National Renal Care (NRC) offers the full range of renal services including chronic haemodialysis, peritoneal dialysis and acute dialysis. Established in 1995, NRC is the only private dialysis therapy provider in South Africa that has a national network of units in every major centre across the country, treating over 1500 chronic dialysis patients every month.

NRC is the only provider in South Africa that can offer a comprehensive dialysis centre network with over 45 chronic units and five specialist peritoneal dialysis units countrywide. More than 150 physicians and nephrologists refer patients to NRC.

National Renal Care services

NRC currently offers the following services:

• ­Are you at risk – A screening programme offered through the Healthy Start Clinic. A finger-prick blood test (similar to a glucose test) is used to measure a patient’s plasma creatinine and then calculate their kidney function (the MDR calculator is applied to calculate kidney function). Once this is determined, patients can be managed appropriately, based on the calculated results.
• Chronic haemodialysis – All NRC dialysis units offer bicarbonate dialysis, a range of biocompatible membranes with flexible dialysis shifts to meet the patient’s lifestyle. Quality is assured through adherence to national and international protocols as well as measurement of dialysis efficiency (KT/V). A comprehensive home haemodialysis programme is also available, including training and home visits. 
• Peritoneal dialysis – Both Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD) are offered. A complete home visit and delivery service is offered, including delivery of disposables locally and internationally. To ensure the most efficient peritoneal dialysis prescription is administered, all patients undergo annual Peritoneal Dialysis Equilibration Prescription tests (PET). 
• Acute dialysis – A comprehensive mobile acute dialysis service with staff on 24-hour call. The range of services includes haemodialysis, peritoneal dialysis, continuous therapies for unstable patients, plasma filtration therapy and blood exchange.

Healthy Start Clinic

Unique to NRC, The Healthy Start Clinic is a lifestyle management program for patients with end stage kidney disease and patients at risk of developing end stage renal disease. These patients include diabetics, patients with hypertension, and patients with a family history of kidney disease and patients with compromised kidney function.

 The Healthy Start Clinic’s primary aim is to help patients remain as healthy as possible while retaining a high quality of life. Preventative strategies include early detection and treatment, meticulous hypertension control, strict glycaemic control, anaemia management and appropriate dietary and lifestyle changes. Patient and family education, and psychosocial counselling plays a key role. Where dialysis is unavoidable the clinic helps to prepare patients for treatment and improve patient outcomes while reducing costs. Dialysis access is gained early to ensure optimum use and efficiency.

Value Added Services

NRC offers a range of additional services that add measurable value to patients:

• Nutritional guidelines – NRC has developed a training manual to educate dieticians and NRC staff countrywide on the nutritional needs of patients with kidney disease.
• Patient and family education – All patients treated by NRC and their family members are provided with information regarding kidney disease, treatment modalities and other pertinent details (such as nutrition and exercise to optimise health). 
• Patient support – NRC encourages and helps form support groups for patients and their families. Newsletters are distributed regularly by each of the NRC dialysis units, with news and articles of interest regarding kidney disease.

Our commitment to quality

NRC maintains the highest quality of medical care through various initiatives. These include:

• Dialysis adequacy testing – Dialysis adequacy tests are conducted every three months for haemodialysis patients and annually for peritoneal dialysis, with all costs borne by NRC.
  
  Patient survival has been shown to increase in association with a Kt/V (dialysis adequacy test) of up to 1.2. NRC’s average Kt/V is 1.21.
• Water quality testing – The quality of the water used is tested with the assistance of the South African Bureau of Standards for endotoxins, bacteria and chemistry.
• Adopting international quality guidelines – All NRC units operate under both international and locally accepted guidelines and procedures, using the US Dialysis Outcome Quality Initiative (DOQI) guidelines as a benchmark.
• These guidelines include an anaemia management programme and a nutritional management programme. Anaemia and nutritional management is an important predictor of patient survival. Guidelines recommend a target haemoglobin of 10-11g/dl for patients with chronic kidney disease. The average NRC haemoglobin is 10.6 g/dl. Guidelines for nutrition include a target albumin of 35g-40g/l. The average albumin of the NRC patient is 38g/l]
• Hepatitis screening – All staff and patients are screened for Hepatitis B, and then immunized to prevent the disease being contracted. 
  Dedicated Nurse programme – Each staff member is assigned to specific patients to ensure individualised patient care as well as to facilitate early detection of potential problems. To this end, clinical indicators are monitored closely and visits are used as an opportunity to continue patient education. 
• Satisfaction surveys – Patients, doctors and staff are encouraged to give feedback via the use of periodic surveys. Satisfaction survey forms are used to provide NRC with insight into any perceived or real problems and give NRC the opportunity to address issues as and when appropriate to do so. 
• A detailed patient database – NRC has developed and maintains a national database as a vital patient management tool. The database may be accessed via the Internet by funders and doctors, with information available at all times. Unique to NRC and a first within the South African renal healthcare market, this service provides funders in particular with quality indicators for benchmarking against international and local standards.
• Continuing Medical Education (CME) – NRC sponsors regular CME on Chronic Kidney Disease with a view to keeping the medical fraternity up to date with treatment trends in renal disease.
• Quarterly reports – These are compiled on each patient and submitted to their respective medical funders and doctors, supplying detailed information on the clinical indicators and patient outcomes. The reports include specific blood results, treatment modality and medication, as well as hospitalisation and transplant status.
• Research resources – NRC’s patient database and quarterly reports provide a powerful research resource, whether from an academic perspective or for clinical trials aimed at improving renal therapies. NRC has conducted and presented a number of research papers at the South African Nephrology congress in 2000, 2002 and 2004, with two papers being awarded best abstract submitted. NRC also presented at an international conference during 2005 (Tampa, Florida USA) and in San Francisco in February 2006. 
  Involvement with renal medicine associations – NRC maintains cordial relationships with renal medicine organisations in South Africa and abroad, using any opportunities that arise to improve the service offering to patients. 
• Patient forums – Patients are invited to attend annual forums held in the major centres around South Africa. These events provide a platform for sharing opinions, airing grievances and offering constructive criticisms.

Our staff

Every NRC dialysis unit boasts a representative mix of knowledge and skills, giving patients the benefit of comprehensive expertise. Additionally, acuity levels at NRC’s units are consistently higher than industry averages while the Name Nurse programme ensures dedicated attention is given to every patient.

Staff training and wellness

Ongoing training and skills development initiatives ensure that staff members remain abreast of current trends. An internal training programme, co-coordinated by a clinical division, is complemented by:

• Sponsoring six NRC nurses to participate in a renal nursing course at the University of Port Elizabeth each year.
• Providing practical training opportunities for third-year clinical/renal technology students at South African technicons. 
• In-service training on new equipment and techniques.
• Developing practice and patient management competencies. 
• Regular and refresher CPR training. 
• Encouraging staff to attend national and international conferences on renal disease and its management.
• Offering a staff wellness programme that caters primarily for their emotional, spiritual and mental wellbeing.

Supplier profile

NRC purchases consumables from a broad spectrum of suppliers. It is our policy to provide the doctors and patients with a variety of consumables to meet the patient dialysis prescription. NRC does not limit itself to the use of a single brand of disposables, and uses appropriate disposables to ensure optimal outcomes for patients.