Friday, January 9, 2015

KIDNEY DISEASE - WHAT ARE MY TREATMENT OPTIONS?

Sometimes kidney diseases lead to kidney failure which requires dialysis or a kidney transplant to keep you alive when the kidneys have stopped working. Dialysis removes waste products from the blood when the kidneys fail.
Kidney failure occurs in two ways:
Acute Kidney Failure
Sudden drop in kidney function, often short-lived, but can occasionally lead to lasting kidney damage.

Chronic Kidney Disease
More often kidney function worsens over a number of years.
Good news: if kidney disease is found early, medication, dietary and lifestyle changes can increase the life of your kidneys and keep you feeling good for as long as possible.

When you have been diagnosed with Chronic Kidney Disease (CKD) you have lost over one-third of your kidney function. This loss of function has persisted for over three months. It is long-term permanent damage to the kidneys.

Signs and symptoms usually start when the kidneys are working below 40%. Once they are working below 10%, dialysis or a transplant is needed to stay alive.
Living With Reduced Kidney Function
Many factors affect the progress of kidney failure - these are not completely understood. If you have kidney disease it is important to follow your health team's advice to slow down its progress. Refer to our LWRKF handbook to help your kidneys stay stronger, for longer and perhaps delay the need for dialysis.

Appropriate management of Chronic Kidney Disease can help to prevent or delay the progression of the illness to its end stages, when dialysis or transplantation is required to sustain life. Effective management of CKD can also help to control symptoms or side effects, such as high blood pressure, loss of appetite, nausea, tiredness and swelling of the hands, face and feet.

Management of CKD should be done in conjunction with your general practitioner, kidney specialist (if applicable) and allied health team. Management of CKD often involves addressing factors related to nutrition, fitness, medication and mind/spirit. It can also impact on sexuality.

Treatment is a Choice
Learning about kidney failure treatments is an important part of deciding which treatment choice is best for you. Hospitals offer education sessions that give you and your family time to ask questions and talk to others. Some people feel they have to start or continue any treatment offered to them.

Decisions about your body are your responsibility
Your health team can provide the best guidance but you’re the one in control. It is important to get to know your health team and build a strong relationship. Open communication about your physical and emotional health, as well as lifestyle needs, can help you get the most out of your treatment.
Treatment options for Kidney Failure
  • Dialysis - removes waste and extra fluid from the blood
  • Transplantation - If you start dialysis you will also be assessed for your suitability for transplantation. Health issues may prevent this option.
  • Conservative or Supportive Care - If you decide that dialysis or transplant is not for you, then your health-care team will support you to stay as healthy as possible without dialysis. Your life-span however will be limited.

TREATMENT - DIALYSIS
What does dialysis do? 
Dialysis helps to maintain your body’s balance by removing waste and extra fluid from the blood, keeping the blood’s chemical balance at a safe level and assisting with blood pressure control. Dialysis is a useful and important treatment.
  • Haemodialysis
    Uses a machine acting as an artificial kidney cleans the blood. Requires good access to your bloodstream, which may be an issue if you have diabetes. If you have heart problems, changes in blood pressure and waste levels associated with haemodialysis can cause problems.
  • Peritoneal Dialysis
    Allows the blood to be cleaned inside the body and is usually done at home. PD may not be possible if you’ve had major abdominal surgery causing scarring. It may also be difficult to obtain the right amount of dialysis with PD if you are tall and muscular, or overweight.
 WHERE CAN I DO MY DIALYSIS
- WHAT ARE MY OPTIONS?

You can choose one of two locations to have your dialysis - Home-based Dialysis or Unit-based Dialysis.
Home Dialysis
If you choose to dialyse at home you are trained to manage your own dialysis. There are two forms of Home Dialysis.
  • Home Haemodialysis
    Special plumbing is installed in your house and the quality of the water supply is tested. If needed, a friend, carer or partner can be trained to assist. You can choose to dialyse day or night. Go to our new dedicated Home Dialysis website for more information.

  • Home Peritoneal Dialysis
    Peritoneal Dialysis (PD) occurs inside your body using the peritoneal membrane as a filter. This membrane is located in your abdomen (belly). During PD the membrane is used to filter waste products and extra fluid from your blood. A special peritoneal catheter is used to transfer dialysis fluid into and out of the peritoneal cavity.
Unit-based Dialysis
  • Haemodialysis Is offered as a hospital treatment when some dialysis patients attend a special dialysis or satellite unit to dialyse for several hours, usually three times a week. Some hospitals offer nocturnal dialysis sessions, which is dialysing while you sleep.



WHICH TREATMENT SHOULD I CHOOSE?

The choice of treatment is influenced by many factors including:
  • personal preference
  • your health and medical suitability
  • your lifestyle
  • availability of resources
  • where you live
  • finances e.g. travel costs
Medical issues can influence the choice of dialysis. Most people can do both types of dialysis and those with reasonable health may be suitable for transplantation. Your kidney doctor or specialist nurse will advise if you are not medically suited for a particular type of treatment.




TREATMENT - TRANSPLANTATION

Transplantation is also a form of treatment for kidney failure but it is not a cure. If you start dialysis you will also be assessed for your suitability for transplantation. Health issues may prevent this option.
Kidney transplants are very successful. Over 94% of transplants are working one year later. The average wait for a deceased donor kidney is about 4 years.

Staying fit and as healthy as possible helps you remain suitable for a transplant and aids your recovery. It is a good idea to have regular health and dental checks as well as maintaining your:
  • recommended fluid and dietary restrictions   
  • ideal body weight for your age and size - people who are overweight are at increased risk of problems during surgery
  • dialysis schedule
  • regular fitness or exercise plan



CONSERVATIVE OR SUPPORTIVE CARE

Some people choose no active treatment, known as conservative or supportive care. It is also sometimes referred to as palliative care. Without transplant or dialysis to replace kidney function, progression to end of life will occur. If you decide that dialysis or transplant is not for you, then your health-care team will support you to stay as healthy as possible without dialysis.
If you choose conservative care a doctor still manages your medications and general health, but this will limit your life-span. You will continue to see your health care team and maybe a palliative care team as well. The palliative care team supports you and your family to live as independently and comfortably as you can in the face of serious illness.


THE FUTURE - STEM CELL TREATMENT?

Stem Cell Treatment from Dr Sharon Ricardo of the Australian Stem Cell Centre>

Dr Ricardo's advice is:
"currently the only proven treatments offered involving stem cells are for the treatment of some blood and auto immune diseases. Treatments involve either bone marrow or cord blood, such as a bone marrow transplant for leukaemia. Other stem cell based therapies are still in research phase or in clinical trials. Clinical trials are essential to ensure treatment is proven, safe and effective, before widespread use in patients. Many treatments offered by overseas organisations do not appear to have undergone any clinical trial process and therefore we cannot know if they are safe or if they even work."