What are my pre-dialysis options and what does this mean for me?

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1 What are my pre-dialysis options and what does this mean for me? Gabby Hadley CKD Community Support Team Lead Nurse Queen Elizabeth Hospital Birmingham ADPKD Information Day 18/11/17

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5 Where do I go from here? Low clearance clinic Transplant and dialysis preparation Muliti-disciplinary

6 Why Low Clearance Clinic? Designated doctors and nurses in clinic Discussion of care on a weekly basis For SUPPORT

7 When?

8 Classification of CKD Stage G1 Stage G2 Stage G3a Stage G3b Stage G4 Stage G5 Normal and high Mild reduction related to normal range for a young adult Mild-Moderate reduction Moderate-severe reduction Severe reduction Kidney failure egfr > 90 egfr egfr egfr egfr <15 Adopting healthy lifestyles may help prevent RF getting worse May need more medications May start to experience some symptoms. Treatment choices Approaching the time of starting treatment of choice

9 What can we do when the kidneys fail? Kidney failure Dialysis Kidney transplant Conservative Treatment

10 When will I start dialysis This usually depends on both : symptoms blood test results (% kidney function) But there are circumstances where dialysis is needed regardless of symptoms

11 There are two types of dialysis Peritoneal Dialysis Haemodialysis

12 How do you perform Peritoneal Dialysis?

13 Peritoneal Dialysis

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15 There are two types of peritoneal dialysis

16 What is the difference? APD (Automated peritoneal dialysis) Performed with a machine during the night while you are asleep CAPD (Continuous ambulatory peritoneal dialysis Performed manually 4 times a day Each exchange takes approx. 30 mins

17 The advantages of PD Privacy, flexibility and comfort of home treatment No travelling to dialysis centre to perform treatment Can work and plan own days Supplies can be delivered abroad to your holiday destination Less diet and fluid restrictions No needles required

18 Points to consider : Training by dedicated team is required A plastic tube is inserted into your abdomen Storage space is needed for supplies Some people may need help if they have problems with eyesight, dexterity and mobility There is a very small risk of infection

19 Who can do PD? Certain extensive bowel surgery unable to undertake PD If poor eyesight, problems with manual dexterity or mobility may require help Enlarged kidneys space for PD

20 Haemodialysis

21 Haemodialysis

22 How is haemodialysis performed? A fistula

23 What are the advantages of haemodialysis? Nursing staff provide the care Unit based treatment although you can be trained to do it at home No equipment needed to be stored at home You will be with other patients while having your dialysis Traditionally only 3 per week You can read, watch a DVD or TV while having your dialysis

24 Haemodialysis and points to consider Travel to clinic 3 times a week on a fixed schedule Requires permanent access (fistula or dialysis line) Insertion of 2 needles at each treatment Fluid and diet restrictions Work may need to fit around dialysis times Holidays need careful planning

25 Home Haemodialysis Training at QEH normally take place in approx. 6 weeks At designated training suite with times to suit Normally need a carer whilst on dialysis Advantages of dialysis time to suit individual Treatment sessions daily Nocturnal Dialysis

26 Conservative care An alternative for people who are frail or would not benefit from dialysis Older patients not undertaking dialysis there may be no significant shortening of life expectancy Support given from medical team to treat and reduce symptoms of kidney disease Plan for future care

27 Resources Your local Pre Dialysis team (CKD Team) Peer Support Workers Psychological support Benefits advice & grants

28 Symptoms of more severe CKD Tiredness Swollen ankles, feet or hands Passing urine more often particularly at night Shortness of breath Itchy skin Nausea

29 Making Decsions

30 How do people make decisions We often make decisions without knowing all of the necessary information.

31 Any Questions?