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An Introduction to Kidney Disease Treatment Options Prevent, Detect, Support, Research.
Contents
Foreword 3
What are kidneys? 4
Peritoneal dialysis (PD) 10
Haemodialysis 18
Transplantation 28
Comprehensive conservative care 35
How do I make the choice? 40
What if I am struggling to cope? 43
What does that word mean? 44
Where can I get more information? 46
Acknowledgements:
This booklet was produced by Kidney Health
Australia in collaboration with the Royal North Shore
Hospital. It has been supported by funding from the
Joe White Bequest. The reprinting of this resource has
been supported by Fresenius Medical Care.
An Introduction to Kidney Disease Treatment Options
© Kidney Health Australia 2017, reprinted 2020.
Copyright:
This publication is copyright. Apart from any use as
permitted under the Copyright Act 1968, no part may
be reproduced without written permission from Kidney
Health Australia. Requests and enquiries concerning
reproduction and rights should be directed to Kidney
Health Australia, PO Box 9993, Melbourne VIC 3001.
Disclaimer:
Always consult your doctor before beginning any
health treatment. This booklet is intended as a
general introduction to the topic and should not be
seen as a substitute for your doctor’s or other health
professional’s advice. All care is taken to ensure that the
information contained in this booklet is accurate at the
time of publication.
2 Kidney Health Australia
Foreword
Topics that are covered in this booklet include
transplantation, haemodialysis, peritoneal dialysis
and comprehensive conservative care.
If you are reading this for the first Kidney Health Australia is here
time, it may be that you have just to support you throughout your
received news that you need to journey and our fully qualified
consider kidney disease treatment team of nurses and allied health
options, or you may be supporting professionals are only a phone call
a loved one in this situation. away should you wish to speak to
someone confidentially.
Welcome to Australia’s kidney
community; please keep in touch
so that we may be able to provide
you with whatever support and
assistance you require.
To receive monthly updates on the
latest in the kidney community and
managing your kidney health visit
kidney.org.au/subscribe
The Kidney Health Australia team
1800 454 363
kidney.helpline@kidney.org.au
kidney.org.au
Kidney Disease Treatment Options 3
What are kidneys?
Most people are born with two kidneys, each growing
to the size of your fist. Your kidneys are bean shaped
and are positioned near the middle of your back, on
either side of your backbone (spine). Your kidneys are
part of the body’s urinary system.
What do healthy kidneys do? What happens when the kidneys
Kidneys are the unsung heroes don’t work properly?
of the body. The kidneys play a Sometimes kidney function can
number of important roles change quickly. For example,
in the body such as: your kidneys may stop working
• Extracting excess fluid to properly because of a sudden loss
make urine (wee) of large amounts of blood (e.g.
during surgery) or as a result of an
• Controlling blood pressure
accident, illness or infection.
• Filtering waste products from
the blood
A sudden change in kidney
• Controlling body fluids function is called acute kidney
• Stimulating the production of injury. This is often temporary but
red blood cells can occasionally lead to lasting
• Controlling potassium, calcium kidney damage. More often kidney
and phosphorus levels function worsens over a number of
• Regulating vitamin D. years – it is a chronic, or ongoing,
condition. Chronic kidney disease
(also referred to as CKD) is called a
silent disease as there are often no
warning signs. Sometimes people
lose up to 90 per cent of their
kidney function before getting
any symptoms.
4 Kidney Health Australia
Symptoms you may experience
• Retention of fluid causing
breathlessness and swelling
• Tiredness
• Headaches
• Poor memory and concentration
• Irritability
• Sleep disturbances
• Feeling washed out
• Itchiness
• Nausea and loss of appetite
• Weight loss
• Altered sexual function.
To heart: Clean,
balanced blood
Blood containing
water, toxins, salts
and acids goes in
To urine: Toxins,
waste, extra water
Kidneys: Clean filter
and finetune blood
Kidney Disease Treatment Options 5
Treatment options
When you have end stage kidney A kidney transplant involves the
disease your body cannot get rid transplantation of one kidney into
of extra water and waste products. your body from either a living or
If this becomes dangerous to deceased donor. If you are suitable
your health you will need to make for a kidney transplant, this is the
some decisions about the kind of most effective treatment for kidney
kidney disease treatment that you failure. Compared with other
want. This could include dialysis, kidney failure treatment options,
preparing for a kidney transplant, transplantation could increase your
or choosing comprehensive life expectancy and improve your
conservative care. Your kidney quality of life.
function will need to be replaced
by either a kidney transplant Some people choose not to
or dialysis. have dialysis or a transplant and
instead choose comprehensive
Dialysis has a number of options, conservative care. With this option,
which include home dialysis medications and diet are used
(either peritoneal dialysis or home to manage the symptoms of end
haemodialysis) and centre-based stage kidney disease.
haemodialysis (in a satellite dialysis
unit or a hospital dialysis unit). It is also important to know
that many people start on one
treatment type and then transfer to
another for many different reasons.
6 Kidney Health Australia
Depending on your health some or It is important to remember that
all of these treatment options will it is your decision to make and
be available to you. Your doctor and your health care team will help
clinical nurse specialists can advise to provide you with as much
you about the ‘medical’ advantages information as possible to make
or disadvantages and availability of the decision.
each treatment option.
Kidney Disease Treatment Options 7
Resources
Kidney Health Australia
fact sheets
(translated versions available).
Kidney Health Australia booklets:
An Introduction to Haemodialysis,
An Introduction to
Peritoneal Dialysis,
An Introduction to Home Dialysis,
An Introduction to Comprehensive
Conservative Care.
Kidney Health Australia book:
Living with Kidney Failure.
kidney.org.au/your-kidneys/
living-with-kidney-disease/
families-and-carers
Choosing your treatment
kidney.org.au/your-kidneys/
treatment
Kidney Helpline
1800 454 363
kidney.helpline@kidney.org.au
8 Kidney Health Australia
You are not alone
In Australia:
• Over 2,000 people start
dialysis or receive a transplant
every year
• There are currently over 20,000
people in Australia on dialysis or
living with a transplant.
Out of every 10 people needing
treatment for kidney disease
the causes are:
PKD
6% Not
reported
6%
Hypertension
Diabetes
14%
36%
Glomerulonephritis
18%
Other
20%
Kidney Disease Treatment Options 9
Peritoneal dialysis (PD)
How peritoneal dialysis works
Peritoneal dialysis (PD) is the oldest The insertion of the peritoneal
form of dialysis, and was first used catheter requires a short hospital
in 1923. In Australia approximately admission. The catheter provides
20 per cent of all people on dialysis a pathway through which dialysis
use PD. solution (dialysate) can be placed
into the peritoneal cavity. Dialysate
PD works inside the body using is a liquid that usually contains
your natural peritoneal membrane glucose (a type of sugar) but
which allows impurities to be also contains substances that are
drawn out of the blood. The similar to those in your blood.
peritoneal membrane lines
your abdominal (peritoneal) Once the dialysate is inside
cavity, and covers organs such the peritoneal cavity, the cavity
as your stomach, liver, spleen acts as a reservoir holding the
and intestines. The peritoneal dialysis solution. Your body’s
membrane (also called the waste products pass from your
peritoneum) is semi-permeable. bloodstream across the peritoneal
This means that it naturally allows membrane and into the dialysate.
some substances to pass through, After a set number of hours, the
but not others. used dialysate, with the impurities
from your blood, is drained from
For PD to work there has to be the peritoneal cavity and replaced
permanent access to the peritoneal with fresh solution and the process
cavity. This is achieved by a soft commences again. This happens
tube (called a peritoneal catheter) every day at home either during
which extends through a small the day using manual bags or at
incision in the tummy into the night using a machine.
peritoneal cavity.
10 Kidney Health AustraliaThe basic PD cycle (exchange)
The PD cycle once established At the start of each exchange,
is: drain, fill, dwell. Each time this you will carefully connect your
cycle is repeated, it is called catheter with a tubing set that
‘an exchange’. includes a bag of new dialysate
and a drain bag. The connecting
Drain: First you connect your tube tubing set, and bags for the new
to the PD set and drain out the old and old solution (dialysate) are only
dialysate which has been in the connected when the dialysate is
peritoneal cavity for the prescribed being changed. In between these
length of time (often 4-8 hours). exchanges, the catheter and a
small ‘extension’ tube at the end of
Fill: Your peritoneal cavity is filled it are the only visible parts and are
with the new dialysate. Once your taped gently against your tummy.
peritoneal cavity is full you will
disconnect from the tubing This is the basic PD cycle. Later
and bags. in this booklet you will read about
two different types of PD. One type
Dwell: The dialysate remains in involves doing four cycles like this
your cavity for a period of time. during the day. The other type
Waste and extra fluids are drawn of PD uses a machine to do the
out of the blood vessels and cycles for you while you sleep.
through your peritoneal membrane
into the dialysate during this time.
Kidney Disease Treatment Options 11How peritoneal dialysis
affects your body
During PD the average adult
comfortably holds 2-3 litres of
dialysis solution in their peritoneal
cavity. Although this seems to
be a large amount of fluid to
hold in your abdomen, little or no
discomfort should be experienced.
The fluid moves between the two
layers of the peritoneum, which
results in only a minor increase in
the width of your waist. You may
initially be aware of the extra fluid,
but this feeling will decrease over
time. In children the volumes are
much smaller and tailored to the
size of the child.
The peritoneal catheter is your
access for dialysis. It is permanent
and is about 30cm long. The point
at which the peritoneal catheter
leaves your abdomen is called
the exit site. It is important that the
exit site is kept clean to prevent
infection. You will be shown how
to check and clean your exit site
every day. The catheter will be
securely taped to keep it in position
Peritoneal catheter supported with tape and prevent it from moving around.
12 Kidney Health AustraliaDifferent types of peritoneal dialysis
There are two different ways Continuous Ambulatory
of doing PD, which suit Peritoneal Dialysis (CAPD)
different lifestyles. With CAPD you always have
dialysate in your body so your
blood is constantly being cleaned.
Usually four exchanges are done
each day. Each exchange takes
about 30-45 minutes and can be
done almost anywhere, with a few
sensible precautions. In between
exchanges you are free to go about
your daily activities. Overnight you
have a long dwell while you sleep.
Exchanges are typically done on
waking, at lunch time, at dinner-
time and prior to going to bed.
Some flexibility is available for
busy days.
CAPD works by gravity. When the
drain bag is placed at floor level
the fluid drains out. By raising the
new dialysate bag above shoulder
level, the new dialysate flows into
your peritoneal cavity.
PD bag exchange
Kidney Disease Treatment Options 13Automated Peritoneal Dialysis
(APD)
During APD a machine called a You are connected to the machine
cycler automatically does the during this entire process.
exchanges for you. Each night During the day some dialysate is
your catheter is attached to the usually left in your body so that
tubing of the cycler. It does several dialysis continues. In the evening
exchanges, moving the clean and the dialysate is drained out
used dialysate in and out of your automatically by the cycler.
body while you are asleep. APD is
done every night and usually takes
between 8–10 hours.
Connecting to the APD machine
14 Kidney Health AustraliaHow will peritoneal dialysis affect my lifestyle?
Levels of activity and lifestyle Employment
choices vary across stages of life Your work routine (days that you
and from person to person. What work and hours that you work) may
is important to you may be less play a large part in your decision
important to other people. You may about which form of dialysis
work, be retired, travel, play sport will suit you best. People using
or have a family to care for. PD can usually schedule their
dialysis exchanges around work
Diet and fluid commitments or use APD and do
As PD provides continual dialysis the exchanges at night. Depending
most people do not need to on your work place and the type
change their diet and fluid intake of work that you do, it may also be
to keep their blood chemistry possible to do the PD exchanges
normal. You will be advised of during the day at work.
any changes to your diet that are
needed based on your blood
results, your well-being and how
well you are balancing your fluid
levels in your body.
Kidney Disease Treatment Options 15Finances Sport and exercise
If your ability to work changes, Continuing sport and exercise is
this may impact on your income encouraged for everyone on PD.
and your household finances. With PD you are more likely to
See the Patient & Carer support have the flexibility to fit your
page at kidney.org.au for dialysis routine around your
more information. exercise. If you play a contact sport,
it is important to make sure your
When you have PD at home there peritoneal catheter is protected. If
is no charge for your PD machine you swim, you need to pay careful
and supplies. These are delivered attention to the advice of your
to your home once a month. Some healthcare team about water
people choose to buy special quality and safety.
storage items to help organise
their supplies, and you may notice Travel and holidays
that you use extra hand soap and With careful planning you can
paper towels. travel and go on holidays while
on PD. It may involve making
Some prescription medications arrangements to have supplies
may also be needed for your PD. sent to your destination. You will
Some dialysis units assist with the need to organise this before your
cost of buying digital scales (to trip, and you may have to pay
weigh yourself), a blood pressure some costs.
machine and any other equipment
or resources you may need. This More detailed information on
does vary, so please check with peritoneal dialysis is available
your dialysis unit. in the booklet An Introduction
to Peritoneal Dialysis and
other resources.
16 Kidney Health AustraliaResources
Kidney Health Australia
fact sheets:
Peritoneal Dialysis –
A Treatment Option.
Kidney Health Australia booklets:
An Introduction to
Peritoneal Dialysis.
Kidney Health Australia book:
Living with Kidney Failure.
kidney.org.au/your-kidneys/
treatment/dialysis-key-facts/
peritoneal-dialysis
Kidney Helpline
1800 454 363
kidney.helpline@kidney.org.au
Kidney Disease Treatment Options 17Haemodialysis
How haemodialysis works
All haemodialysis requires vascular The dialysis machine
access, a dialysis machine, and a The dialysis machine is the engine
dialyser. Your blood flows from your that runs and controls your dialysis.
vascular access and is pumped The dialysis machine is prepared
through lines before and after the with lines, dialysate and a dialyser.
dialyser on the dialysis machine, It also has safety features to detect
and the clean blood is returned to air and blood clots.
your body.
Operating a dialysis machine
18 Kidney Health AustraliaVascular access with a fistula
A fistula is the name for joining Most people using dialysis have
an artery to a vein. This is usually a fistula as it provides the best
surgically created at the wrist area long-term vascular access, and
of your non-dominant forearm (the usually has the lowest risk of
arm you don’t write with). With a complications.
fistula, blood flows quickly from the
artery and makes the vein wider. Vascular access with a graft
This provides the good blood flow If your veins are too small or
in your arm, which is needed for delicate for a fistula to work then
dialysis to work. The fistula is where vascular access with a graft may
you put in the needles for the be needed. This is an artificial tube
dialysis. Two needles are required, which is placed in an arm or leg,
one to remove the blood and the one end is attached to an artery
other to return it. and the other end is attached to a
vein. The needles for dialysis are
put into the graft.
Artery Graft Fistula
Vein
Artery
Vein
Graft
Kidney Disease Treatment Options 19Vascular access with a central venous catheter Sometimes it is not possible to create a fistula or a graft. In these cases vascular access is with a central venous catheter. This is also known as a dialysis catheter. A central venous catheter is a soft plastic tube that is placed into a large vein in the chest. This then splits in half to take the two needles for the dialysis. Unlike a fistula, a central venous catheter can be used straight away. Some people may have a temporary central venous catheter while they are waiting for their fistula to be ready. Central venous catheters can work well, but they do have an increased risk of infection if not managed carefully. They also have a higher incidence of getting blocked, and are usually not suitable for long term use. 20 Kidney Health Australia
The Dialysis Routine
The time spent on haemodialysis For example:
varies. On average the treatment • Increase to alternate days (every
will be three times a week for four second day), or even four, five,
to five hours, every week of the six or seven times per week
year. You will also need to allow
• Increase or decrease the hours
time for preparing and completing
of each dialysis session as long
the treatment.
as the target number of dialysis
hours is reached each week
Routines in a dialysis unit do not
• Do the dialysis overnight
change. The staff at the dialysis
(can be up to eight hours)
unit will help you to find a routine
that fits in with your lifestyle, • Do the dialysis on a public
but there can be limitations to holiday when dialysis units
appointment times. are closed.
An advantage of doing The advantages of additional hours
haemodialysis at home is that of dialysis are discussed later in
you can change your dialysis this booklet. They include more
routine to suit you. energy, better blood test results, a
longer life-span and less diet and
fluid restrictions.
How many hours of haemodialysis
you have each week should be a
shared decision between yourself
and your health care team based
on your blood results and general
well-being.
Kidney Disease Treatment Options 21What are the differences between home
haemodialysis or unit based haemodialysis?
Haemodialysis can be performed • Hospital dialysis unit – these
at home or at a centre. Centre- units are located at a hospital.
based dialysis can occur in either They are staffed by nurses and
a satellite dialysis unit or a hospital are usually for people who
dialysis unit. require extra medical support.
• Home – you are trained by
nurses to manage your dialysis Your health care team will advise
in your own home you of the available treatment
options for you, and will help you
• Satellite dialysis unit –
choose the best dialysis that fits
these units are located in
with your lifestyle and wishes.
the community, and you can
manage your dialysis yourself or
with the help of nurses
Unit-based
haemodialysis
22 Kidney Health AustraliaThere are many benefits to Some things that people like
having your haemodialysis about having haemodialysis at
at home: a satellite or hospital dialysis
• Less time spent in hospital centre are:
• Less time spent travelling to • The haemodialysis is supported
and from hospital by a nurse but many units
encourage you to help with
• More frequent haemodialysis
your own dialysis
means you will feel better
• You will often meet the same
• Flexibility to fit haemodialysis
people when you go in for
around your work and family
haemodialysis and you can
commitments
share experiences
• Flexibility to fit haemodialysis
• Home and haemodialysis are
around your lifestyle.
kept separate.
Many people comment that doing
haemodialysis at home gave them
back their life.
Kidney Disease Treatment Options 23How will haemodialysis affect my lifestyle?
Levels of activity and lifestyle Diet and fluid
choices vary across stages of life Usually kidneys get rid of many
and from person to person. What wastes and extra minerals from
is important to you may be less food that your body does not
important to other people. You may need. When you are on dialysis the
work, be retired, travel, play sport treatment does this, but cannot
or have a family to care for. always remove enough wastes.
However everyone is different
when it comes to diet restrictions
and haemodialysis. People who
have longer or more frequent
haemodialysis, such as every
second day or overnight, are less
likely to have to make changes to
their diet and fluid.
When you are on haemodialysis,
knowing what you can eat can be a
challenge. Most people need help
from an Accredited Practising
Dietitian experienced in kidney
disease (often called a Renal
Dietitian) to set up a personalised
meal plan. Nurses at the dialysis
units can refer you to a dietitian.
24 Kidney Health AustraliaEmployment
When you are on haemodialysis, Haemodialysis takes up many
fluid is removed during the dialysis hours each week. You can work
process. For some people they still with all types of haemodialysis
pass urine and get rid of fluid that but you may need to adjust your
way, but many do not. Therefore working hours, particularly when
most people on haemodialysis you first start dialysis and your
need to limit the amount of fluid body is adjusting. Your work routine
they have each day. Fluids are (days that you work and hours that
liquids that you drink, and any you work) may also play a large
foods that are liquid at room part in your decision about which
temperature. This includes ice form of dialysis will suit you best.
cream, yoghurt and ice cubes.
Fluid is also contained in foods Finances
like cooked pasta and rice, salad If your ability to work changes,
ingredients, soup and watermelon. this may impact on your income
and your household finances.
If you do frequent haemodialysis at See the Patient & Carer support
home you should have better fluid page at kidney.org.au for
control and improved freedom more information.
with what you can eat and drink.
An accredited practising dietitian
or your nursing team can help you
to sort out the fluids that you can
have each day.
Kidney Disease Treatment Options 25Sport and exercise Travel and holidays
Continuing sport and exercise With careful planning you can
is encouraged for everyone travel and go on holidays while
on haemodialysis. With home on haemodialysis. It may involve
haemodialysis you are more making an appointment to have
likely to have the flexibility to fit your haemodialysis at another
your dialysis routine around your facility. You will need to organise
exercise. If you play a contact sport, this before your trip, and you may
it is important to make sure your have to pay some costs.
fistula is protected. If you swim, you
need to pay careful attention to the More detailed information on
advice of your health care team haemodialysis is available in
about water quality and safety. the booklets An Introduction to
Haemodialysis, An Introduction
You can also exercise during to Home Dialysis and other
your haemodialysis sessions. resources.
The options include:
• Cycling on a portable pedal
machine
• Zumba on dialysis
• Resistance exercises with a
stretch band.
Talk to your health care team to
see which options for exercise on
dialysis are available for you.
26 Kidney Health AustraliaResources
Kidney Health Australia
fact sheets:
Haemodialysis –
A Treatment Option.
Home Haemodialysis –
A Treatment Option.
Kidney Health Australia booklets:
An Introduction to Haemodialysis,
An Introduction to Home Dialysis.
Kidney Health Australia book:
Living with Kidney Failure.
kidney.org.au/your-kidneys/
treatment/dialysis-key-facts
Kidney Helpline
1800 454 363
kidney.helpline@kidney.org.au
Kidney Disease Treatment Options 27Transplantation A kidney transplant is treatment for kidney failure but it is not a cure. A transplant offers a more active life, without needing dialysis. However, the new kidney requires ongoing care. You will need to take medications to stop your body rejecting the kidney (anti-rejection) for as long as you have the transplanted kidney. Are kidney transplants successful? Kidney transplants are very How long your transplanted kidney successful. On average, 95 per will work can depend on many cent of transplants are working factors. If a kidney transplant one year later. In Australia, around stops working, dialysis treatment four in every ten kidney transplants will be necessary again. Another are still working 15 years later. transplant may also be possible at Some people have had kidney a later time. transplants that have lasted more than 30 years. If the transplant works well for the first year, the chances are good that it will function very well for many years. Success rates are higher with living donor kidneys than for deceased donor kidneys. 28 Kidney Health Australia
Clean solution
Peritoneal cavity
Tubing set
Catheter
Old solution
Kidney transplant anatomy
Kidney Disease Treatment Options 29Who can have a kidney
transplant?
Kidneys can be donated by living Factors affecting your suitability for
donors or deceased donors. Having a kidney transplant include:
a transplant from a living kidney • Agreement with the idea of
donor means you will have better transplantation and acceptance
outcomes. If you have a transplant of the risks involved
from a living donor it usually means
• Your general health, apart
you will not have to wait as long for
from kidney failure
your transplant.
• Willingness to go through
with the tests and the
You can be given the option
transplant surgery
of transplantation if you are
considered to be medically • Willingness to take the
suitable by the kidney transplant anti-rejection medications.
team. Unfortunately a transplant
is not suitable for everyone, as the Most metropolitan cities have
risks are sometimes too high. a hospital that performs kidney
The transplant team may decide transplants. If you live in a regional
that the risks of the operation or or rural area of Australia, or in a city
the medications may make your that does not have a transplant
health worse. However, it is hospital, you will need to travel to
everyone’s right to be considered the closest transplant hospital for
for a transplant. your evaluation and tests, and for
the transplant procedure itself. Your
You will need to speak with health care team will be able to
your nephrologist for further discuss these travel arrangements
information about your with you.
circumstances if you are
regarded as not being suitable
for a kidney transplant.
30 Kidney Health AustraliaAre kidney transplants
successful?
Kidney transplants are very
successful. On average, 95 per
cent of transplants are working one
year later. If the transplant works
well for the first year, the chances
are good that it will function very
well for many years.
Success rates are higher with living
donor kidneys than for deceased
donor kidneys.
Percentage of people alive after Percentage of transplanted
five years who received a kidney kidneys working after five years
from a: from a:
Kidney Disease Treatment Options 31Kidney donors
Kidneys for transplantation come The surgery and pre-surgical care
from either living donors or for you will be the same whether
deceased donors. your transplanted kidney is from
a living or deceased donor. It is
recommended that you discuss
your situation with your health care
team, to make sure you understand
your options.
For every 10 kidney transplants
performed in Australia:
32 Kidney Health AustraliaHow will transplantation affect my lifestyle?
Diet and fluid Finances
You should follow a healthy diet The transplant surgery is done
when you have a kidney transplant. as part of the usual health
There are no actual restrictions care system in Australia. The
and usually you are encouraged medications you need are available
to drink plenty of fluids. An on the usual PBS system. If you
Accredited Practicing Dietitian can have a living donor from overseas
advise if there are any restrictions you may need to check if they will
you should make, or help with incur any costs.
controlling your body weight, if this
is difficult for you. Sport and exercise
Gentle exercise is recommended
Employment during your recovery form surgery.
You will need to allow time off Once you have recovered from
work for your surgery (usually surgery, check with your doctor if
about 6 weeks). You will also need you can resume active sport. You
to schedule time for medical should avoid any contact sport that
appointments and tests before can damage the transplant kidney.
your surgery. These will reduce
considerably around 3 months after
your surgery.
Kidney Disease Treatment Options 33Travel and holidays Resources
You can travel with some sensible Kidney Health Australia
precautions to ensure you always fact sheets:
have access to your special Peritoneal Dialysis –
medications. Travel insurance A Treatment Option.
may be difficult to secure. See fact
sheet on travel and transplant. Kidney Health Australia booklets:
An Introduction to
More detailed information on Peritoneal Dialysis.
kidney transplantation is available
in the booklet An Introduction to Kidney Health Australia book:
Kidney Transplantation and other Living with Kidney Failure.
resources following.
kidney.org.au/your-kidneys/
treatment/dialysis-key-facts/
peritoneal-dialysis
kidney.org.au/your-kidneys/
treatment/kidney-transplants
Kidney Helpline
1800 454 363
kidney.helpline@kidney.org.au
34 Kidney Health AustraliaComprehensive conservative care
Comprehensive conservative care is the treatment
choice for kidney failure if you have decided that
dialysis and transplant are not right for you. This might
be because you are already very frail and do not want
complex treatments. You may have tried the other
treatments for a while and now want to stop.
With comprehensive conservative Choosing comprehensive
care you will still be supervised and conservative care means that you
supported by health professionals. accept that your loss of kidney
You may have medications and a function will progress and there
special diet to improve your quality is a high chance that this will lead
of life. to your death. However, if you are
frail and in poor health with other
medical conditions as well as
kidney disease, choosing dialysis
may not lead to any longer survival.
Kidney Disease Treatment Options 35How comprehensive conservative care works Your general practitioner (GP), a Kidney failure symptoms can kidney specialist (nephrologist), include itchy skin, restless legs, and specialist nurses, a social worker, general pain. Your comprehensive a dietitian, and a palliative care conservative care team will help team are some of the health you to live independently and in professionals who may be comfort. Some people can survive involved in your comprehensive with comprehensive conservative conservative care. These health care for many years. professionals will all support you with pain and symptom management. 36 Kidney Health Australia
Why would I choose
comprehensive
conservative care?
Comprehensive conservative care Whatever the reasons, you may
may be an appropriate choice for get to the stage where you feel
you when dialysis is very unlikely that dialysis is a struggle. Or you
to improve the quality or length of may not want to start dialysis
your life. because you feel that you do
not want a complex treatment to
Many people can enjoy full lives extend your life.
while on dialysis or living with a
transplant. It is possible to work, When making a decision about
study, care for a family, play sport, treatment, it is important
travel, and spend time with friends. to remember that it is your
choice, and that comprehensive
However, both dialysis and conservative care is one option.
transplantation have limitations. If you are not sure, it is always
Transplantation is not always possible to try dialysis to see how
available, or it may not be things go.
successful. Transplanted kidneys
may eventually fail.
Dialysis requires you to commit to
regular treatments, either at home
or by attending a dialysis centre.
Dialysis may require diet and liquid
restrictions. If you also have other
chronic medical conditions, a lack
of independence and poor health
may make life on dialysis seem
very difficult.
Kidney Disease Treatment Options 37How will comprehensive
conservative care affect
my lifestyle?
If you choose comprehensive It is wise to make sure your
conservative care, your health financial arrangements are in order
care team will continue to provide while you are able to think clearly
ongoing treatment to manage and make your wishes known. This
the symptoms of reduced kidney may include preparing or updating
disease. How this impacts on your Will, writing an Advanced Care
your lifestyle will depend on the Directive, and appointing a Power
frequency and severity of of Attorney.
your symptoms.
Your health care team,
Many people who choose Palliative Care Australia
comprehensive conservative care palliativecare.org.au, or the
live for months or even years. The Office of Public Advocate/
goal during this time is to have the Guardianship in your state can
best quality of life that you can. also provide more information.
Your health care team may suggest More detailed information on
changes to your diet or fluid intake comprehensive conservative
to help you to feel better. Your care is available in the booklet
ability to work or travel will depend An Introduction to Comprehensive
on how well you feel. Community Conservative Care, and other
home care and nursing services resources following.
are available to help you remain
independent in your own home for
as long as possible.
38 Kidney Health AustraliaResources
Kidney Health Australia
fact sheets:
Comprehensive Conservative Care –
A Treatment Option.
Kidney Health Australia booklets:
An Introduction to Comprehensive
Conservative Care.
Kidney Health Australia book:
Living with Kidney Failure.
kidney.org.au/
your-kidneys/treatment/
comprehensive-conservative-care
Kidney Helpline
1800 454 363
kidney.helpline@kidney.org.au
Kidney Disease Treatment Options 39How do I make the choice?
The choice between a kidney transplant, dialysis
and comprehensive conservative care depends on
factors such as your age, health and lifestyle.
Your health professionals can help you make a choice.
They are experts in treatment. However you are the
expert in your life and you have to live every day
with your decision. If you make the decision about
6-12 months before you need treatment then you will
have plenty of time to prepare.
The process of decision making
You already make decisions every • Some people prefer a
day. What shall I wear, which car health professional or their
should I buy, where should I go at family to make a health
the weekend? decision, some people like to
make it themselves
Here are some facts about • Some people change their
making decisions: minds lots of times, others stick
• Some decisions are bigger to the first choice
than others but the process is • Some people like to make
the same decisions early, others leave it
• Some people are happy to to the last minute.
make decisions with very little
knowledge, some want to There is no right or wrong as long
know it all as you are happy with the result.
What sort of decision maker are
you? How do I make the choice?
40 Kidney Health AustraliaHere are some easy steps to
making your treatment decision.
Step 1 Step 2
Identify the decision Identify your priorities
In the case of treatment for If it is a big decision you should
kidney disease these are the think about what is important
common decisions: to you. This will help you focus
• Is transplantation suitable when you start to learn about
for me? your options.
• If yes, will it be a living donor or
This might include:
a deceased donor?
• Your family or pets
• Is dialysis suitable for me?
• Your work, study or a hobby
• If yes to dialysis, which type • Freedom to go on holiday or
seems to fit my lifestyle best? trips away
• Would I prefer not to have • Finances
a major treatment and let • Social life or daily routine.
nature take its course with
comprehensive conservative Step 3
care? Find out what your options are
Write all your options down and
discuss them with your family and
significant others.
Kidney Disease Treatment Options 41Step 4 Step 5
Knowledge is power Compare the options and
Learn as much as you can about make a choice
the options that you are interested My Kidneys, My Choice is a useful
in. This make take a few weeks decision aid that will help you to
and involve many sources of make your choice. It contains a
information. check-list of issues that you should
consider when making your choice.
Remember to consider “would this The decision aid is available from
option affect the things in life that the Choosing your treatment page
are important to me?” at www.kidney.org.au
Take advantage of the nurses and
social workers who offer group
and individual education sessions.
Use booklets (like this one), good
quality websites, videos, and
consider talking to other people
in the same position. Your health
care team can offer advice on any
possible reasons why a particular
treatment may not be possible due
to current or previous health issues.
Record all your information for
each option. Sometimes seeing
information on paper can make a Step 6
decision easier. Chat to your health care team
and discuss the way forward
42 Kidney Health AustraliaWhat if I am struggling to cope?
It is normal to feel anger, despair, fear and other
negative emotions during the journey of kidney
disease diagnosis and treatment. These feelings
usually improve with time. If the impact of kidney
disease treatments and the changes to your lifestyle
are overwhelming you, then it is important that you
talk to someone.
The nurses, social worker or doctor Resources
at your renal unit are the best Organisations such as beyondblue
place to start. Social workers are (beyondblue.org.au or call
employed in renal units to provide 1300 22 4636) provide a
professional counselling to patients confidential telephone information
and their family members. They are and advice helpline.
very familiar with the issues you are
experiencing. There is no need to
feel embarrassed or ashamed or to
suffer in silence.
You can also see your GP who can
arrange a referral to a psychologist
or social worker in your community.
These services can be accessed
through Medicare.
If you find yourself feeling
low, please ask for help.
Kidney Disease Treatment Options 43What does that word mean?
A D
Accredited practising dietitian Dialysate
Accredited Practising Dietitians (APDs) have A special fluid used in dialysis to remove waste
the qualifications and skills to provide expert and extra fluid from the blood.
nutrition and dietary advice. Dialyser
Acute kidney injury The part of a kidney machine which acts like a
A loss of kidney function that happens quickly filter to remove waste from your body.
which may or may not be permanent. Dialysis
Automated Peritoneal Dialysis (APD) A treatment for kidney failure, which removes
A type of PD where a special fluid is put into wastes and extra fluid from your blood by
the peritoneal cavity through a soft plastic tube, filtering through a special membrane. There
then drained out of your body continuously are two types of dialysis, haemodialysis and
for a few hours by a machine, usually at night. peritoneal dialysis.
See also CAPD. Dialysis machine
A machine used in dialysis that filters your blood
C to remove excess water and waste products
Central venous catheter when your kidneys are damaged, dysfunctional,
A special tube which is surgically inserted into or missing.
your neck, collarbone or top of your leg to allow
temporary access for haemodialysis. E
Chronic kidney disease (CKD) Exit site
A term used widely to describe kidney damage The point where the peritoneal catheter exits
or reduced kidney function (irrespective of the your abdomen.
cause) that persists for more than three months.
Sometimes CKD leads to kidney failure, which F
requires dialysis or a kidney transplant to keep Fistula
you alive. Produced when a vein and an artery in your
Continuous Ambulatory Peritoneal arm or leg are joined together to make it
Dialysis (CAPD) easier to move blood in and out of your body
A type of PD where a special fluid is put into during haemodialysis. Also known as an
the peritoneal cavity through a soft plastic tube, arterio-venous fistula.
then drained out a few hours later. This is usually
done three or four times each day. See also APD. G
Graft
Commonly used method of providing access to
your blood in which a vein and an artery in the
arm are joined together with a piece of special
44 Kidney Health Australia plastic-like tubing.H R
Haemodialysis Renal
A treatment for kidney failure. Your blood Another word for kidneys.
is pumped through special tubing to a Renal Dietitian
haemodialysis machine. The machine acts like a A Dietitian experienced in kidney disease who
kidney, filtering waste products from the blood can help develop an eating plan needed as part
before returning it to your body. of the management of kidney disease.
Health care team Renal Nurse
Living with kidney disease means that you will Nurses who are trained in kidney
have contact with many health professionals. disease treatments.
In addition to your nephrologist (kidney
Renal social worker
specialist), you health care team will also
Social workers who are trained in providing
include renal nurses, renal dietitian, renal social
people with kidney disease and their
workers, your GP, and other health professionals
families with the support needed to cope
depending on your circumstances.
with kidney disease.
N S
Nephrologist
Semi-permeable membrane
A doctor who specialises in kidney function.
A thin lining that allows some things to pass
P through it, but blocks others.
Palliative care T
Doctor and nurse specialists who support
Transplant
you with pain and symptom management.
A surgical procedure to place a kidney from a
Seeing a palliative care team does not change
live or deceased donor into a person whose
your lifespan but may increase your quality
kidneys no longer function properly.
of life. Some people visit a palliative care team
for many years.
U
Peritoneal dialysis (PD)
Urine
Treatment for kidney failure during which
The name for excess fluid and waste products
dialysis fluid is moved in and out of your
that are removed from your body by the kidneys.
peritoneal cavity to remove wastes and fluid
Commonly called wee.
from the blood.
Peritoneal membrane V
The membrane that lines your peritoneal cavity
Vascular access
and covers organs such as your stomach, liver,
Access to your blood stream for haemodialysis.
spleen, and intestines.
Kidney Disease Treatment Options 45Where can I get more information?
Booklets in this series cover home dialysis, peritoneal
dialysis, haemodialysis, transplantation, and
comprehensive conservative care. We encourage
you to read all the booklets so you can make an
informed decision about your treatment.
Resources Kidney Helpline
Living with 1800 454 363
Kidney Failure book. kidney.helpline@kidney.org.au
Kidney Health Australia Free health information service
Community Newsletter. for anyone requiring assistance
with managing their kidney
Social groups – Kidney Club. health, understanding their kidney
disease diagnosis or information
www.kidney.org.au on Kidney Health Australia
support programs.
Connect with us on Facebook,
Instagram and Twitter.
46 Kidney Health Australiawww.kidney.org.au
As the peak body for kidney health in Australia, we strive to create a
healthier community through increased awareness and early detection
of kidney disease. We connect kidney patients to vital resources and
services to help them manage their condition and improve their quality
of life; and, we support and foster advocacy and research to drive
improvements in the diagnosis, management and eventual cure of
kidney disease.
Our support services Primary care education
• Educational resources on kidney health and and resources
kidney disease, covering diagnosis, treatment • Free accredited face-to-face and online
options and management education for health professionals
• Fact sheets, books and educational videos • Accredited Quality Improvement activities
about kidney disease • CKD Ambassador program
• A large range of self-management • CKD management handbook and
resources including recipe books and CKD-Go! app
nutrition resources
• Educational videos
• Renal unit locations guide
• Nephrology referral guidelines and
• Holiday dialysis bus downloadable referral letter templates
• Transplant housing • eGFR calculator and resources
• Support groups • Scientific reports and publications.
• Kidney Health Week – national kidney
awareness week
• ‘Big Red Kidney Walk’ – fundraising walk
• Regular newsletters.
Kidney Disease Treatment Options 47Connect with us: Freecall 1800 454 363 www.kidney.org.au
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