June 2016 HEALTHTODAY 17 K idney transplant has long been an option to treat people with chronic kidney disease (CKD), an incurable kidney condition that sees the affected kidney worsening over time. Paediatric nephrologist Dr Wan Jazilah Wan Ismail points out, however, that it is a major surgical procedure when it comes to children, and hence, the benefits versus possible disadvantages or side effects have to be considered very carefully. When is the right time for a kidney transplant? CKD is classified into stages 1 to 5, and kidney transplant is usually an option for children with stage 5 (the last stage). “That is when the kidney has only 10-15% of its normal functions left,” says Dr Wan Jazilah. There are other considerations as well. According to Dr Wan Jazilah, surgeons in this country are more comfortable with operating on children who weigh at least 17 or 18 kg. “This can be a problem, as some of my young patients on dialysis have little appetite – it can be very difficult to get them to put on weight!” Dr Jazilah explains that, in Malaysia, many of our surgeons are trained to perform kidney transplant on adults rather than children. Therefore, the minimum weight requirement for children to undergo this procedure can be higher than in other countries where there are more surgeons trained to operate on children. Who can donate a kidney? Ideally, the donor should have no health problems such as high blood pressure, diabetes and such. Health Bites Our Children’s Kidneys II Following last month’s Health Bites, Dr Wan Jazilah now shares some insight into treatments for children with more advanced kidney diseases. Let’s start with kidney transplant. words Lim Teck Choon Dr Wan Jazilah Wan Ismail Head of Paediatric Department Hospital Selayang MHTJUN16_pg17-20_Healthy Bites.indd 17 19/05/2016 3:08 PM
Transcript
June 2016 HEALTHTODAY 17
Kidney transplant has long been an option to treat people with chronic kidney disease (CKD), an incurable kidney
condition that sees the affected kidney worsening over time. Paediatric nephrologist Dr Wan Jazilah Wan Ismail points out, however, that it is a major surgical procedure when it comes to children, and hence, the benefits versus possible disadvantages or side effects have to be considered very carefully.
When is the right time for a kidney transplant?CKD is classified into stages 1 to 5, and kidney transplant is usually an option for children with stage 5 (the last stage). “That is when the kidney has only 10-15% of its normal functions left,” says Dr Wan Jazilah.
There are other considerations
as well. According to Dr Wan Jazilah, surgeons in this country are more comfortable with operating on children who weigh at least 17 or 18 kg. “This can be a problem, as some of my young patients on dialysis have little appetite – it can be very difficult to get them to put on weight!”
Dr Jazilah explains that, in Malaysia, many of our surgeons are trained to perform kidney transplant on adults rather than children. Therefore, the minimum weight requirement for children to undergo this procedure can be higher than in other countries where there are more surgeons trained to operate on children.
Who can donate a kidney?Ideally, the donor should have no health problems such as high blood pressure, diabetes and such.
HealthBitesOur Children’s Kidneys II
Following last month’s Health Bites, Dr Wan
Jazilah now shares some insight into treatments for children with more
“Sometimes, the potential donor may seem healthy on the outside, but may be found to be unsuitable after we conduct a health check-up,” Dr Wan Jazilah says.
There has to be a match in blood type between the child and the donor – hence, parents being ideal - but the healthcare team would also check for other things. For example, they have to be sure that the kidney will not be attacked by the child’s immune system once it has been placed in the child’s body.
If there are no suitable donors to be found among the child’s immediate family members, kidneys from other donors can be considered. However, Malaysia often faces a shortage of kidney donors. According to our National Transplant Resource Centre, in 2015 there were only 1,288 kidneys from live donors and 511 from brain-dead donors, compared to 19,479 patients (both adults and children) on the waiting list!
There is still hope, though. Dialysis (see the next section) is a life-support treatment that allows the child to still function and live a reasonably normal and healthy life, and it is an option to consider for children with advanced CKD.
What Parents Should Know • Before the surgery, parents will be
informed of all possible risks and side effects of the surgery on their child, and the kidney transplant will only take place after the parents have given their consent. The child will have to undergo quite a number of medical examinations, so parents should help the child understand what he or she will be going through.
• After the surgery, the child will
be placed under observation. A sign that things have gone well is when the child begins to urinate normally. The healthcare team will also observe the child for signs of the body rejecting the kidney. The child will spend a few days in the intensive care unit, explains Dr Wan Jazilah, before being transferred to the normal ward. Close medical supervision can last up to 6 weeks.
• The child will be discharged after that, but he or she may need to continue seeing the healthcare team every day for about a month. After that period, the healthcare team will arrange for routine medical appointments.
During these sessions, the child’s weight and blood pressure will be measured, and there will also be blood and urine tests.
• The child may also be given immunosuppressant medications (which reduce the risk of the body rejecting the kidney) that usually have to be taken daily. Parents will need to make sure that the child really takes these medications. The downside to taking immunosuppressant medications is that they leave the child more vulnerable to infections, hence the importance of bringing the child to his or her medical appointments.HT
Dialysis describes a treatment which uses an external means to carry out the main function of a failing kidney: to
remove excess waste and water from the blood.
In the old days, the most common method of dialysis used was called haemodialysis. It is still used today, but it has some disadvantages. It requires the child to visit a dialysis centre several times a week, and each session can easily last 3 to 5 hours.
“These days, we have another option, called peritoneal dialysis,” says paediatric nephrologist Dr Wan Jazilah Wan Ismail. Peritoneal dialysis can be done at home, so it allows the child to go to school, play with friends and
lead a generally normal life with fewer disruptions.
Peritoneal dialysis at a glance1. The child will have a soft tube,
called a catheter, surgically embedded in the child’s belly. Dialysis fluid or dialysate will fill the child’s abdominal lining or peritoneal region via the catheter.
2. The dialysate stays in that area for a certain amount of time (the actual duration depends on the type of fluid used), during which the blood vessels in that area release excess fluids and waste materials from the blood into the dialysate.
3. The used dialysate is then drained and discarded.
There are 2 types of peritoneal dialysis.• Continuous Ambulatory
Peritoneal Dialysis (CAPD) does not require any machine, and hence, is often the more affordable option. It can be done while the child performs his or her daily activities. A bag of dialysate will be hooked to the catheter and will be later drained once the cleansing is complete (about 30-40 minutes).
• Automated Peritoneal Dialysis (APD) requires the use of a device – there are newer models which are easily
June 2016 HEALTHTODAY 19
HealthBitesOur Children’s Kidneys II
Dialysis treatment is shifting towards peritoneal dialysis, which is considered more flexible and less disruptive to the child’s routine. words Lim Teck Choon
portable and can be taken along during vacations. Obviously the more expensive option, it allows cleansing to be done when the child is resting or asleep, thus greatly minimising disruption to the child’s life.
Getting Ready for Peritoneal DialysisTo prepare the child for peritoneal dialysis, a catheter needs to be inserted into his or her belly. The area surrounding the tube will be covered in dressing (usually gauze) to keep it in position and keep the area clean. Parents must know how and when to change the dressing, so that the area can properly heal.
The child will stay in the ward for
a few days as the healthcare team monitors his or her health. During this time, the nurse will train the parents on long-term proper care of the catheter, such as:• Wash hands with soap and water,
and wear clean gloves before touching the catheter or the skin around it.
• How to hold and clean the catheter without injuring the skin.
• How to identify signs of infection and what to do when things go wrong.
It is very important that the parents are very familiar with the correct procedure, says Dr Wan Jazilah. “The person responsible for the child should be able to remember these
important steps, so we normally prefer the parents themselves to be involved, rather than grandparents or other elderly family members,” she adds.
Don’t dislodge the catheter!The parents should also teach the child to take care of the catheter properly. While the catheter can be covered by a pouch or a piece of cloth, there is a risk of dislodgement or even tearing if the child is not careful, which could lead to injury and even infection.
Thus, Dr Wan Jazilah always recommends the following to parents:• The child should avoid water sports
whenever possible, especially swimming in water that may not be properly chlorinated. If the child insists on swimming, cover the catheter properly.
• The child should avoid carrying younger siblings or animals such as cats and dogs – their movements may dislodge the catheter.
• Tell the child not to show off the catheter to his or her friends. The other children may touch and end up dislodging it.
Burning outPeritoneal dialysis can be a tedious process, and both parents and child run the risk of ‘burning out’. “Imagine doing your laundry by hand every few hours. That’s how it can feel sometimes,” explains Dr Wan Jazilah.
Talking to a counselor may help to deal with the stress and the burn out. Alternatively, there are support groups for parents with children who have kidney diseases, that meet face-to-face or on social media such as Facebook. These support groups can be great motivators for parents who are feeling the ‘burn’.
Need some support?The National Kidney Foundation offers counseling, support groups and even family activities to help families cope with the stress and strain that comes with supporting a family member with CKD. Call Tel: 03-7954 9048 (ext 223, 224, 226 or 103), e-mail [email protected] or visit www.nkf.org.my for more information. HT
June 2016 HEALTHTODAY 21
Other useful informationFamilies who experience financial strain can contact the following organisations to apply for financial assistance at the following places:1. National Kidney Foundation: call 03-7954 9048 or visit www.nkf.org.my.2. Social Security Organisation (PERKESO): call 03-4264 5000/03-4257
5755 or visit www.perkeso.gov.my. 3. Pension Division, Public Service Department (JPA): call 03-8885
3000/8885 4000 or visit www.jpapencen.gov.my/kemudahan_perubatan.html (for pensioners only).
4. Majlis Agama Islam: contact the Majlis Agama Islam office in your state, visit www.e-maik.my/v2/index.php/mains.html for more information (for Muslims)
5. Taiwan Buddhist Tzu-Chi Foundation Malaysia: call 03-7880 9048 or email [email protected] (for non-Muslims).
