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Our Nephrology Services

  • In office visits
  • Outpatient dialysis
  • Renal Nutrition Consultation
  • Home-dialysis training, and support for hemodialysis and peritoneal dialysis
  • Patient and community education


Our Nephrology Team



     Rafal Ciecierski, MD


Aleshia Cole, APNP

What is chronic kidney disease (CKD)?

Chronic kidney disease includes conditions that damage your kidneys and decrease their ability to keep you healthy by doing the jobs listed. If kidney disease gets worse, wastes can build to high levels in your blood and make you feel sick. You may develop complications like high blood pressure, anemia (low blood count), weak bones, poor nutritional health and nerve damage. Also, kidney disease increases your risk of having heart and blood vessel disease. These problems may happen slowly over a long period of time. Chronic kidney disease may be caused by diabetes, high blood pressure and other disorders. Early detection and treatment can often keep chronic kidney disease from getting worse. When kidney disease progresses, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant to maintain life.


What is the lifetime risk for developing CKD?

The Facts About Chronic Kidney Disease (CKD)

  • 26 million American adults have CKD and millions of others are at increased risk.
  • Early detection can help prevent the progression of kidney disease to kidney failure.
  • Heart disease is the major cause of death for all people with CKD.
  • Glomerular filtration rate (GFR) is the best estimate of kidney function.
  • Hypertension causes CKD and CKD causes hypertension.
  • Persistent proteinuria (protein in the urine) means CKD is present.
  • High risk groups include those with diabetes, hypertension and family history of kidney failure.
  • African Americans, Hispanics, Pacific Islanders, American Indians and Seniors are at increased risk.
  • Three simple tests can detect CKD: blood pressure, urine albumin and serum creatinine.

For more information on CKD, visit our health library by clicking here.

Newly diagnosed? Here’s what you need to know

  1. Know your kidney numbers. This goes for blood and urine. EGFR, or estimated glomerular filtration rate, is a measure of kidney function and is performed through a blood test. Be sure to get your urine tested as well for a protein called albumin. Too much albumin in the urine is an early sign of kidney damage.
  2. Get your blood pressure checked. Blood pressure checks are important since high blood pressurecan damage the kidneys. Know what numbers are considered acceptable for your condition and work with your health care professionals to take steps that will keep you in that range.
  3. Talk to your doctor about medication dosage and imaging tests. Many prescription and over-the-counter medications are filtered by the kidneys. This means that normal kidneys remove medications from the body. When your kidneys aren't working properly, medications can build up and cause you harm. If you just got a diagnosis of kidney disease, it’s important to work with your doctor to make any adjustments to your medication regimen, such as dosing changes or substitutions. This will help prevent any negative effects from the medication, including further kidney damage. Exposure to intravenous contrast dyes used in imaging (MRI, CT or angiograms) can cause kidney damage, so be sure to speak with your doctor before scheduling one of these tests.
  4. Talk to a dietitian. Eating a proper diet is essential for those with any stage of kidney disease. Across the board, cutting down on sodium is an important recommendation, but the kidney diet is very individualized. Be sure to make an appointment with a renal dietitian (one who specializes in kidney disease) immediately to receive your personalized diet plan. Medicare covers dietitian services for those with eGFR less than 50 as well as for those with diabetes. For kidney health recipes visit our Kidney Kitchen.
  5. Have your blood cholesterol levels checked regularly. 
  6. Stop smoking. In addition to causing lung cancer and lung disease, smoking is also associated with kidney disease, kidney cancer and bladder cancer. Smoking slows the blood flow to vital organs like the kidneys, causing damage. Think of smoking as stepping on the accelerator for any disease that you may have. So if you have kidney disease, smoking can make it even worse. To learn more click here.
  7. Plan to see the kidney specialist. Most experts agree that you should see a nephrologist when your eGFR (estimated glomerular filtration rate—a measure of kidney function) is less than 30.
  8. Learn about treatment options for kidney failure. If you’re in the late stages of kidney disease (stage 4 or 5), ask your kidney doctor or advanced practitioner about the different types of treatment for kidney failure so you can choose the one that best suits your health and lifestyle. They should address options such as home dialysis (either hemodialysis or peritoneal dialysis) and pre-emptive transplant, in addition to in-center hemodialysis.
  9. Create an access to your bloodstream. If you’re planning to start hemodialysis, you’ll need to prepare by having surgery to create an access to your veins. Be sure to avoid needlesticks in that arm at this time. Once you have your access placed there will be additional precautions you should take to keep your access working well. 


Contact Us

For more information about Agnesian HealthCaere Nephrology Services, or to schedule an appointment, call (920) 926-8573.

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