About the Unit
The Royal Infirmary of Edinburgh was established in 1729. Some more detail is available from Edinburgh University pages. Dialysis was first performed in Edinburgh in 1958. In 2003 the renal unit moved to the new Royal Infirmary site at Little France, near Craigmillar Castle (see illustration).
Closely associated Research teams occupy space within the Medical School. These and other related research groups are located at the Queen’s Medical Research Institute at Little France, as part of the Centre for Inflammation Research.
Show maps of the Royal Infirmary and region.
|LEFT: The new Royal Infirmary, MIDDLE: nearby Craigmillar Castle, from the Gazeteer for Scotland; RIGHT: the old Royal Infirmary|
Until 2003 the Renal Unit occupied a 1960s prefabricated wing and some ageing ‘Nightingale’ type wards at the historic Royal Infirmary in the centre of Edinburgh. The first renal transplant in Britain was performed in Edinburgh in 1961. Read more about the history of dialysis and transplantation in Edinburgh.
The clinical service
Dialysis was first provided in Edinburgh in 1959 (read more about history). Now we care for about 310 patients on dialysis, over 470 local patients who have functioning renal transplants. That’s almost 800 patients kept alive by dialysis or transplantation, and 150-300 patients each year (depending on definition) who have developed acute kidney failure. Most of those with acute kidney failure recover.
Acute renal failure
The acute service is based on the HDU (high dependency unit) in Ward 215. 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 hospital and in other local hospitals, and some 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 one of the other junior doctors. 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. 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 an attraction to working on the unit. About 60-70 renal transplants are performed annually, and the Unit also undertakes liver, pancreas/pancreatic and islet transplants.
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 consultant nephrologists and 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
Inpatient beds for general nephrology are located on ward 206 at the Royal Infirmary. Patients cared for on these wards include 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 a middle grade member of staff and two or three other junior doctors.
Royal Infirmary Outpatient haemodialysis area at the Royal Infirmary (ODA) – this has 28 stations operating 3 shifts daily 7am – 1 am Mon-Sat, supervised by a permanent staff grade doctor, middle grade doctors in training, and four consultant nephrologists.
Peritoneal dialysis is undertaken by patients at home supervised by the Community Dialysis Team. Most patients are receiving CAPD but many carry out either CAPD or automated PD at night. About 20% of the long-term dialysis patient population are receiving peritoneal dialysis.
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 Dialysis Team.
Satellite haemodialysis units provide outpatient haemodialysis for around half of our patients. They are located at
- 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 – 6 stations operating 2 shifts daily. BGH is located in 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.
- St Johns Hospital satellite unit – at Livingston, West Lothian – 10 stations, about 40 mins travel to the West.
General outpatient nephrology
More than twelve outpatient sessions are provided each week in general nephrology (ie excluding care of dialysis and transplant patients), over half by consultant staff. Clinics take place at the Royal Infirmary, Western General Hospital, at St John’s Hospital in West Lothian, and at the Borders General Hospital in Melrose.
Vascular access and PD catheters
Surgery to provide vascular access is provided by either the vascular surgical 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.
Medical staff include 9 consultant nephrologists, and 6 consultant academic staff, who also have major research and teaching responsibilities. All have particular interests and expertise as well as providing general and on-call cover. Some of our consultants also cover some acute general medicine. Specialisations include:
- Peritoneal Dialysis
- Treatment of PKD
- Genetic conditions
Edinburgh has 7 training posts for middle-grade staff, all of whom are 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) – some training is likely to be in Fife (40 minutes from Edinburgh), where there are both renal and general medicine services.
While in Edinburgh trainees rotate through the first four major clinical areas mentioned above.There is a very strong research interest and track record in Edinburgh. Many of our trainees have either come from, or go on to, substantial research posts supported by major research bodies such as the Medical Research Council, Wellcome Trust, or National Kidney UK.
Immediate care for inpatients is provided by a group of rotating 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 NHS Education Scotland (NES).
Over 100 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. A staff grade doctor supports care of dialysis patients. Advanced nurse practitioners support care in many clinical areas. Specialised senior nursing roles include anaemia coordinator, education coordinator, vascular access coordinator, conservative care specialist.
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. It is 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 days and 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 email@example.com
Nursing vacancies are advertised in various ways but some at least are available via the SHOW website – click for further information.
We are fortunate to have exceptional support from technicians, dietitians, pharmacists and social workers with specific responsibility for the Unit.
Teaching and research
Edinburgh has a leading research-based university, and its medical school is among the highest ranking in research record and in competitiveness for entry in the UK. This is supported by a very strong tradition of supporting medical education at the highest levels in Edinburgh. Many historically famous physicians have been trained in Edinburgh, and several major textbooks still come from Edinburgh. More information is provided on other pages.