CKD MANAGEMENT

Dr Nonkala's nephrology practice offers conservative, specialised, acute and intensive CKD management and medical care of related kidney pathologies.

Dr Nonkala uses a holistic approach which emphasis early screening for kidney damage, patient education and attempts to reverse early kidney damage with lifestyle, while also making use of a multi-disciplinary team (psychologist, social worker, physiotherapist, dietician, spiritual mentor and primary physician) to support patients with more advanced kidney failure.

MANAGING CKD IN SA

In South Africa, managing Chronic Kidney Disease (CKD) focuses on slowing progression and preventing complications and, if required, renal replacement therapy (RRT) like dialysis or kidney transplant services.

Access to CKD management in South Africa is limited for many people in the public healthcare sector, where RRT is strictly rationed. This highlights the importance of early screening for kidney damage even more.

Conservative kidney disease management - medications to relieve the symptoms of renal failure or polycystic kidney disease (without treating renal failure itself), and controlling CKD risk factors like blood glucose & blood pressure, and treating HIV & hyperparathyroidism which contribute to kidney damage.
Specialised kidney care - pre-pregnancy via an assessment particularly where pre-existing kidney problems are present, so as to help the patient fulfil her dream of bearing a child.
Acute kidney care - e.g. to treat glomerular nephritis (inflammation in the kidney).
Intensive kidney disease care - dialysis or kidney transplant services.

Conservative or Intensive Care

CKD in Pregnancy

Acute Kidney Care

All Renal Pathologies

Facilitation of Kidney Biopsies

Early Detection is Key!

Progression of Kidney Disease based on eGFR

GENERAL CKD MANAGEMENT

CKD management hinges on the stages of CKD. The earlier kidney damage is detected, the greater the chance of halting or even reversing damage, whereas in End-Stage Kidney Disease (ESKD) only dialysis or kidney transplants can help. In general the management of CKD entails:

Medications - e.g. for the tight control of diabetes or hypertension which are key causes of CKD. All medications should be reviewed to ensure they are appropriate for kidney function and to avoid nephrotoxic drugs.
Managing CKD Complications - incl. Anemia (erythropoiesis-stimulating agents may stimulate red blood cell production), Hyperphosphatemia (Phosphate binders may help reduce blood phosphate levels), Metabolic Acidosis (Bicarbonate supplementation needed), Bone Health (medications to help maintain bone health).
Dialysis - Haemodialysis or peritoneal dialysis can be used to filter the blood when the kidneys are no longer functioning properly.
Palliative Care - patients with advanced CKD can focus on managing symptoms, improving quality of life, and providing psychosocial support.

With Dr Nonkala's expert care, you can maintain your level of functioning for longer!

DIALYSIS

Kidney dialysis is a life-sustaining treatment that removes waste products and excess fluid from the blood when the kidneys are not functioning properly. It is indicated for individuals with acute kidney injury or kidney failure / End-Stage Kidney Disease in order to alleviate symptoms like fatigue, nausea and swelling.

Dialysis may affect fertility. It extends life but is not a cure for CKD.

Dialysis is performed through two main methods:

Hemodialysis: blood is filtered outside the body by a dialyzer machine, then returned to the body
Peritoneal dialysis: the body's abdominal lining is used as a filter and dialysis fluid is pumped into and out of the abdomen

Dr Nonkala does a work-up of the patient and manages the dialysis prescription. He'll visit the patient to assess and manage any acute illness or hospitalizations required, and to educate re dietary restrictions and fluid intake for improved dialysis outcomes.

In addition to Haemodialysis, Dr Nonkala also offers peritoneal dialysis which you do in the comfort of your home under his clinical oversight.