Testing for chronic kidney disease when any associated risk factors are present should be part of an annual health check. General practitioners will promote this and offer timely specialist referral to a nephrologist for ongoing and collaborative management of individuals identified with kidney disease. The timing of a referral for these patients to a nephrologist may have an impact on the timing of dialysis initiation. Referral currently occurs at various stages of kidney disease. An early referral allows the opportunity for a specialist to assess the rate of disease progression, exclude any reversible causes and allow for adequate dialysis planning to optimise patient outcomes. With late stage chronic kidney disease, the decision of when to initiate dialysis therapy is multifactorial. There is a large variability in the timing due to nonspecific and vague symptoms of uraemia (urine in blood) and the speed of kidney decline. Dialysis should be considered when the benefit from relieving these symptoms outweighs the risks and their associated effect on quality of life. Preparation for dialysis is integrated into patient care in the late stages of chronic kidney disease. Ideally, the decision to start dialysis is made after careful consideration for kidney transplant, a chosen dialysis modality and once a functioning access has been created. Various international guidelines assist with the approach and timing of dialysis initiation. Some guidelines recommend dialysis to commence once symptomatic with GFR between 5-10, others recommend to initiate when GFR is over 15 or to initiate just with the presence of uraemic symptoms irrespective of kidney function level. The Initiating Dialysis Early and Late (IDEAL) study which examined mortality related to the timing of dialysis initiation found no difference in survival between early or late initiation of dialysis. The IDEAL study did reflect that the majority of patients had displayed symptoms of uraemia at or below GFR 10 so timely dialysis initiation from this point more likely. Haemodialysis is the predominant dialysis modality for renal replacement therapy. It is simply a process of purifying the blood using an artificial filter. A range of filters and dialysis fluid is used to meet the specific requirements of dialysis and individual patient needs. The other two forms of renal replacement therapies are peritoneal dialysis and kidney transplant. The haemodialysis clinic at Pindara Private Hospital offers treatments that are managed by nephrologists, specialised nurses and technicians. The most advanced dialysis equipment is used to ensure safety and comfort during dialysis. Holiday dialysis is also available for Australian and overseas tourists. Health promotion is the main objective of kidney disease. Careful management of declining kidney function and effective dialysis, once required, allows for improved quality of life and the best outcomes for individuals. The therapeutic environment is improved through better communication, positive attitudes, and more active participation of patients in care. With optimal health as the focus and effective communication between healthcare workers, the delivery of quality care will be optimised to offer the best possible outcomes for individuals with chronic kidney disease. pindaramagazine.com.au Pindara Magazine 39
Pindara Private Hospital Magazine - Issue Ten
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