An Advanced Kidney Care (AKC) clinic is held at both Kent and Canterbury Hospital on Wednesday mornings and Maidstone on Friday mornings. Within this clinic patients may see a Consultant Nephrologist, an Advanced Kidney Care Nurse, a Dietician and a Renal Counsellor.
These clinics are held for people with Chronic Kidney Disease (CKD) who are usually referred to the clinic when their estimated glomerular filtration rate (eGFR) falls below 15ml/min (or eGFR less than 25 ml/min and declining).
We aim to offer patients and their families the benefit of a full range of professional support from our multidisciplinary team.
Treatment of problems and complications associated with chronic kidney disease is optimised within the AKC Clinic. Efforts are made to improve blood pressure control, effectively manage anaemia and bone disease and reduce the risk of cardiovascular disease. Dieticians provide verbal and written advice to keep the biochemical parameters such as potassium and phosphate at appropriate levels, and identify malnourished patients who are provided with food supplements if necessary.
Initial assessment is done by the advanced kidney care team in an Assessment and Support Kidney Care (ASK) Clinic. These 45-minute appointments give patients and their relatives an overview of the treatment options available and the opportunity to have their questions answered. We also invite patients to attend our interactive education session where they are provided with more detailed information about all aspects of renal replacement therapy (RRT), transplantation or conservative management, thus enabling them to choose the type of treatment most suited to their lifestyle.
Following assessment and education, discussion will take place about treatment choices and a plan will be made.
Patients who opt for haemodialysis are referred for formation of an Arterio-Venous (AV) fistula, if necessary after radiological imaging of the veins in their arms. Haemodialysis is commenced according to availability within the Renal Units and the patients are later transferred to their nearest dialysis unit.
Patients suitable for home haemodialysis are referred to Home Therapies team. Following full assessment of their general state of health, social circumstances and suitability of accommodation for carrying out haemodialysis at home, these patients are either trained in a training area at Kent and Canterbury Hospital or at their nearest renal satellite unit.
A peritoneal catheter (Tenckhoff catheter) is inserted into the abdomen under general anaesthesia, when eGFR is around 10 ml/min, in those patients who have chosen Peritoneal Dialysis (PD) as their preferred modality of treatment. Patients can then either choose to continue with manual PD (Continuous Ambulatory Peritoneal Dialysis or CAPD) or automated PD (Automated Peritoneal Dialysis or APD).
Renal transplant workup is started in suitable patients and pre-emptive (before the need for dialysis) transplantation is encouraged if appropriate. Combined kidney and pancreas transplantation is carried out in selected diabetic patients. Referral to a living donor clinic is made to assess potential donors. All patients worked up for cadaveric or living-donor transplantation are seen by a transplant surgeon before going on the waiting list.
A Conservative Management Team assesses and cares for the patients who have decided not to have renal replacement therapy. This Team works closely with local community nurses, social workers, nursing/residential homes, palliative care nurses and hospices.
