Cardiorenal
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The cardiorenal service at St Georges Hospital is an interdisciplinary service which includes members of both kidney and heart team providing care for complex, multi morbid, often elderly and frail patients with chronic kidney disease and heart disease.
The Chronic Kidney Disease Heart Failure Clinic
The chronic kidney disease (CKD) heart failure clinic is a part of the cardio renal service which was started in 2017. The clinic runs every Thursday afternoon in St George’s Hospital. In this multi-disciplinary clinic the patients with chronic kidney disease and heart failure are seen by a cardiologist and a nephrologist at the same time. The clinic reduces the number of hospital visits and reduces delay in initiation of therapy, which may happen due to conflicting advice from different hospital encounters.
The clinic aims to maximise medical and device therapy to improve patient outcomes by reducing hospitalisation and mortality, which is increased in heart failure patients with CKD. The initiation an up titration of many of the guideline directed heart failure medications in chronic kidney disease patients requires close monitoring; which the clinic provides.
The clinic works closely with the community heart failure nurses, renal and cardiac pharmacy teams. The clinic provides access to intravenous iron in CKD patients with heart failure which improves symptoms and quality of life.
The patients referred to this clinic suffer from heart failure and advanced CKD who are not on maximum guideline directed medical therapy. Patients can be referred from both primary as well as secondary care. The referral criteria, investigations required, aims of the clinic, discharge criteria can be viewed in the attached document.
The cardio renal metabolic MDT
The cardio renal metabolic multidisciplinary team will provide care for patients with chronic kidney disease, heart failure with diabetes or obesity. It is an NHS England supported project which will identify patients suffering from chronic kidney disease, heart failure with diabetes or obesity from the community and create a personalised care plan with medications, lifestyle interventions and monitoring; to be delivered by primary care providers.
The team members include Nephrologist, Cardiologist, Diabetologist, Specialist Nurse, Pharmacist and Primary Care Physician. The MDT will happen weekly and will cover selected primary care networks in the region to evaluate the efficacy. The referral criteria, investigations required, aims of the clinic, discharge criteria can be viewed in the attached document.
The inpatient care for chronic kidney patients with heart failure
Patients admitted with chronic kidney disease and heart failure suffer from higher inpatient mortality and longer length of stay. Treatment of such patients may be difficult and require higher doses of intravenous diuretics, combination diuretics which may cause electrolyte imbalances.
These patients are treated by a team including cardiologist and nephrologists who are aware of the challenges and implements carefully designed fluid removal and guideline directed medical therapy to facilitate early discharge and prevent rehospitalisation.
The team is skilled in identification of significant acute kidney injury, as opposed to rising creatinine due to diuretics and other therapy; and manage appropriately.
The team has the expertise to provide renal replacement therapy for these complex patients when appropriate and necessary.
