Aeromedical Implications
Effect of aviation on condition
- Fatigue
- Sleep deprivation aggravating fatigue
- Increased cardiac workload during stressful phases of flight potentiating haemodynamic imbalance secondary to fluid shift
- Hypoxic, hypobaric, low relative humidity flight environment compounding oxygen transfer in affected tissues
Effect of condition on aviation
- Reduced exertional capacity / G- intolerance due to electrolyte and fluid balance issues
- Subtle cognitive impairment due to electrolyte changes and renal anaemia
- Cardiorespiratory compromise (shortness of breath, cardiac stress) due to renal anaemia
- Physical effects of peripheral oedema
Effect of treatment on aviation
- Variability of stability in between dialysis treatments
- Side effects of medication such as steroids and other treatments
Approach to medical certification
Based on condition
- Stage 1 – eGFR ≥ 90 – No aeromedical concerns
- Stage 2 – eGFR 60-89 - Not CKD unless haematuria, structural or pathological abnormalities present
- Stage 3a – eGFR 45-59 – Assess cause / trajectory – requires annual review
- Stage 3b – eGFR 30-44 – may be unfit for unrestricted certification – refer to CASA
- Stage 4 – eGFR 15-29 – unlikely fit for certification - refer to CASA
- Stage 5 – eGFR <15 – unfit for medical certification – refer to CASA
- Prescence of significant proteinuria may result in aviation disposition classification at one level down
Based on Treatment
- Acceptable – monitoring only or stable treatment without significant side effects
- Caution – use of steroids >10mg prednisolone equivalent requires medical certificate holder not to be engaged in safety sensitive duties
- Renal Transplant – CASA will not consider aeromedical certification for pilots or ATCs until 12 months following transplantation. Recertification will be considered on a case-by case basis
- Unacceptable – renal dialysis.
Demonstrated Stability
- Post renal transplant – individualised assessment on return to work and recertification
- Post changes in treatment – will need to be cleared by CASA.
Risk assessment protocol - Information required
A report from the treating doctor will be required.
- CASA requires a report from the relevant specialist(s) - e.g., Renal Physician, Cardiologist, Endocrinologist, depending on system involvement, symptoms, and findings of preliminary investigations. The report(s) should detail:
- Confirmed diagnosis
- Clinical status
- Presence, severity, and impact of ongoing symptoms (such as breathlessness, oedema, cognitive symptoms etc)
- Current treatment
- Side-effects
- If clinically indicated or if coronary risk score >14, stress test
- Results of recent investigations – eGFR (serial results), microalbuminuria, full blood count
- Progress
- Prognosis in the short, medium, and longer term
- Management - Proposed monitoring and follow-up plan. Please detail periodic investigations required.
The investigations listed above under the approach to medical certification must be less than 3 months old at the time of review for certification.