What is Renal Medicine?
Renal medicine, or nephrology, is the branch of medicine that involves the diagnosis and management of people with diseases and conditions of the kidneys.

Your kidneys are two bean-shaped organs, found at the back of your abdominal cavity, that filter out wastes and excess fluid from your blood and excrete them as urine.

Renal medicine includes the urgent care of acutely ill patients as well as those with chronic illness who require long term care. A doctor who specialises in disorders of the kidneys is called a nephrologist. Conditions seen by a nephrologist may include:

• Acute renal failure – the sudden loss of kidney function
• Chronic, or long term, renal failure – gradual worsening of kidney function
• Haematuria – blood loss in the urine
• Proteinuria – protein loss in the urine
• Kidney stones
• Chronic or frequent urinary tract infections
• Hypertension – that has not responded to antihypertensive therapy.

Many kidney disorders may be treated with medications but if kidney function starts to fail and the condition becomes severe, dialysis and later, kidney transplantation, may be required.

Our Department
Outpatient clinics are held at Wellington Hospital, Kenepuru Hospital and Kapiti Health Centre.  Renal physicians also attend clinics at Hutt Hospital.

Inpatient Care
Renal inpatient care is provided on Ward 5 North, Level 5, Wellington Regional Hospital. Ward 5 North has 36 beds with renal, oncology and haematology specialties co-located. The ward provides a full renal medical and nursing service including diagnostic investigations, peritoneal dialysis and renal transplantation, as well as general medical, surgical and nursing care for renal patients. Acute inpatient services operate 24 hours a day, 7 days a week.

Incentre haemodialysis
Incentre haemodialysis treatment is provided in two facilities –

1) The hospital haemodialysis unit is located on Level 5, Wellington Regional Hospital

This 9 station unit provides haemodialysis treatment for patients with acute and chronic renal failure, on both an inpatient and outpatient basis. A number of patients are on permanent incentre haemodialysis treatment, while others are waiting for home training or home patients who are inpatients. There is also a designated isolation room for dialysis treatment.

Haemodialysis treatment is also able to be provided in the intensive care unit (ICU), Ward 6 South (CCU beds and cardiac high dependency area), and Ward 5 North. These areas have designated dialysis outlets at the patient bedside.

Visitor dialysis treatments are accommodated whenever possible for planned holiday patients both national and international, and at short notice for compassionate reasons.

The incentre unit is open 7 days a week from 0700 – 2230 hours. A dialysis nurse is rostered on call each night to accommodate an acute dialysis treatment required after hours.

2) The Porirua Community Dialysis Centre (PCDC) is located on Level 3, 14 Hartham Place – a commercial building located in the shopping centre in Porirua.

The 8 station centre provides satellite haemodialysis where stable and generally independent patients can receive haemodialysis treatment in a supportive environment within the local community.

Close links are maintained with the incentre dialysis unit, and the nursing staff is an integrated team who work across both the areas on a rotational basis. There is ongoing movement of patients between the two units, depending on the patient situation.

The satellite centre is open Mon, Wed and Friday 0730 – 2300 hours, and Tues, Thurs and Saturday 0730 – 1600 hours. There is a plan to extend operational hours by opening afternoon shifts on Tues, Thurs and Saturday, later in 2009. 

Home dialysis
The community dialysis unit located at Margaret Stewart House, 16 Hospital Road, Wellington provides training and support for patients at home on self-care peritoneal dialysis and haemodialysis. There is also provision for live-in accommodation for out of town patients in training.

An integrated group of community dialysis nurses provide training, ongoing patient management and support, follow up home visiting and an on-call after-hours telephone service.

Follow-up outpatient and medical reviews for home dialysis patients are managed at Margaret Stewart House.

The unit is open Monday to Friday 0730 – 1600 hours.

Pre-dialysis
A full pre-dialysis service is provided. Pre-dialysis coordinators work in collaboration with the renal medical staff to educate and support patients in planning for the most appropriate modality of renal replacement therapy. A pre-dialysis coordinator visits the patient at home, and maintains contact either in person or by telephone to provide ongoing support and education to facilitate a seamless transition to commencement of treatment.

Pre-dialysis coordinators work Monday to Friday 0800 – 1630 hours.

Vascular access coordination
The vascular access coordinators coordinate the vascular access surgical waiting list, scheduling of vein mapping and interventional procedures, and ongoing surveillance of all vascular access, as well as the coordination of the Tenckhoff catheter surgical procedures. There is strong collaboration with the vascular access and general surgeons.

They work closely with the staff in the dialysis areas to provide assessment and planning for the management of vascular access and ongoing staff education.

The vascular access coordinator role covers Monday to Friday 0800 – 1630 hours.

Transplant coordination
The transplant coordinators coordinate the live donor transplant list and general transplant list for all patients in the central region, provide initial patient education post-renal transplant, and coordinate the nursing follow-up, support and ongoing education of all renal transplant patients.

The transplant coordinator role covers Monday – Friday 0800 – 1630 hours

Visitor / Holiday Haemodialysis treatments
The service receives regular requests for visitor/holiday dialysis treatments.  Not all requests are able to be accommodated but whenever possible, the service is flexible in accepting visiting patients for treatment in either the hospital dialysis unit or the home training unit at Margaret Stewart House.  

Prior to confirmation of request acceptance, consideration is given to the workload and activity of the units, available staffing resources and nature of the request.

After a request for treatment has been approved and confirmed, the service maintains a commitment to provide treatments even if circumstances of workload change nearer the time. 

The following are important points for all requests for holiday/visitor dialysis treatments:

• Request is to be made a minimum of 8 weeks before intended visit.  For requests from international visitors, this timeframe should be extended as much as possible. 

• Maximum period of treatment is for 2 weeks (with 3 treatments maximum per week).

• Travel arrangements should not be confirmed until confirmation of acceptance for dialysis treatments has been received (acceptance offer forwarded to patient).

• Flexibility is expected in the scheduling of days and times for treatment, and an acknowledgement that this may need to change.

• If initial request is received from the patient or family member, communication is required with patient's dialysis centre staff to confirm patient's suitability for visitor treatments.

• The patient's dialysis centre is required to provide the following:
  • completion of Capital & Coast District Health Board renal service visitor referral form (which includes dialysis treatment information)
  •  copy of recent blood results
  • copy of MRSA, serology (hepatitis B, hepatitis C, HIV), VRE results (test results to be within four weeks of intended visit).

• Consideration is given to requests received at short notice on compassionate grounds (due to family illness or bereavement) and treatment accommodated when at all possible.

• Patients who usually dialyse at home independently on a Gambro AK95 machine are able to dialyse themselves on a machine at the training unit at Margaret Stewart House, after hours (ie any time after 4.00 pm).  Patients need to be fully independent as there are no staff on site.  The patient's dialysis centre staff are required to sign off approval for the patient to do this, and to accept responsibility for any on-call issues that may arise. The option to do this allows greater flexibility for appropriate patients, particularly when the units are too busy to accept holiday/visitor patients.   

NB:  This option only exists for patients fully independent on a Gambro AK95 machine.   

• Only patients with New Zealand citizenship or New Zealand residency status are eligible to receive holiday/visitor treatments at no cost.  In addition, Australian citizens also have eligibility due to a reciprocal agreement that exists.

• All other patients are required to pay for the cost of dialysis treatments.   The identified cost is $550 NZD (plus GST), which equates to $618.75 NZD per treatment.  Patients receive an invoice for the total cost of all treatments prior to the first scheduled treatment.  Payment is required prior to the last scheduled treatment and is made directly to Finance at Capital and Coast District Health Board (by cheque or credit card).  

All initial requests for holiday/visitor treatments should be made by email to RenalDepartment@ccdhb.org.nz

If you have an urgent problem requiring immediate renal assessment you are referred acutely to the Renal Service where you will initially be seen by the Registrar (trainee specialist) who will decide whether you need to be admitted to hospital.  Investigations will be performed as required, and the more senior members of the team involved where necessary.

If the problem is not urgent, the GP will write a letter to the Renal Service requesting an appointment in the outpatient clinic.  One of the consultant renal specialists working in the service reviews these referral letters to determine who should be seen first, based on the information provided by the GP.  Very urgent cases are usually seen within a couple of weeks, but other cases may have to wait a longer time.  Most first appointments are within six weeks.  Sometimes the renal specialist will contact the GP to discuss your case and give advice rather than arranging a clinic appointment.

When you are seen in outpatients, the doctor will ask questions about your illness and examine you to try to determine or confirm the diagnosis.  This process may also require a number of tests (e.g. blood tests, x-rays, scans etc).   Sometimes this can all be done during one clinic visit, but for some conditions this will take several follow-up appointments.  Occasionally some tests are arranged even before you are seen at the hospital to try and speed up the process.  

Following your appointment, your GP will receive a letter with advice detailing any necessary treatment. 

If you are concerned that you have not received notification of an appointment, either contact your GP or contact the hospital on (04) 385 5999.