An Interactive Guide for Dialysis Patients
ACKNOWLEDGEMENTS
Special Thanks to all the patients, care givers and professionals who contributed to the
development of the “Navigating the Dialysis System” book.
Derek Forfang, Patient Leadership Committee Chair
Christine Hoglund, Patient Leadership Committee
Joe Tobias, Patient Leadership Committee
Dianne Tobias, Patient Leadership Committee
Sinaletinae Leaupepe, Patient Leadership Committee
Gary Penders, Patient Leadership Committee
Lenora Coss, Patient Leadership Committee
Harvey Cooper, Patient Leadership Committee
Lawrence Mau, Patient Leadership Committee
Shannon Moore, Patient Leadership Committee
Julie Roe, Patient Leadership Committee
Mark Pendleton, Patient Leadership Committee
Margaret Farr, Patient Leadership Committee
Robin Miller, Patient Leadership Committee
Kenneth Johnson, Patient Leadership Committee
Denise Mertz, Patient Leadership Committee
Peter Traub, Western Pacific Renal Network #17
Allison Kregness, Western Pacific Renal Network #17
Additional Acknowledgements
Southeastern Kidney Council, Inc., Network #6
Zenith Printing
“Navigating the Dialysis System”
Illustration
By
Emma Arnold, Western Pacific Renal Network #17
Index
A. Introduction…………………………..Tab A
B. What is Dialysis?.............................Tab B
C. Treatment Options ………………….Tab C
D. Accesses for Dialysis ……………...Tab D
E. The Dialysis Diet …………………….Tab E
F. Fluid Control on Dialysis…………...Tab F
G. Dialysis Medications ………………..Tab G
H. Dialysis Lab Tests …………………...Tab H
I. Glossary………………………………..Tab I
J. Dialysis Patient Resources ………...Tab J
Introduction
This book has been created for you by the volunteer pa ents of the Pa ent Leadership Commi ee of Western Pacific Renal Network also known as ESRD Network #17. The Network is a
not-for-profit company that contracts with the Centers for Medicare & Medicaid Services
(CMS) to bring the end-stage renal disease (ESRD) program to its geographic area. The Network is made up of renal nurses, social workers and data specialists with many years of experience working with people who receive ESRD treatment. The main focus of the Network is
to improve pa ent care. The Pa ent Leadership Commi ee (PLC) is comprised of a group of
volunteer pa ents who represent the Network #17 area which covers the 45 northern most
coun es of California, the state of Hawaii, the US Territories of American Samoa and Guam,
and the US Commonwealth of Saipan.
"Naviga ng the Dialysis System" was created by pa ents not as a text book on dialysis and
End Stage Renal Disease, but as an overview of facts about several ESRD topics so you and/or
your family members/caregivers can have an in-depth meaningful conversa on with your Dialysis Care Team about issues specific to your care. You will find informa on and a list of
ques ons in each sec on that you can discuss with your doctor, renal nurse, social worker,
and die an. We have also included an area a er each chapter for you to take notes or write
down your own ques ons.
You need to become an expert and an advocate for yourself in caring for your ESRD. It has
been found that pa ents who are engaged in their own care live longer and have a be er
quality of life. We discuss in this book, many different treatment types so that you can decide
what the most appropriate op on for you would be. We cover other very important issues in
dealing with your kidney disease like diet, lab work, fluid management, medica on, and determining what is the best and safest vascular access choice for you.
There are mes it does and will feel like we are not in control of our bodies anymore and we
are vic mized by this disease, but we don't need to be vic ms. Yes, things have changed. But
remember you are s ll the Captain of your ship. You are the KEY player on your Care Team
so grab the wheel and take control as we “navigate” on this journey together.
Your Network #17 Pa ent Leadership Commi ee Team
Derek Forfang
PLC Chair
09/28/2013
What is Dialysis?
Including
Questions for
Your Patient Care Team
Developed by the
Patient Leadership Committee/Mark Pendleton
&
Western Pacific Renal Network #17
What is Dialysis?
Dialysis is the artificial replacement for lost kidney function. It's
the process of eliminating waste & unwanted water from the
blood that normally our kidneys do naturally. Some people,
however, may have failed or damaged kidneys which cannot
carry out the function properly and they may need dialysis.
Dialysis is used for patients who have become ill or have acute kidney failure
(temporary loss of kidney function), or for the patients who permanently have
lost kidney function (chronic kidney disease). When we are healthy, our kidneys
regulate our body levels of fluid (water), minerals, and remove waste. Dialysis
cannot correct the failed kidneys, but can help replace some vital functions, such
as waste and fluid removal.
Approximately 7.5 liters (7500 ml) of blood are filtered by a healthy person's
kidneys each day. We couldn't live if waste products weren't removed from our
kidneys. People whose kidneys either don't work properly or not at all,
experience a buildup of waste in their blood. Without dialysis the amount of
waste products in the blood would increase and eventually reach levels that
would cause serious illness and hospitalization.
What Type of Dialysis is Available for Me?
There are two main types of dialysis; Hemodialysis & Peritoneal Dialysis.
(aka: PD, CAPD, CCPD)
Hemodialysis:
This process allows blood to circulate through a special filter
(dialyzer) outside of your body through tubing connected to your
dialysis access. Your blood is slowly pumped from your body into
the dialyzer where waste products and extra fluid are removed. The filter does
what the kidneys would normally do and then the blood is returned to your body.
Hemodialysis, on the average, lasts about 3 to 4 hours per treatment, three
times per week at a certified dialysis center or in your home. The duration of
each session depends on the results of your lab values and how much fluid
weight you gain between your dialysis treatments.
Your dialysis treatment is a prescription, ordered by your doctor, along with
medications and diet. It is a lifetime treatment unless you receive a kidney
transplant in which case your dialysis treatments will stop and your new kidney
will take over.
Peritoneal Dialysis (PD)
A sterile (dialysate) solution is run through a tube that is placed in your
abdomen where the peritoneal membrane acts as the kidney. This is called an
“exchange”. The dialysis solution is left in your abdomen for the prescribed
amount of time so that it can absorb waste products and extra fluid. It is then
drained out through a tube and discarded as illustrated below.
The abdomen is the area where peritoneal dialysis uses the natural filtering
ability of the peritoneal membrane, internal lining of the abdomen, to
accomplish the continuous dialysis treatment process. PD uses the lining of the
abdomen as a filter of waste products and extra fluid from the blood. This
dialysate exchange is generally repeated several times during the day and
performed at home.
The elimination of extra fluid (ultrafiltration) is done by adding a high
concentration of glucose (sugar) to the dialysis solution. The glucose
causes extra fluid to move from the blood into the dialysate. Therefore a
larger quantity of fluid is then drained and the “exchange” is repeated again.
Before having PD, the patient needs to have a small surgical procedure to
insert a catheter into the abdomen. Although PD takes more time than
hemodialysis, the net effect in terms of total waste product and fluid removal,
is about the same. PD is ideal for patients who may find hemodialysis too
exhausting or restrictive.
Summary
Although dialysis helps patients whose kidneys have failed, it's not as
efficient as a normal kidney. Consequently, patients on dialysis need to be
careful about watching their diet and the amount of fluid they drink. Often
patients on dialysis can work and lead normal lives. Following your treatment
as prescribed by your Nephrologist, dialysis schedule, medications, diet and
fluid intake will determine how well you do with the dialysis procedure.
This booklet will provide you with questions to ask your dialysis team and
also list the many resources available to dialysis patients. Do not be afraid to
ask questions and get the answers you need. Assisting in the quality care
provided to all dialysis patients is the mission of this project.
Questions to ask my Nephrologist & Dialysis Team
1.
Does the dialysis treatment hurt?
2.
Why do I have to weigh myself before and after treatment?
3. Can I have someone sit with me during my treatment?
4. Can I bring my own pillow or blanket to the facility?
5.
Who will start my dialysis treatment and how will I be
connected to the dialysis machine?
6.
How will I feel during the dialysis treatment?
7.
Can I eat or drink during my dialysis treatment?
8. What should I do if I don’t feel well during treatment and how
do I tell someone?
9.
Can I use the restroom if necessary?
10. How will I feel after my dialysis treatment?
11. What should I do if my fistula or graft starts bleeding after
treatment and I am at home?
12. If my dialysis facility is closed, who do I call and where do I
go in an emergency?
13. What drugs do I receive during my dialysis treatment & why?
14. Can I lead a normal life on dialysis?
Notes
Notes
Additional Information
Nephrologist______________________________________________
Phone Number____________________________________________
Dialysis Clinic____________________________________________
Phone Number____________________________________________
Emergency Contact________________________________________
Developed by Patients for Patients
Western Pacific Renal Network
505 San Marin Dr. Suite A-300
Novato, CA 94945
(415) 897-2400
Toll Free 1-800-232-3773
www.esrdnet17.org
Supported by the Centers for Medicare and Medicaid Services (CMS) Contract #HHSM-500-2013-NW017C. The opinions and
conclusions expressed are those of the authors. They do not necessarily reflect CMS policy.
Treatment Options
Including
Questions for
Your Patient Care Team
Developed by the
Patient Leadership Committee/Lenora Coss
&
Western Pacific Renal Network #17
What Are Treatment Options?
When your kidneys fail, you need treatment to replace the work of healthy
kidneys to survive. If you choose to receive treatment, your choices are
hemodialysis, peritoneal dialysis, or kidney transplant. There is no one
option that is right for everyone. There are many things to consider when
looking at your options, including but not restricted to, your overall health
and physical abilities, your support system, living arrangements, lifestyle,
and personal preferences. You will find the one that is right for you by
asking questions of the people that are taking care of you. You should try to
learn as much as you can about each treatment option before you make
your choice. Many people change to another option after trying one and
deciding that another treatment would work better for them.
Hemodialysis
If you choose hemodialysis (HD), the process involves cleaning your
blood using a filter called a dialyzer. Blood leaves your body through an
access, either with the creation of an Arterio-Venous Fistula (AVF) or an
Arterio-Venous Graft (AVG) surgically placed in your arm, or a Central
Venous Catheter (CVC) placed in your chest. The blood then enters the
dialyzer through tubing called lines, where it is cleaned and then returned
to your body through your access. This process continues for the amount
of time prescribed by your Nephrologist.
You can have hemodialysis done in a
dialysis center, typically 3 times a week; or
you can do it at home, usually with the help
of a family member or caregiver. Also, there
are different types of hemodialysis both at
home and in-center; standard hemodialysis, nocturnal hemodialysis,
and short daily hemodialysis. This book will briefly describe each one of
these options. Ask your Patient Care Team for additional information.
How often and how long your treatments will be, depends on your
individual needs and the prescribed orders by your Nephrologist.
Treatments can be adjusted as your needs change. This process of review
occurs with all types of dialysis treatments. Your Patient Care Team in all
types of dialysis will consist of doctors, nurses, dialysis techs, social
workers, and dietitians.
Standard Hemodialysis
Standard hemodialysis, most often done in-center, is usually done three
times per week, for 3 to 4 hours. In-center, certified hemodialysis
technicians usually put the access needles in, start and monitor the
treatments. Registered nurses assess patients, monitor patients during
treatments, and give medications. Standard hemodialysis, if done at home,
would usually require the help of a partner or caregiver.
Nocturnal Hemodialysis
Nocturnal hemodialysis is done either in-center or at home, lasting 6 to
9 hours, while you sleep. If done in-center, the same staffing would be
monitoring your treatment as in standard dialysis. If done at home, you
would need a fully trained family member or caregiver.
Short Daily Hemodialysis
Short daily hemodialysis treatments usually
take 2 to 3 hours, 5 to 7 days a week. This kind
of dialysis is most commonly done at home.
There are fewer side effects than with standard
hemodialysis, such as headaches, cramps, or
nausea. However. there may be insurance and
payment issues with short daily dialysis.
Home Peritoneal Dialysis
Peritoneal dialysis (PD), removes bodily waste products through the blood
vessels in your abdominal lining (peritoneum). This is done with dialysate that
flows into and out of the abdomen. You can give yourself treatments at home,
at work, or while traveling. You may be able to use fewer medications and eat a
less restrictive diet than you can on hemodialysis. You need manual dexterity
and the ability to care for yourself or a reliable caregiver. A team will be
available to instruct and educate you and will monitor your progress to ensure
that the prescribed treatment is working properly.
Access is through a thin soft plastic catheter usually
placed near your belly button by a surgeon under
general or local anesthetic. You’ll be taught how to
care for the catheter, do all the procedures, and how
to take care of yourself.
In Continuous Ambulatory Peritoneal Dialysis,
(CAPD), dialysate is exchanged manually several times during the day in any
clean place.
In Continuous Cycling Peritoneal Dialysis (CCPD)/ Automated
Peritoneal Dialysis (APD), a machine called an automated peritoneal cycler
performs 3-5 automated exchanges at night while you sleep.
You can do one or the other or a combination of both. Peritoneal dialysis is
done every day. With arrangements and assistance
from your training facility, supplies needed for peritoneal
dialysis will be delivered to your home. Which type of
Home PD is best for you, depends on your lifestyle,
personal preferences and medical condition.
Home Hemodialysis (HHD)
Along with treatment options available, home hemodialysis can be the
treatment of choice for some patients. At home, you may be better able to
fit your treatments into your daily schedule. There are three types of home
hemodialysis, as described on page three of this booklet, which can be
accomplished at home as well. They are as follows:
1. Conventional home hemodialysis
2. Short daily home hemodialysis
3. Nocturnal hemodialysis
The clinic will provide a machine for use in the home or help the patient
get a machine from a supplier. The patient does not have to buy the
machine. Supplies, such as dialysis solution, will be delivered to the home
once or twice a month.
During training, the patient learns to:







Prepare equipment and supplies
Place the needle in the vascular access
Monitor the machine
Check blood pressure and pulse
Keep records of the treatments
Clean the equipment and the room where dialysis is done
Order supplies
Training often takes 3 to 8 weeks. The training staff makes sure the
patient is confident about performing each task before doing home HHD.
Someone from the clinic will be available to answer phone calls 24 hours
a day. Some programs also monitor treatments over the Internet.
The patient returns to the clinic once a month to see the Nephrologist,
dialysis nurse, social worker and dietitian. A blood sample will be tested to
ensure the HHD treatments are working and to detect any problems, such
as anemia or high potassium levels, that should be treated.
Home Hemo continued:
Conventional Home Hemodialysis

In recent years, many people have found that doing HD at home has
many benefits. New dialysis machines are smaller and easier to use,
making home HD more practical. Some machines may require special
wiring or plumbing changes in the home, but others use standard
household outlets. The home must have room for the HD machine,
supplies, and in some cases a water purification machine.

The patient starts learning to do treatments at the clinic, working with a
dialysis nurse. Most people who
do home HD have helpers who
train with them at the clinic. The
helper can be a family member,
neighbor, or close friend. Some
programs do not require a
helper if the patient can do all
the tasks alone.
Short Daily Hemodialysis

Some people dialyze at home during the day and because they do it
every day or at least five or six times a week, they do not have to dialyze
as long. They can finish in 2 or 3 hours, saving even more of their time
as they do not have to travel to and from the dialysis clinic. Daily
treatments keep blood pressure more level than standard HD.
Nocturnal Hemodialysis

Some people dialyze at night while they sleep, freeing up the whole day
for other activities. This gentle treatment is easier on the patient's
dialysis access and heart. A longer treatment time for nocturnal HD
allows for a slower blood flow rate. Because the treatments are longer,
they remove more phosphorus and other wastes products than shorter
treatments can. Nocturnal HD is done from 3 to 6 nights per week.
Kidney Transplant
In a transplant, the surgeon places a functioning kidney from a living donor
or a cadaver kidney from a deceased donor into a person whose kidneys are
no longer functioning. Tests starting with blood typing and tissue typing are
run to determine if a donor kidney is compatible with you. Tests are also
done for the safety of a living donor. If there is no living donor you can be
placed on a waiting list.
Your doctor will refer you to a transplant center or you may choose a center
from your insurance company’s list of preferred providers. Your eligibility for a
transplant will be evaluated including your
Donor
health, your compliance with your current
functioning kidneys
treatment, and your support system. It is
important to stay in touch with your
transplant team and be prepared to
respond to your transplant center at a
moment’s notice if you are called.
During a transplant, a surgeon makes an
incision and places the new kidney in the
lower abdomen. The blood vessels of the
new kidney are attached to the blood
Recipient
Non-functioning kidneys
vessels in your lower abdomen just above
one of your legs. The ureter (the tube that links the kidney to the bladder) is
connected to your bladder. The surgery is performed by a trained transplant
surgeon under general anesthesia and takes on average from 3 to 4 hours.
After a transplant, you will spend several days to a week in the hospital
recovering. You will be taught what is necessary to care of yourself and your
new kidney including such things as; diet, medications and wound care.
During the first 4-6 weeks after discharge you will be seen frequently by your
transplant team. You will also have some restrictions in what you are allowed
to do so you will need help at home.
You will be taking medications called immunosuppressants to keep your
immune system from attacking your new kidney and your body from
rejecting the kidney. It is important to take your medications as prescribed
and to follow your doctor’s instructions. Some of these medications you
will be taking for the rest of your life. These medications are very strong
and have some very pronounced side effects.
CONSERVATIVE TREATMENT
You and your doctor decide what will be your conservative treatment if you
have chosen not to do dialysis or a transplant. It is important to be aware
that your life expectancy will be only a few weeks, the exact length of time
will depend on many factors.
Before making this or any decision it is very important to get all the
information you need. The decisions made will depend on your current
health and your expectations regarding quality of life. A good way to get the
information you need is to ask your doctor. As you think of questions write
them down and then you won’t forget during your next scheduled visit.
Advance Healthcare Directives
Today's treatments for kidney failure allow you to
participate in life and enjoy your family and
friends. Dialysis is a life-saving treatment, but it is
not a cure. Looking ahead can be overwhelming
and scary. It helps to take control of your care by
telling your healthcare providers and your family about your wishes and the
type of care you want as your disease progresses. This will also make it
easier for them to make decisions for you if you become too sick to make
them yourself. All of these decisions are called "advance care planning"
which is simply planning for your care before you need it. Your dialysis
facility staff is ready to work with you to put some of these decisions in
writing so you can have peace of mind about your future.
Questions to ask my Nephrologist & Dialysis Team
1.
I don’t like needles. Does that mean I can only do PD?
2.
Can I change treatment types if I don’t like my first
choice?
3.
Will someone evaluate my home to see if I can do home
dialysis?
4.
How would I get help at home from a nurse or dietitian?
5.
Can I travel if I choose any type of dialysis?
6. Does every dialysis facility provide all the same options?
7. Do all the treatment types cost the same?
8. Would my diet be the same on each treatment type?
9. Can I still work if I do any of the treatments?
10. Can I keep my same doctor if I change treatment types?
11. How do I get referred for a transplant?
12. Can I choose any transplant center?
13. What do I have to do to get on the transplant “waitlist”?
14. What happens if I choose not to continue with dialysis?
15. How do I learn about “Advance Healthcare Directives”
and what does that really mean to me and my family?
Notes
Notes
Additional Information
Dialysis Social Worker______________________________________
Phone Number____________________________________________
Nephrologist______________________________________________
Phone Number____________________________________________
Dialysis Clinic____________________________________________
Phone Number____________________________________________
Developed by Patients for Patients
Western Pacific Renal Network
505 San Marin Dr. Suite A-300
Novato, CA 94945
(415) 897-2400
Toll Free 1-800-232-3773
www.esrdnet17.org
Supported by the Centers for Medicare and Medicaid Services (CMS) Contract #HHSM-500-2013-NW017C. The opinions and
conclusions expressed are those of the authors. They do not necessarily reflect CMS policy.
Accesses for Dialysis
Including
Questions for
Your Patient Care Team
Developed by the
Patient Leadership Committee
&
Western Pacific Renal Network #17
Choosing the Right Access for Your
Dialysis Treatments
You may have been told that you need dialysis, so what does this mean
exactly? Dialysis is one type of treatment that cleans the blood when the
kidneys are not able to. During a hemodialysis treatment a machine pumps
blood away from your body through a tube to a filter that cleans your blood
and then returns it to your body through another tube. Another option is to
use your own abdominal wall (inside body lining) as a filter, a process called
peritoneal dialysis.
What are the different options for a permanent access?
If you choose hemodialysis, the process requires an access to your blood
stream (vascular access). An Arterio-Venous Fistula (AVF) is created from
your own blood vessels or an Arterio-Venous Graft (AVG) is surgically
placed in your arm. You may have a Central Venous Catheter (CVC) placed
in your chest or along side of your neck area if you need dialysis immediately.
To be able to achieve adequate cleansing of your blood and to keep you at
your healthiest, it is important that the access you have for hemodialysis is
the right one for you. For optimal results it is important to be evaluated for
an access before you start dialysis. A surgeon who has experience in
placing fistulas is your best choice for a successful access. “Vessel
Mapping” is a great way to find out if you are a candidate for a fistula. This is
a procedure performed with a device that is
used outside your body to take “pictures” of
where your blood vessels are and see if they
are adequate size to create a fistula. If you
have a catheter or AVG, ask your kidney
doctor if you are a candidate for an AVF.
Arterio-Venous Fistula
An Arterio-Venous Fistula, often referred to as a fistula or an AVF, is a
surgical connection between one of your own veins and an artery. The blood
flow from the artery allows the vein to strengthen and become large enough for
dialysis. On average, it can take six to eight weeks for this type of access to
become ready to use for treatment. A fistula is the access most often
recommended for hemodialysis patients. The advantages of an AVF are longer
life, fewer infections, and fewer follow-up procedures.
External View of AV Fistula
Internal View of AV Fistula
Arterio-Venous Graft
With a Arterio-Venous Graft (AVG), a flexible tube is used to connect
one of your arteries to a vein. An AVG will take about 2 to 4 weeks to heal
before it can be used for dialysis. Some important facts to consider about
AVG’s are that they may not last as long as a fistula (3-5 yrs), and they can
become infected and clot more often than a fistula. Additionally, they may
need more procedures to correct complications. A graft doesn’t need to
develop as long as a fistula does, so it can be used for dialysis sooner after
placement, often within 2 or 4 weeks.
External View AV Graft
Internal View of AV Graft
Central Venous Catheter
Another vascular access choice that is not considered a permanent
access is called a Central Venous Catheter (CVC). A catheter is a small
flexible tube that is inserted into a large vein in your neck through your chest.
The top of the catheter is outside your body for access during dialysis and
the tip of the catheter is placed near your heart. A catheter can be used right
away and seems less painful than other access options, but a catheter puts
you at greater risk for serious complications (infection and clotting) than an
AVF or AVG.
Peritoneal Dialysis Catheter
In peritoneal dialysis, dialysis fluid (called dialysate) is infused into the
abdominal cavity (called the peritoneal cavity) through a catheter. The
fluid is held within the abdomen for a prescribed period of time; this is
called a “dwell time”. The lining of the abdomen (the peritoneum) acts as a
membrane to allow excess fluids and waste products to pass from the
bloodstream into the dialysate. When the dwell is completed, the "used"
dialysate can then be drained out of the abdomen (called an exchange) into
a sterile container (for CAPD) or into a shower or bathtub (for CCPD). This
used fluid contains the excess fluid and waste from the blood, which is
usually eliminated in the urine. The peritoneal cavity is then filled again
with fresh dialysate.
Vascular Access
Comparison
AV Fistula
AV Graft
AVF
AVG
6-8 weeks
2-4 weeks
What Vascular Access
is considered the “Gold
Standard”?
Will I have surgery to
place my vascular
access?
Can my access be used
right after surgery?
Can all accesses be
used for dialysis?
Which access can
become infected most
frequently?
Which vascular access
has the least infections?
Which vascular access
has the most
complications?
Which accesses allow
me to shower or take a
bath?
Which vascular access
will give me the best
dialysis treatment?
Which vascular access
is the safest?
Which vascular access
will make me feel the
best?
Central
Venous
Catheter
CVC
Important Points to Consider
When Choosing A Vascular Access Surgeon For Your Fistula, bring this
list of questions with you to the appointment for discussion. With AVF being
the “Gold Standard” it is important to know the following:
1. How many fistulas has the surgeon placed in the last three to six
months?
2. How many of the fistulas placed by this surgeon in the last year are
working well?
3. How many fistulas did the surgeon place compared to grafts and
catheters?
4. What type of pre-surgical assessment does the surgeon do?
5. Does the surgeon do vessel (vein) mapping?
6. Does the surgeon map the arteries and veins in both arms?
7. Does the surgeon do the vessel mapping him or herself or send
patients to an ultrasound lab?
8. If the surgeon says you are not a candidate for a fistula, get a second
opinion.
Do not hesitate to ask your Nephrologist and/or the Vascular Surgeon
any of the questions above. The quality of your life depends on the
vascular access you receive.
You have options when it comes to choosing how you will receive
hemodialysis. You can educate yourself about your options and with your
doctor to choose the best vascular access for you.
It will be challenging to apply these suggestions. But remember: It is
YOUR life and YOUR access, and the rewards of choosing the best
possible vascular access will be with you for many years to come!
Get all the facts before making this decision!
Vascular Access
Questions to ask my Nephrologist & Surgeon
1.
Why is vascular access for dialysis so important?
2.
What are the different types of accesses for dialysis?
3.
How do I choose the right access and which one is the
safest for me?
4.
When should I get my dialysis access placed?
5.
What is vessel mapping and why would I need it?
6. Who places my dialysis access and where is it done?
7. After my access surgery, will there be much pain?
8. How do I take care of my dialysis access after surgery?
9. Do I have the right to choose my own surgeon?
10. Can I have more than one access at a time?
11. If I have a catheter and it is working, why can’t I keep it?
12. If I don’t like my fistula or graft, can I change back to a
catheter?
13. If I choose home dialysis, which type of vascular access
would be the best for me?
14. Can my family participate in this decision with me?
15. How are the different types of dialysis accesses paid for?
Notes
Notes
Additional Information
Vascular Access Surgeon___________________________________
Phone Number____________________________________________
Nephrologist______________________________________________
Phone Number____________________________________________
Dialysis Clinic____________________________________________
Phone Number____________________________________________
Developed by Patients for Patients
Western Pacific Renal Network
505 San Marin Dr. Suite A-300
Novato, CA 94945
(415) 897-2400
Toll Free 1-800-232-3773
www.esrdnet17.org
Supported by the Centers for Medicare and Medicaid Services (CMS) Contract #HHSM-500-2013-NW017C. The opinions and
conclusions expressed are those of the authors. They do not necessarily reflect CMS policy.
The Dialysis Diet
Including
Questions for
Your Patient Care Team
Developed by the
Patient Leadership Committee
&
Western Pacific Renal Network #17
Why is the Renal Diet so Important?
End Stage Renal Disease (ESRD) is a condition where the kidneys will
lose total function over time. These organs are important because its job is
to cleanse the body of wastes and also regulate the blood pressure. The
term "renal" refers to the kidneys in the body and when people think about
these organs, they normally don’t realize how hard they work to maintain
our lives.
For patients suffering from ESRD, one of the greatest challenges is to
learn a new way of preparing meals and eating the proper diet. The more
you learn about the function of the kidneys in
general, and your condition in particular, the
better you will be able to understand exactly how
you need to adjust your diet in order to eat
properly with the correct protein intake to make
yourself feel better.
One of the most important things to know when
starting on your new renal diet is to understand
what the kidneys actually do. The kidneys function as a waste removal
system, ridding the body of excess potassium, sodium, phosphorous, fluids
and other chemicals harmful to your system.
Because ESRD represents the end of the kidneys' ability to function as
well as it should, it is essential that you limit your intake of foods containing
sodium and potassium and fluid. Your body won't have to work as hard
between your dialysis treatments and the renal diet will reduce the harmful
buildup of toxins in your system. Your dialysis treatment will be easier and
you will feel better if you maintain the proper diet and fluid regimen.
Every dialysis facility has a Renal Dietitian who is available to you and/or
your family for questions, instruction, educational materials, and resources.
The Renal Dietitian will review your lab tests to see how well you are doing
with your renal diet and will help you every step of the way.
What You, Your Dietitian & Dialysis Team Will Monitor
Water intake (fluid) is discussed in a separate booklet in this series so we
concentrate on the toxins that will build up in your body
with ESRD that are particularly important to monitor.
Your dietitian will review all your lab tests with you
monthly to keep you well informed and educated.
The following are four of the most important elements
in your body that can affect your ESRD more quickly than others. Let’s take
a look at each one of them to better your understanding.
Protein
Before making any changes to your diet, make sure you discuss them
with your doctor or dietitian.
Diet plays an important role in the management of kidney disease. The
diet your physician will ask you to follow will be based upon your level of
kidney function, your body size, and any other medical conditions you may
have. The renal diet will be helpful in your getting the most benefit from your
dialysis treatments.
Protein is needed to maintain muscles and aid in building resistance to
infections. It also helps repair and replace body tissue. As your body
breaks down protein foods, waste products called urea nitrogen are formed.
With ESRD, urea builds up in the bloodstream much quicker. Eating too
much protein may cause too much urea and this will make you feel sick and
not want to eat. Eating the right amount of protein along with dialysis may
be helpful in reducing your blood urea nitrogen levels.
Reducing protein intake will be monitored closely by your doctor and
dietitian.
Protein continued:
Examples of foods high in protein are:
• Meat
• Poultry
• Milk Products
• Eggs
Foods low in protein includes the following:
• Fresh beans (pinto, kidney, navy)
• Grains
• Vegetables
You need both high quality and low quality protein in your diet. Your dietitian
and doctor will determine how much protein should be in your diet.
Sodium (Salt)
Sodium or salt is needed by your body for many functions such as
controlling muscle contractions, balancing fluids, and controlling blood
pressure. Healthy kidneys remove excess sodium in the urine. As kidney
function fails, sodium and fluids may accumulate
in your body. Fluid retention may cause swelling
in your eyes, hands, and/or ankles. With ESRD
your kidneys no longer have the ability to remove
fluid from your body except for instance, through
sweating. Too much fluid can put stress on your
heart and lungs and make your dialysis
treatments uncomfortable. Large fluid weight
gains removed on dialysis due to water intake can create muscle cramps and
low blood pressure. To keep your sodium level in balance, your doctor,
dietitian and dialysis team may ask you to limit the sodium in your diet.
Sodium continued:
Foods high in sodium include the following:
• Table salt
• Bouillon cubes
• Potato chips
• Nuts
• Bacon
• Cold Cuts
• Cheese
• Canned, dehydrated, or instant soup
• Canned vegetables
• Processed dinner mixes (such as Hamburger Helper, Rice-a-Roni)
Low sodium alternatives:
• Season with a variety of spices like garlic, oregano and use lemon
 Do
not add salt while cooking or at the table
Potassium (K+)
Potassium helps to keep your nerves and muscles, especially your heart,
working properly. Potassium is a mineral and can be found in many foods.
The kidneys are responsible for helping to keep the correct amount of
potassium in your body. It can be very dangerous if your potassium level is
too high. Too much potassium can make your heart beat irregularly or even
stop without warning.
It is important to remember that almost all foods contain potassium. Serving
size will determine whether foods are a low, moderate, or high potassium
level. Important to remember; A large serving size of a low potassium
food can become a high potassium food.
Your dialysis dietitian will provide you with a more complete list of foods that
are high and low in potassium.
Potassium continued:
Foods that are high in potassium include the following :
Fruits & Vegetables (not approved by your dietitian)
Bananas
Broccoli & Brussels Sprouts
Chocolate
Oranges
Potatoes
Coffee (limit to 2 cups per day)
Cantaloupe
Tomatoes
Salt Substitute (read labels carefully)
Prunes, Mushrooms, Bran & Bran products
Nuts & Dried Fruit
Foods that are low potassium include the following:
Apples
Beans (green or wax)
Rice
Grapes
Cucumber
Noodle
Pears
Watermelon, Lettuce (watch fluids
Cereal
Bread & Bread products
Cherries
Phosphorus
Phosphorus is a mineral that works with calcium to keep your bones
healthy and strong. Phosphorus is needed by the body for building and
maintaining bones, teeth, normal nerve and muscle
function. When kidney function fails, the body has a
difficult time keeping phosphorus and calcium in
balance. As a result of this imbalance, the body
cannot get rid of excess phosphorus (phosphorus
levels increase) and the body cannot take in
enough calcium (calcium levels decrease). In an
effort to try and correct this imbalance, the body will
“steal” calcium from the bones, which makes the bones weak and more
subject to breaking.
Problems associated with high phosphorus levels include itchy skin, bone
and joint pain, and brittle bones. Important to remember; A large serving
size of a low phosphorus food can become a high phosphorus food.
If your phosphorus level remains high, your doctor may prescribe a
phosphate binder for you to take. This medication will bind with the
phosphorus in the food you eat and prevent phosphorus from being
absorbed in the body. It is important that you take this medication exactly
as instructed by your doctor and with your meals, not before or after. High
phosphorous levels can cause calcium and phosphorus to form deposits in
the heart, lungs, joints and skin that affect organ functioning. Phosphorus is
in the food you are eating and the binders will work accordingly with the
food.
Phosphorus continued:
Foods that are high in phosphorus include:
• Cola Drinks
• Peanut Butter
• Cheese
• Sardines
• Chicken/Beef Liver
• Nuts
• Caramels
• Beer
• Ice Cream
Foods that are lower in phosphorus include:

Broccoli
• Non-dairy Milk Substitutes
• Sherbet
• Non-cola Sodas
• Zucchini Squash
• Hard Candy
Follow Your Diet Like You Follow Your Heart
&
You Can’t Go Wrong!
Questions to ask my Dietitian & Dialysis Team
1. What is a “Renal” diet?
2. How much food can I eat everyday?
3. Can I afford a “Renal” diet?
4. How do I measure the amount of food to eat?
5. Will I lose weight on the diet?
6. I’m Diabetic. Is my “Renal” diet the same?
7. How will I know if I eat too much Potassium?
8. How will I know if I eat too much Sodium (Salt)?
9. How can I tell the difference between “water” weight
gain and regular weight gain?
10. What does “Dry Weight” mean?
11. Will I feel better if I follow the “Renal” diet?
12. When do I take my phosphorus binders; before,
with or after meals?
13. Who will help me and/or my family to learn the diet?
Notes
Notes
Additional Information
Renal Dietitian____________________________________________
Phone Number____________________________________________
Nephrologist______________________________________________
Phone Number____________________________________________
Dialysis Clinic____________________________________________
Phone Number____________________________________________
Developed by Patients for Patients
Western Pacific Renal Network
505 San Marin Dr. Suite A-300
Novato, CA 94945
(415) 897-2400
Toll Free 1-800-232-3773
www.esrdnet17.org
Supported by the Centers for Medicare and Medicaid Services (CMS) Contract #HHSM-500-2013-NW017C. The opinions and
conclusions expressed are those of the authors. They do not necessarily reflect CMS policy.
Fluid Control on Dialysis
Including
Questions for
Your Patient Care Team
Developed by the
Patient Leadership Committee/Harvey Cooper
&
Western Pacific Renal Network #17
Why is Fluid Intake so Important on Dialysis?
When our kidneys fail and we begin a course of treatment on dialysis, it is
very important to monitor the amount of fluid to take into your body. Excess
fluids can create many problems for your health as your kidneys are no longer
able to get rid of the fluid as urine. Your weight will increase before dialysis and
perhaps your feet/ankles will swell. You may also become short of breath or
the dialysis treatment may be a little less comfortable.
Controlling Fluids
A dialysis patient finds it harder to keep the right fluid balance when their
kidneys no longer work. Eating too much salt (sodium) will make you thirsty
and when you drink, your body cannot get rid of the extra fluid because your
kidneys no longer work. One important aspect of the dialysis treatment is to
take off extra fluid your kidneys can no longer remove. This is important,
because if you have too much fluid, you may develop:

Fluid buildup in you body called edema (eh-dee´-ma)

Headaches and low energy

Shortness of breath from fluid in your lungs

Heart problems

High blood pressure
The goal of controlling your fluid intake is to help you feel comfortable before,
during and after your dialysis treatment. Peritoneal dialysis (PD) or in-center
hemodialysis (HD) can’t do all of the fluid removal, you have to help too. Some
people on PD and most people doing in-center HD have some type of fluid
limit. (Daily and nocturnal HD remove much more fluid, so using those
treatments may mean that you have less fluid restrictions.) How much fluid you
can have each day will depend on how much urine you make.
Hemodialysis and Fluid Intake
As was stated before, controlling your fluid intake will make in-center
hemodialysis easier and more comfortable. You will have fewer complications
and be less likely to feel “washed out” after a treatment. Your Nephrologist and
dialysis team will tell you how much fluid you can drink every day. Many people
on hemodialysis need to limit fluid intake to about 32 ounces (approximately 1
liter or 1000 ml or four - 8 ounce cups) a day.
Water is heavy! A liter of water weighs one kilo or 2.2
pounds. With no kidney function, your fluid intake on
in-center hemodialysis will be about 1 liter per day, or just
under 32 ounces. If you weigh yourself at the same time
each day, wearing the same clothes, you will know if you
are on track. If you make some urine and do daily or
nocturnal hemodialysis, you will be able to drink more
fluids under the direction of your Nephrologist.
Peritoneal Dialysis and Fluid Intake
Most people on peritoneal dialysis have some kidney function left so they still
make some urine. Over time, this kidney function (called “residual” kidney
function) often drops. How much fluid you can have each day will depend on
how much urine you make. So it is important to measure your kidney function by
testing your serum creatinine or creatinine clearance and reviewing those values
with your Nephrologist.
If your kidney function drops, you may need more peritoneal dialysis and/or
less fluids. Be alert for signs of edema and tell
your peritoneal dialysis nurse or Nephrologist if you:

Have fluid build-up

Notice a lot of sudden weight gain

Using more 4.25% dialysate solution than you did
before to remove more fluid from your body

If you are having more headaches
Tips On Limiting Fluids And Controlling Thirst
Here are some easy, proven ways to limit fluids and deal with thirst, without
drinking too much. Which ones do you want to try?

Drink only when you are thirsty and just enough
to quench your thirst

Be aware of all the fluids in your diet. A fluid is
anything liquid at room temperature. This means
ice cream or Jell-O®, soup, gravy, etc.

Drink from small cups or glasses

Eat a piece of cold or frozen fruit

Eat soups or cereal with a fork instead of a
spoon to limit fluid intake

A little ice can quench thirst more than the same amount of liquid. Try
freezing regular or diet ginger ale or apple juice into slushes or popsicles

Rinse your mouth with cold water or swish mouthwash and spit it out
Tips continued:

Suck on a piece of regular or sugar-free peppermint candy, which will help
quench your thirst and keep your breath fresh

Check with your doctor or pharmacist to see if any of your medications cause
thirst or dry mouth

Each day fill a jar with the water equal to your daily fluid limit. Each time you
drink, you will pour that amount out of the jar. You will be able to see how
much you have left

Spread out your fluids evenly throughout the day

If you are gaining too much weight, measure all your fluids for a day or two so
you will know just how much you have been drinking

Avoid high-sodium foods and foods with hidden sodium as shown below:
Questions to ask my Nephrologist & Dietitian
1. Do I measure all fluid into my daily allowance such
as; ice cubes, water I take with my pills, juicy fruit?
2. What foods can make me more thirsty than others?
3. How much fluid can I drink in between my dialysis
treatments?
4. What happens if I drink too much fluid between my
dialysis treatments?
5. Why do I have to control my fluids if I still have urine
output?
6. Do all dialysis treatment options (Peritoneal & Home
Hemo Therapy) have the same fluid restrictions?
7. What are the most common side effects of too much
fluid in my body?
8. How will my dialysis treatments be affected if I have
too much fluid in my body?
9. How do you figure my “estimated dry weight”?
10. Where can I get help to control my thirst?
Notes
Additional Information
Nephrologist______________________________________________
Phone Number____________________________________________
Renal Dietitian____________________________________________
Clinic Phone Number_______________________________________
Dialysis Clinic____________________________________________
Phone Number____________________________________________
Developed by Patients for Patients
Western Pacific Renal Network
505 San Marin Dr. Suite A-300
Novato, CA 94945
(415) 897-2400
Toll Free 1-800-232-3773
www.esrdnet17.org
Supported by the Centers for Medicare and Medicaid Services (CMS) Contract #HHSM-500-2013-NW017C. The opinions and
conclusions expressed are those of the authors. They do not necessarily reflect CMS policy.
Dialysis Medications
Including
Questions for
Your Patient Care Team
Developed by the
Patient Leadership Committee/Shannon Moore
&
Western Pacific Renal Network #17
Common Medications for Dialysis Patients
Dialysis performs a number of functions as it cleans the blood of toxins.
There are some things, however, that it cannot do. To get the most benefit from
your dialysis experience, your Nephrologist will also prescribe medications and
supplements that will help maintain your health. Some of the medications you
may be taking already and others you may not need.
Every dialysis patient is unique and the medications prescribed by your
Nephrologist may vary as your needs change. It is important to take all
medications as ordered.
If you have any questions about your medications or you are experiencing
side effects that are uncomfortable, it is important to tell your dialysis care team
right away.
The following medications and supplements are commonly prescribed for
dialysis patients:

Blood Pressure medications
 Calcium
tablets: used to keep bones strong and heart muscle healthy
 Erythropoietin

(EPO): a hormone to stimulate red blood cell production
Iron: used to help produce red blood cells
 Phosphate
binders: these medications help “bind” excess phosphorus
that can build up in the body and affect your bone strength
 Vitamins
diet
and minerals: used to enhance health and supplement the
Included below are explanations on why additional medications and
supplements are important.
 B
Vitamins with Folic Acid: B vitamins also play a
role in making red blood cells. Folic Acid works with B
vitamins to make new red blood cells.
 Blood
Pressure/Antihypertensive medications: Medicines that keep
your blood pressure under control. A common side
effect of renal disease is high blood pressure.
 Calcium
Supplement: Calcium supplements lower
high phosphorus levels and prevent calcium loss in
the bone reducing the chances of bone fracture.
 EPO
Supplement: Healthy kidneys make a chemical called erythropoietin
or EPO. If you are on dialysis, your EPO levels may be low which can lead
to anemia.
 Iron
Supplement: Iron helps the body make red blood cells
or hemoglobin. Iron supplements can help to prevent anemia.

Phosphate Binders: These medicines bind phosphorous in the intestine.
Dialysis does not remove all of the excess phosphorus. Taking phosphate
binders helps remove excess phosphorous from your body. High
phosphorous levels can cause calcium and phosphorus to form deposits
in the heart, lungs, joints and skin that affect organ functioning.
As a dialysis patient, you may be on several different medications and
supplements at once. It is a good idea to write down a schedule to help you
remember when you take each medication, if they need to be taken on an
empty stomach or during meals for example.
Below are a few suggestions that may be helpful in managing your
medications and supplements that have been prescribed for you. If you have
any questions about what medications you are taking and why you are taking
them, please contact your Patient Care Team.
Tips for Medication Management:

Know the medications that have been prescribed to you

Understand why you have been prescribed these medications

Keep your medications organized

Make a list of all current medications, including over-the-counter,
vitamins and dietary supplements

Give the list of all your medications to your dialysis care team including
the over-the-counter medicines; vitamins, etc.

Record the days and times when you take your medications

Know which medications can or cannot be taken together

Take medications at the same time each day unless directed otherwise,
this may make it easier to remember taking them

Use a plastic medication organizer or medication log

If you use a computer, create an electronic medication organizer or
spreadsheet

Take only the medications prescribed by your physicians

Follow all of the directions for each medication

Tell your doctor and dialysis care team if you’re having side effects

Check with your doctor first before you stop taking your medication

Always carry an updated list of all the medications you are taking in
case of an emergency
Remember, the medications that have been prescribed for you by your
dialysis care team play a very important role in your dialysis treatment. It is
important that you stick with the medication plan and keep your dialysis team
informed if you feel one of your medications is not working for you or if you
are having side effects. It is important not to stop your medications without
talking to your Nephrologist or dialysis care team first because those
medications play an important role in maintaining your health.
Keeping track of your prescribed medications can be challenging, especially
if you're taking several different medicines. Writing things down will make
managing your medications a lot easier. Use our printable medicine tracker to
stay organized. Always check with your prescribing doctor before stopping or
adjusting your medication.
Questions to ask my Nephrologist & Dialysis Care Team
1. What medications have been prescribed for me?
2. Are there times I should take certain medications and why?
3. How can I make my medication easier to swallow without
drinking extra fluid?
4. Do I take my medications with food?
5. Which medications do I take with food?
6. What should I do with my medications on dialysis treatment
days?
7. What should I do if I miss a dose of one or more of my
medications?
8. Who will review my medications with me and how often will
that be done?
9. What happens if I don’t feel good when taking a medication?
10. What about over the counter (OTC) medications?
11. Where and how do I get my medications?
12. Is there financial help with medication costs and do I
qualify?
13. Is there something I can use to keep track of my
medication?
Notes
Additional Information
Pharmacy________________________________________________
Phone Number____________________________________________
Nephrologist______________________________________________
Phone Number____________________________________________
Dialysis Clinic____________________________________________
Phone Number____________________________________________
Developed by Patients for Patients
Western Pacific Renal Network
505 San Marin Dr. Suite A-300
Novato, CA 94945
(415) 897-2400
Toll Free 1-800-232-3773
www.esrdnet17.org
Supported by the Centers for Medicare and Medicaid Services (CMS) Contract #HHSM-500-2013-NW017C. The opinions and
conclusions expressed are those of the authors. They do not necessarily reflect CMS policy.
Dialysis Lab Tests
Including
Questions for
Your Patient Care Team
Developed by the
Patient Leadership Committee/Shannon Moore
&
Western Pacific Renal Network #17
Understanding Your Lab Tests & Results
Lab tests are a regular occurrence when you are a dialysis patient. Once a
month, like clockwork, a dialysis technician or nurse will draw your blood,
usually from your dialysis access prior to starting your treatment. These lab
tests and their results will tell a lot about how well you are being dialyzed and if
adjustments need to be made to your dialysis treatments, diet or medications.
While understanding your monthly lab results may seem like learning a
foreign language, they serve an important purpose. Understanding what all the
results mean can be a powerful tool to help you manage your own health.
As a dialysis patient, you have a vested interest in knowing what your lab
tests mean for your overall health. It will also give you the ability to talk to your
dialysis care team about any questions you may have in regards to your test
results. Maybe your potassium is getting too high. Talking with your dietitian
would be a great way to go over your meal plans to make sure you are eating
the right foods for a low potassium diet.
Normal Values & Your Results
Your test results will be shown as a number, say 10. The number 10 would be
the value of a substance, like creatinine, that is being measured in your blood.
Most often, in lab results, a target range is used to show the variations of a test
result. For example, the range of creatinine values for a dialysis patient is from
10-18 mg/dl. A value of 10 would then fall within normal target range. If the
value were 20 then the creatinine would be falling outside of the normal target
range. An abnormally high value would alert your dialysis care team that some
adjustments need to be made to your dialysis treatment prescription, for
example, time on treatment, medications, or diet.
These tests are important because if your lab results are between the target
ranges, then you are receiving adequate dialysis. It also means that your diet,
medications and the amount of dialysis time prescribed is working for you.
If, however, your lab results fall outside the prescribed ranges, then you are
either not receiving adequate dialysis or your diet or medications need to be
adjusted. The quality of life and how good you feel while you are on dialysis
depends a lot on making sure you are eating well, taking your medications and
being dialyzed the appropriate amount of time.
Your lab results will tell the dialysis care team many things. If you are getting
enough nutrition from the foods you eat and your medications are working, like
your phosphate binders to keep your phosphorus down, then no adjustments
will need to be made.
Below, is a list of a typical dialysis lab tests. Your clinic may include more
tests other than what is stated below. This list will help you to understand your
lab tests, what they measure and how to know if you are within your target
range for a given test.
 Complete
Blood Count (CBC): looks at your blood cells themselves; the
percentage of red, white and other cells in your blood.
 Hemoglobin
(HGB): is a protein, carried by red blood cells, which transports
oxygen through the body.
Target Range: 10-12 g/dL for men and women on dialysis
 Hematocrit
(HCT): is the measurement of the amount of red blood cells
compared to water (plasma) in the blood.
Target Range: between 30-36%
 Ferritin
(Iron): is the amount of iron that can be stored in the body.
Target Range: Between 100-500 mg/mL
 Transferrin
Saturation (TSAT): is the amount of iron available to form blood cells
Target Range: Between 20-50%
Potassium (K): regulates muscle action in the body. It is one of the tests that your
care team will watch closely. High levels of potassium can be dangerous to the
function of your heart, so your dietitian will give you a list of high potassium
foods to limit or avoid in your diet.
Target Range: Less than 6.0 mEq/L for people on dialysis
 Sodium
(Na): is necessary for maintaining blood pressure and volume in the body.
Too much sodium in the blood will cause the body to retain water, which can
cause swelling “edema” and also can cause your blood pressure to rise.
Target Range: 135-145 mEq/L
 Blood
Urea Nitrogen (BUN): is a waste product of protein metabolism, the more
protein you eat, the more urea is produced. Eating lots of protein will make your
BUN high. BUN is also used to calculate how much dialysis you are getting.
Target Range: 60-80 mg/dL for people on dialysis
 Creatinine
(CR): is a waste product of muscle breakdown. Creatinine is a good
indicator of how well your kidneys are functioning. High creatinine levels show
the level of kidney disease. Dialysis removes excess creatinine from the blood.
Target Range: 10-18 mg/dL for people on dialysis
 Glomerular
Filtration Rate (GFR): is an estimate of how well your kidneys are
filtering your blood.
Range is less than 15 GFR for people with kidney failure

Kt/V: is another way of measuring dialysis adequacy.
K = dialyzer clearance, the rate at which blood passes through the dialyzer
t = stands for time
V = the volume of fluid in a patient's body
Target Range: At least 1.2 for hemodialysis patients, 2.0 for peritoneal
dialysis patients

Parathyroid Hormone (PTH): helps you absorb calcium from what you eat and
drink. High phosphate levels lead to high PTH.
Normal range is between 10-50 pg/ml
 Calcium
(Ca): is stored in your bones and is needed to keep them strong.
Target range: Between 8.4-9.5 mg/dl
 Phosphorus
(P): is made by protein breakdown and is also found in many
foods that you eat. It is a chemical that works with calcium to keep bones
strong and healthy but monitored closely on dialysis.
Target Range: 3.5-5.5 mg/dL for people on dialysis

Calcium-Phosphorus Product (Ca x P): A ratio of your serum calcium level and
serum phosphorus levels. This is important in monitoring your risk of
developing phosphate crystals in the body’s soft tissues and joints.
Target Range: Needs to be less than 55 for people with kidney disease and
over age 12
Additional Lab tests for the patient with Diabetes

Blood Glucose: is the main tool to determine diabetes control. This test
checks you blood glucose level at any one given time.
Normal: <100 mg/dl
Pre-diabetes: 100-125 mg/dl
Diabetes: 126 mg/dl or more

Hemoglobin A1c: this test gives you a picture of your average blood glucose
control for the past two to three months if you are diabetic.
Target range: Below 6.5%
Your Personal History
Now it is time to take a look at your own lab results. Are there tests that
are not listed in this booklet that you would like more information about? Do
you have questions about your values? Would you like to talk to your dietitian
to see if you can lower a lab value through a diet change?
It is a great idea to write down your questions so that you can go over the
lab tests at your next dialysis appointment. Having someone from your dialysis
care team go over the lab tests is a great way to learn and also to understand
what can be done to keep your lab values within the target range to maintain
optimum health.
Questions to ask my Nephrologist & Dialysis Team
1. How often do I have my lab work drawn?
2. How will I know the results of my tests?
3. Who goes over the lab results with me?
4. Is there some type of report card available with the results
written on it that I can keep?
5. Can lab tests be repeated during the month to check for
improvement or do I have to wait until the next month?
6. Is the amount of time prescribed for my dialysis treatment
directly related to the results of my lab tests?
7. If I choose home dialysis therapy will my lab tests be done
less frequently?
8. Which lab test result is the most important to watch?
9. Do I have to be fasting (no food or drink prior to testing) for
my monthly lab tests?
10.Who pays for the lab tests?
11.Do I have to pay separately for having the lab tests done
every month?
12.If a lab test is repeated, which test result is used for my
monthly review?
Notes
Notes
Additional Information
Nephrologist______________________________________________
Phone Number____________________________________________
Dialysis Clinic____________________________________________
Phone Number____________________________________________
Developed by Patients for Patients Western Pacific Renal Network
505 San Marin Dr. Suite A-300
Novato, CA 94945
(415) 897-2400
Toll Free 1-800-232-3773
www.esrdnet17.org
Supported by the Centers for Medicare and Medicaid Services (CMS) Contract #HHSM-500-2013-NW017C. The opinions and conclusions
expressed are those of the authors. They do not necessarily reflect CMS policy.
ESRD from A to Z
A dictionary for dialysis and
transplant patients
Created by the Southeastern Kidney Council
Consumer Committee
A glossary of terms often used when talking about dialysis,
transplantation, and End Stage Renal Disease.
The mission of the Southeastern Kidney Council is to improve the
lives of patients with or at risk for End Stage Renal Disease by
promoting and advancing quality of care.
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This dictionary was developed by the Consumer
Committee of the Southeastern Kidney Council,
ESRD Network 6. It is designed to be used by
people who have ESRD, their families and
friends. We hope this dictionary will help you
better understand words associated with the
disease and increase communication with your
health care team.
The words are listed in alphabetical order.
Words that appear in bold italic are defined
elsewhere in the dictionary.
Southeastern Kidney Council, Inc.
1000 St. Albans Drive, Suite 270
Raleigh, NC 27609
(919) 855-0882
(919) 855-0753(fax)
www.esrdnetwork6.org
info@nw6.esrd.net (e-mail)
1-800-524-7139 (patients only)
This publication was developed under contract with the
Centers for Medicare & Medicaid Services
Baltimore, Maryland,
CMS Contract #500-00-NW06
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Access
A means to reach the bloodstream. In
hemodialysis, fistulas, grafts, catheters, and
subcutaneous vascular access’ are used.
Access to the peritoneal cavity for peritoneal
dialysis is through a peritoneal catheter.
A
Access Aneurysm
A thinned, bulging, pulsating area on the fistula
or graft. Aneurysms can be caused by repeated
puncture of an access in one spot. This trauma
weakens the access wall and could cause it to
rupture.
Hemodialysis
access
Acute Renal Failure
A condition in which the kidneys suddenly stop working. In many cases,
kidneys can recover.
Acute Tubular Necrosis (ATN)
Reversible kidney damage resulting in delayed kidney function.
Adequacy
The amount of dialysis to prevent uremic symptoms. In hemodialysis,
this is measured by Kt/V and URR. In peritoneal dialysis, this is
measured by Kt/V and Creatinine Clearance.
Advanced Directives
Written documents to record a patient’s wishes regarding his or her
medical treatment, in case that patient is unable to make their choices
known later.
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A
Albumin
One of a class of proteins in the blood. A reduced level of albumin may
be a sign of inadequate protein intake in the diet.
Allograft
An organ or tissue transplant from one human to another.
American Association of Kidney Patients (AAKP)
An organization composed primarily of patients on dialysis, transplant
recipients and family members. AAKP is a non-profit association which
strives to meet the needs of all kidney patients through educational
programs, patient advocacy and the promotion of rehabilitation.
American Kidney Fund (AKF)
A national non-profit organization that provides direct financial assistance
to those who suffer from kidney disease.
Anemia
A common condition in patients with kidney disease which there are not
enough red blood cells in the blood to carry oxygen. Anemia is often
referred to as “low blood” and causes weakness and fatigue.
Angioplasty
The inflation of a balloon inside a narrowing blood vessel. The inflation of
the balloon makes the vessel opening bigger and allows for more blood
flow.
Antibiotic
A medication used to kill bacteria that may be causing an infection in the
body.
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Antibody
A protein in the body that helps fight disease.
A
Anticoagulant
A substance that is given to prevent clotting of the blood (example:
Heparin).
Antigen
A substance in the body that stimulates the production of antibodies.
Antihypertensive
A medication that reduces high blood pressure (hypertension).
Anuria
A condition in which a person stops making urine.
Arterial Line
The tube carrying blood from the body into the artificial kidney
(dialyzer).
Arteriogram, Renal
An X-ray test involving injection of dye into the main artery supplying the
kidney, used to determine if the blood vessels to the kidney are normal.
.
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Arteriovenous Fistula
Surgical connection of an artery directly to a
vein, usually in the forearm, created in patients
who will need hemodialysis. The AV fistula
causes the vein to grow thicker, allowing the
repeated needle insertions required for
hemodialysis
A
Artery
A blood vessel that carries blood away from the
heart and to the body.
Artificial kidney
Another name for a dialyzer.
Ascites
Fluid which is retained in the abdominal cavity.
Autoimmune Disease
A disorder in which the tissues and organs of the body are attacked by
their own immune system.
AV Fistula
See Arteriovenous Fistula.
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B
Bacteria
“Germs” too small to see with the naked eye that can produce diseases or
infections.
Bath
Another name for dialysate fluid, which is a clean salt-containing
solution. Inside the dialyzer waste products will flow from the blood into
the dialysate and are then washed away.
Bilateral nephrectomy
The removal of both kidneys.
Biopsy
The process of surgically removing tissue from living patients for
diagnostic examination.
Bladder
The part of the urinary tract that receives urine from the kidneys and
stores it until urination.
Blood Flow Rate (BFR) or QB
The amount of blood passing through the artificial kidney (dialyzer) each
minute. This is determined by the speed at which the blood pump is set.
Blood Glucose Meter
A machine that helps test how much glucose (sugar) is in the
blood. A specially coated strip containing a fresh drop of blood is
inserted in a machine, which then calculates the level of glucose
in the blood sample and displays a result.
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B
Blood Leak
The dialyzer fibers or membrane develop a small break or tear allowing
blood to leak into the dialysate.
Blood Pressure
Pressure of the blood flowing through the blood vessels. Stated as a
systolic number over a diastolic number.
Blood Pump
A pump that is used to bring blood from the patient and push it through the
artificial kidney or dialyzer and back to the body.
Blood Sugar
See Glucose.
Blood Urea Nitrogen (BUN)
A waste product, or toxin, that appears in the blood as protein from food is
digested. BUN levels are a measure of how well the kidneys are
functioning as well as adequacy of dialysis
and nutritional status. A high BUN indicates
that the kidneys are not removing enough
waste.
Bloodlines
The arterial line and venous line used in
hemodialysis.
Bright’s Disease
See Glomerulonephritis.
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B
Bruit
The sound of blood moving through a fistula or graft that indicates that
the access is working. Bruits can also be heard from an artery and may
indicate a blockage.
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C
Cadaver Donor
A person who has just died that has agreed, before their death, to offer an
organ, tissue or blood for transplantation.
Calcium
A mineral that the body needs for strong bones and teeth. A combination
of too much phosphorus and too little calcium causes weak, brittle bones.
Cannulation
The process of inserting a needle into the graft or fistula.
CAPD
See Continuous Ambulatory Peritoneal Dialysis.
Catheter
A tube inserted through the skin into a
blood vessel or body cavity to draw out
blood or body fluids, or to put in fluid. In
peritoneal dialysis, a catheter is used to
instill dialysis solution into the abdominal
cavity and drain it out again. In
hemodialysis, a catheter in a vein can
be used to create a temporary or longerterm dialysis access.
Hemodialysis catheter
CCPD
See Continuous Cycling Peritoneal Dialysis.
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C
Centers for Medicare & Medicaid Services (CMS)
(formerly know as HCFA – Health Care Financing Administration)
The department of the federal government that oversees the Medicare
and Medicaid programs.
Central Venous Stenosis
Narrowing of the central veins in the body that can make the arm on the
that side unsuitable for a vascular access.
Chronic Renal Failure (CRF)
Slow and progressive loss of kidney function over several years, often
resulting in End Stage Renal Disease.
Clotting time
The time it takes for the blood to form a clot.
CMS
See Centers for Medicare & Medicaid Services.
Complaint and Grievance Procedure
A process for a concerned person to request an investigation into an
allegation involving a facility, physician, or other provider. The dialysis
facility and the ESRD Network both have such a procedure.
Conductivity
The measure of ions in a solution. A conductivity meter measures the
chemical composition of dialysate by measuring the dialysate’s ability to
conduct an electrical current. If the conductivity of dialysate is not correct
an alarm will go off, and the dialysate is bypassed to the drain. This
means the dialysate will not come in contact with the patient’s blood.
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C
Conductivity Alarm
The conductivity alarm indicates an inappropriate mixture of water and
dialysate concentrate. See Conductivity.
Congestive Heart Failure (CHF)
A condition in which the weakened heart does not pump blood effectively.
This results in the body retaining excess fluid. The fluid collects in the
lungs making breathing difficult. In a dialysis patient, treatment may
include removal of excess body fluid during dialysis.
Continuous Ambulatory Peritoneal Dialysis (CAPD)
A type of dialysis where the patient’s peritoneal membrane is used as
the dialyzer. The patient dialyzes at home, using special supplies, but
without the need for a machine. When you are on CAPD, you change the
fluid in your peritoneal cavity by doing what is called "an exchange". This
can be performed in any clean and convenient place - at home, at work, at
school or on vacation. The exchanges use gravity to drain the used fluid
out of the peritoneal cavity and to replace it with fresh fluid. Most CAPD
patients need to do about 3 to 5 exchanges a day. (See Peritoneal
Dialysis)
Continuous Cycling Peritoneal Dialysis (CCPD)
A type of dialysis where the patient dialyzes at home and uses a machine
which automatically delivers cycles of dialysis exchanges. A typical
CCPD schedule involves three to five exchanges during the night while
the person sleeps. One or more additional exchanges may also be
performed during the daytime. (See Peritoneal Dialysis)
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C
Creatinine
A waste product released from the muscles of the body. Creatinine is
normally removed from the blood by the kidneys.
Creatinine Clearance
A test that measures how well the kidneys remove creatinine from the
blood. A decreased creatinine clearance reading means decreased
function of the kidneys.
Cross-Matching
A test used to establish blood compatibility before transfusion. Before a
transplant, the donor’s blood is tested with the recipient’s blood to see
whether they are compatible.
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D
Declotting
The removal of a blood clot so fluid can flow through a blood vessel or
tube, such as a dialysis access.
Department of Health and Human Services (DHHS)
DHHS administers many programs at the Federal level dealing with the
health and welfare of the citizens of the United States. It is the “parent” of
the Centers for Medicare & Medicaid Services (CMS).
Diabetes Mellitus
A disease that occurs when a person has high blood sugar.
Diabetic Nephropathy
Kidney disease caused by diabetes.
Diabetic Neuropathy
Damage of nerves by diabetes.
Diabetic Retinopathy
An eye disease caused by diabetes that may result in reduced vision or
blindness.
Dialysate/Dialysate fluid
Also called bath. The solution used to remove excess fluids and waste
products from the blood.
Dialysate Flow Rate (DFR) or QD
The rate at which dialysate fluid moves through the dialyzer.
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D
Dialysis
The process of cleaning wastes from the blood artificially. This job is
normally done by the kidneys. If the kidneys fail, the blood must be
cleaned artificially with special equipment. The two major forms of
dialysis are hemodialysis and peritoneal dialysis.
Dialysis Technician
An individual who provides dialysis care under
the supervision of a registered nurse or a
physician. Also called a Patient Care
Technician (PCT).
Dialyzer (artificial kidney)
An artificial kidney used with the hemodialysis
machine. The dialyzer has two sections
separated by a membrane. One section holds
dialysate fluid and the other holds the patient’s
blood. Waste products and fluid travel from the
blood in to the dialysate fluid, across the
dialyzer membrane, and are disposed of.
Diastolic
The bottom blood pressure number (or second number) which measures
the force of the heart muscle at rest, when it expands and fills with blood.
Dietitian
An expert in nutrition who helps people with special health needs plan the
kinds and amount of foods to eat. Also called a nutritionist.
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D
Disequilibrium Syndrome
The term used to describe a condition which may result from dialysis
therapy, most commonly in patients new to dialysis. Some symptoms
may be headache, cramps, nausea, or vomiting.
Donor
A person who offers blood, tissue, or an organ for transplantation.
Dry Pack
A dialyzer that has not been pre-processed for first use of hemodialysis.
Dry Weight (ideal weight) (target weight)
The weight at which all excess fluids have been removed.
Durable Medical Equipment (DME)
Items commonly covered under the Medicare program such as oxygen
equipment, wheelchairs, and other medically necessary equipment
prescribed by a physician for a patient’s in-home use.
Dwell Time
In peritoneal dialysis, the amount of time that dialysate fluid remains in
the patient’s abdominal cavity during an exchange.
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Edema
Swelling caused by too much fluid in the body.
E
Electrolytes
Salts in the body fluids including sodium, potassium, magnesium, and
chloride. The kidneys control the amount of these electrolytes in the body.
When the kidneys fail, electrolytes get out of balance, causing potentially
serious health problems. Dialysis can help correct this problem.
End Stage Renal Disease (ESRD)
Any irreversible kidney disease that requires dialysis therapy or kidney
transplant in order to live. The term “end-stage” means that the renal
disease is permanent and irreversible, and not that the person’s condition
is terminal.
Erythropoietin
A hormone which stimulates the body to produce red blood cells. It is
normally produced in the kidney, but with renal failure the body cannot
produce this hormone, resulting in anemia.
Equipment Technician
An individual who performs the required tasks for the maintenance,
monitoring, and repair of dialysis machines, reuse processing and water
treatment systems and equipment at the dialysis facility.
ESRD
See End Stage Renal Disease.
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E
ESRD Networks
The ESRD Networks were established by the U.S. Government in 1978 to
oversee dialysis and transplant facilities and ensure that patients receive
high quality care. The Networks collect data, oversee quality
improvement activities, encourage rehabilitation, establish a grievance
procedure for patients, and provide resource materials to ESRD staff and
patients.
Exchange
In peritoneal dialysis, the draining of used dialysate fluid solution from
the abdomen, followed by refilling with a fresh bag of solution.
Exit Site
The site at which the catheter exits the body.
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Femoral Catheter
A temporary catheter placed in the femoral vein in the groin.
F
Ferritin
The amount of stored iron in the body.
First-Use Syndrome
Symptoms that may occur after starting hemodialysis with a dry pack or
dialyzer that has not been pre-processed for first use of hemodialysis.
Symptoms may include chest pain, back pain, nervousness, and itching.
Fistula
See Arteriovenous Fistula.
Fistulogram
A special procedure performed in the Radiology Department of a hospital.
With the use of X-ray dye, the blood flow through a fistula will be
evaluated. The procedure can detect problems such as a clot or
narrowing. Early detection and treatment of problems with a fistula can
improve its performance and limit future complications.
Flu
See Influenza.
Fluid Overload
Excess sodium (salt) and fluid retained in the body between dialysis
treatments; may cause shortness of breath and swelling.
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F
Fluid Restriction
The amount of fluid a patient is allowed to drink in a 24-hour period to
avoid adding extra weight that would cause fluid overload and undue
stress to the heart.
Folic Acid
A vitamin necessary for red blood cell production.
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G
Glomeruli
Plural of glomerulus.
Glomerulonephritis
Also called Bright’s Disease or Nephritis. It is an inflammation of the
glomeruli. It usually affects both kidneys and generally first occurs in
early childhood. Recovery from the acute form may take one year. Those
with the chronic form suffer low, progressive damage which may ultimately
lead to ESRD.
Glomerulus
A tiny set of looping blood vessels in the kidney where the blood is
filtered.
Glucose
A type of sugar found in the body. Also called blood sugar.
Graft
In hemodialysis, a
vascular access
surgically created using a
synthetic tube to connect
an artery to a vein. In
transplantation, a graft
is the transplanted organ
or tissue.
Hemodialysis Graft
Guaiac Cards
Cards used to test for hidden blood in the stool.
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Hematocrit
A measure that tells how many red blood cells are present in a
blood sample. Low hematocrit suggests anemia or increased
blood loss.
H
Hemodialysis
The use of a machine to clean wastes
from the blood after the kidneys have
failed. The blood is circulated through
tubes to a dialyzer, which removes
wastes and extra fluid. The cleaned
blood then flows through another set
of tubes back into the body.
Hemoglobin
The substance in red blood cells that
carries oxygen around the body. Low
hemoglobin suggests anemia or
increased blood loss.
Heparin
A medication that prevents the blood from clotting too quickly.
Hepatitis
Inflammation of the liver.
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H
Hepatitis B Antigen Test
A test which determines the presence of an antigen associated with the
circulation of the Hepatitis B virus in the blood.
Hereditary
A disease, trait, or condition that is passed on in a family (blood relatives).
High Blood Pressure
See Hypertension.
Human Insulin
Insulin that is chemically the same as insulin that a person’s body
produces naturally.
Hyperglycemia
Too high a level of glucose (sugar) in the blood; a sign that diabetes is
out of control.
Hyperkalemia
A high level of potassium in the blood; can cause irregular heartbeat and
cardiac arrest if severe.
Hypertension
High blood pressure, which can be worsened by too much fluid in the
blood vessels or fluid overload.
Hypoglycemia
Low blood sugar.
Hypotension
Low blood pressure.
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I
Ideal Weight
See Dry Weight.
Immune System
The body’s system for protecting itself from viruses and bacteria or any
“foreign” substance.
Immunosuppressant
A drug given to suppress the natural responses of the body’s immune
system. Immunosuppressants are given to patients to prevent the body’s
immune system from fighting and rejecting the transplanted organ. Also
given to patients with autoimmune diseases.
Implantable Port
See Subcutaneous Vascular Access.
Infiltration
The leakage of a substance into body tissues. In hemodialysis patients,
infiltration of blood into the tissues surrounding the access can occur if
the needle punctures the back of the vessel wall or is partially dislodged
from the access.
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I
Influenza (flu)
A contagious disease that is caused by the influenza virus. It attacks the
respiratory track (nose, throat, and lungs). The flu is different from a cold.
It usually comes on suddenly and may include symptoms such as fever,
headache, tiredness, dry cough, sore throat, body aches, and nasal
congestion. The influenza vaccine is recommended every Fall for all
people age 50 and over, for people of all ages who have chronic diseases,
or for anyone of any age who wants to reduce the risk of contracting the
“flu”. A flu shot can be given at any time during the autumn or winter but
is most effective when it is given from early October to mid-November,
before the flu season begins.
Insulin
A hormone that controls the body’s use of glucose (sugar). When the
body cannot make enough insulin or is resistant to its own insulin, the
person with diabetes may have to inject insulin.
Internal Jugular Catheter (IJ)
A temporary dialysis catheter that is placed in the internal jugular vein of
the neck.
Intravenous (IV)
Within a vein.
Iron Deficiency
Lack of enough available iron to make red blood cells.
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K
Kidney Failure
The loss of kidney function. (See also End Stage Renal Disease)
Kidney Transplantation
The replacement of a diseased kidney with
a healthy one.
Kidneys
The two bean-shaped organs located on
either side of the spine, just above the
waist. They rid the body of waste materials
and maintain fluid balance through the
making of urine.
Kt/V
A measurement of how much urea is being removed from the blood
during dialysis. The measurement takes into account the efficiency of the
dialyzer, the treatment time, and the total amount of urea in the body.
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L
Lipid
A term for fat. The body stores fat as energy for future use just like a car
that has a reserve fuel tank. When the body needs energy, it can break
down the lipids into fatty acids and burn them like glucose (sugar).
Living Related Donor (LRD)
A living family member that donates an organ.
Living Unrelated Donor (LUD)
A living person, not a family member, who donates an organ.
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M
Medicaid
A state and federally funded program that helps pay for medical bills. A
person’s income must be below a certain level to receive Medicaid.
Benefits vary from state to state.
Medicare
A federally funded program that helps pay for medical bills. The Centers
for Medicare & Medicaid Services (CMS) administers this program.
Membrane
A thin sheet or layer of tissue that lines a cavity or separates two parts of
the body. A membrane can act as a filter, allowing some particles to pass
from one part of the body to another while keeping others where they are.
The artificial membrane in a dialyzer filters waste products from the
blood.
Modality
Methods of treatment for kidney failure. Modality types for End Stage
Renal Disease include transplant, peritoneal dialysis, and
hemodialysis.
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N
National Kidney Foundation (NKF)
A voluntary health organization which seeks to prevent kidney and urinary
tract diseases, improve the health and well-being of individuals and
families affected by these diseases, and increase the availability of all
organs for transplantation.
Needle Gauge
Refers to the size of the needle. The larger the number, the
smaller the size of the needle.
Negative Pressure
The method of removing extra water and salt from the blood
by creating pressure inside the blood compartment of the
dialyzer, allowing the process of ultrafiltration to take place.
Nephrectomy
Surgical removal of a kidney.
Nephritis
See Glomerulonephritis.
Nephrolithiasis
Kidney stones.
Nephrologist
A medical doctor who treats patients with kidney problems or
hypertension.
.
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Nephron
A tiny part of the kidneys. Each kidney is made up of
about 1 million nephrons, which are the working units
of the kidneys, removing wastes and extra fluids from
the blood.
N
Nephrosis
A condition in which there is a large and abnormal
leakage of protein into the urine.
Nocturnal Home Hemodialysis (NHHD)
Hemodialysis done at night while a person sleeps.
The patient sleeps through the treatment and disconnects in the morning.
The patient typically dialyzes 6 nights a week and usually for a minimum
of 7 hours each night.
Nocturnal Intermittent Peritoneal Dialysis (NIPD)
A type of dialysis where the patient generally dialyzes at home and uses
an automated peritoneal cycler for delivering dialysis exchanges. NIPD
differs form CCPD in that the patient does not perform any exchanges
during the day.
Non-Insulin Dependent Diabetes Mellitus (NIDDM)
Diabetes mellitus that does not require the use of insulin injections; it
may be controlled by diet and medications. (See Type II Diabetes
Mellitus)
Nuclear Scan of the Kidneys
A test of the structure, blood flow, and function of the kidneys. The
doctor injects a solution into an arm vein and uses a radiation detector to
monitor its progress through the kidneys.
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N
Nutritionist
See Dietitian.
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O
Occlude
Obstructed or blocked flow in a blood vessel, graft, or catheter.
Occupational Therapist
A person trained to help patients to improve the use of fine motor skills.
(i.e., finger and hand movement).
Organ Donation
The act of giving one's organs to someone else.
Organ Procurement
The process of acquiring donor organs such as kidneys in the ESRD
program. UNOS directs the collection and placement of donor kidneys.
Organ Procurement Organizations (OPO)
An organization that coordinates activities related to organ procurement.
OPO activities include: evaluating potential donors, discussing donation
with surviving family members, arranging for the surgical removal and
transport of donated organs, and educating the public about the need for
donations.
Osmosis
Passing of fluid through a semipermeable membrane from a solution
with a low solute concentration to a solution with a higher solute
concentration until there is an equal concentration of fluid on both sides of
the membrane.
Osteodystrophy
Bone disease.
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P
Palpate
To examine by touching.
Parathyroid Glands
Glands producing parathyroid hormone which regulates calcium
metabolism.
Parathyroidectomy
The procedure of surgically removing the parathyroid glands.
Patent
Unblocked flow of blood in a blood vessel, graft, or catheter.
Patient Care Technician (PCT)
See dialysis technician.
Perfusion Machine
A machine that keeps a donor kidney in the best possible condition
outside the body until such time as it can be transplanted into a recipient.
Peritoneal Cavity
The space inside the abdomen but outside the internal
organs.
Peritoneal Dialysis
A treatment for kidney failure in which dialysate is
put into the peritoneal cavity. The dialysate causes
waste and excess water to be drawn across the
peritoneal membrane into the cavity. When the
process is complete, the fluid is drained off and
replaced.
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Peritoneum
The membrane lining the peritoneal cavity.
P
Peritonitis
Infection in the peritoneal cavity usually treated with antibiotics.
Phosphate Binders
Phosphate binders help to pass excess phosphate out of the body in the
stool, reducing the amount of phosphate that gets into the blood. These
medicines "bind" the phosphate in the digestive tract by combining with it
to form a compound that isn't absorbed into the blood.
Phosphorus
A mineral necessary for bone strength. A combination of too much
phosphorus and too little calcium causes weak, brittle bones.
Polycystic Kidney Disease
An inherited disorder characterized by many
grape-like clusters of fluid-filled cysts that
make both kidneys larger over time. These
cysts take over and destroy working kidney
tissue.
Potassium
An essential chemical salt in the body that
regulates heart and muscle movement. High or low levels in the blood
may cause muscle weakness and cause the heart to stop.
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P
Priming
Filling and rinsing the bloodlines and the dialyzer with a solution of
saline.
Proteinuria
The presence of protein in the urine. This indicates that the kidneys are
not working properly.
Pyelonephritis
An infectious swelling of the tissue of the kidneys, which at the onset may
not interfere with kidney function, but if left untreated, may lead to kidney
failure.
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Q
QB
See Blood Flow Rate.
QD
See Dialysate Flow Rate
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R
Rehabilitation
A return to stable health, a positive outlook, and enjoyable activities that
make people feel better physically and mentally. A successful
rehabilitation program uses medical treatment, counseling, education,
diet, and exercise.
Rejection
When the body does not accept a transplanted organ.
Renal
Having to do with, or referring to, the kidneys.
Renin
A hormone produced by the kidney which helps regulate the volume of
fluid in the body and blood pressure.
Reuse
The process of cleaning and sterilizing dialyzers to use again. Strict
reuse regulations have been established by the Federal Government to
insure patient safety and quality of treatment. A dialyzer is reused only by
the same patient.
Reuse Technician
An individual who performs the procedures necessary to clean and
properly prepare dialyzers to be used again.
Rinseback
The process of using saline to flush the patient’s blood back into the body
from the dialysis tubing after dialysis.
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Saline
A salt solution containing sodium and chloride.
S
Self-dialysis
Dialysis performed with little or no staff assistance (except in emergency
situations) by an ESRD patient who has completed an appropriate course
of training.
Semipermeable Membrane
A material through which only certain particles may pass, and to which
other particles cannot pass.
Staff-assisted dialysis
Dialysis performed by the staff of the renal dialysis center or facility.
Sepsis
An infection in the blood caused by bacteria.
Shunt
Another word for fistula or graft.
Sodium
One of the major chemical salts of the body. Found and taken into the
body most commonly as table salt. When excess amounts cannot be
excreted from the body by the kidneys, edema and high blood pressure
may result. The intake of this salt must be controlled by diet in patients
with most types of renal failure.
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S
Sodium Modeling
Sodium modeling means to adjust the concentration of sodium in the
dialysate to fit the individual patient, according to the doctors orders.
Sodium modeling may make the dialysis treatment more comfortable by
reducing some symptoms such as cramping. It may also reduce drops in
the blood pressure.
Solute
A substance dissolved in another substance (i.e., salt water).
Steal Syndrome
Occurs when a fistula or graft “steals” too much blood away from the
distal (farthest from center of body) part of the arm, usually the hand.
Stenosis
The narrowing (getting smaller) of a blood vessel which can lead to
clotting of the vessel.
Sterile
Being completely free from all germs.
Subclavian/Subclavian Vein
Means "beneath the clavicle." The clavicle is the collarbone, a bone in the
shoulder. The subclavian vein is the large vein behind the collarbone
which is sometimes used for hemodialysis.
Subclavian Catheter
A catheter placed in the subclavian vein.
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Subcutaneous Vascular Access (LifeSite®)
A small metallic device or devices placed under the
skin, usually in the upper chest area, to deliver
hemodialysis. These devices are connected to
tow hollow, flexible catheters that are in turn
connected to large veins in the central venous
system. The entire system is completely under the
skin.
S
Suture
The material used to surgically close a wound or join tissues.
Systolic
The top blood pressure number which measures the force of contraction
of the heart muscle as blood is pumped out of the heart chambers.
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T
Target Weight
See Dry Weight.
Tenckhoff catheter
A type of catheter used in peritoneal
dialysis.
Thrill
The buzzing sensation that can be felt
by touching a fistula or graft. This
indicates that the access is working.
Tenckhoff Catheters
Thrombus
A clot formed in a blood vessel.
Tissue Typing
A laboratory test done on your blood to find the degree of matching
between a potential donated kidney and the patient waiting for
transplant.
Toxins
Waste products that accumulate in the blood of ESRD patients that are
usually harmful to the body.
Transfer Set
The section of tubing attached immediately to a peritoneal catheter.
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T
Transient Patients
Patients receiving treatments at a facility and who are not a part of a
facility’s regular caseload (i.e. traveling patients).
Transplant
The replacement of a diseased organ with a
healthy one.
Transplant Coordinator
The nurse who works with the transplant
surgeon and the dialysis team to coordinate
testing before transplant and to coordinate the
patient’s care after transplant.
Transplant Surgeon
The doctor responsible for placing the transplanted kidney.
Trendelenburg position
A body position in which the head is placed at 45 degrees with the legs up
(feet above the head). This position helps when a person has
hypotension.
Tunneled Cuffed Catheter
A dialysis catheter that is inserted into a blood vessel through a tunnel
created under the patient’s skin. Inside the tunnel tract, surrounding
tissue grows into an attached cuff to help stabilize the catheter and
provide a physical barrier to bacteria.
Twenty-Four Hour Urine Collection
The volume of the total amount of a person’s urine for a 24-hour period.
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T
Type I Diabetes Mellitus
This type of diabetes, usually occurs at a young age and results from a
lack of insulin production by the body and requires insulin therapy.
Type II Diabetes Mellitus
Non-Insulin dependent diabetes. Usually occurring in adults. See NonInsulin Dependent Diabetes.
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U
Ultrafiltration
The process of removing excess water from the blood during dialysis.
Ultrasound
A technique that bounces safe, painless sound waves off
of organs to create an image of their structure.
United Network for Organ Sharing (UNOS)
A nonprofit charitable organization that maintains the nation’s organ
transplant waiting list under contract with the Health Resources and
Services Administration of the U.S. Department of Health and Human
Services.
United States Renal Data System (USRDS)
A national data system which collects, analyzes, and distributes
information about End Stage Renal Disease (ESRD) in the United
States. The USRDS is funded directly by the National Institute of Diabetes
and Digestive and Kidney Diseases (NIDDK) in conjunction with the
Centers for Medicare & Medicaid Services (CMS).
Urea
A waste product found in the blood and caused by the normal breakdown
of protein in the body. Urea is normally removed from the blood by the
kidneys and then excreted in the urine.
Uremia or Uremic Syndrome
Changes in the body caused by the build-up of waste products in the
blood when the kidneys fail to function.
Ureter
One of the two tubes that carry urine from the kidney to the bladder.
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U
Urethra
The tube that carries urine from the bladder to the outside of the body.
Urinalysis
A test of a urine sample that can reveal many problems of the urinary
system and other body systems.
Urinary Tract
The system that takes wastes from the blood and carries
them out of the body in the form of urine. The urinary tract
includes the kidneys, renal pelvises, ureters, bladder, and
urethra.
Urinate
To release urine from the bladder to the outside.
Urine
Liquid waste product filtered from the blood by the kidneys, stored in the
bladder, and expelled from the body through the urethra by the act of
voiding or urinating.
Urologist
A surgical doctor that treats diseases of the urinary tract and urogenital
system.
URR (Urea Reduction Ratio)
A blood test that compares the amount of blood urea nitrogen (BUN)
before and after dialysis to measure the effectiveness of the dialysis
prescription.
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V
Vascular Access
See Access.
Vasculitis
Inflammation of the blood vessel walls.
Vein
A blood vessel that carries blood toward the heart.
Venous Line
The tube carrying the blood back into the body from the artificial kidney
machine.
Vital Signs
Blood pressure, temperature, pulse, and respiratory rate.
Vocational Rehabilitation (VR)
The process of facilitating an individual in the choice of, or return to, a
suitable vocation. When necessary, assisting the patient to obtain training
for such a vocation. Vocational rehabilitation can also mean preparing an
individual regardless of age, or physical condition to cope emotionally,
psychologically, and physically with changing circumstances in life,
including remaining at school, work, or a work equivalent (homemaker).
Void
To urinate or empty the bladder.
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ESRD Resources
Resource Descrip on Address Organiza on for kidney
pa ents that provides
educa onal material to
pa ents about treatment
op ons and resources
American Associa on of
Kidney Pa ents
3505 E Frontage Rd.
Suite 315
Tampa, FL 33607
Federal agency that
administers Medicare and
Medicaid necessary for
ESRD treatment payment
CMS
7500 Security Blvd.
Bal more, MD 21244
Provides free materials to
kidney pa ents about
treatment op ons,
rehabilita on, and main‐
taining ac ve lifestyle
Life Op ons
Rehabilita on Program
C/O The Medical
Educa on Ins tute
414 D’Onofrio Dr. Suite 200
Madison, WI 53719
Provides informa on for
kidney pa ents about
kidney disease, treatment
op ons, and resources
Na onal Kidney Founda on
30 East 33rd St.
New York, NY 10016
Independent agency of
the federal government
that administers social
security benefits
necessary for Medicare
enrollment
To locate the appropriate office
for your region please call the
toll free number or visit the
website listed
Phone Number Website American Associa on of Kidney Pa ents (AAKP) 1‐800‐749‐2257
www.aakp.org
Centers for Medicare and Medicaid Services (CMS) Life Op ons 1‐877‐267‐2323
www.cms.gov
1‐800‐468‐7777
www.lifeop ons.org
Na onal Kidney Founda on (NKF) Social Security Administra on (SSA) Western Pacific Renal Network #17 (WPRN) Organiza on contracted
by CMS to bring the ESRD
program to Northern
California and the Pacific
Islands
Western Pacific Renal Network
505 San Marin Dr.
Bldg A Suite 300
Novato, CA 94945
1‐800‐622‐9012
www.kidney.org
1‐800‐772‐1213
www.ssa.gov
1‐800‐232‐3773
www.esrdnet17.org
To file a grievance, please contact : Western Pacific Renal Network
505 San Marin Drive
Building A, Suite 300
Novato, CA 94945
(415) 897‐2400
Toll Free: (800) 232‐3773
Network Website:
www.esrdnet17.org Supported by Centers for Medicare & Medicaid Services. The opinions and conclusions expressed are those of the authors. They
do not necessarily reflect CMS policy. The authors assume full responsibility for the accuracy and completeness of the idea
presented.
Contract #HHSM‐500‐2013‐NW017C.