.

 

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