Bloods – it’s all about blood. You can now look up your own blood results on Patientview.org Contact us if you wish to.

A percentage

What the kidneys do… They filter the blood removing toxins that come from food, drink and normal metabolism. They also filter water out of the body. Each day, the kidneys process about 190 litres (335 pints) of blood through 145 miles (225km) of ‘tubes’ and millions of mini filtering systems called ‘nephrons’.

They also… Produce chemicals to: They also have some other jobs. Make red blood cells Balance the calcium Control the blood pressure They also have some other jobs.

So what can be done? When kidneys are working > 10% Medication is used to help correct: Bone chemistry Blood pressure Anaemia Acid Base balance Symptoms ……. and more How the patient can help preserve health: Balanced diet, cut salt, appropriate weight, no smoking, exercise, moderate alcohol, medication knowledge + clinic attendance are also important.

So what can be done? When kidneys are working < 10% All on the previous slide is continued but transplant or dialysis might be needed. How the patient can help preserve health: Balanced diet, cut salt, appropriate weight, no smoking, exercise, moderate alcohol & medication knowledge + clinic attendance are also important.

Bone metabolism - calcification Kidney failure can lead to weakening of bones and calcification of soft tissue. Medication and diet (when necessary) can prevent this.

Hep B immunisation Hep C check HIV check Hep B immunisation Hep C check HIV check These checks are routinely done before haemodialysis starts. (It is not expected that dialysis patients will be positive, but Hospital Infection Control likes to know who has got what)

So what is this RRT (renal replacement therapy) that can save lives? Renal Transplantation Peritoneal Dialysis Haemodialysis

eGFR < 15 And symptomatic When do we start RRT? Tiredness Fluid balance levels Nutritional intake

Renal Transplantation

Transplant: yes – the best way to replace lost kidney function but only about 25% of those whose kidneys fail are fit for it. Some people have no control over being fit enough - and some people do. Make your lifestyle choices.

Renal Transplantation ü Only start preparing for this when eGFR < 16 Goal is to be worked up/transplanted before dialysis is needed depending if your kidney comes from the waiting list or a live donor. Is it time to start talking about this with family/friends? See web page for information. www.kidneynorfolk.co.uk

Peritoneal Dialysis The Tube

Continuous Ambulatory Peritoneal Dialysis (CAPD) Continuous Ambulatory Peritoneal Dialysis (CAPD). This involves using bags to drain fluid out of and fill fluid into your abdomen 4 times a day through a tube that is surgically placed in your tummy. Doing dialysis this way will mean you that don’t have to go to hospital 3x/week for the treatment. But you will have to be up for and willing to do these fluid exchanges 4 times a day every day. Each fluid exchange takes about ½ hour. You don’t have to do the fluid exchanges at the same time every day, you can be flexible with the times, and once you are confident it is just as easy to do these fluid exchanges away from home.

Exchanging the fluid in the garden Swimming with a PD tube ….or in a car…. …..or on holiday

Monthly delivery of PD fluid!

Doing PD on a walk on holiday in France

The APD machine (automated peritoneal dialysis) Automated Peritoneal Dialysis using the overnight machine (APD) (People will start CAPD first for about 2 months). APD uses a machine by your bed that fills your abdomen with fluid and then drains the fluid in and out overnight whilst you sleep. This way of doing PD means you don’t usually have to do any fluid exchanges during the day.

A message from long timers: Dialyse to live, Do not live to dialyse

Peritoneal Dialysis û Done 4 x a day (takes half an hour to do) APD = over night, every night Done every day Live with a tube in you (infection concern) ü üü Done at home (or wherever you are) Easy to travel with Better diet (less restricted) Better fluid amount (less restricted) Gentler on cardiovascular system See web page for videos and leaflets

Haemodialysis The Fistula

Vein preservation for Fistula Try and keep needles out of the arm to preserve your veins for the fistula For blood taking use hands if possible

NECK LINES (if we don’t have a fistula to use) Temporary Infection risk Bathing Dangling!

Haemodialysis (HD) at the hospital 3x/week Haemodialysis (HD) at the hospital 3x/week. Each session is usually 4 hours long. This is where you lie or sit on a bed and blood is removed from you (only about 300mls at a time), filtered/cleaned, and then put back into you. You don’t feel the blood going in and out.   To do HD a fistula needs to be created in your arm. People having an AV (arteriovenous) fistula will receive an appointment from vascular studies before the fistula is made. Vascular Studies will scan the blood vessels to help the surgeons choose the best ones for the fistula. We hope to do this about 6 months before HD is needed so there is time for the fistula to become usable. Remember to try and preserve / look after your veins as well (see the leaflets on the website). Haemodialysis at home (Home HD) (People will start Hospital HD first). If you come to think that doing HD at home is a better idea we can discuss this. It can take about 6 months after people have started HD in the hospital to plan, train and move onto HD at home.

Haemodialysis Frequency Sat Sun Mon Tue Wed Thu Fri The more regular the haemodialysis sessions the better control of your blood you will have. Hospital haemodialysis will only offer 3 times a week haemodialysis. If you do it at home you can do it 4,5,6, or 7 times a week . See videos on Home Haemodialysis on the web page. T O X I N S F L U I D Dialysis Day 1 Potassium Phosphate Fluid ↑ ↑ ↑ ↑ ↑ & Dialysis Day 3 Dialysis Day 2 More regular Home HD Haemodialysis Frequency

HD at Hospital

A fistula is needed for Haemodialysis

Haemodialysis set up at home

Haemodialysis set up at home

Haemodialysis set up at home

Haemodialysis set up at home

Haemodialysis set up at home

Haemodialysis set up at home

Haemodialysis set up at home

Haemodialysis set up at home

Haemodialysis set up at home

Haemodialysis set up at home

Haemodialysis set up at home

Haemodialysis set up at home – now the HD has started.

Haemodialysis set up at home – somebody needs to bring the tea….

Haemodialysis set up at home – we don’t provide the TV!

Conservative Management/ Conservative Care When dialysis won’t help. See leaflets on web page