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Renal Replacement Therapy (RRT) |
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Making a Choice If our kidneys stop working we can:
These are the renal replacement therapies. The more the kidneys fail the less able they are to filter out waste products. The waste products therefore stay in your blood and this can be measured. Creatinine is one of those waste products and when its level reaches 300 (normal range is under 125) you might be close to needing renal replacement therapy. Renal replacement therapy (RRT) is the therapy that takes the place of kidney function when the kidneys eventually fail. When your blood level of creatinine reaches 300+ we will explain this to you. RRT is life saving and will be needed for the rest of one's life, but keep in mind that one can have a good quality of life with renal replacement therapy. For any concerns about starting
dialysis or getting ready for it ring The Choices: Transplantation is the best way to replace kidney failure (but you have to be fit for this, ask your doc). Transplantation can give you back more than 50% kidney function which is more than adequate. Go for renal transplantation if you can. Dialysis at home is the next best (if you can cope with this). If you dialysis at home you:
Dialysis at the hospital is for those who can not have/cope with the above. If you have dialysis at the hospital you:
But dialysis in hospital is going to be the best option for those who would find it too demanding to do it at home or in a self care centre. Dialysis How do you chose between Peritoneal Dialysis (PD) and Haemodialysis (HD)?? Both can be done at home. (PD is always done at home). PD has its advantages but is not suitable for everyone. PD is a gentle treatment and doesn't need any machines or electricity so it can be done pretty much anywhere. Good for going where you want to go. Doing PD also means we can preserve your veins which are used a lot in HD should you need that one day. There are few medical reasons why somebody could not have either dialysis so the choice is often down to personal preference. This is important because the therapy is regular and on going. A serious medical history of the abdomen can make PD unworkable as can being obese. But being obese makes all these therapies much harder. If one treatment does not work out we can move you over to another.
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Follow these links to find out about
transplantation and dialysis. Which one would suit you best? The more you know about them the more comfortable you will feel about them. People on dialysis can have a good quality of life. They can continue to work, go on holidays abroad, and can play sports.
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Creating "access". Before you start dialysis your 'access' has to be created. 'Access' is the means by which dialysis can act on your blood. It gives access to your blood so it can be cleaned and excess water can be removed. It involves a minor operation carried out in hospital where you will stay one to three nights. The access is different for the two types of dialysis. For peritoneal dialysis a Tenckhoff catheter (a special plastic tube) is placed into the abdomen. This stays there and is used each time you exchange the special 'PD' fluid. For haemodialysis a fistula is made. This is the joining of an artery and a vein in the arm and is done by the vascular surgeons. The vein usually takes about 6 to 12 weeks to enlarge in size. It can then be used to access the blood, which is passed through the dialysis filter, and replaced back into the same enlarged vein (the fistula). To get a better understanding of what a Tenckhoff catheter is click here (1) and here (2) To get a better understanding of what a fistula is click here. You can see a picture of one here Norwich's Vascular Surgeons' Contact Numbers.
Preserve your veins: A fistula is a life line. For those on haemodialysis it is the access to keep them alive. A poor fistula is a poor life line and can result in poorer health. Making fistulae is difficult. It is not a major operation but it is a tricky one. You can help the vascular surgeons create a better fistula by preserving the veins in your arms. This means the veins that they might want to make a fistula in one day. This is important. It means that you do your best to not let anybody put needles (usually for blood taking) in the veins that they might want to make a fistula in now or later in your life. Unless there are good reasons not to we create fistulae in the less dominant arm. So if you are right handed we would make the fistula in the left arm and visa versa. If you are right handed we do not want anybody putting needles in your left arm. Ideally any needles to give drugs or to take blood should be put into the back of your hands (left or right) as this preserves the veins in both arms. If this is not possible we ask you to present your dominant arm for any needling. To learn more about this CLICK HERE. (This site has a lot of other information that you might want to browse through as well.) (If you want to read what the vascular surgeons have to say about it all CLICK HERE and then click on the guidelines menu - but the language used is a bit medical as it was not written for patients.) To speak to our Haemodialysis Access Nurse Specialist about any concerns regarding your fistula, new, old or not yet created, ring Steph Kershaw:
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Deciding not to have dialysis. Conservative management of Kidney Failure. You might not want renal replacement therapy. This is sometimes called the fourth option. People with other serious medical problems might not do well on dialysis. For these people dialysis would not significantly prolong their life or make them feel better. The very elderly fall into this group. The trouble is that with this group of people it is hard to know who will do OK and who will not. For what ever reason, you might feel that dialysis is too much to put up with. We can still continue to treat you if you do not want to have dialysis. We will help your kidneys last as long as possible, and we will treat any symptoms of renal failure. The links below talk about this:
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Conclusion: The whole renal team will support you the best way we can. For those starting dialysis we will try to make this transition as trouble free as possible. At present you may have many more questions than answers. To help with these questions:
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The Renal Information Evening There are 'renal information evenings' every third Thursday and first Thursday (of the following month) at 6.30 - 8.30 pm for patients, family and friends to find out more about kidney failure and its treatment. At these meetings there will be explanations of:
You will have the opportunity to meet many of the staff involved in the above areas and ask questions. There are usually a couple of people undergoing peritoneal dialysis and haemodialysis who will share their experiences with you and who will accept questions. THE INFORMATION EVENINGS ARE HELD IN Contact the CKD nurse on (01603) 288920 if
you wish to attend. You may attend more than once.
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Further information:
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Mark Holdsworth. CKD Nurse on 01603 288920.
