Post-operative care in the Kidney Transplant Recipient
In appropriately selected patients with established renal failure, restoration of renal function by successful kidney transplantation improves both survival and quality of life. However, transplantation brings with it new challenges. Clinicians and patients need to be aware of the risks of transplantation including allograft rejection and the hazards associated with long term immunosuppressive therapy such as opportunistic infection, increased risks of cancer as well as cardiovascular and metabolic side effects of immunosuppression. These guidelines aim to provide an overview of strategies for provision of optimal care for the kidney transplant recipient. The guidelines should be useful for all clinicians involved in the care of these patients including nephrologists, transplant surgeons and their trainees, nurses, pharmacists and general practitioners. As guidelines, they cannot be exhaustive and do not aspire to cover some of the more specialised aspects of post transplant care (such as treatment of antibody mediated rejection, post-transplant thrombotic microangiopathy etc).
The aims of the guidelines are to provide a generalisable standardised approach to long term care of the kidney transplant recipient. This should encompass the clinic setup, optimising medication adherence, basic principles of immunosuppressive therapy and regimens as well as investigation and management of transplant dysfunction. The guidelines will also detail strategies to minimise risk of cardiovascular, metabolic, infective and neoplastic complications of transplantation. Finally, we also cover haematological and musculoskeletal complications and reproductive health in the transplant recipient.
Renal Association Post-Operative Care Guideline
Peritoneal Dialysis Clinical Practice Guideline
Peritoneal dialysis (PD) is long established as a major option for renal replacement therapy in patients with end-stage renal disease. It is an important part of an integrated service for renal replacement therapy that is frequently selected by patients as their preferred initial mode of therapy and is a therapeutic option for patients wishing or needing to swap from HD and after renal transplant failure. PD is the best option for infants and small children. NICE Clinical Guideline 125 (2011) recommends PD as the initial dialysis treatment of choice of chronic kidney disease stage 5 for children aged 2 years or older, people with residual renal function and adults without significant associated comorbidities.
For the first time, this Renal Association guideline includes recommendations relating to PD in children. Recommendations in this guideline will refer to both adult and paediatric patients, except where the recommendation specifies one of these patient groups or provides alternative recommendations to them.
Peritoneal Dialysis Guideline