Kidney care with no dialysis unit?

Well that might be an aspiration – to get so good at early identification and management of kidney disease that people didn’t need dialysis any more. We are a long way off that but if we do achieve the goals of the organ donor task force and the current levelling off in the number of new patients requiring dialysis, seen over the last few years continues, we might not need to keep expanding the number of dialysis units and the total number of people on dialysis may even start to decrease beyond 2015.

So early detection, better chronic disease management, earlier and more transplantation: dare I say “care planning” is the way to go.

But a kidney service with no dialysis unit? A bit premature you might think. A pub with no beer. Well no. As part of the Royal Free Hospital plans for people to be managed as close to home as possible and to optimise care, the main hospital chronic dialysis facility has closed down and unit-based haemodialysis is now provided by a network of local community and hospital based facilities. The main Royal Free site doing what it can only do – management of complex acute kidney injury, inpatient care and transplantation: providing a team, infrastructure and co-ordinating care; training, education and research.

In fact, you would find a very similar model in many countries with the university hospitals providing research and training, a consult service but often with only a small on-sight haemodialysis unit. At the Royal Free the demand isn’t directly around the hospital, it’s in the adjacent neighbourhoods and so John Connelly, Clinical Director and Dave Thomas, kidney services manager, developed a win-win case for moving dialysis closer to peoples’ homes and freeing up valuable, and expensive to run teaching hospital space.

The move to more local provision has also reduced the institutionalising effect dialysis can have on patients such that many more people are now involved in increasing degrees of self care. I am sure that is also a result of Katy Gerrard’s efforts to implement care planning for those with advanced kidney disease. The Royal Free “my kidney care plan” has proved to be very popular with both patients and staff. Katy told me that overall most patients found it useful and reported that it has improved their care. Initial results are promising and are to be presented at the forthcoming Renal Association/British Renal Society meeting.

LINK: Care planning - mini topic review 1 April 2011