|
There are several formulae used to assess progress of the disease and these take into account: ethnicity, body weight and creatinine levels. In women the normal level of creatinine is lower than in men. Research done in East Kent indicates only a small proportion of those with kidney disease were known to the renal service and fewer older people and women were referred, yet a creatinine of 150 in a woman indicated more severe kidney disease than for a similar level in a man. Late referrals may already have a low haemoglobin, and potassium levels that are out of control. Research has also indicated better survival if a patient was referred before haemodialysis was required.
The BTL service now takes patients over the age of 65 years for haemodialysis if they are fit and strong. There were about 600 patients receiving haemodialysis, mainly in hospital units. Peritoneal dialysis being used for home treatments. There was a National Service Framework to help achieve a consistent approach across the NHS. The laboratories at BTL now provide a GFR when a GP requests blood creatinine levels, so they can start treating the cause, metabolic imbalance and cardiovascular risks. The aim is to achieve a blood pressure of 130/80, or even 125/75, in people with diabetes. Nurse consultants are now working with GP practices in the local Primary Care Trust to help develop screening (blood and urine dip-stick tests) for at-risk patient groups.
Nephrologists help identify the cause of renal damage and to prevent a decline to renal failure by reducing proteinuria and using ACE inhibitors and angiotensin receptor blockers. One of the challenges was the increasing erythropoietin deficiency that develops when the peritubular cells become damaged. The resulting anemia can lead on to cardiac damage. Treatment with EPO can be by sub-cutaeous injection administered by a 'pen' or standard syringe. Renal bone disease can be a further problem, with some effective but expensive medications.
People with Stage 4 or 5 chronic kidney disease are referred to a Low [Creatinine] Clearance Clinic for multi-disciplinary assessment and to agree a long-term plan for treatment. Some patients decide not to receive renal replacement therapy and there is a specialist nurse to support those in end-stage renal failure. In the first nine months of this service about 30 patients were referred for this support, so it is too early to evaluate the service. Patients who opt for peritoneal dialysis receive intensive training and support. Those who choose to receive haemdialysis need early referral to the surgeons to have a fistula created or for transplant assessment. Each form of treatment has advantages and disadvantage particularly for family and social life. There is a high incidence of depression. Dialysis requires careful management of the diet and a low fluid intake: foods usually advised for diabetics may have to be avoided for renal patients.
Back to Top
Back to Notices
Page last updated by DEB on 10/10/2005 |
