Capital & Coast DHB Renal Service
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 or renal physician. Conditions seen by a nephrologist may include:
• Acute kidney injury – the sudden loss of kidney function
• Chronic, or long term kidney disease – gradual worsening of kidney function
• Haematuria – blood loss in the urine
• Proteinuria – protein loss in the urine
• Kidney stones
• Hypertension (high blood pressure) – 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/or kidney transplantation, may be required.
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 treatment is provided in two facilities –
1) The hospital haemodialysis unit (DU) 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. 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.
The in-centre unit is open 7 days a week from 0700 – 2230 hours. A dialysis nurse is rostered on call each night to accommodate an emergency dialysis treatment required after hours.
2) The Kenepuru Dialysis Unit (KDU) is located on the Kenepuru Hospital campus in Porirua.
The 24 station satellite unit provides haemodialysis for stable patients in a supportive environment with a focus on encouraging levels of self-care. Currently 20 stations are operational with capacity to increase spaces as patient numbers indicate.
Close links are maintained with the incentre dialysis unit with an integrated team of nursing staff who work across both the areas on a rotational basis.
The satellite unit is open 7 days a week from 0700 - 2230 hours.
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.
A full pre-dialysis service is provided. Clinical nurse specialists 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 nurse 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.
Clinical nurse specialists 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 Tenckhoff catheter surgical procedures. This involves strong collaboration with the vascular and general surgeons.
CCDHB Renal Service is a kidney transplanting centre with a full live donor transplant programme. Clinical nurse specialists 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.
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.
Current situation (December 2016): The unit is closed for holiday patients due to local patient numbers. Exceptional circumstances (compassionate reasons) will be considered on an individual basis.
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.
All initial requests for holiday/visitor treatments should be emailed to RenalDepartment@ccdhb.org.nz
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).
- Patients who usually dialyse at home independently on a Gambro AK96 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 AK96 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). 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).
Renal dietitians are part of the renal team and provide individualised nutrition assessment, advice and support to people with kidney disease. The service covers inpatient care at Wellington Hospital, outpatient clinics at Wellington and Kenepuru hospitals, home dialysis clinics at Margaret Stewart House, Wellington and Kenepuru Dialysis Units and telephone contact. Below are some useful links for renal nutrition:
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.
Common Conditions / Procedures / Treatments
This is when a patient’s kidneys are unable to remove wastes and excess fluid from the blood.… More
Haemodialysis is a treatment that cleans and filters your blood by removing the waste products and extra fluid that your kidneys can no longer eliminate.… More
Peritoneal dialysis is a treatment where the peritoneal membrane (lining around the inside of your intestinal wall) is used to filter and cleanse the impurities, waste products and extra fluid from your body.… More
Transplantation places one healthy kidney into your abdomen. This one kidney is sufficient to replace the work of your two failed kidneys.… More
To determine the cause of kidney problems, it is sometimes necessary to undertake a kidney biopsy.… More
This term means protein in the urine and may indicate that there is a problem with your kidneys. More
This term means blood in the urine and may be the result of inflammation or other problems with your kidneys, blockages in your ureter, infection or other problems with your bladder or problems with your prostate. More
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General Enquiries: (04) 385 5999
Fax: (04) 385 5856
Emergency Department: Open 24 hours / 7 days, Phone (04) 385 5999
Private Bag 7902
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This page was last updated at 12:02PM on December 16, 2016. This information is reviewed and edited by Capital & Coast DHB Renal Service.