What do you know about kidney health?

If you are like me, you may have specialised in a particular area of healthcare and had very little renal nursing experience. Perhaps you would like to know a little more about renal nursing, how to care for people with renal issues or how to care for your own kidneys?

Let’s investigate this topic together, in the lead up to World Kidney Day, 9th March 2017.

Firstly, THANK YOU TO ALL THE RENAL NURSES OUT THERE!

Nursing is a complex role that requires special skills and knowledge – and a pretty special person to provide quality nursing care!

1.7 million Australians are believed to have kidney disease, according to Kidney Health Australia (2017). Amazingly, it is suggested that 90% of this 1.7 million consists of people that do not even know that they have the condition (Kidney Health Australia, 2017).

‘While the mortality associated with many chronic diseases including some cancers is stable and even declining, two Australians every hour continue to die with kidney related disease’.

(Kidney Health Australia 2017)

Did you know that your kidneys filter your blood 12 times an hour? Or that you may lose as much as 90% of kidney function before you notice that you have a problem (Victorian Government 2016)?!

Signs that you may have a kidney problem could include:

• Foamy urine
• Oedema
• Pain around the kidneys, in the back or under the lower ribs
• Painful, burning urination
• Decreased appetite
• Shortness of breath
• Nausea
• Vomiting
• Tiredness
• Lack of concentration; and
• Haematuria.

(Victorian Government 2016)

Nephrology nursing may include:

• Nursing assessments
• Risk factor identification
• Client and staff education
• Incorporation of client’s carers or family members
• Training people for home dialysis
• Renal transplant care (pre and post)
• Prevention of complications
• Rehabilitation
• Acute dialysis; and
• Multidisciplinary team care.

(National Kidney Foundation 2016)

‘The nephrology nurse must possess a knowledge base that includes the following:

• Anatomy and physiology of the kidney and urinary system
• Nephrology nursing process
• Pharmacology
• Nutrition
• Teaching theory
• Psychosocial aspects of chronic kidney disease (CKD)
• Concepts and principles of dialysis and related therapies
• Circulatory access for haemodialysis
• Concepts and principles of renal transplantation.

Experience:

12 months experience as a registered nurse in a medical-surgical unit or intensive care unit may be required prior to entering nephrology nursing’ (National Kidney Foundation 2016).

How Can You Take Care of Your Kidneys?

• Stay hydrated
• Healthy diet including limited salty, fatty foods
• Maintenance of healthy blood pressure
• Maintenance of a healthy weight via exercise and healthy dietary habits
• No smoking
• Limit alcohol intake to ‘two small drinks a day for a man and one small drink a day for a woman’; and
• Reduce your stress.

(National Health Service 2015; Health Direct 2015)

Additionally, you may be at risk of kidney disease if you: have already had cardiovascular problems; have a family history of kidney failure; are aged above 60 years; have an acute kidney injury; or, are Aboriginal or Torres Strait Islander in origin (Victorian Government 2016).

Chronic Kidney Disease

People with chronic kidney disease are placed at double or even triple the risk of cardiovascular complications (Victorian Government, 2016); thereby, conditions such as hyperlipidaemia must be managed effectively (Murphree & Thelen 2010).

Kidney disease is referred to as being chronic when there is ‘persistent kidney damage or a glomerular filtration rate (GFR) of <60mL / min / 1.73m² for at least 3 months’ (Murphree & Thelen 2010).

Potential complications to watch for (Murphree & Thelen 2010):

• Anaemia
• Abnormal bone metabolism
• Metabolic acidosis; and
• Malnourishment.

Peeters et al. (2014) report that ‘additional support by nurse practitioners attenuated the decline of kidney function and improved renal outcome in patients with CKD’.

For people with end-stage kidney disease, an interdisciplinary and person-centred nursing approach is needed that includes renal and palliative care nurses (Kane, Vinen & Murtagh 2013). Aspects such as education, psychological support, advance care planning and management of symptoms, are all important for end-stage kidney disease nursing care (Kane et al. 2013).

As you likely expected, early diagnosis and intervention is key to preventing renal damage or complications. This may be difficult, as kidney disease can be a ‘silent disease’ (Victorian Government, 2016). Diagnosis can involve tests such as: blood tests, imaging, biopsy, and/or urine tests (Victorian Government, 2016). ‘Damaged or inflamed kidneys ‘leak’ substances such as blood or protein into the urine. The preferred test for detecting protein in the urine is a urine albumin-to-creatinine ratio (urine ACR) test, which shows the amount of albumin (a type of protein) in the urine’. (Victorian Government, 2016).

Blood tests may involve looking for:

• Acidosis
• Hyperkalaemia
• Hyponatraemia
• Calcium and phosphate abnormalities
• Anaemia
• And primarily, poor GFR (glomerular filtration rate).

You can access help or advice from:

• Your doctor
• Kidney Health Australia Information Service – Tel. 1800 454 363
• Quitline – Tel. 13 78 48

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References:

1. Health Direct 2015, Kidney Disease Prevention, Health Direct, viewed 27 February 2017, https://www.healthdirect.gov.au/kidney-disease-prevention
2. Kane, PM, Vinen, K & Murtagh, FEM 2013, ‘Palliative care for advanced renal disease: a summary of the evidence and future direction’, Palliative Medicine, vol. 27, no. 9, pp. 817-21, viewed 27 February 2017, http://journals.sagepub.com/doi/full/10.1177/0269216313491796
3. Kidney Health Australia 2017, World Kidney Day, Kidney Health Australia, Melbourne, VIC, viewed 27 February 2017, http://kidney.org.au/kidney-health-week/world-kidney-day
4. Murphree, DD & Thelen, SM 2010, ‘Chronic kidney disease in primary care’, Journal of the American Board of Family Medicine, vol. 23, no. 4, pp. 542-50, viewed 27 February 2017, http://www.jabfm.org/content/23/4/542.full
5. National Kidney Foundation 2016, Renal Career Fact Sheet – Nephrology Nurse, National Kidney Foundation, New York, NY, viewed 27 February 2017, https://www.kidney.org/
6. National Health Service 2015, Keeping your kidneys healthy, NHS Choices, UK, viewed 27 February 2017, http://www.nhs.uk/Livewell/Kidneyhealth/Pages/Loveyourkidneys.aspx
7. Peeters, MJ, van Zuilen, AD, van den Brand, JA, Bots, ML, van Buren, M, Ten Dam, MA, Kaasjager, KA, Ligtenberg, G, Sijpkens, YW, Sluiter, HE, van de Ven, PJ, Vervoort, G, Vleming, LJ, Blankestijn, PJ & Wetzels, JF 2014, ‘Nurse practitioner care improves renal outcome in patients with CKD’, JASN: Journal of the American Society of Nephrology, vol. 25, no. 2, pp. 390-98, viewed 27 February 2017, http://jasn.asnjournals.org/content/25/2/390.abstract
8. Better Health Channel 2016, Kidney disease, Better Health Channel, Victorian Government, Melbourne, VIC, viewed 27 February 2017, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/kidney-disease

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