Dr. Sunio with Kidney Patient
How Your Kidneys Work
Most people have two kidneys. The kidneys have several very important jobs which include:
  • Clean waste products from your blood.
  • Maintain normal fluid balance.
  • Helps keep the blood pressure in normal range.
  • The kidneys produce a hormone called erythropoieten to help stimulate red blood cell production.
  • The kidneys help keep your bones healthy by maintaining normal levels of certain chemicals in your blood.

If you have Chronic Kidney Disease it is important that you do the following:
  • If you are diabetic keep your blood sugar under control.
  • Keep your blood pressure within normal range.
  • Keep appointments with your doctor.
  • It is recommended that you see a kidney doctor (Nephrologist) if your glomerular filtration rate (GFR) is less than 45 or less than 60 if you have protein in your urine.


Leading Causes of Kidney Disease
  • Diabetes
  • High Blood Pressure
  • Glomerulonephritis
  • Polycystic Kidney Disease


Chronic Kidney Disease (CKD)
Chronic Kidney Disease is defined as the presence of one or more of the following:
  • Kidney damage for > 3 months, as defined by structural or functional abnormalities of the kidney, with or without decreased glomerular filtration rate (GFR).
  • GFR < 60mL/min/1.73m2 for > 3months, with or without kidney damage.


Acute Renal Failure
Acute renal failure occurs rapidly, usually within days, and is typically related to a serious illness, surgery, exposure to toxic substances, or trauma to the kidney. This condition may be reversible with treatment. Patients may need temporary dialysis treatments until the kidney resumes normal function.


Kidney Stones
Kidney stones include a variety of small, rock-like particles that form in your kidneys. Our nephrologists specialize in identifying the type of stone causing you discomfort and recommending treatment to prevent formation of more stones. The most common stone type is calcium oxalate.

Things you can do to reduce your chances for developing new kidney stones of this type include:
  • Following a low oxalate diet.
  • Increasing your fluid intake to the recommended eight (8) glasses of water each day.
  • Maintaining the recommended dietary intake of calcium each day.



Nephrology Doctor

Nutrition and Diet

When a person's kidney function declines to a stage that they are no longer able to balance specific electrolyte and mineral levels in their blood certain dietary changes may be required.

The kidney doctor (Nephrologist) will assess your particular needs based on your lab work and physical exam. Common dietary restrictions for patients with Chronic Kidney Disease (CKD) are Sodium, Potassium and Phosphorus. For people with Kidney Stones (Nephrolithiasis) a low Oxalate diet might be recommended.

For people who have high blood pressure (Hypertension) it is recommended that they limit the amount of sodium in their diet. A 2 Gram sodium diet is often recommended. Limiting sodium intake will help maintain blood pressure at a more normal level and decrease fluid retention and swelling (Edema).

Kidneys that are functioning normally will remove excess Potassium through the urine. Patients who have Chronic Kidney Disease may have an elevated level of potassium that stays in their blood. By limiting the amount of high potassium foods that are eaten it will help keep the potassium level in a normal range. Excessively high levels of potassium in the blood require emergency treatment and can be life threatening.

Phosphorus is a mineral that is found in many foods. It is important to keep the blood phosphorus level within a normal range to help protect the bones. Sometimes it is necessary to take medications that bind to the phosphorus in the foods that are eaten to keep this level in normal range.

Lists of foods for Sodium, Potassium and Oxalate:

Important Minerals in Your Diet
Good nutrition habits can be built upon a better understanding of the minerals in your blood that your nephrologist will monitor over time. CLICK HERE for a general overview on the importance of these key minerals in your diet.


Making Wise Food Choices
Healthy nutrition is critical for your care. Learn more by visiting our Food Lists to Support Healthy Kidney Functions.


Frequently Asked Questions about Kidney Diets
Please visit our Nutrition FAQ page


Recipe Links
For healthy recipies, please visit:



Access Services
Dialysis Access Management

At Nephrology Physicians, we offer the full scope of care for patients with ESRD and specialize in the following procedures:
  • Vein Mapping
  • Angioplasty, Stenting, and Fistula Salvage
  • Thrombectomy & Trhombolysis
  • Dialysis Catheter Placement and Removal
  • Peritoneal Dialysis Catheter Placement and Repositioning
Learn more about each of the procedures.



Kidney Care Nurse Practitioner

Dialysis Options

General Information
Nephrology Physicians is the only practice in the Michiana area to offer all options of dialysis modalities through our association with Fresenius Medical Care. To learn more about these services visit www.freseniusmedicalcare.com

Hemodialysis
Hemodialysis removes wastes and extra fluid from your blood. During this process, blood is pumped though a filter called a dialyzer. As your blood is filtered only a small amount is outside of your body at a given moment and your filtered blood is retuned to your body. A special access is created, typically in your arm, to allow faster and safer connection to the equipment on a routine basis.

Home Hemodialysis
In 2006 Nephrology Physicians initiated the Michiana area's first option for patients to dialyze at home and our program continues to be highly regarded as an innovative program.

Home dialysis is very similar to more traditional in-center dialysis except the machine to cleanse your blood is more compact. Home dialysis offers many opportunities for flexibility in scheduling your treatments at times that meet your personal lifestyle. Home Dialysis does require a committed partner to assist you in performing the procedure safely. Your nephrologist will discuss this option with you and your partner to identify if this option is suitable for your needs.

Our program uses the NxStage System One Cycler to perform your dialysis treatments. You can learn more about this system at http://www.nxstage.com.

Prior to starting home dialysis, you will receive your treatments at an in-center facility to understand the specific processes that occur during dialysis. This is a time when you will become proficient in self-cannulation techniques to enable you to hook up to your home machine. Several weeks are typically required to work with specialized home dialysis nurses on all of the critical aspects to completing this procedure routinely in a safe and healthy manner.


Peritoneal Dialysis
This type of dialysis is done at home. The lining of the abdomen acts as a natural filter to clean the blood with a solution called dialysate. Dialysate is infused into the peritoneal cavity through a catheter. Waste products and excess fluid are drawn into the dialysate from the blood and drained from the body when the fluid is drained out through the catheter.

Peritoneal Dialysis Fact Sheet

There are two types of peritoneal dialysis:
  1. Continuous Ambulatory Peritoneal Dialysis (CAPD): Exchanges are done 4-6 times a day.
  2. Continuous Cycling Peritoneal Dialysis (CCPD): A machine called a cycler does the exchanges automatically at night while the person sleeps.

Nocturnal Dialysis
Nocturnal hemodialysis treatment takes place for an average of 8 hours a night, 3 times a week at the dialysis facility. Dialysis professionals monitor you throughout the night while you sleep.

While traditional hemodialysis provides effective treatment, nocturnal hemodialysis offers a longer, slower treatment for patients who need additional time to remove fluids.

The only local nocturnal program is offered at the Fresenius Medical Care - South Bend facility at 320 St. Joseph, South Bend, IN


Do I still see my nephrologist while I am on dialysis?
Your nephrologist manages your dialysis treatment prescriptions. Your doctor will meet with you during your dialysis treatment on a monthly basis. This rounding includes the whole care team including nursing staff, a social worker, and dietician to better understand how you are adjusting to the treatments and address any of your questions. Your doctor may make adjustments to your medications or your dialysis prescription to maximize your health and comfort level. Our Nurse Practitioners assist the nephrologist in managing your treatment by rounding up to three additional times per month to monitor your progress, discuss changes to your care, and assist in helping you find other resources to manage your disease.



Nephrology Care Nurse Practitioner

Patient Education Programs

NephWise
This is an informative, introductory class for patients who have recently been diagnosed with CKD Stage 3. This group session is held monthly at our office and last approximately 1 hour. For additional information or to reserve a space, please contact our office at 574-273-6767.

MIPPA
This educational program abbreviation references the Medicare Improvements for Patients and Providers Act. This service is available for Medicare beneficiaries with a diagnosis of CKD Stage 4. This is a series of one-on-one visits at the office with a nephologist and/or Nurse Practitioner.

TOPs
This educational program abbeviation references the Treatment Options Program offered by Fresenius Medical Care. This free class is provided for patients with a CKD Stage 4 or 5 diagnosis who want to paticipate in learning about dialysis options. For additional background information visit www.ultracare-dialysis.com



Internet Education Links

National Kidney Foundation (NKF): Information for organ donors and recipients, for patients and professionals, m0eetings and events and support. An AZ guide for kidney disease.
www.kidney.org

American Kidney Foundation (AKF): Information about this national voluntary health organization, as well as kidney disease facts.
www.kidneyfund.org

American Association of Kidney Patients (AAKP): Have you recently been diagnosed with reduced kidney function? View information on resources for those with chronic kidney disease (CKD) or at risk.
www.aakp.org

Kidney School is an interactive, web-based learning program designed to help people learn what they need to know to understand kidney disease.
www.kidneyschool.org



Transplant Education

Understanding Kidney Transplant Information and Advice for Patients
Please visit: www.transplantexperience.com



Our Physicians and Staff are dedicated to taking care of patients with Chronic Kidney Disease. If you have been diagnosed with Chronic Kidney Disease, Kidney Stones or Hypertension talk to your doctor about a referral to Nephrology Physicians. We offer the most comprehensive care for kidney disease in the Michiana area. To refer yourself, go to https://www.nephinc.com/patient-referral.asp or call 574-273-6767 ext. 1205.