NDT Plus Advance Access originally published online on August 11, 2008
NDT Plus 2008 1(5):285; doi:10.1093/ndtplus/sfn132
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Life at the UK renal registry—an unforgettable experience
1st Department of Medicine, University of Debrecen Medical School, Debrecen, Hungary
Correspondence: Correspondence and offprint requests to: Dr Thomas Ben, 1st Department of Medicine, University of Debrecen Medical School, Pf. 19, 4012 Debrecen, Hungary. Tel: +36-52-413653; Fax: +36-52-413653; E-mail: tben{at}internal.med.unideb.hu
Received for publication July 20, 2008. Accepted for publication July 23, 2008.
On 21 June 2007, at the ERA-EDTA Conference in Barcelona, I was one of nine candidates to win a short-term fellowship to visit the UK Renal Association Renal Registry (UKRR) at the Southmead Hospital, Bristol, UK. My successful application had been designed around three aims: to gain an understanding of how the UKRR worked and explore what lessons there might be for the Hungarian Renal Registry, to obtain experience in undertaking analyses with registry data so that quality analyses of existing Hungarian Renal Registry data may be performed, and to observe how a peritoneal dialysis programme can be organized and consider how such a programme might be introduced to my renal unit in Debrecen, Hungary.
The UKRR started with a pilot of seven renal units and has expanded over 10 years to cover all UK renal units. Over those 10 years, registry data have played a major role in building the ‘business cases’ for the expansion of renal units when funding has had to be sought from commissioners. The planning of renal services in Hungary would also benefit from having such epidemiological data available. Before this can happen, however, there needs to be an improvement in renal information technology (IT) systems; gaining an understanding of the IT systems already in use in renal units in Hungary will be the first step. Hopefully we too will ultimately be in a position to publish centre performance data with each centre clearly identified.
Throughout my 3 months in Bristol, I worked hard to maximize my training by working closely with the PD team. PD is less common in Hungary than in the UK as doctors gain little experience with it during their training. Socioeconomic problems do not help, and there is no patient education team, psychologist or renal dieticians. Indeed the multidisciplinary team model of health care provision in the UK was one of the biggest lessons for me during my stay; the nurse-led patient education team advised patients on RRT before dialysis and the majority of dialysis lines (tunnelled and non-tunnelled) are inserted by one highly trained nurse with a noticeable improvement in infection rates. Clear guidelines in the UK have empowered nurses who do not need a doctor's approval in order to perform simple tasks—a world away from the way things happen in Hungary.
All in all, my short-term fellowship was a wonderful learning experience and I have returned to Hungary full of ideas and enthusiasm. As I finish writing up the analysis commenced in Bristol, I am hopeful that our renal units can continue to build on these links into the future.
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I would like to thank all the staff at the UK Renal Registry in Bristol for their help and support and in particular Dr Charlie Tomson, Dr David Ansell and Dr Fergus Caskey and also Professor Alison MacLeod of the Department of Medicine and Therapeutics, University of Aberdeen.
Conflict of interest statement. None declared.
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