Our renal staff’s effort has been Magnificent all worth it
IT’S now April and fear has started to resemble hope.
Most of us will recognise that Covid-19 has been a huge challenge for the NHS, but for one part of the health service in particular the enormity of the challenge may not be so familiar.
Renal services provide care to people with kidney disease. Among this group are people with kidney failure, and for these people lifelong dialysis or a kidney transplant is needed to keep them alive.
Suspending these services during Covid-19 simply isn’t an option. Perhaps the scale of the challenge may also surprise people.
Take the region of Wales where I practise as an example. It does around 1,200 dialysis treatments a week from the main centre in Swansea and its satellite units dotted across rural West Wales.
So what has Covid-19 meant for these people? Dialysis patients are among the most vulnerable for getting Covid-19; travelling to a dialysis unit three times a week for treatment that lasts around four hours means they can’t fully shield.
If infected, a person on dialysis is at high risk of suffering severe Covid; they are classed as extremely clinically vulnerable by the government’s categories.
Data from the UK registries shows that once infected a person receiving in-centre haemodialysis has a one in five risk of death within two weeks – far higher than the risk of death of Covid-19 in the general population, which is closer to one in 200. This means a 30-year-old in-centre dialysis patient has the same risk of death if
PROFESSOR CHRIS BROWN is consultant pharmacist for the Renal Medicines Service at Morriston Hospital in Swansea. Here, he outlines the challenges of kidney care during the pandemic and how the service was able to deliver a successful vaccination programme to its patients
infected with Covid-19 as an 80-year-old in the general population. Urgent vaccination for these people was clearly needed, but how? With the time spent on dialysis they would experience difficulty in accessing community vaccination appointments because of their treatment schedules.
The best option for these patients would be to have the vaccine administered on dialysis sessions.
But this would not be without its challenges.
Co-ordinating vaccines times with dialysis schedules, geography and the need to maintain core services would stretch our renal staff further. But vaccination was our hope for better times ahead.
Our patients had lived in real fear from the start of the pandemic and our staff continued to work
relentlessly, to the point of exhaustion, throughout the pandemic.
Now we have given the second dose. We mobilised a team from the main centre in Swansea to provide a programme for vaccination for people attending their routine dialysis sessions across our region.
This included dialysis units in Carmarthen, Haverfordwest and Aberystwyth, which make up the South West Wales renal region.
Specialist renal pharmacists buddied with a dialysis nurse from each of our dialysis units.
We used our knowledge of our patients and our digital prescribing system
to deliver this programme at scale and at pace, getting the first dose into people in a matter of days once given the go-ahead, and not a single dose of vaccine was wasted.
Despite the challenges of administering the vaccine on dialysis units in this way, we showed it was certainly possible, and that dialysis centres across the UK could follow suit – and many of them did. More than 99% of patients consented to the vaccine, which is extremely high, much higher than may have been expected. We achieved this because the vaccine was being offered by the staff who care for these people week in week out and who understood
their unique situation.
As clinicians we can spend 15 hours a week with the people we dialyse. It was not only our moral duty that pushed us to vaccinate in this way, but our commitment to this special group of people who fight day in day out to stay alive.
Now we have administered the second dose of the vaccine it will be taking effect to help protect our renal community.
It has been emotional, tiring and required long hours from early morning to late night. But despite this it has felt like injecting hope. I am proud to be part of the dedicated team who make up this very special renal service.