The aim of this clinic is to provide co-ordinated multi-disciplinary care for patients with advanced renal disease who may require renal replacement therapy such as dialysis or transplantation.
The pre-dialysis clinics are staffed by a consultant nephrologist, a specialist registrar, a pre-dialysis nurse specialist, a renal specialist dietician, a renal anaemia nurse and a renal counsellor.
Patients with chronic kidney disease are usually referred to the clinic when their glomerular filtration rate (GFR) falls below 20ml/min.
By providing a clinic with a varied specialist staff, most aspects of kidney care can be addressed. There is a particular emphasis on education and counselling so that you can make an informed decision about what is the most appropriate form of long term treatment for your kidney disease. This is particularly important as it allows suitable preparation before the need for renal replacement therapy.
Initial assessment is done by the advanced kidney care team and patients are invited to a number of education sessions where they are provided with detailed information about all aspects of renal replacement therapy.
These sessions give you and your relatives the opportunity to have your questions answered, and help you to choose the type of treatment most suited to you.
Occasionally, the specialist pre-dialysis nurses and counsellor arrange to perform a home visit, or offer one-to-one education sessions if this is more useful to you.
Treatment of problems and complications associated with chronic kidney disease is optimised. Efforts are made to improve blood pressure control, promote a healthy life style and reduce the risk of cardiovascular disease.
Intravenous iron therapy and erythropoietin stimulating agents (ESA) to manage anaemia, and vitamin D for hyperparathyroidism are commenced as appropriate. Regular assessment by renal dieticians identifies malnourished patients who are given dietary advice and provided with food supplement if necessary.
Dieticians also provide verbal and written advice to keep the biochemical parameters such as potassium and phosphate at appropriate levels.
You may be assessed for either:
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Haemodialysis - carried out at the main unit, a satellite unit or at your own home if appropriate
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Peritoneal dialysis - either automated peritoneal dialysis or continuous ambulatory peritoneal dialysis
Renal transplant work-up is started in suitable patients and pre-emptive transplantation and live-donor transplantation is encouraged if appropriate.
The conservative management team assesses and looks after patients who are not suitable or have decided not to have renal replacement therapy.
We offer outreach pre-dialysis clinics in Mayday Hospital, and in the Royal Surrey Hospital to try and reduce the burden of travelling for some patients.
Over the past two years, the number of patients attending this specialist clinic has increased significantly, and we have demonstrated improved markers of care for people starting dialysis therapy.
In addition, as a result of identifying appropriate patients for transplantation at an early stage, the number of people receiving a kidney transplant before the need for dialysis is increasing each year.
Referrals
We encourage referrals to this clinic to be co-ordinated through the extensive network of consultant nephrologists working within the renal unit.
Usually patients with chronic kidney disease are seen at one of the local nephrology clinics in southwest London and Surrey. If it is apparent that planning for renal replacement therapy is needed, this is generally co-ordinated within the renal unit.
However, if a GP identifies a new patient with advanced renal disease, we welcome telephone discussions with the consultant nephrologist responsible for that area to offer advice, early appointments, and occasionally direct access to the pre-dialysis clinic.
