A pilot weight loss clinic, set up to support renal patients in getting onto the kidney transplant list, has been funded by Nottingham Hospitals Charity.
Every renal patient is different. Individuals may have a different medical conditions, requiring different treatment and dialysis options.
For those who are deemed suitable for a transplant, a last hurdle before going onto the kidney transplant list can be weight, as patients need to have a Body Mass Index (BMI) of under 35. However, this can be very difficult to achieve, due to many of the symptoms associated with renal conditions.
Patients with kidney disease already have numerous dietary restrictions, and so ordinarily healthy foods that you might choose if you were dieting, such as fruit and vegetables, can be restricted too. Fluid can also be restricted – which means that for patients who feel particularly thirsty, eating can be the ‘next best thing’, which can then have a knock on impact on weight. This is without the additional challenges of limited mobility, shortness of breath and dialysis time that can impact on weight.
Bruno Mafrici, a Clinical Specialist Renal dietitian at Nottingham University Hospitals NHS Trust, recognised that within the department, there was a gap in tailored support, and that these patients were really struggling to reach a weight goal, but would otherwise be great candidates for a transplant.
The team knew that an individual approach would be required to support these patients, but it would be difficult to find within the existing team capacity. So in 2022, Bruno applied for a £111,000 grant from Nottingham Hospitals Charity, to fund a year-long pilot clinic to specifically support patients who would benefit from a bespoke weight management programme.
In the weight loss clinic
First, a patient is assessed face to face, whereby the team will help find the best suitable step forward, whether that’s individual support or group work, or a mixture of the two.
The clinic is led by a multidisciplinary team, comprising of a dietitian, physiotherapist and psychologists, as well as the renal consultants and clinicians supporting the patients throughout their treatment.
Success so far
The clinic has led to a clear improvement in patient outcomes, including one patient who has successfully had a kidney transplant having been supported by the clinic, and two additional patients who are now on the list. As a whole, around 60% of patients taking part in the project have lost weight – and for those who have not, the team has identified factors which have contributed to this.
Around 50 patients have been referred to date, which equates to around 10% of total patients on the renal unit.
“You have to go through a lot to make sure diet is right as a renal patient day-to-day, but also you’re trying to lose weight to get on the transplant list – it can be quite a challenge. Having support like this is absolutely fantastic. It’s that extra help, for the final challenge to get on the transplant list. The team have really helped me get there."
Greg Stretton, Lead Physio in Respiratory Medicine (pictured second from right), has been involved in the project. He said:
“For renal patients, this is a chance to have a life changing operation which will lead to a significantly better quality of life. But to get there - losing weight and maintaining weight loss is not easy for anybody. If you are a person with kidney disease this presents additional challenges which can make it even harder.
“Standard weight loss programmes available on the NHS and in the community do not meet the needs of these complex patients, so being able to run this clinic has been a brilliant step in the right direction. A lot more patients would benefit from it – if we can get more funding, that would help even more patients get on the transplant list.”
Saving the NHS money
Patients needing dialysis treatment come into hospital between 3-4 times a week, and so transplantation is not only beneficial for the individual patient but also represents value to the greater health economy. The first year of care after a kidney transplant costs around £17,000 and £5,000 for every subsequent year; whereas the average cost of dialysis is £30,800.This means than for every patient that will receive a kidney transplant from the project will lead to an average cost saving of £13,800 for the first year and £25,800 for every subsequent year.
Mental health support for patients
Clinicians behind the programme recognise that there is a lot of stigma about being overweight, which adds to the mental and physical needs of people with kidney disease. Up to a third of patients experience depression and anxiety and prior to this project, did not have the peer support to deal with these mental health challenges.Staff also acknowledged it can be quite lonely when losing weight, and as such a group setting of between 7-8 other patients can help. For patients to be among other individuals who are going through the same thing, it allows them to talk about their experiences, support each other and find motivation to take the next steps forward.
Greg continued:
“Fear can also be a big factor in their treatment. Lots of people have a health condition but may be frightened about treatment or transplant – and if you are scared then are you motivated to get to that point where you are able to have a transplant?
“Mental health support has been a big factor in this project. We’ve been supporting people with their battle with their physical health, but we hope people feel like someone really cared and listened to their story. They are all individually much more than just a renal patient.”