Kidney patients should get more care from nurse practitioners and have dialysis closer to home

More kidney transplantations, care that is planned better, and more people having dialysis are among the priorities of England's new national clinical director for renal services.

Donal O'Donoghue, a consultant renal physician who takes up his three days a week post immediately, also wants to see more seamless care, so that patients with kidney disease do not have to see a range of different professionals for their problems in areas such as blood pressure, diabetes, and cholesterol concentrations.

“The appointment [of a national clinical director] is a recognition of renal services: that there is a job to done and that kidney disease is a common problem that affects 5% of the population,” said Dr O'Donoghue, who retains his clinical appointment at Salford Royal NHS Foundation Trust, where he has been since 1992.

“I will be working to promote a world class service for patients. I will continue with my clinical base, because I enjoy it and because it is a reality check.”

Dr O'Donoghue, a former president of the British Renal Society, said that seamless care was a key priority. “The vast majority of patients with kidney disease have stage three disease, and only a minority will benefit from secondary care. Even for those where secondary referral is appropriate, a lot of the care plan can be delivered in primary care,” he said.

“It is important to recognise that chronic kidney disease is one of the vascular diseases. We want to move to a situation where we don't have patients going for diabetes care one week, blood pressure the next, kidney the week after, and lipids the next week. There is no reason why nurse practitioners in primary care—who already see people with high blood pressure and diabetes—may not acquire the skills to manage kidney aspects of patients they are already seeing.”

Pre-dialysis care is also a target, and Dr O'Donoghue is keen to reduce the number of people who start dialysis in an unplanned fashion, a group of people he calls “crash landers.”

“Pre-dialysis care sets the outcomes for subsequent problems. We know that it varies [among regions] considerably. If you look at rates of crash landers . . . they vary between 20% and 60% [of dialysis patients],” he said.

“We need to do something about that, and a reduction in crash landers is one of my priorities.

“I also want to increase haemodialysis capacity, so that people can get it locally without long travelling times. An increased transplant rate is also a key target.”

He is keen too on seeing more renal research in England. “The evidence base we have is considerably less than in other vascular areas, like coronary heart disease and diabetes. More research here is a national priority too.”