It is a worrying time for renal patients at St George's and patients have many questions. This section is designed to provide you with the latest information from the hospital. We will not try to repeat fast changing information here. Instead we will link you to trusted sources of information. Please contact us with any questions or information that you think we are missing.
The key message is to stay at home for the next 12 weeks (from 23rd March 2020) and shield yourself.
Updates to the article are being made regularly.

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Changes to this article

1. Original article - 22nd March
2. UPDATE 2 added & links to keeping active while at home - 29th March
3. UPDATE 3 added a brief note from the renal team about dialysis supplies following national press coverage of shortages.
4. UPDATE 4 we have held a series of online sessions which have included substantial Q&As which includes advice for patients. The article includes a video recording of the session, presentation and related information.

 

Contents of this article

• Updates from the renal team at St George's hospital
  • dialysis supplies
  • transplantation suspension
  • dialysis changes
  • transport
  • outpatient appointments
• Frequently Asked Questions
  • Isolating/Shielding
  • Appointments
  • Illness
  • Hospital preparations including visiting
  • General

 

Update letters from the Renal Team at St George's

Please note that advice and guidance may change in this rapidly evolving pandemic. Always check this and official sites regularly for the latest information.

 

UPDATE 3 - 24th April - Dialysis supplies

There were numerous articles published in the national press on 23rd April raising concerns over dialysis supplies and machine availability following the increase in demand caused by around a quarter of all COVID-19 patients in ICU requiringing dialysis for AKI (Acute Kidney Injury).

The issue appears to be one affecting ICU patients who are on haemofiltration machines rather than regular dialysis patients who use haemodialysis machines.

We asked the hospital for comment and they provided this:

 

The issue is the worldwide availability of consumables for haemofiltration for the machines used in critical care environments. There are no supply problems for anything related to haemodialysis.

We’ve supported local intensive care teams to ensure that their supply problem does not become a problem and over the past few weeks installed a significant amount of haemodialysis equipment in these intensive care areas.

Furthermore, the haemofiltration equipment used at St Georges has many months of consumable stock available.

As a result St Georges has and will continue to support any patients who are in local hospitals who need kidney support in any environment they need to be care in. Likewise, our critical care team is able to support other London units which are also installing haemodialysis technology in their areas.

Whilst a potential problem was identified we have been well prepared in South West London for this and the contingency plans we have made are working well.

PD and home HD patients should not be concerned about their deliveries for treatments.

In our satellite units contingency plans where staffing could be affected does include a reduction to 3.5hrs of treatment so that more patients can be put on and taken off in a session if staffing is affected. Every patients treatment has been reviewed to identify those in whom this would not be desirable.

Whilst it is very difficult times in healthcare I’m pleased to report that staff and inpatients in the renal unit seem to be managing well. Staff are now starting to consider how and where we can start getting the usual functions of the service back to normal. 

Keep safe,

Dr Daniel Jones
Consultant Nephrologist

 

We can say, as a group of clinicians, we are confident that we have enough resources to provide safe care to our dialysis, transplant, CKD and AKI population.

Dr Debasish Banerjee MD FHEA FASN FRCP
Care Group Lead, Renal

 

And Kidney Care UK provided this commentary on the situation for Acute Kidney Injury patients in ICU. (Intensive Care Unit)

Kidney Care UK is concerned at reports of a critical shortage of supplies for the provision of dialysis treatment in Intensive Care Units for patients with acute kidney injury (AKI) caused by COVID-19. For those patients who are on ventilators, over 28% will develop severe AKI and require dialysis treatment. A huge amount of work is going on amongst kidney doctors and critical care specialists to address this shortage by sharing resources effectively and using alternatives to usual treatments.

It is important to say we have been reassured by medical colleagues that that this urgent situation affects ICUs and patients with acute kidney injury, and they do not anticipate any issues with supplies of the material needed for long-term haemodialysis or peritoneal dialysis.

 

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UPDATE 2 - 28th March

The renal unit has advised us about the following changes to the service at St George's and the sad news death from coronavirus of a former transplant surgeon.

1. Suspension of the transplant programme. Earlier this week we decided we had to close to all transplantation. All LONDON units have done this and the reason predominately is about availability of anaesthetists and post operative care in high dependency. There are also unclear implications about immunosuppression medications and it’s been difficult for doctors and patients to know what to do. This will be reviewed regularly as we all want to restart this as soon as if is safe to do so. We are to send letters to patients who are active in the transplant list to explain what is happening.
2. Increase in dialysis facilities on Champneys ward. We are expecting an increase in the numbers of our existing haemodialysis patients who will need admission for hospital care as well as a need to treat more patients who develop kidney failure.  Our haemodialysis capacity on Champneys has been insufficient for the last year. To prepare for the increased need this week we have increased the capability of Champneys ward to 23 dialysis stations (from 8 stations) to ensure we will be able to treat those admitted. We will introduce this increased dialysis capacity in a phased way to meet demand over the next few weeks.
3. We are sorry to announce the death of our former colleague, and transplant surgeon, Dr Adil El Tayar. He had volunteered to work at Hereford hospital during the coronavirus outbreak but fell ill at his home in London. Dr El Tayar worked at St George's for many years over several periods of time. He also worked elsewhere in the NHS, in Saudi Arabia and set up a transplant programme in his native Sudan.
   Consultant surgeon at St George's, Abbas Ghazanfar paid this tribute to his former colleague: He was a noble human being ... Mr El Tayar was a very hard working and dedicated surgeon who gave the precious gift of life to so many people around the world by his excellent transplanting skills ... he was an excellent colleague, a truly humble soul.
   You can read his obituary here: https://www.sgkpa.org.uk/news/former-st-georges-transplant-surgeon-mr-adil-el-tayar-has-died-of-covid-19

 

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UPDATE 1 - 21st March 2020

Dialysis:

Those attending our dialysis clinics are likely to need to be flexible in the treatment sessions.  We’ve made areas on site dedicated areas for this who are isolating due to symptoms and separate areas for those who we know are positive. 

Dialysis patients can email dialysis@stgeorges.nhs.uk  to get an automated service/information update. We will not have capacity to respond to emails from this address.

Transport:

Dedicated transport arrangements have been secured for those who are symptomatic or positive for Coronavisrus (COVID-19).  It is important that patients do not travel to the units with others if they as isolating due to symptoms and instead inform their unit so we can coordinate their care and ensure appropriate transport is arranged. 

Where possible using personal transport is ideal particularly if families are self-isolating and can drive to an area we coordinate with them. This gesture will considerably alleviate pressure on our systems and would be appreciated it also helps maintain self-isolation. 

Outpatients:

We are minimising all outpatient encounters to essential and if necessary we can perform a video consultation easily (through an established provider but not currently authorised by the hospital Trust so we can’t promise this to all patients). 

Patients should be reassured that even if they were due to seen at a date in the next three months the renal team will be reviewing their records and results, and, if necessary, arranging for further tests away from the Tooting site such as the Nelson hospital in Merton, St Johns in Wandsworth or Queen Mary’s Hospital in Roehampton.

Next week our message will be we will only call you on the telephone for a consultation if necessary. Other reviews will occur virtually and we will write to the patient to communicate what we advise.

At present administrators are calling patients to provide updates, if anyone needs to speak to a doctor then it’s important they highlight this to the administrator.

If this fails then patients can call the consultant secretaries to leave a message.

Kidney transplantation:

We have suspended our live kidney donation program similar to other transplant units in London. The kidney transplant program however is still open to carrying out deceased donor transplants. This is however reviewed on a daily basis and we are guided by the NHS Blood and Transplant (NHSBT) and the British Transplant Society (BTS) our Renal and Transplant Team and the St George’s Hospital Directorate to enable us do what is best at each stage of this pandemic. Patients and families are being involved in the risk:benefit discussion and we are continually reviewing the pressure in critical care facilities to ensure safety is maintained for the aftercare before we proceed.

What can patients do?

Patients should try and ensure their mobile phone numbers are up to date on NHS systems. 

Please don’t ring the hospital to do this as this needs to be checked or altered on central NHS systems.  For those registered with online services with their GPs (this is not patient view), they can do this themselves. Where this is not available then they should contact their individual GP practices and update. During this crisis, these details will be used by the NHS to provide you with specific advice and guidance.

There are excellent resources from Kidney Care UK which people can access and I’d encourage everyone to do this and only call us if the answer is not available there.

The most important message for our kidney community is to follow the advice about social distancing and staying at home which we are hearing on our TVs. This will protect many.

The service will try and keep you informed and I know patients will appreciate how difficult this is as the situation is rapidly changing.

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Frequently Asked Questions

Renal Patients Shielding or Isolating

Isolating the most vulnerable means society working together to shield the most vulnerable

1. I have chronic kidney disease (CKD). Am I considered in the highest risk group of vulnerable people? Should I be self isolating or practising social distancing?
   CKD patients are consider to be amongst the 8m million vulnerable people in the UK population. Patients are strongly advised to follow the practise of social distancing and self isolating when required by the guidance.
    
2. I'm a Peritoneal dialysis (PD) or Haemodialysis(HD)). Am I considered in the highest risk group of vulnerable people? Should I be self-isolating or practicing social distancing?
   Dialysis patients are among the highest risk group of vulnerable people. They are strongly advised to self-isolate for 12 weeks from the 21st March. More guidance will be provided in the week beginning the 23rd March.
    
3. I'm a transplant patient. Am I considered in the highest risk group of vulnerable people? Should I be self-isolating or practicing social distancing?
   Transplant patients are among the highest risk group of vulnerable people. They are strongly advised to self-isolate for 12 weeks from the 21st March. More guidance will be provided in the week beginning the 23rd March.
    
4. What does self- isolation mean and what does it mean that I have to do?
   Self-isolation is where a person avoids contact with others as a result of contracting the virus or having been in contact with someone who has the virus. It also applies to where a vulnerable person isolates themselves from the community in their own home to avoid contracting the virus (shielding).
    
5. If I am self-isolating as I have been asked to, what does that mean for those I am living with? And what do I do if someone in my home is still going out to work and/or meeting other people?
   The government has produced guidance for households where either someone has the virus, self isolates because they have been in contact with someone who has the virus, or shares a home with someone who is vulnerable.
    
6. I am the relative of, caring for, or living with a vulnerable renal patient what should I be doing?
   The government has coined the phrase "shielding" to describe the activities you should undertake to protect the vulnerable person. Details can be found here:
   https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19
    

Appointments

1. I am on haemodialysis, should I still attend the hospital for dialysis? What number should I call if I need to make special arrangements before attending dialysis?
   Dialysis is a life-saving treatment. Under no circumstances should you stop dialysis unless as part of a conservative care plan agreed with the hospital. Those attending our dialysis clinics are likely to need to be flexible in the treatment sessions due to the need to reduce contact with those who are currently infected with the virus.  We’ve made dedicated areas for those who are isolating due to symptoms and separate areas for those who we know to be positive for the virus. 
   Dialysis patients can email dialysis@stgeorges.nhs.uk to get an automated service/information update. Please note the renal team will not have capacity to respond to emails from this address.
    
2. Are Peritoneal Dialysis (PD) appointments still going ahead?
   Appointments will go ahead for urgent care. For others, they may be replaced by a phone call. Speak to the PD team to get more information.
    
3. How will I know I will be safe attending St George's or a satellite centre?
   Patient safety is the renal care team's first priority. Additional cleaning is taking place on top of the usual regime. Where possible appointments will be by telephone or video call (virtual consultations). Where you need to attend the hospital the team will keep you separate from patients with the virus. The renal team has been using isolation procedures for patients with infectious diseases for many years. Patients isolating with symptoms or a positive test will be kept separate from other patients.
    
4. Can I speak to a doctor on the phone rather than come in for an appointment?
   The renal team are only conducting essential outpatient appointments and if necessary will perform a virtual consultation.
   Patients can be reassured that even if they were due to seen at a date in the next three months the renal team will be reviewing their records and results, and, if necessary, arranging for further tests away from the Tooting site such as the Nelson hospital in Merton, St Johns in Wandsworth or Queen Mary’s Hospital in Roehampton.
   Next week our message will be we will only call you on the telephone for a consultation if necessary. Other reviews will occur virtually and we will write to the patient to communicate what we advise. At present administrators are calling patients to update and if someone needs to speak to a doctor then it’s important they highlight this to the administrator. Patients can call the consultant secretaries to leave a message.
    
5. I am running out of medication what should I do?
   You should follow your normal procedure for this. Contact your GP for most medication. Where the medication is delivered by Alcura, contact them or the Home Delivery Team. Where the medication is prescribed by the renal consultant, contact the consultant's secretary.
    
6. I am running out of PD supplies can I come to the Courtyard to get some?
   Avoid coming to the hospital site wherever possible. You should contact Baxter for resupply. If the need is very urgent call the team by telephone first.
    

Illness

1. What do I do if I am self-isolating or have symptoms and I am due for dialysis or an out-patients appointment?
   You should let you dialysis team know immediately by phoning the number of your dialysis location : https://www.sgkpa.org.uk/main/hospital-contact-details
    
2. Can I use hospital transport if I have symptoms or have tested positive for the coronavirus?
   You should not take normal hospital transport in this case. Call your dialysis location phone number and they will arrange for dedicated transport.Once you have contacted the dialysis unit, where possible if families are self-isolating and can drive to an area where the dialysis team can coordinate with them. This will alleviate pressure on the hospital systems and would be appreciated. 
    
3. Should I be wearing a mask if I come to hospital and have symptoms or have tested positive for the coronavirus?
   The hospital does not encourage the use of masks for patients without the virus. However if you have symptoms or have tested positive, you may be asked to wear a mask.
    

Hospital preparations

1. How well is St George's coping with the Coronavirus and what specific measures does it have in place?
   With London as the epicentre of the UK coronovirus, pressure is significant on intensive care at the hospital and this is likely to increase over the coming weeks. St George's like other UK hospitals has been preparing to increase its readiness to receive an influx of coronavirus patients by increasing its training of staff and intensive care capacity. Please help them by following the guidance on this page and avoid coming to the hospital unless necessary as outlined on this page.
    
2. How can I avoid areas of the hospital where I might pick up the virus?
   The following information is available for patients visiting the hospital.
   https://www.stgeorges.nhs.uk/newsitem/coronavirus/
    
3. What specific measures are taking place for renal patients?
   Specific measures are outlined above in the appointments section and in the UPDATE1 section.
    
4. I want to visit a patient at the hospital. Is that possible?
   Yes but there are significant new restrictions as a result of the coronavirus epidemic, Visiting times have been restricted and the number of visitors per patient at a given time have been reduced. This is all in the bid to reduce the spread of the virus. See here for details:
   https://www.stgeorges.nhs.uk/newsitem/coronavirus/
    

General

1. Is there anything I can do to help?
   Very importantly we all need to work together to follow the government directives. As always you can donate to support the hospital. Additionally if you are not in the vulnerable categories you could consider volunteering even if it is just helping your neighbour. We will post here if there are specific roles or issues needing support.
    
2. What else should I be doing beyond the government advice?
   You should ensure that your contact details are up to date on the NHS systems (Via your GP). That includes your mobile, home and next of kin phone numbers, as well email address if you have one. For example, as of 24th March 2020,  at least 3 text messages had been sent to High Risk patient's mobile phones.
    
3. Are there any special support measures or financial help for kidney patients?
   The government has announced a raft of financial support which can be found here:
   https://www.gov.uk/coronavirus
   There is support for kidney patients that may be available here:
   https://www.sgkpa.org.uk/main/money-difficulties 
    
4. What is the difference between social distancing and self-isolation?
   Here is a BBC article explaining: https://www.bbc.co.uk/news/uk-51506729 
    
5. Where can I find more information?
   Please see the Key Information Sources below.
    

Please let us know if there are other questions you would like answered here. Email info@sgkpa.org.uk

 

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As we receive more information on changes at the hospital and nationally we will post it here and on Facebook.

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