Racquel Abalos (centre), pictured with husband, Randy, and Dr. Michelle Hladunewich, gave birth to baby Gabrielle after being carefully managed through a pregnancy on dialysis.
One grateful mother can testify to the quality of Sunnybrook's nephrology care. An all-new facility promises more successes in research and treatment
"She's perfect."
Those are the words all parents long to hear at the birth of their child, but they were particularly poignant for Racquel Abalos and her husband, Randy.
Racquel was just 27 when she was diagnosed with nephropathy, or kidney disease. When she became pregnant, her doctor at an area hospital immediately referred her to Dr. Michelle
Hladunewich, head of Sunnybrook's nephrology and obstetrical medicine divisions. Dr. Hladunewich's PreKiD Clinic provides care to young women with kidney disease or hypertension who are planning a pregnancy, require follow-up during pregnancy or who need immediate postpartum care.
To improve Racquel's chances of a healthy pregnancy and successful birth, Dr. Hladunewich recommended she start treatment. "She told me I would have to go on dialysis," recalls Racquel.
"Frequent and longer dialysis sessions dramatically improve pregnancy outcomes," says Dr. Hladunewich, who recently led a major study that showed intensive dialysis treatment in pregnant women with kidney failure leads to a higher proportion of live births than standard dialysis care. "This study provides hope to young women on dialysis who might want to consider having a family," says Dr. Hladunewich.
During her pregnancy, Racquel underwent dialysis for six hours a day, six days a week, with one day of rest before commencing again. There was also a risk the baby could be born with health issues – the medications that Racquel was taking are harmful to babies.
Dr. Hladunewich notes that pregnancy is often impossible in young women with advanced kidney disease because fertility declines as kidney disease progresses. "In the few women who are able to conceive while on dialysis, pregnancy is typically very complicated and can be dangerous for both mother and baby."
According to Dr. Hladunewich, since 2000 there have only been 22 babies born in the Greater Toronto Area to women on dialysis. Medical complications associated with kidney disease mean that pregnancies in dialysis patients are uncommon. Typically, a pregnant woman on dialysis requires meticulous care by a dedicated health-care team, including nephrology, obstetrics and a full multidisciplinary staff. Team members are available around the clock to provide care during the pregnancy, which is considered to be high-risk.
Under the expert guidance of Dr. Hladunewich, and with the help of the team at Sunnybrook, Racquel, who has since had a kidney transplant, gave birth to Gabrielle Ivy in September 2012. "Gabrielle means 'God is my strength,'" she says.
"I had the best care possible," says Racquel. "Dr. Michelle and the home dialysis team, especially my nurse Raquel [Bersamira], cared for me 24-7. Dr. Michelle even checked in on me on weekends."
"We have very good success stories," says Dr. Hladunewich. "In pregnancy and kidney disease, women who've been told they can't have a baby or safely get through a pregnancy, that's something we're quite world-renowned for – managing pregnant women on dialysis."
Dr. Hladunewich's internationally renowned pregnancy clinic is just one example of the unique kidney care clinics and experts available at Sunnybrook. Dr. Alireza Zahirieh's HIV renal disease clinic offers care for patients with HIV infection and works in conjunction with a large HIV infectious disease clinic. Dr. David Naimark focuses on progressive diabetic kidney disease, while Dr. Sheldon Tobe is a world expert in hypertension. His hypertension clinic improves the lives of people with or at risk of developing kidney disease by focusing on the diagnosis and control of high blood pressure, a common cause of kidney disease.
Beyond offering expert care, these clinics also play an important role in the practice-changing research carried out by the nephrology division – a link that helps discoveries reach patients faster. The clinics are also education hubs, where doctors train the kidney care specialists of tomorrow.
"Sunnybrook's an academic centre. Each of us contributes in our own particular areas. There are not that many centres in the country with the kind of expertise put together here," says Dr. Tobe. "All the nephrologists in our centre are either highly productive researchers or educators, or both. A lot of our focus is on training the next generation," he says.
"Because nephrology doesn't have that many treatments, research is badly needed in terms of figuring out why people develop kidney disease and how you delay or – better yet – reverse the process. The fact that we have people involved in that makes Sunnybrook a leader," says Dr. Zahirieh.
That leadership will be all the more productive with Sunnybrook's new Kidney Care Centre, set to open this fall. The new centre promises modern, spacious facilities to help the doctors and their teams carry out their work and move forward with their research.
"Once you have space, there's the opportunity to be innovative," says Dr. Hladunewich. "We'll have the opportunity to expand and build on our existing research programs, [and] state-of-the-art facilities to teach the next generation will be critical, as well."
No doubt patients will also appreciate the new space. And if it helps practitioners enhance their already-esteemed care, all the better. "I don't think you could have a better team. We really have a collaborative environment," says Dr. Hladunewich. "We've always been ahead of our time. We've always been innovative. We're a very creative team. I think that's good for patients."
- Dr. Michelle Hladunewich on
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Once you have space, there’s the opportunity to be innovative”THE NEW KIDNEY CARE CENTRE
This fall, Sunnybrook hopes to cut the ribbon on a new 28,000-square-foot Kidney Care Centre, which will be located adjacent to the Bayview campus. The centre promises state-of-the-art facilities to provide dialysis for research and training, and a wider array of treatments for people with chronic kidney disease.
"We're all looking forward to the move. We're going to have a much bigger, better clinic space," says Dr. Sheldon Tobe, who has a hypertension clinic at Sunnybrook.
In addition to 24 bright and spacious hemodialysis stations, there will also be space for education and research, aiding Sunnybrook's clinician-researchers in their quest to improve the prevention and treatment of kidney disease.
The new centre will also improve their ability to teach the next generation of kidney care experts by providing leading-edge facilities that complement the skills of the clinician-educators and teachers.
The project also includes renovating and updating the hemodialysis unit at Sunnybrook, used for patients with more acute needs who may require immediate access to the full range of hospital services.
"Dialysis is not an easy journey – it's for four hours, three to four times a week. [Now] their families can be here with them," says Dr. Hladunewich.
Although construction is already under way, fundraising efforts continue to meet the costs of the new centre .
"Sunnybrook is poised to transform the services it provides to kidney patients and to truly become a global centre of excellence. We can only achieve this with financial support from the community," says Dr. Hladunewich. •
This content was produced by The Globe and Mail's advertising department, in consultation with Sunnybrook. The Globe's editorial department was not involved in its creation.