Outcomes from the first dedicated diagnostic and interventional nephrology (DIN) service in a UK renal unit

Abstract

Background:  We report the clinical outcomes, operational and training model from the first diagnostic and interventional nephrology (DIN) department in a UK renal unit.  Methods: Patient outcomes were evaluated for an array of diagnostic and therapeutic interventional procedures performed at the DIN unit, SDIN (the Sunderland Diagnostic and Intervention Unit), within the first year of its establishment. Data was retrospectively collected for the period beginning 1st October 2019 to 1st October 2020 for patients who underwent the following procedures: ultrasound guided renal biopsy, Tunnelled Dialysis Catheter (TDC) insertion and exchange, Peritoneal Dialysis (PD) catheter insertion/exchange, and Areteriovenous Fistula (AVF) Point of Care Ultrasound (POCUS). These figures were compared to the cohort from the one-year period pre-SDIN, between the 1st October 2018 and 31st September 2019. All results are expressed as mean and percentages unless otherwise specified.  Results: Renal Biopsy: 104 biopsies were performed with an improvement in median waiting time from 12 to 7 days with 98.4% being diagnostic. Tunnelled Dialysis Catheters: 99 TDCs were inserted or exchanged with the catheters remaining in place for a mean duration of 156 days. We report an incidence of 2 infections per 1000 catheter days within the 90-day observation period. Peritoneal dialysis catheters: 16 PD catheters were inserted and they remained in place for an average of 153 days.  Eleven (69%) catheters had no complications within the 28-day observation period, 3 (19%) catheters required manipulation. AVF POCUS: 279 AVF POCUS scans were performed during the SDIN period. The waiting time from referral to scan was reduced from a mean of 35 days to 2 days.  Conclusions: A comprehensive DIN service leads to significant improvements in training, service and patient outcomes and would be an ideal model for wider adaptation across the UK renal units.