Caring for patients with chronic kidney disease.
Associate Professor Bobby Chacko established Hunter Kidney Clinic in 2012. Alongside Dr. Emmanuel D’Almeida, Associate Professor Bruce MacKinnon and Accredited Practising Dietitian Joanna Stockings, our one-stop renal clinic treats patients with chronic kidney disease.
What is kidney disease?
Your kidneys are responsible for keeping your blood clean and chemically balanced. They help control your blood pressure, keep your bones healthy, and create red blood cells. When your kidneys aren’t working properly, they allow waste and water to flow back into your blood stream, causing a build up which can lead to problems with your heart, lungs, blood and bones.
Kidney disease refers to any abnormality of the kidneys, meaning your kidneys are damaged and are not filtering your blood effectively. Chronic kidney disease happens when a disease or condition weakens kidney function, causing kidney damage to worsen over time.
What causes kidney disease?
The most common causes of kidney disease are diabetes and high blood pressure. Other risk factors include heart disease, smoking, obesity, abnormal kidney structure, older age, frequent use of medications, and family history of kidney disease.
Kidney disease is sometimes referred to as a ‘silent disease’ as there are often few or no symptoms. Symptoms can be non-specific (meaning they can also be caused by other illnesses), and easily missed because your kidneys are able to make up for lost function. The most common symptoms are related to changes in the frequency, quantity or appearance of your urine, blood in your urine or pain passing urine, swelling in your legs or ankles, pain in your back where the kidneys are located, and high blood pressure. Tiredness, loss of appetite, nausea, vomiting, shortness of breath, itching and bad breath can all be signs of kidney disease progressing, as waste products and extra fluid build up in your blood.
Kidney disease is normally diagnosed through urine tests for blood or protein, X-ray scans of the kidneys, or blood tests to measure kidney function.
Treating kidney disease
Kidney disease can be slowed and even prevented, if detected early enough. Diet changes and medication can help to improve kidney function, in the early stages of the disease. In the later stages, kidney replacement therapy with dialysis or a kidney transplant may be needed, to make up for the loss of kidney function.
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A healthy diet and exercise are important parts of living well with kidney disease. Each person's dietary needs are unique and are based on the stage of kidney disease, any other medical conditions, medications, weight, and overall health.
Our dietitian Joanna works closely with her clients to optimise their dietary intake for health benefits in chronic disease, with a focus on practicality and enjoyment of food.
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Medication can be prescribed for kidney disease to slow down the damage being caused to your kidneys. Some examples are:
anti-hypertensives to control your blood pressure.
medications to keep your heart healthy (such as cholesterol tablets).
medications to control other health conditions you may be living with such as diabetes, thyroid disorders, pain and arthritis.
diuretics (such as frusemides) to increase your urine output.
phosphate binders to control your phosphate levels.
vitamin D to maintain strong bones and other benefits.
injections, including erythropoeitin and iron, to control anaemia.
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Dialysis involves a machine cleaning your blood to filter out toxins, wastes and extra fluid. It doesn’t replace your kidneys or return your kidney function to normal, but does help to improve your health and enables people to live even after their kidneys have failed. Dialysis is an ongoing process which is usually performed for the rest of your life, or until you receive a transplant. There are two different types of dialysis - haemodialysis and peritoneal dialysis. Peritoneal dialysis affords patients more flexibility and can be less disruptive to your lifestyle, however haemodialysis is ideal for patients with less kidney function.
Haemodialysis uses a dialysis machine and a special filter called an dialyser (or ‘artificial kidney’) to clean your blood. Blood is pumped out of your body to the dialyser, then returned to your body by tubes that connect you to the machine. This can be done in a hospital, in a dialysis centre, or at home. Your doctor will give you a prescription that tells you how much treatment you need, and this will be monitored with monthly pathology tests to ensure you’re getting the right amount of dialysis. Haemodialysis in a hospital or treatment centre is usually done 3 times per week for around 4 hours each time, while at home treatments can be done more frequently, for fewer hours each time.
Peritoneal dialysis cleans your blood by putting a cleaning fluid called dialysate in your belly and then removing it, in cycles. A soft, flexible tube called a catheter allows the dialysate to enter the belly, which is inserted during a minor surgical procedure, and remains throughout your dialysis treatment. Continuous Ambulatory Peritoneal Dialysis (CAPD) is a continuous, machine-free treatment relying on gravity which allows you to go about your normal activities in between ‘exchanges’ (putting in and taking out the fluid). Exchanges take around 30-40 minutes and this process is usually repeated 3-5 times in a 24-hour period. Automated Peritoneal Dialysis (APD) uses a machine called a cycler to do your exchanges overnight.
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A kidney transplant is a treatment for kidney failure, where a healthy donor kidney replaces kidneys that are no longer able to function. Most people go on dialysis first while they’re waiting for a suitable kidney to be available. A transplant can offer more freedom and a better quality of life than dialysis, however not every patient is a good candidate for transplant.
