Inpatient work includes:
- the treatment of AKI and CKD
- the investigation and management of fluid and electrolyte disorders
- the immunological and metabolic nature of kidney disease
- elective interventions and medical emergencies arising among patients on RRT.
This work also involves renal chemotherapy and monoclonal therapies, plasma exchange services, and investigative procedures in an inpatient setting.
Nephrologists usually have responsibilities in other hospitals, both in person and by provision of telephone advice.
Different models for providing inpatient care have developed according to local needs and the numbers of consultant renal physicians. In small units with two or fewer consultant renal physicians, consultants may provide continuing cover for all inpatient aspects of renal medicine. In larger units, individual consultants may provide continuing cover for subspecialty interests (eg transplantation and vasculitis) or may rotate cover for all inpatients, devoting time to other activities (eg research, management, teaching and audit) when not directly involved in inpatient care. The RCP’s working party report from 2007, The changing face of renal medicine in the UK: the future of the specialty recommended a minimum of four consultant renal physicians to make a renal unit autonomous for clinical care, including on-call commitments.
The RCP’s Joint Specialty Committee (JSC) for Renal Medicine has recommended that all patients admitted to a renal unit should be seen by a consultant within 24 hours and that all inpatients should be reviewed by a consultant at least twice a week. Consultant renal physicians should therefore visit the wards daily to see new admissions and new referrals from other specialties and should perform at least two full ward rounds each week. Most renal units already provide 7-day acute and emergency consultant-led services.