CURRICULUM VITAE
Richard James Fluck
CV Dr Richard Fluck 3rd August 2005
CURRICULUM VITAE
SURNAME:
Fluck
FORENAMES:
Richard James
SENIOR EDUCATION
Haberdashers' Aske's School, Elstree
UNIVERSITY EDUCATION
Trinity Hall, Cambridge
Sept. 1979 to June 1982
The London Hospital Medical College,
London University
Sept. 1982 to June 1985
MAJOR AWARDS
Entrance scholarship, Haberdashers' Aske's 1971
Open scholarship, Trinity Hall, Cambridge, 1979
Tripos scholarship, Trinity Hall, Cambridge, 1982
College prize (medicine), Trinity Hall,
SCHOOL QUALIFICATIONS
A levels Pure mathematics
Applied mathematics
Chemistry
Physics
DEGREES AND DIPLOMAS
B.A. (Cantab)
M.B.,B.S.(London)
M.A. (Cantab)
M.R.C.P. (UK)
FRCP
GMC Registration (full)
3069619
MPS
145476
CV Dr Richard Fluck 3rd August 2005
Grade A1
Grade A2
Grade A
Grade A
1st Class
1985
1986
1988
2000
1982
EMPLOYMENT
Current
21.10.96 to date
21.10.96 to date
01.11.04 to date
Consultant Physician with an interest in
Nephrology
Derby City General Hospital
01332-340131
Clinical Director, Renal Services
Service Director, Medicine
Other Appointments
01.04.04 to date
Previous
1.6.94 to 20.10.96
Renal Association Executive Member
Clinical Advisory Board Executive
Lecturer and Honorary Senior Registar
Department of Nephrology,
Royal Hospitals NHS Trust & Medical
Unit, London Hospital Medical College,
Whitechapel, London E1 1BB
Dr J Cunningham, Consultant Nephrologist
Dr F P Marsh, Consultant Nephrologist
Dr M J Raftery, Consultant Nephrologist
Dr L R I Baker, Consultant Nephrologist
Dr M Yaqoob, Consultant Nephrologist
Dr M J Hurst, Locum Consultant Nephrologist
Prof. R D Cohen, Professor of Medicine
Prof G A Hitman, Professor of Diabetology
Prof G M Besser, Professor of Endocrinology
Dr J Monson, Reader in Endocrinology
Research Fellow
and
Department of Nephrology, St Bartholomew's
Medical College, West Smithfield, EC1A 7BE
Honorary Registrar Department of Nephrology, St Bartholomew's
Hospital, West Smithfield, EC1A 7BE
01.01.90 - 31.5.94 Prof A.E.G Raine Consultant Nephrologist
Dr L.R.I Baker Consultant Nephrologist
Dr C.R.V Tomson Consultant Nephrologist
Dr M.J. Hurst Locum Consultant Nephrologist
01.01.93 - 31.12.94 British Heart Foundation Junior Fellow
Medical Registrar
Gastroenterology and General Medicine, The
Royal London Hospital, Whitechapel E1
01.09.89 -31.12.89
CV Dr Richard Fluck 3rd August 2005
Medical Registrar
Colchester District General Hospital
Senior House Officer
The Renal Unit, The Royal London
Hospital
Medical Unit, Mile End Hospital E1
Senior House Officer
Senior House Officer
Accident and Emergency, The Royal
London Hospital
House Physician
Herts and Essex Hospital, Bishops
Stortford
House Surgeon
Surgical Unit and Department of Urology
CV Dr Richard Fluck 3rd August 2005
Publications
1: Chesterton L, Lambie SH, Hulme LJ, Taal M, Fluck RJ, McIntyre CW.
Online measurement of haemoglobin concentration.
Nephrol Dial Transplant. 2005 Jul 5; [Epub ahead of print]
PMID: 15998655
2: Selby NM, Fonseca S, Hulme L, Fluck RJ, Taal MW, McIntyre CW.
Hypertonic glucose-based peritoneal dialysate is associated with higher
blood pressure and adverse haemodynamics as compared with icodextrin.
Nephrol Dial Transplant. 2005 Jun 21; [Epub ahead of print]
PMID: 15972319
3: Sigrist MK, Devlin L, Taal MW, Fluck RJ, McIntyre CW.
Length of interdialytic interval influences serum calcium and phosphorus
concentrations.
Nephrol Dial Transplant. 2005 Aug;20(8):1643-6. Epub 2005 May 3.
PMID: 15870223
4: Lambie SH, Taal MW, Fluck RJ, McIntyre CW.
Online conductivity monitoring: validation and usefulness in a clinical trial
of reduced dialysate conductivity.
ASAIO J. 2005 Jan-Feb;51(1):70-6.
PMID: 15745138
5: Lambie SH, Hulme LJ, Taal M, Fluck RJ, McIntyre CW.
Prospective study of gentamicin locking of tunnelled dialysis catheters: the
effect on infection rates and CRP.
Kidney Int. 2005 Jan;67(1):378.
PMID: 15610271
6: McIntyre CW, Hulme LJ, Taal M, Fluck RJ.
Locking of tunneled hemodialysis catheters with gentamicin and heparin.
Kidney Int. 2004 Aug;66(2):801-5.
PMID: 15253736
7: Lambie SH, Taal MW, Fluck RJ, McIntyre CW.
Analysis of factors associated with variability in haemodialysis adequacy.
Nephrol Dial Transplant. 2004 Feb;19(2):406-12.
PMID: 14736966
8: Marshall J, Jennings P, Scott A, Fluck RJ, McIntyre CW.
Glycemic control in diabetic CAPD patients assessed by continuous glucose
monitoring system (CGMS).
Kidney Int. 2003 Oct;64(4):1480-6.
PMID: 12969169
CV Dr Richard Fluck 3rd August 2005
9: McIntyre CW, Lambie SH, Fluck RJ.
Biofeedback controlled hemodialysis (BF-HD) reduces symptoms and
increases both hemodynamic tolerability and dialysis adequacy in nonhypotension prone stable
patients.
Clin Nephrol. 2003 Aug;60(2):105-12.
PMID: 12940612
10: McIntyre CW, Lambie SH, Taal MW, Fluck RJ.
Assessment of haemodialysis adequacy by ionic dialysance: intra-patient
variability of delivered treatment.
Nephrol Dial Transplant. 2003 Mar;18(3):559-63.
PMID: 12584279
11: McIntyre CW, Taal MW, Fluck RJ, Hinwood D.
Adherence of tunnelled haemodialysis catheter to superior vena caval stent:
successful percutaneous removal.
Nephrol Dial Transplant. 2003 Feb;18(2):432-3.
PMID: 12543904]
12: Taylor GS, Patel V, Spencer S, Fluck RJ, McIntyre CW.
Long-term use of 1.1% amino acid dialysis solution in hypoalbuminemic
continuous ambulatory peritoneal dialysis patients.
Clin Nephrol. 2002 Dec;58(6):445-50.
PMID: 12508967
13: McIntyre CW, Fluck RJ, Freeman JG, Lambie SH.
Characterization of treatment dose delivered by albumin dialysis in the
treatment of acute renal failure associated with severe hepatic dysfunction.
Clin Nephrol. 2002 Nov;58(5):376-83.
PMID: 12425489
14: McIntyre CW, Patel V, Taylor GS, Fluck RJ.
A prospective study of combination therapy for hyperphosphataemia with
calcium-containing phosphate binders and sevelamer in hypercalcaemic
haemodialysis patients.
Nephrol Dial Transplant. 2002 Sep;17(9):1643-8.
PMID: 12198217
15: McIntyre CW, Fluck RJ.
Simultaneous non-surgical removal and insertion of peritoneal dialysis
catheters for defective drainage: a bedside, day case technique.
Clin Nephrol. 2002 Jun;57(6):462-7.
PMID: 12078951
16: McIntyre CW, Fluck RJ, Freeman JG, Lambie SH.
Use of albumin dialysis in the treatment of hepatic and renal dysfunction due
to paracetamol intoxication.
Nephrol Dial Transplant. 2002 Feb;17(2):316-7.
PMID: 11812892
CV Dr Richard Fluck 3rd August 2005
17: McIntyre CW, Fluck RJ, Lambie SH.
Steroid and cyclophosphamide therapy for IgA nephropathy associated with
crescenteric change: an effective treatment.
Clin Nephrol. 2001 Sep;56(3):193-8.
PMID: 11597033
18: Wood H, McCarthy G, Fluck R, Bayston R.
Shunt nephritis: fortuitous diagnosis and confirmation by serology (ASET).
Eur J Pediatr Surg. 1998 Dec;8 Suppl 1:66-7.
PMID: 9926336
19: Hoque S, Weir A, Fluck R, Cunningham J.
Rhodococcus equi in CAPD-associated peritonitis treated with azithromycin.
Nephrol Dial Transplant. 1996 Nov;11(11):2340-1.
PMID: 8941608
20: Strivens E, Siddiqi A, Fluck R, Hutton A, Bell D.
Hyperkalaemic cardiac arrest. May occur secondary to misuse of diuretics
and potassium supplements.
BMJ. 1996 Sep 14;313(7058):693.
PMID: 8811786
21: McMahon AC, Vescovo G, Dalla Libera L, Wynne DG, Fluck RJ, Harding
SE, Raine AE.
Contractile dysfunction of isolated ventricular myocytes in experimental
uraemia.
Exp Nephrol. 1996 May-Jun;4(3):144-50.
PMID: 8773476
22: Lamb EJ, Fluck RJ, Venton TR, Woodhead JS, Raine AE, Dawnay AB.
Effects of parathyroid hormone and 1,25(OH2)D3 on protein glycation in
moderate
uraemia.
Nephron. 1996;74(2):295-300.
PMID: 8893144
23: Roger SD, Fluck RJ, McMahon AC, Raine AE.
Recombinant erythropoietin increases blood pressure in experimental
hypertension and uraemia without change in vascular cytosolic calcium.
Nephron. 1996;73(2):212-8.
PMID: 8773347
24: Barker S, Kapas S, Fluck RJ, Clark AJ.
Effects of the selective protein kinase C inhibitor Ro 31-7549 on human
angiotensin II receptor desensitisation and intracellular calcium release.
FEBS Lett. 1995 Aug 7;369(2-3):263-6.
PMID: 7649269
25: Fluck RJ, Raine AE.
CV Dr Richard Fluck 3rd August 2005
ACE inhibitors in non-diabetic renal disease.
Br Heart J. 1994 Sep;72(3 Suppl):S46-51. Review.
PMID: 7946803
26: Fluck RJ, Roger SD, McMahon AC, Raine AE.
Modulation of platelet cytosolic calcium during erythropoietin therapy in
uraemia.
Nephrol Dial Transplant. 1994;9(8):1109-14.
PMID: 7800209
27: Fluck RJ, McMahon AC, Alameddine FM, Dawnay AB, Baker LR, Raine
AE.
Platelet cytosolic free calcium concentration and parathyroid hormone:
changing relationships with haemodialysis in end-stage renal disease.
Clin Sci (Lond). 1992 Jun;82(6):651-8.
PMID: 1320545
In press
Use of on-line conductivity monitoring to study sodium flux in chronic
haemodialysis patients: prospects for treatment individualisation.
CW McIntyre, SH Lambie, RJ Fluck. In press Nephron 2005
Under review/ revision
Acetate-free double chamber haemodiafiltration (PHF) is associated with
improved systemic haemodynamics and lower troponin-T levels as compared
with standard dialysis
NM Selby, RJ Fluck, MW Taal, CW McIntyre. Submitted ASAIO J 2005.
Blood pressure lowering remains an important determinant of proteinuria
during renin and angiotensin system inhibition in CKD patients
MW Taal, L Hulme, RJ Fluck, CW McIntyre. Submitted Nephrol Dialysis
Transplant 2005
An Unusual Case of Renovascular hypertension- Renal Artery Stenosis of a
Pelvic Kidney with Aberrant Blood Supply. Priestman W, Taal MW, McIntyre
CW. Submitted Nephrol Dialysis Transplant 2005.
On-line monitoring of Kt/V to continuously modify haemodialysis treatment
times allows effective and consistent delivery of adequate dialysis
Chesterton LJ, Lambie SH, Taal MW, Fluck RJ, McIntyre CW. Submitted Clin
Nephrol 2005
Plus 54 published abstracts since 2000
CV Dr Richard Fluck 3rd August 2005
GENERAL INFORMATION
Current posts
I have been consultant renal physician in Derby since 1996. When appointed I
worked single handed for 3 years before Dr McIntyre joined me, and more
recently Dr Taal. Despite working single handed for a prolonged period of
time, I set about developing all aspects of nephrology within Derby, looking at
service delivery, planning, education, teaching and training and research.
With the support of my colleagues in the MDT, Derby now has an excellent
record in clinical standards, education and research. The number of patients
on dialysis has over doubled, standards of care continue to rise and the
service receives referrals from a wide area, covering a catchment population
of 750,000+. Since 1999 the staff have produced over 40 peer reviewed
publications, nearly 100 abstracts and attracted large amounts of research
funding.
In training, the unit has also progressed and offers a high quality education for
both PRHO, SHO and SpR grades. A significant proportion of the SHOs who
are attached to the unit have moved into Renal training programmes (5 in the
last 2.5 years), reflecting the high quality support, teaching and inspiration
they receive. From 1 SpR post in the department, there are now 2 in post. The
SAC have indicated that the training at Derby is exceptional and that they
consider the Department suitable to receive approval for a 3 rd number. There
are also 3 Research Fellows in the department, plus one Research Dietician.
I have taught and lectured to all grades of medical staff on aspects of renal
and acute medicine. I have also spoken on several national courses for
Nursing and Medical staff, receiving very high feedback. In the last year I
have twice spoken to the Renal SpR club, again with very good feedback, the
last occasion being on leadership development.
For the last three years I have been service director for medicine. I have
applied my organizational and communication skills to this very difficult role.
Major projects have included Emergency Care Reform (Project Lead,
Trustwide), EWTD (Directorate), undergraduate teaching programme
(Strategy document for Directorate), plus the usual plethora of smaller
CV Dr Richard Fluck 3rd August 2005
projects, clinical governance issues and service planning across a wide
spectrum of services.
A new involvement has been the PBL course at Derby. The Renal department
has been given an entire block to teach on, of which I gave 3 of the 13
lectures. We have repeated this course just this year. Feedback again was
excellent – the overall course organizer said that they had 90 people wanting
to be Nephrologists after year 1, and the second time around many of the
students were surprised that a) all the clinicians seemed to get on together
and b) our lectures seemed to be coordinated!
In the last 18 months I have been elected onto the Renal Association, and sit
on the Clinical Advisory Board. As part of that I have designed and led an
audit of vascular access in all renal units in the United Kingdom. I have been
a programme organizer for the British Renal Society’s Annual Conference in
2005 and 2006 and am involved in the production of Criteria for Success.
In summary, I feel that I would bring my excellent organisational,
communication and teaching skills to this important role. The challenges are
to recruit people into nephrology training numbers, to educate them so that we
produce high quality clinicians and inspire them by example and opportunity.
Previous posts
Prior to Derby I was honorary senior registrar and lecturer to the
medical unit and the renal unit, within the Royals NHS trust and Queen Mary
Westfield College, London. My time was divided between the medical unit,
covering acute general medicine, with interests in diabetes and metabolic
disease, and the department of nephrology.
The senior registrar was responsible for the day to day ward
management, with a team that includes 1 registrar, 3 SHOs and 2 HO grade
staff. We performed 5-10 native and transplant renal biopsies, 2-3
percutaneous tenckhoff insertions and 3-4 permcath insertions per week,
using our own access to radiology support. In this post, I established the
percutaneous insertion techniques utilized for permcaths and tenckhoff
catheters, training all registrars to perform these procedures. In addition, I
trained all junior staff in temporary access procedures via femoral, jugular or
subclavian routes. The second post covered transplantation and access
CV Dr Richard Fluck 3rd August 2005
surgery. This team consists of 1 registrar or senior registrar, 1 SHO and 1 HO.
The consultant cover consists of 1 nephrologist and 1 transplant surgeon.
Again, all renal transplant biopsies were performed on the ward, by the
registrar. Finally, the Smithfield site registrar covered all aspects of the
program on that site, together with providing ITU and other specialities with
renal advice and support.
My renal research interests included the myopathy of renal failure and
disorders of cellular calcium control in uraemia, continuing my research
started at St Bartholomew's Hospital. I had access to the well equipped
laboratories at St. Bartholomew's, in the Renal Research Laboratories. In
particular, the labs have equipment to measure intracellular calcium in both
single cells and pooled cell suspension, the techniques for which I was in part
responsible for establishing at the Renal Research Laboratory.
Finally I was also involved in teaching medical students, ENB renal and
ITU nursing courses and ward nursing staff, in both informal and formal
settings. Since the merger, the academic side, in terms of seminars, has
lapsed, but there are plans to establish an academic half day, covering
seminars, outside speakers, case presentations, radiology and pathology
reviews. I sat on the Renal Directorate as junior doctor representative, and
designed the current junior doctor rota through the renal directorate.
The renal component alternates at 4 monthly intervals with a general
medical component. When on the Medical Unit, I worked as the day to day
organiser for a medical team, consisting of 2 HO and 1 SHO grade staff. This
firm covered the medical unit, whose consultants had interests in diabetes,
endocrinology and metabolic disease.
Previously, I worked in the Department of Nephrology and the Renal
Research Laboratory, St. Bartholomew's Hospital, carrying out research under
the supervision of Professor A.E.G Raine, to take the MD examination.
The laboratory work centred on the study of the effects of uraemia on
cellular calcium control, in a variety of cell types. The project involved the
establishment of the methodology for cytosolic calcium measurement in cell
suspensions, using Fura-2, and the use of experimental models of acute and
chronic uraemia. Currently, cellular calcium responses to a variety of agonists
can be measured in platelets, aortic vascular smooth muscle cells and cardiac
myocytes. In addition, we have recently acquired the equipment to measure
single cell intracellular calcium, with the simultaneous monitoring of cell
contractility.
CV Dr Richard Fluck 3rd August 2005
The project has three broad areas of interest. First, the effects of
secondary hyperparathyroidism and its therapy, on cellular calcium overload
and impaired cell calcium control, in moderate renal failure are being
investigated. Second, the impact of uraemia on myocardial function and the
relevance of cellular calcium homeostasis to cardiac dysfunction is being
assessed. This has involved studies in patients, with echocardiographic
assessment of left ventricular diastolic function and measurement of platelet
cytosolic calcium, and experimental models, utilising cardiac myocytes ( in
collaboration with Ms. A.C. McMahon). The third area is the relevance of
changes in platelet, vascular and cardiac cytosolic calcium to EPO associated
complications ( in collaboration with Dr. S.D.Roger).
This post also involved me in clinical duties within the Renal Unit.
These consisted of outpatient clinic sessions ( general nephrology, dialysis
follow-up and transplantation) and registrar level on call commitments (1:4
with prospective cover). These involved me in the full range of renal services
including the management of acute and chronic renal failure, transplantation
and general nephrology.
My prior general medical registrar experience has been at the London
Hospital, Whitechapel and Colchester District General Hospital. At the
London, as the gastroenterology and general medical registrar, clinical duties
involved general medical take and cover for emergency endoscopy, two upper
GI endoscopy sessions per week, two outpatient clinics (medicine and
gastroenterology) and supervision of two house officers. At Colchester District
General Hospital I was the medical registrar for four medical firms, covering
general medicine, gastroenterology, diabetes, cardiology and haematology,
supervising the work of four senior house officers, four house officers, and
covering 60 general medical beds ( including a 6 bed CCU and 6 bed HDU),
30 geriatric beds and providing medical supervision for an 8 bed ITU. The on
call commitment also covered medical cover for 3 other hospitals in the town.
During this time, I was trained in upper GI endoscopy, became proficient at
various techniques such as central and arterial lines, pleural and liver
biopsies, peritoneal dialysis, emergency therapy of upper GI bleeding,
temporary cardiac pacing and learnt the rudiments of assisted ventilation.
Again I had an active teaching role, a busy OP schedule and sat on the
Medical Division and District Drug and Therapeutics committees, for whom I
carried out an audit of cardiopulmonary resuscitation.
CV Dr Richard Fluck 3rd August 2005
As an SHO I gained general experience in the management of patients
in casualty, general and renal medicine, together with basic invasive
techniques.
CV Dr Richard Fluck 3rd August 2005