The Royal Infirmary of Edinburgh was established in 1729. 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.
The Department provides an area renal service for Edinburgh, Lothian and Borders (population 800,000). There are 12 NHS consultants and seven Honorary Consultants who all contribute to the clinical services both in Renal and Transplant. There is a Speciality Doctor who has a primary responsibility to the out-patient dialysis service. There are 8 Specialty trainees in Renal Medicine, 7 CMTs/FY2s and 6 advanced nurse practitioners. The Renal Unit at present has a 12 bed renal high dependency ward with dialysis stations for unstable patients shared with the Transplant Unit. There is a 22 bed general nephrology ward and 21 bed transplant ward. The hospital also has a Medical Day-case unit and a Daybed Surgical unit for patients admitted for procedures such as renal biopsy, angiography and vascular access. There is a 38-station haemodialysis unit at the Royal Infirmary of Edinburgh. There is a 9 station satellite haemodialysis unit at the Western General Hospital, a 12 station satellite haemodialysis unit at the Borders General, and a 10 station Satellite unit at St Johns Hospital, Livingston all operating 3 shifts per day. There are currently approximately 275 haemodialysis patients under the care of the unit, five home haemodialysis patients and approximately 35 peritoneal dialysis patients (CAPD and APD). There are 80 new patients to renal replacement treatment.
A renal transplant service (living donor and Cadaveric) is provided for Lothian, Borders, Fife, Tayside, Grampian and Highland giving a catchment population of 2.6 million. The Transplant Unit also provides pancreas transplantation for the whole of Scotland (5.1 million). Approx 100 renal transplants and 15-20 combined kidney and pancreas transplants are carried out per year at present. The Transplant Unit is also centre to The Scottish National Pancreatic Islet Transplant Programme and has carried out 31 islet transplants since it was established in 2009. At present there is a local renal transplant follow up population of approximately 400 but with additional follow–up of patients who are ultimately repatriated to referring areas when stable, approximately 3000 follow-up appointments per year are currently required.
Research and Development
There are ample Research opportunities with well-established research groups based in the Centre for Inflammation Research led by Prof J Hughes, Dr N Dhaun, Dr D Kluth, , Dr B Conway, and Dr D Ferenbach, Dr R Hunter and Dr E Miller Hodges. There are also Transplant Research groups led by Professor S Wigmore and Professor L Marson. NHS Lothian is also committed to improving the quality and safety of its services for patients. NHS Lothian is participating in the Scottish Patient Safety Programme and it is evident that this initiative is strongly supported by clinical staff with many elements of the programme impacting on Renal Medicine. Dr S Watson as Executive Chief Quality Officer has a National role in patient safety and can support development of interested candidates in this field.
Staffing and training
Edinburgh has 8 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 advanced nurse practitioners and 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.
Nursing vacancies are advertised in various ways but some at least are available via the SHOW website
University links, student attachments
The university is not yet taking on elective students but previously they have to apply to The University of Edinburgh email: firstname.lastname@example.org