Renal services are a specialised area of medicine involving diagnosis, management and treatment of complications for patients with kidney impairment and/or disease. The onset of kidney disease
can be sudden (acute) or develop over months or years (chronic), and may or may not progress to kidney failure.
End-stage kidney disease (ESKD) results when the kidney function is insufficient to excrete waste, concentrate urine, regulate electrolytes and produce hormones to the extent death will occur unless
a renal replacement therapy (RRT) is instituted. The continuum of care for patients with chronic kidney disease (CKD) encompasses managing early and potentially treatable disease through to the
management of ESKD, including renal-related surgery and RRT in the form of dialysis or transplantation services.
Care and management throughout the continuum of illness—from prevention, screening, diagnosis and pre-dialysis care through to treatment, supportive care and palliative care—is complex and
requires specialised care. This care is delivered in a range of settings by a number of health professionals and through varying treatment modalities, including surgery, dialysis and supportive care.
Renal care requires close collaboration between primary care providers, renal teams and other specialist services. The range of settings for the delivery of renal services includes the patient’s home,
hospital, stand-alone facilities and/or community healthcare settings.
Existing comorbidity combined with age and other patient characteristics can be used as a guide to classify ESKD risk. The mix of patients categorised by ESKD risk is likely to have implications for
facilities in terms of staffing and service delivery. Frequently renal patients have high levels of other comorbidities which interact in determining care needs. The Caring for Australasians with Renal
Impairment (CARI) guidelines1
are recognised as best practice standards in provision of renal services and should be followed by renal service providers, wherever possible.
Renal services within the scope of the CSCF and their location within the CSCF are outlined in Table 1. The CSCF’s focus is on treatment services for patients with diagnosed renal impairment and/or
disease provided by public or private health facilities, and includes renal dialysis services, renal-related surgery services and superspecialty renal transplantation services.