July 2017 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 1.87 million population. It is the devolved government’s policy to transform as much healthcare as possible to local community providers. Renal service delivery for adults has been decentralised and is provided by six renal units geographically distributed throughout the country. Commissioners also recognised the importance of investing in a high quality renal transplant programme and funded the appointment of additional renal failure and transplant surgical & nursing staff in 2013 and have fully supported development of streamlined clinical pathways for living kidney donor procedures.
Haemodialysis: There is 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) seven years ago to just under 93 ppm in 2014 (UK Renal Registry 18th annual) report. Pressure on dialysis space has also been reduced by many eligible 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 haemodialysis twice daily.
Home haemodialysis – Continued efforts are being made to expand home therapies including peritoneal dialysis, assisted PD, home haemodialysis and a 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 are making the transition to home haemodialysis.
Transplantation. Northern Ireland now has an enviable track record in provision of live kidney donor transplant procedures (>30 patients per million population – highest rate in Europe). The expanded transplant surgical, medical and nursing team has ensured the sustainability of the increased rate of transplantation. The Northern Ireland transplant programme embraces all forms of kidney transplant procedure including ABO incompatible transplantation. The combination of increased living kidney donation, pre-emptive transplantation and greater use of DCD kidneys has helped to prevent a further increase in the number of prevalent dialysis patients.
Acute kidney injury. Electronic alerts for acute kidney injury (e-Alert for AKI) were introduced by clinical chemistry laboratories to all hospital Trusts in 2014. This has improved recognition for AKI and coupled with sustained educational initiatives (e.g. AKI training by nephrologists for all Foundation Year 2 doctors) has helped to improve management of AKI. NICE guidance for AKI (CG169) was supplemented by the publication in Northern Ireland of updated GAIN guidelines for AKI in 2014.
Manpower. The size of the renal medicine training programme was reduced several years ago to match a sustainable workforce plan. There has been a limited expansion in number of consultant nephrologists over the last 5 years. Most trainees are pursuing dual accreditation in internal medicine and nephrology.
Contact Prof Peter Maxwell, Lead Renal Clinician