Leading research at the Lister helps keep renal patients dialysing well – a patient’s story

David Robinson, a 67 year old retired butcher who has lived and worked in Bedford all of his life, saw things change for him significantly in the summer of 2015. That is when he was referred by his local diabetes team to the renal service at the Lister hospital in Stevenage.

They discovered that his underlying medical conditions – diabetes and cardiac disease – had led him to experience progressive renal failure, which if left untreated would have threatened his life. In preparation for David to move on to haemodialysis, the Trust’s vascular surgery team created what is called an arterio-venous fistula – a connection between an artery and vein – in his left upper arm to allow his veins to develop so that the needles necessary to support long-term dialysis could be inserted.

Whilst under the care of the renal team, David was admitted to the Lister with a severe chest infection that turned out to be pneumonia. During this two-week stay in hospital, it became clear to his doctors that he needed to move on to dialysis quickly.

David takes up the story:

“I’ve had diabetes for a while now and generally speaking I’ve managed to do okay and lead as normal a life as possible. But back in 2013 I began to get swelling, particularly in my right leg. On one occasion when I was admitted to my local hospital here in Bedford, 13 litres of fluid was drained off.

“I felt okay at the time, but my leg continued to swell and I had to wear surgical stockings to help with that. There was also no apparent reason why the swelling was happening. But after a while, my diabetes team began to worry that it could be linked to kidney disease and they referred me to the Lister, where I was reviewed by one of its consultants.

“It was then that I discovered that despite feeling fine, my kidneys were not working. In fact I had what was called progressive kidney disease, which meant that unless something was done about that, the condition would just get worse and could threaten my life.

“The recommended treatment was dialysis and I opted for haemodialysis, which involves removing excess fluid, salt and wastes from the blood – effectively doing the job done by my kidneys. I had the procedure done to have a fistula created in my arm, but events overtook me when I was admitted to hospital in April 2016 with pneumonia.

“It took two weeks to recover from that and the renal team told me that I needed to start on haemodialysis right away.”

Whilst fistulas are the most effective means of supporting high quality haemodialysis, they can suffer problems – such as blood clots linked to a narrowing of the vein being used. Left untreated, the quality of dialysis reduces and the fistula can become unusable.

Spotting problems and addressing them early ensures that the fistula continues to be used and the patient experiences good quality dialysis. At the Lister, the renal team works with interventional radiologists to treat fistulas that have become compromised.

Narrowing of the vein – which is called a stenosis – is now treated using a technique called a fistuloplasty or venoplasty. During the procedure, the patient has a local anaesthetic to numb the area and sedation, if required. A small tube called a sheath, which is around 2mm wide, is guided into the fistula. Guide wires are then used to insert a catheter with a special deflated balloon in to the tube, which is then inflated to expand the narrowed segment of vein.

More recently, the Lister-based team has been using a special drug-eluting balloon, which works by inhibiting the growth of cells in one layer of the vein, which leads to narrowing. This approach means that the treatment is likely to last longer, ensuring that patients experience better quality dialysis and longer intervals between such procedures needing to be carried out.

Reflecting on his experiences since April 2016, when he first started dialysing, David continued:

“I attend the Bedford renal dialysis unit three times a week and have done so for over 18 months now. In that time, my fistula has had problems on three occasions – most recently in July of this year. Although I have to go to the Lister, it’s a simple, painless procedure that I know keeps my dialysis on track.

“The team at the local renal unit and their colleagues at the Lister have done a great job looking after me and although dialysis takes up a large chunk of the day – I’m on the machines for four hours every visit – I continue to try and lead as normal a life as possible. The next step will be to have a conversation with the team about whether or not I am suitable to go on the transplant list – but for now, I’m concentrating on keeping well and enjoying family life!”

Find out more about this research.