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Pre-Dialysis Education Programme FAQs
Appointments
Please email to startright@nkfs.org or call us at 6506 2187 for assistance.
Treatment
You may consult your nephrologist in your current treating hospital.
Upon enrolment into NKF, our nephrologist will review you on a monthly basis at the dialysis centre. Nursing staff managing your dialysis may also consult the nephrologist in charge of respective dialysis centres on issues as they arise, if required.
There are four treatment options for kidney failure: Haemodialysis, Peritoneal Dialysis, Kidney Transplant or Conservative Care.
| Haemodialysis | Pros | Cons |
|---|---|---|
| Haemodialysis is the process of cleansing the blood by removing waste products, extra salt and water through a dialysis machine. Blood, via a surgically-created fistula, is pumped from the body and filtered through the artificial kidney (dialyser) attached to the dialysis machine. |
• Trained nurses perform various aspects of the treatment such as needling, at the dialysis centre • May develop a support network with other patients dialysing at the same time |
• Patients are required to travel to a dialysis centre three times a week, 4 hours per session • Less privacy at the dialysis centre as there are other patients doing dialysis at same time • Loved ones/friends are not allowed to visit during treatment session • The fistula needs to be accessed each time using 2 needles, which can cause pain/ discomfort. Problems such as blood clots or blockage can happen, which require treatment in hospital |
| Peritoneal Dialysis | Pros | Cons |
| Peritoneal Dialysis is a home-based, self-administered, needle-free treatment. It helps to remove toxins and excess water in the blood using a dialysis solution that is introduced into the abdomen via a surgically-inserted catheter. |
• Patients can perform the treatment in the comfort of their home without the need to travel to a dialysis centre • Provides more freedom to carry out daily activities • Able to better preserve remaining kidney function • Usually fewer fluid and dietary restrictions • No needles required • Can preserve blood vessels for future haemodialysis access creation, if needed |
• Treatment is performed every day • Catheter may affect body image • Swimming is not allowed due the risk of infection • Potential for weight gain due to glucose (sugar) in dialysis solution • Blood glucose requires closer monitoring and control in patients with diabetes • Storage space is required at home for medical supplies and peritoneal dialysis solution • Potential for infection in the catheter |
| Kidney Transplantation | Pros | Cons |
|
Kidney transplantation is the process where a kidney is surgically removed from a donor and implanted into the patient. The patient may receive a new kidney from a living donor or from someone who has passed on, also known as a deceased donor.
Patients are encouraged to consider a living donor kidney transplant before the need to start dialysis. |
• Improved quality of life compared to dialysis
• Able to lead a more normal family and work life • Free from the fluid and dietary restrictions required while on dialysis • Free from the long hours of dialysis treatment |
• As with any major surgical procedures, there are risks involved. These risks and benefits will be explained to help you make an informed decision.
• Regular monitoring, follow-ups are required. Lifelong anti-rejection medications are needed to prevent your body from rejecting the transplanted kidney • Risk of infections are higher post-transplant, as the immune system is suppressed |
| Conservative Care | Pros | Cons |
|
Conservative Care is an approach which uses medication to manage the symptoms and
improve the quality of life for the patient and his/her family while managing kidney failure, without dialysis or kidney transplantation.
It addresses the physical, psychosocial, and spiritual concerns and focuses on comfort, respect for decisions and support for the patient and his/her family. |
• More free time for loved ones and freedom to carry out daily activities as compared to patients on dialysis
• No needles or surgery required • Eliminates the risk of infection due to dialysis • Patient can travel if he/she feels well • Patient will receive multidisciplinary support from their team at the treating hospital |
• Treatment focuses on symptom management and psychosocial support. It is not aimed at curing kidney disease or prolonging your life
• Patient will need to travel to the hospital for regular clinic appointments • Additional medications may be needed to provide relief for patient from physical and/or psychological symptoms |
Before a dialysis patient can start HD treatment, he/she is required to undergo a day surgery to create an arteriovenous (AV) fistula/synthetic bridge graft to connect their vein directly to the artery. This helps to increase blood flow and pressure in the blood vessel to facilitate HD.
The fistula/graft is usually constructed in the forearm and requires 6-12 weeks to mature and be ready for use.
However, additional surgery may be required for patients whose fistula does not mature successfully. A temporary catheter may be inserted in the neck for quick vascular access if they need to begin dialysis treatment immediately. Patients who have opted for haemodialysis are recommended to consult their doctors or nurses early to plan ahead for the treatment.
A permanent catheter will be inserted into your abdomen (day surgery) and is ready for use after 2-3 weeks. Sometimes the catheter may be used earlier for PD if urgent treatment is required.
A PD nurse will conduct a home visit to ensure that your living environment is clean and suitable for dialysis at home. You will also undergo training for 3-5 days by your healthcare team together with your family members/caregivers to learn how to perform PD on your own and take care of your PD catheter.
CKD is a progressive loss of kidney function over time and usually does not have any obvious symptoms until the later stages.
A heathy diet and lifestyle, as well as optimising control of chronic conditions especially diabetes and high blood pressure, can help keep kidney diseases at bay.
Having first-degree relatives (i.e. parents, children and siblings) with kidney disease increases your risk of developing the disease in your lifetime as you share similar lifestyle habits.
It is also important to go for regular health screening to detect any risks or symptoms early and better manage any condition that may be present.
The main treatment provided will be to relief the symptoms and manage complications of kidney failure, for example, swelling from fluid retention, itching from toxin accumulation, tiredness from anaemia, high potassium and phosphate levels.
Without dialysis, toxins will build up. Depending on how quickly the toxins build up, and importantly how quickly your remaining kidney function declines, demise may occur anywhere from a few days to several weeks.
There is no good evidence TCM can improve kidney function. Kidney failure is irreversible.
Do not take traditional medicine or health supplements from dubious sources that may cause serious health problems. If you have kidney disease, avoid taking anti-inflammatory painkillers such as Diclofenac (Voltaren), Naproxen (Synflex), Etoricoxib (Arcoxia) as they may worsen your existing kidney function.
You should always consult with your nephrologist before consuming any medication or supplements.
Financial and Care Counseling
Please inform the hospital’s doctor or nurse that you wish to speak to the medical social worker (MSW).
The patient/family will undergo counselling with the renal coordinator and the treating medical team to receive timely and appropriate education about the available treatment options, so as to make informed decisions on which treatment option is best suited for the patient.
The MSW will refer financially needy patients to the NKF.
If you face financial difficulties, please email to startright@nkfs.org or call us at 6506 2187.
Our medical social workers will discuss and advise you on the various support options such as the availability of insurance claim and coverage or conduct a financial assessment to determine the subsidies for which you are eligible.
Eating Right & Keeping Fit For Chronic Kidney Disease (CKD) Patients
Learning how to eat right is important after being diagnosed with CKD. The goal is to preserve existing kidney function and to delay the progression to CKD stage 5, also known as kidney failure.
Click here to learn more about Eating Right for CKD patients.
Yes. CKD and kidney failure patients are encouraged to continue exercising if you are well enough to do so.
Regular exercise helps you to maintain muscle strength, endurance and the ability to be independent in your daily activities.
Click here to learn more about the type of exercises that are suitable for your condition.
Others
There are various dialysis treatment options and you could opt for one that accommodates your work schedule.
If your employer requires you to put in full-time working hours, you could opt for either nocturnal haemodialysis at the dialysis centre or automated peritoneal dialysis from home; both are performed while you are asleep.
