Nephrology

Nephrology services

Traditionally, services for renal patients within Lincolnshire were provided by the ‘hub’ at Leicester and due to this the service remains linked to Leicester for some provision although there is an increasing trend towards relative independence and more local provision for patients.

The service can be thought of as having several separate areas of provision although in reality these are closely linked and include:

Haemodialysis

The service currently supports three haemodialysis units – Lincoln, Boston and Skegness. The Boston and Skegness units are private provider units but are managed by medical staff from Lincoln County Hospital with Dr Amir Malik providing medical support to Boston and Dr Jane Little to Skegness.

Lincoln County Hospital currently has 76 haemodialysis patients, Boston 72 and Skegness 12. In addition there is an inpatient area at Lincoln which provides dialysis support for patients normally on haemodialysis within the county but who have intercurrent medical problems (renal or otherwise) requiring admission.

Haemodialysis clinics are conducted weekly at Lincoln (Monday pm) and Boston (Tuesday). Skegness is visited monthly by the haemodialysis matron and every three months by the multidisciplinary team including the consultant. Much of the haemodialysis access and access management is now carried out locally by Paul Dunning, Peter LeeChong and Dr Pradeep Burli.

Peritoneal dialysis

Peritoneal dialysis catheters are inserted by the team at Leicester but the rest of the routine management is provided locally by the renal community team supported by the renal consultants. Simple trouble shooting is managed locally but more serious complications such as peritonitis are dealt with at Leicester – this is likely to change as local services expand.

Peritoneal dialysis clinics take place at Lincoln (first and third Wednesday mornings) and Boston (fourth Wednesday afternoon).

Transplantation

All transplantation is done at Leicester but once patients have been successfully transplanted for more than one year follow up is done locally. Transplant clinics take place fortnightly (first and third Tuesday mornings).

Renal Community Team

This has multiple roles including dialysis modality counselling, peritoneal dialysis training and management, management of patients on a conservative pathway and post-transplant education. The team consists Gill Simpson/Liz Barnard – job share, Julie Newton and Jane Meadows.

General nephrology

The majority of the general nephrology work is carried out in outpatients. General nephrology clinics take place at Lincoln (alternate Monday mornings, alternate Tuesday mornings, alternate Thursday mornings and every Friday morning). In addition there is a low clearance clinic at Lincoln on a Tuesday morning.

General nephrology clinics at Boston are all day Mondays (with a low clearance clinic on the first Monday of the month). Clinics take place at Grantham on alternate Wednesday afternoons.

Inpatient nephrology services/acute kidney injury

Patients with acute kidney injury and other nephrological problems are managed on Burton Ward at Lincoln County Hospital. There is an inpatient ward round to see renal referrals each weekday starting at 2pm on Burton Ward.

Acute haemodialysis is not undertaken at Lincoln at present other than on the Intensive Care Unit although this service development is planned in the future.