Renal

Barts Health Renal Service is a leading specialist centre for the diagnosis and treatment of all forms of kidney disease [pdf] 1MB. We are committed to providing high quality, safe and compassionate care to all of our patients.

We are one of the largest renal units in the country with an international reputation for our patient-centred treatments and a highly regarded kidney transplantation programme. For more information about our services please select from the menu on the right.

Our patients come from across North East London, Essex and the surrounding areas. The Renal Unit at The Royal London Hospital forms the centre of the service providing a full range of treatment options for patients with kidney disease.

We offer support services at a range of other hospitals across London for the convenience of our patients.

We provide renal services from:

  • Homerton University Hospital
  • King George Hospital
  • Newham University Hospital
  • Queen’s Hospital
  • St Bartholomew’s Hospital
  • Whipps Cross University Hospital

Why choose us

The Barts Health renal service maintains close links with our academic partners at the William Harvey Research Institute and Queen Mary, University of London.

We have a strong track record for leading and taking in part in clinical studies and collaborating with other kidney centres in the UK and abroad. Our aim is to further develop our medical understanding of kidney disease and to provide our patients with fast access to new treatments and therapies.

We also have a dedicated team of scientists undertaking laboratory research. This has led to research being published in prestigious peer reviewed journals.

Ground breaking research

As part of the Barts Biomedical Research Unit, funded by the National Institute for Health Research, we have focused on the development of highly translational repositioning strategies including novel cardiac imaging techniques. These are currently being evaluated for patients with chronic kidney disease and patients on the transplant waiting list.

For more information, please visit the William Harvey Research Institute website

For patients

We offer the most up to date diagnostic techniques, as well as dialysis, transplantation and end of life care. Our patients receive exemplary care and the survival rates, compared with other hospitals, are excellent.

The Renal Centre

With a long tradition of innovation and excellence, The Renal Centre at The Royal London forms the hub of the service. We provide a full range of treatment options for patients with kidney disease in our new state-of-the-art surroundings.

Our department comprises a purpose built outpatient facility, renal assessment unit, 70 station dialysis unit (including a blood borne virus isolation area), inpatient area (with 62 beds) and from 2013, a high dependency facility.

We treat for patients with chronic kidney disease, haemodialysis and peritoneal dialysis as well as kidney transplantation including a ‘blood group and HLA incompatible’ program.

The unit has a very strong reputation for both undergraduate and post graduate education and is one of the countries strongest centres for translational research.

Find out about disabled access to the Unit here.

Haemodialysis

For over 40 years, we have been providing haemodialysis treatment for patients with end stage kidney failure.

The kidneys contain millions of tiny filters (called nephrons). If these become damaged through disease, then they lose their ability to filter out excess fluid and waste products. If left untreated, then it can lead to coma or even death.

Haemodialysis (also known as HD) is a treatment that pumps your blood through a machine with a special filter to remove waste and excess water. The filter is called a dialyser. Each time your blood goes through the dialyser, it gets a little bit cleaner. This process is carried out three times a week and usually lasts about four hours.

Our aim is make treatment as convenient as we can for our patients, so we operate this service at a number of  locations around North East London.

An alternative to haemodialysis may be peritoneal dialysis. We also offer home dialysis.

Home haemodialysis and self-care

We offer a Home Haemodialysis (HHD) service, which enables patients to use a therapeutic kidney machine in the comfort of their own home. Patients benefit from fewer hospital visits and greater independence.

Inpatient services at The Royal London

We have comfortable, modern accommodation for patients requiring planned and emergency procedures for renal and urology disorders. In total, we have 62 beds.

The inpatient renal and urology wards provide 24 hour care for patients who may:

  • be newly diagnosed with kidney disease and facing haemodialysis or peritoneal dialysis.
  • have chronic kidney disease
  • require kidney transplantation

We provide an holistic service that cares for every aspect of the patient’s welfare – including their medical needs and psychological wellbeing. This is achieved through collaboration with our multidisciplinary team of ward nurses, nurse specialists, physicians, surgeons, therapists, counsellors and transplant coordinators. Our approach is evidence based, safe, empathetic and always patient-centred.

Outpatient clinics at The Renal Centre

We have a dedicated, comfortable and well equipped unit, with 27 consultation rooms for our renal and urology clinics. Our clinics run from Monday to Friday, and we also host evening sessions.

Our clinics include:

  • anaemia: treatment of chronic anaemia including iron and erythropoietin therapy
  • pre-dialysis clinics provide on-going care for patients approaching ‘end stage kidney failure’ including information on renal replacement therapies
  • dialysis: haemodialysis and peritoneal
  • lithotripsy (a treatment that uses shock waves to break up stones in the kidney or bladder)
  • nephrology for patients with mild to moderate kidney disease requiring on-going investigations and monitoring
  • renal supportive care for patients who choose ‘conservative care’
  • transplantation
  • urological diagnostic services (cystoscopy and urodynamics studies)

Multidisciplinary care

Specialists at The Renal Centre work closely with experts in other fields, to provide coordinated care for patients with complex needs. The specialists meet up at multidisciplinary clinics so that patients can see experts from a range of departments in one convenient location. 

We offer the following multidisciplinary clinics at The Royal London:

  • Renal - Diabetes
  • Renal - HIV
  • Renal - Sickle Cell disease
  • Renal - Liver
  • Renal - Obstetric
  • Renal - Lupus
  • Cardio-Renal

Renal pharmacy service

Our group of specialist pharmacists will look after your drug management.  As a kidney patient, you will be prescribed a range of medicines to treat the cause of your kidney failure, control symptoms and prevent complications. If taken incorrectly, these medicines may not work as effectively and may cause harm. The renal unit has a dedicated team of pharmacists available to help you with your medicines. 

The pharmacists can provide you with information on:

  • how to take your medication
  • possible side effects
  • interactions with other medicines and herbal remedies
  • medication cards to help you remember when to take your medicines

Renal Pyschological Medicine Department

How can we help?

Kidney disease is a life changing illness, which can cause a wide range of practical and emotional challenges and concerns. It is common for patients to experience feelings of anger, sadness, worry and disbelief. We work closely with your healthcare team in the hospital and in the community to contribute to your overall health and emotional well-being.

We can help at all stages of your kidney care, such as:

  • at the beginning of your kidney care journey
  • when you are starting dialysis
  • during your dialysis treatment
  • if you are having a transplant
  • if your transplant fails
  • or, at the end of your kidney care journey.

We can help if you are experiencing:

  • low mood or depression
  • anxiety or stress
  • difficulties coming to terms with your diagnosis
  • difficulties coping with uncertainty about your health and treatment
  • difficulties adjusting to everyday life while living with kidney disease
  • fears about the future.

Family members and carers

A family member or carer may also be referred to our service if they have concerns about being a potential living kidney donor or another aspect of your kidney disease.

How can I get an appointment?

We accept referrals from any member of your renal health care team. Please speak to your doctor, nurse or other health professional who will contact us on your behalf.

Who will I see?

You will meet with either a

  • Psychologist
  • Psychiatrist
  • Assistant or trainee psychologist

Psychologists provide talking therapies which can help you to cope with, and adjust to, living with kidney disease. Psychiatrists are medical doctors that can prescribe medications.

What happens at my appointment?

Appointments take place in in the Renal Department at The Royal London Hospital in a private room. At your first appointment we will discuss your key concerns and decide together on the best way to support you. Appointments last for up to 1 hour.

For clinicians

To refer a patient to the Barts Health Renal Centre, please use the Choose and Book System. Alternatively you can send your referral to:

Barts Health Renal Centre 
The Royal London Hospital 
Whitechapel 
London, E1 1BB

Referring to our service

For urgent requests please contact the on call Renal Specialist Registrar.

Tel: 0203 594 5626 or 
Switchboard: 020 3416 5000 and ask for Bleep 1301

Out-of-hours and emergency referrals

We accept out-of-hours referrals from GPs and the emergency department at The Royal London Hospital. Please call The Royal London Hospital switchboard on 020 3416 5000 and ask to bleep the renal on-call team.

Referrals to the anaemia service

Referrals to the anaemia team are only accepted via the renal team at The Royal London Hospital. In accordance with NICE guidance (Feb 2011), patients will be considered for investigation and treatment when their Haemoglobin (HB) falls below the mean of 11.0g/dl.

East London Community Kidney Service

Barts Health in partnership with CEG, City and Hackney and Tower Hamlets Clinical Commissioning Groups (CCGs) has launched a new virtual Community Kidney Service for patients. 

The benefits to the new East London Community Kidney Service are:

  • easier and quicker access for patients to renal specialists through weekly e-clinics
  • quicker response times for our patients giving them a better experience
  • online referrals leading to faster bookings

How does it work?

Patients are referred to the e-clinic by their GP. The e-clinic consultants will then assess and triage patients by viewing their primary care record.  If needed, the consultants will arrange referral to specialist clinics. The patients GP will get notified on the outcome of the e-clinic assessment.

The service is supported by ongoing education sessions with practice teams to embed the service into routine practice, and also with patients to empower them to take control and manage their condition to delay or prevent progression into End Stage Renal Disease (ESRD) for example needing dialysis or transplant.

Accessing the service

Patients can only be referred through NHS E-Referral (formerly Choose and Book) by their GP.

Each CCG locality will have a separate community kidney service to refer into:

  • City and Hackney Community Kidney E-Clinic
  • Tower Hamlets Community Kidney E-Clinic
  • Newham Community Kidney E-Clinic
  • Waltham Forest Community Kidney E-Clinic

Please speak to your GP to find out more about accessing this service.

Location of the East London Community Kidney Service

The e-clinic is virtual and available to GP practices in only City and Hackney, Tower Hamlets, Newham and Waltham Forest areas.

For queries relating to e-clinic or to the service in general, contact the East London Community Kidney Service team at:

Email: BHNT.communityrenalservice@nhs.net or call 020 3594 2658

note: there is no answering machine. If there is nobody to answer your call, it may ask you for a code. Please hang up and call back later. 

How do we notify you following your referral 

’If you have referred through the Tower Hamlets Community Kidney E-Clinic and Newham Community Kidney E-Clinic’  (also known as the vCKD service), you will be notified via your emis workflow. This means you will not receive email notifications to your generic practice email address.  In Newham, this took place in August and in Tower Hamlets this will start on 8 October 2018. 

If you have any queries, please email us on BHNT.communityrenalservice@nhs.net or call 020 3594 2658

Useful websites

vCKD for patients

Introduction to CKD

Chronic Kidney Disease currently affects up to 10% of the population world-wide; 1 in 5 men and 1 in 4 women between the ages of 65 and 74 have CKD and half of people aged 75 or more have some degree of CKD. The most common causes of CKD in adults are high blood pressure and diabetes. There are no symptoms of early CKD, therefore the following questions should be asked to see if you are at risk:

  • Do you have high blood pressure?
  • Do you suffer from diabetes?
  • Do you have a family history of kidney disease?
  • Do you smoke?
  • Are you over 50 years?
  • Are you of Asian or African origin?

If you answered yes to one or more of these questions, speak to your doctor or nurse! CKD is easily detectable by a simple urine test or a blood test. You can view more information about chronic kidney disease diagnosis on the NHS choices web page.

How can you reduce the risk of CKD?

With the help of The Big Six activities shown below, you can reduce your risk of developing CKD and keep your kidneys healthy. Please click on the below links for more information and guidance on each topic.

  1. Monitoring your blood pressure 
  2. Eating a well balanced, healthy diet
  3. Keeping fit and active with regular exercise
  4. Staying smoke free
  5. Cutting back on alcohol
  6. Controlling your diabetes (if you have it)

Patient education sessions

We are currently running monthly patient education sessions for people who have been referred in to the virtual community kidney service. The education sessions are for patients who would like some more information on their kidneys. The sessions will help to look after them, such as understanding your kidney function, your blood pressure and your tablets. The group sessions are run by two specialist kidney nurses who will be happy to answer any questions that you may have.

Patient involvement group

The patient involvement group has been organised to allow patients and carers to have their say in how we can improve our kidney services and provide a better patient experience. Would you like to be involved in the improvements of kidney services in East London? We are looking for people who either:

  • have kidney problems but are not on dialysis
  • want to help improve the care of people who have mild - moderate kidney disease
  • are patients or care for someone who has kidney problems, but are not on dialysis or have a transplant

If this sounds like you, and you would like more information on how to get involved, please contact us via the email address links below!

Contact us

For more information on the virtual community kidney service please contact the virtual community kidney service project team.

Email us

BHNT.Communityrenalservice@nhs.net

vCKD resources for patients

Visit our patient information page for copies of the latest patient information leaflets.

These are available on request on DVD and in some languages, sylheti, Somali, urdu and Turkish. Our CKD nurse specialist or your practice nurse will guide you on relevant videos.

vCKD for clinicians

Contact us

For queries relating to e-clinic or to the service in general, contact the virtual Kidney Disease Project Team at:

Email: BHNT.Communityrenalservice@nhs.net

For queries relating to Trigger Tools contact your CEG Facilitator. Email:

 

GP information 

As part of the service package, CEG has developed a simple clinical guidance based on the latest NICE Guidance. These focus on CKD prevalence and coding, CKD investigations and management in primary care. 

Services aims

  • Reduce incident End Stage Renal Disease (ESRD) growth in east London
  • Improve primary care identification, coding and management of Chronic Kidney Disease (CKD)
  • Monthly CKD surveillance of eGFR results across east London with practice/cluster trigger tool alerts for patients with a falling eGFR value.
  • Develop a single pathway from primary to secondary care with rapid access to specialist advice provided by e-clinics with triage into specialist OPD renal clinics where necessary or specialist renal nurse led service to promote patient self-management
  • Increase skills in CKD management within primary care
  • Improve care, understanding and experience for patients with CKD in east London

The service comprises three key elements: 

  • an e-clinic - where specialists assess and provide information and advice based on shared-viewing agreements
  • Community CKD trigger tools and prevalence searches – to identify patients at risk and alert practices for their consideration
  • Patient & Practice nurse education - group patient education sessions and 1:1 nurse education sessions on how to look after your kidneys.

How to use the service

The e-clinic will affect how you refer your patients in need of specialist renal advice.

1. Some key things that you will have to do in order to access the e-clinic are:

  • ask for  patient consent/permission to view the medical record and tick ‘share consent’, as you currently do for Diabetes Community Services
  • review patient data in the updated CKD template, to decide whether further tests are needed. Confirm referral to the CKD community clinic by ticking the box.
  • in the consultation field write what you want from the renal consultant – this will function as the referral letter with response times of one week.
  • book the referral through NHS E-Referrals Choose ‘Tower Hamlets or City and Hackney community kidney e-clinic’ - no paper work is required

2. The second aspect is the community CKD surveillance tool kit.

This includes a CKD dashboard and prevalence searches. In addition we have introduced a CEG trigger tool to alert you to CKD patients with a falling eGFR. This needs to be run monthly in the practice.

To use the trigger tools and prevalence searches:

  • your CEG facilitator can help you (see below for your CEG facilitator)
  • the trigger tool search needs to be copied across the practice folder, and then run every month.

3.  Group education sessions are currently taking place. Patients who have been referred through our virtual e-clinic can be invited to attend group education sessions or 1:1 sessions with our kidney nurse specialist.

Your e-clinic clinicians:

  • For City and Hackney: Dr Conor Byrne, Dr Kieran McCafferty and Dr Raj Thuraisingham
  • For Tower Hamlets: Dr Neil Ashman and Dr Andrea Cove-Smith
  • For Newham: Dr Mark Blunden and Dr Ravi Rajakariar
  • For Waltham Forest: Dr Gavin Dreyer, Dr Hamish Dobbie and Dr Katy Bennett-Richards
  • Consultant nurses: Breeda McManus and Dr Nicki Thomas
  • Kidney Nurse Specialist: Helen Rainey

 

Ramadan and Kidney Disease

One in 10 people have chronic kidney disease (CKD) a condition where the kidneys don’t work as well as they used to. It is much more common in people of South Asian origin, black people and older people. Many people don’t know that they have CKD as it often doesn’t cause symptoms.

People with CKD are exempt from fasting as they are at high risk of health complications. Your local Imam or our Muslim chaplaincy service can advise you if you have religious belief doubts.

If you plan to fast then you should see your GP at least four weeks before Ramadan to review the tablets that help control your blood pressure and your diabetes. During Ramadan you should remain well hydrated by drinking through the night – at least eight glasses of fluid (preferably water) for most people. If you are showing signs of dehydration (such as feeling dizzy, not passing urine or feeling confused) then you should break your fast. If these symptoms do not get better quickly you should seek help from a healthcare professional.

If you are a dialysis or kidney transplant patient you are exempt from fasting and must continue your treatment as usual. Speak to your Kidney Doctor or Kidney Nurse for individual health information or contact our Muslim Chaplaincy service for advice on:

  • 020 3594 2070 (for The Royal London)
  • 020 7363 8053 (for Newham and Whipps Cross)