About Chronic Kidney Disease

Transcription

1 About Chroic Kidey Disease A Guide for Patiets ad Their Families

2 Natioal Kidey Foudatio s Kidey Disease Outcomes Quality Iitiative Did you kow that the Natioal Kidey Foudatio s Kidey Disease Outcomes Quality Iitiative (NKF- KDOQI ) develops guidelies that help your doctor ad healthcare team make importat decisios about your medical treatmet? The iformatio i this booklet is based o the NKF-KDOQI recommeded guidelies. Stages of Chroic Kidey Disease There are five stages of chroic kidey disease. They are show i the table below. Your doctor determies your stage of kidey disease based o the presece of kidey damage ad your glomerular filtratio rate (GFR), which is a measure of your level of kidey fuctio. Your treatmet is based o your stage of kidey disease. Speak to your doctor if you have ay questios about your stage of kidey disease or your treatmet. Stages of Kidey Disease Stage Descriptio Glomerular Filtratio Rate (GFR)* 1 2 Kidey damage (e.g., protei i the urie) with ormal GFR Kidey damage with mild decrease i GFR 90 or above 60 to 89 3 Moderate decrease i GFR 30 to 59 4 Severe reductio i GFR 15 to 29 5 Kidey failure Less tha 15 * Your GFR umber tells your doctor how much kidey fuctio you have. As chroic kidey disease progresses, your GFR umber decreases. 2 Natioal Kidey Foudatio

3 Table of Cotets What are the kideys ad how do they help to maitai good health?...5 What is chroic kidey disease?... 6 What causes chroic kidey disease?... 7 What are the symptoms of chroic kidey disease?...8 Ca ayoe get chroic kidey disease?....9 What should I do if I am at icreased risk for kidey disease?...9 Are ay other tests doe to help detect chroic kidey disease?...10 Ca I prevet chroic kidey disease eve if I am at icreased risk?...11 What if my test results show I already have chroic kidey disease?...12 What is your stage of kidey disease?...13 If I have chroic kidey disease, what will my treatmet iclude? Cotiued o other side 3

4 Table of Cotets (cotiued) Ca I keep my kidey disease from gettig worse? What happes if my kidey disease gets worse?...17 How ca I cope with chroic kidey disease? Where ca I get more iformatio?...19 Key poits to remember...21 Test your kowledge...23 Uderstadig your lab values Natioal Kidey Foudatio

5 What are the kideys ad how do they help to maitai good health? Your kideys are two bea-shaped orgas, each about the size of your fist. They are located ear the middle of your back, just below the rib cage. Your kideys are a filterig system. Each kidey is made up of about oe millio tiy uits called ephros. The kideys filter about 200 quarts of blood each day. They remove about two quarts of waste products ad excess fluid i the form of urie. The urie flows through two tubes, called ureters, to the bladder. The urie is stored there util you go to the bathroom. The wastes come from the breakdow of food you eat ad ormal muscle activity. I additio to removig wastes ad fluid from your body, your kideys perform these other importat jobs: They regulate your body water ad other chemicals i your blood such as sodium, potassium, phosphorus ad calcium They remove drugs ad toxis itroduced ito your body They release hormoes ito your blood to help your body. These hormoes: 1. regulate blood pressure 2. make red blood cells 3. promote strog boes. 5

6 What is chroic kidey disease? Chroic kidey disease meas the kideys have bee damaged by diabetes, high blood pressure ad other disorders. Damaged kideys are ot able to keep you healthy by doig the jobs listed o page 5. If kidey disease gets worse, wastes cabuild to high levels i your blood ad make you feel sick. You may develop complicatios like high blood pressure, aemia (low red blood cell cout), weak boes, poor utritio ad erve damage. Also, kidey disease icreases your risk of havig heart ad blood vessel disease. These problems may happe slowly over a log period of time. Early detectio ad treatmet ca ofte keep chroic kidey disease from gettig worse. If kidey disease gets worse, it may lead to kidey failure, which requires dialysis or a kidey trasplat to maitai life. 6 Natioal Kidey Foudatio

7 What causes chroic kidey disease? The two mai causes of chroic kidey disease are diabetes ad high blood pressure. Diabetes happes whe your blood sugar is too high, causig damage to may orgas ad muscles i your body, icludig the kideys ad heart, as well as blood vessels, erves ad eyes. High blood pressure, or hypertesio, occurs whe the pressure of your blood agaist the walls of your blood vessels icreases. If it s ot well cotrolled, high blood pressure ca be a leadig cause of heart attacks, strokes ad chroic kidey disease. Also, chroic kidey disease ca cause high blood pressure. Other coditios that affect the kideys are: Glomeruloephritis, a group of diseases that cause iflammatio ad damage to the kidey s filterig uits. These disorders are the third most commo type of kidey disease. Iherited diseases, such as polycystic kidey disease, which causes large cysts to form i the kideys. These cysts damage the tissue aroud them. Malformatios that occur as a baby develops i its mother s womb. For example, a arrowig may occur that prevets ormal outflow of urie 7

8 ad causes urie to flow back up to the kidey. This causes ifectios ad may damage the kideys. Lupus ad other diseases that affect the body s immue system. Obstructios caused by problems like kidey stoes, tumors or a elarged prostate glad i me. Repeated uriary ifectios. What are the symptoms of chroic kidey disease? Most people do ot have ay severe symptoms util their kidey disease is advaced. However, you may otice that you: Feel more tired ad have less eergy FPO: CMYK Image Needed Have trouble cocetratig Have a poor appetite Have trouble sleepig Have crampig at ight Have swolle feet ad akles Have puffiess aroud your eyes, especially i the morig Have dry, itchy ski Need to uriate more ofte, especially at ight. 8 Natioal Kidey Foudatio

9 Ca ayoe get chroic kidey disease? Yes. Ayoe ca get chroic kidey disease at ay age. However, some people are more likely tha others to develop kidey disease. You may have a icreased risk for kidey disease if you: Have diabetes Have high blood pressure Have a family history of chroic kidey disease Are older Belog to a populatio group that has a high rate of diabetes or high blood pressure, such as Africa Americas, Hispaic Americas, Asia Americas or America Idias. What should I do if I am at icreased risk for kidey disease? If you are at icreased risk for kidey disease, visit your doctor or cliic ad get checked. The followig tests should be icluded: Blood pressure measuremet A simple test for protei i the urie. Protei is ot ormally foud i urie. Protei is a importat buildig block i the body, ad your kideys ormally hold oto ay filtered protei. Whe your kideys are damaged, protei leaks ito the urie. There are differet tests to check protei i the urie. Persistet protei i the urie 9

10 (two positive tests over several weeks) may be a early sig of kidey damage. A simple blood test to measure your level of creatiie, a waste that comes from ormal muscle activity. Whe your kideys are damaged, creatiie ca build to high levels i your blood. The results of your creatiie blood test should be used to estimate your glomerular filtratio rate, or GFR. Your GFR tells how much kidey fuctio you have. Free screeig for kidey disease may be available i your commuity through the Natioal Kidey Foudatio s Kidey Early Evaluatio Program (KEEP ). Check with the Natioal Kidey Foudatio affiliate i your area to fid out if this screeig is available. You may also get more iformatio about KEEP by callig the atioal toll-free umber Are ay other tests doe to help detect chroic kidey disease? Other tests may be doe to help detect chroic kidey disease. Urialysis ca detect may abormalities i the urie, such as blood, protei, pus, sugar ad bacteria Microalbumiuria is a sesitive test to detect a small amout of protei i the urie Urie creatiie estimates the cocetratio of your urie ad helps to give a accurate protei result 10 Natioal Kidey Foudatio

11 Protei-to-creatiie ratio estimates the amout of protei you excrete i your urie i a day. This ca replace the 24-hour urie sample. Ca I prevet chroic kidey disease eve if I am at icreased risk? Yes. You should speak to your doctor about how to reduce your chaces of developig kidey disease. You may be told to: Have regular checkups by your doctor or cliic Follow your prescribed treatmet for diabetes ad/or high blood pressure Lose excess weight by followig a healthy diet ad regular exercise program Stop smokig, if you are a smoker Avoid usig large amouts of over-the-couter pai-relievig medicatios Make some chages i your diet, such as eatig less salt ad less protei Limit your itake of alcoholic driks. 11

12 What if my test results show I already have chroic kidey disease? Your doctor will eed to pipoit your diagosis ad assess your kidey fuctio to help pla your treatmet. Your doctor may ask you to see a specialist to cosult o your case ad help maage your disease. The followig may be doe: Glomerular filtratio rate (GFR), which tells how much kidey fuctio you have. You do ot eed aother test to estimate your GFR. Your doctor ca calculate it from the results of your blood creatiie test, your age, race, geder ad other factors. Your GFR helps your doctor determie your stage of kidey disease. (See the chart What is your stage of kidey disease? o page 13.) GFR is the best way to evaluate your kidey fuctio. A ultrasoud or CT sca takes a picture of your kideys ad uriary tract. This shows whether your kideys are too large or too small, whether you have ay blockages such as kidey stoes or tumors ad whether there are ay problems i the structure of your kideys ad uriary tract. A kidey biopsy ivolves lookig at small pieces of your kidey tissue uder a microscope. This is doe i some cases to help: idetify a specific type of kidey disease determie how much damage has occurred pla treatmet. 12 Natioal Kidey Foudatio

13 What is your stage of kidey disease? Stages of Kidey Disease Stage Descriptio Glomerular Filtratio Rate (GFR)* 1 2 Kidey damage (e.g., protei i the urie) with ormal GFR Kidey damage with mild decrease i GFR 90 or above 60 to 89 3 Moderate decrease i GFR 30 to 59 4 Severe reductio i GFR 15 to 29 5 Kidey failure Less tha 15 * Your GFR umber tells your doctor how much kidey fuctio you have. As chroic kidey disease progresses, your GFR umber decreases. If I have chroic kidey disease, what will my treatmet iclude? Your treatmet pla will deped o your stage of kidey disease ad other health problems you may have. Your treatmet may iclude the followig: Cotrollig other health problems. You may have other disorders, such as diabetes ad high blood pressure, which ca damage your kideys. Oe of the goals of your treatmet is to make sure these are well-cotrolled. Your doctor may prescribe medicatios called agiotesi covertig ezyme (ACE) ihibitors or agiotesi receptor blockers (ARBs) as part of your therapy. Studies have show that these medicatios help to protect your kidey fuctio. You may also eed other blood pressure medicatios to cotrol your high blood pressure. 13

14 Your doctor may ask you to lose weight if you are overweight ad cut dow o salt i your diet to help lower your blood pressure. If you have diabetes, you will also eed to moitor your blood sugar, follow your diet ad take your medicatios as ordered by your doctor. Prevetig heart problems People who have kidey disease also have a icreased chace of developig heart problems. Cotrollig diabetes ad high blood pressure is also very importat to help prevet heart problems. I additio, aemia (low red blood cell cout) should be treated because it ca cause heart damage. To treat aemia, you may eed to take a hormoe called erythropoieti (EPO) ad iro supplemets. If your cholesterol level is too high, your doctor may recommed chages i your diet, regular exercise ad, possibly, special medicatios, to help lower cholesterol. Smokig makes heart ad kidey disease worse ad, if you are a smoker, you will eed to quit. Depedig o your symptoms, your doctor may order additioal tests to check your heart. Treatig complicatios of kidey disease Kidey disease may cause complicatios, such as aemia ad boe disease. I additio to treatig your aemia with EPO ad iro supplemets, you may eed to follow some guidelies to maitai healthy boes. This may iclude limitig the amout of high-phosphorus foods i your diet, takig a type of medicatio called a phosphate bider with your meals ad sacks ad takig a form of vitami D. 14 Natioal Kidey Foudatio

15 Trackig your progress Your glomerular filtratio rate (GFR) will be checked regularly to fid out whether your kidey disease is gettig worse. This usually is doe with blood tests. The amout of protei i your urie will be checked from time to time. Nutritioal tests will be doe to make sure you are gettig eough protei ad calories to maitai your overall health. You may be asked to follow a diet that is restricted i protei, so you will eed to get extra calories from other food sources. Your doctor ca refer you to a registered dietitia who will help you pla your meals to get the right foods i the right amouts. See Uderstadig your lab values o page 24. Ad see pages 9 11 for a list of tests that may be doe. 15

16 Ca I keep my kidey disease from gettig worse? Most likely. The goal of your treatmet is to slow or prevet your kidey disease from gettig worse. Your doctor may cosult with a specialist to develop a treatmet pla specific to your kidey disease. How well your treatmet ca achieve this goal depeds o: Your stage of kidey disease (see chart o page 13) at the time you are diagosed ad begi your treatmet. Your glomerular filtratio rate (GFR) is the best test to measure your kidey fuctio ad determie your stage of kidey disease. The earlier kidey disease is detected ad treated, the better the chace of slowig or stoppig its progressio. How carefully you follow your treatmet pla. You are a key member of the healthcare team. Lear all you ca about chroic kidey disease ad its treatmet, ad make sure to follow all the steps of your treatmet faithfully. Ask your doctor about your test results. Keep track of your glomerular filtratio rate, so you kow your stage of kidey disease. The cause of your kidey disease. Some diseases are more difficult to cotrol. 16 Natioal Kidey Foudatio

17 What happes if my kidey disease gets worse? If your kidey disease gets worse, ad your glomerular filtratio rate (GFR) falls below 30, you will eed to discuss treatmet optios for kidey failure. You will eed to be see by a specialist i kidey disease (called a ephrologist). This doctor may have see you before ad worked with your primary care doctor to develop your treatmet pla. The kidey doctor will help maage your disease ad will provide you with iformatio about kidey failure to make the best treatmet choice for you ad your family based o: Your medical coditio Your lifestyle ad persoal preferece. If your GFR falls below 15, you will eed to start treatmet for kidey failure. Two successful treatmets are available for kidey failure dialysis ad kidey trasplatatio. Dialysis is a treatmet that removes wastes ad excess fluid from your blood. Two types of dialysis are available: hemodialysis ad peritoeal dialysis. I hemodialysis, your blood is cleaed outside your body as it passes through a special filter called a artificial kidey, or dialyzer. I peritoeal dialysis, your blood is cleaed iside your body with the help of a dialysis solutio that is placed ito ad draied from your abdomial cavity (your belly). Kidey trasplatatio ivolves a operatio to place a doated kidey iside your body to take over the work of your failed kideys. The kidey may come from 17

18 someoe who has died (olivig door) or from a livig door who may be a close relative, fried or possibly a strager who wished to doate a kidey to ayoe i eed of a trasplat (odirected door). With a trasplat, you eed to take medicatios every day to prevet your body from recogizig the doated kidey as foreig ad rejectig it. Your doctor will help you decide which of these optios is best for you. How ca I cope with chroic kidey disease? A diagosis of chroic kidey disease ca be difficult to face. You ad your family may eed to make some lifestyle chages to adjust to your coditio ad ew treatmet. It s importat to realize that you do t have to face thigs aloe. A skilled team of medical professioals is available to help you. You may also fid it helpful to speak to other people who have chroic kidey disease. Call your local Natioal Kidey Foudatio Affiliate ad ask if a support group is available. Lear all you ca about kidey disease ad its treatmet. Kowig what to expect ad what you ca do to help yourself gives you more of a feelig of cotrol over your disease. The Natioal Kidey Foudatio ca provide you with may resources to help you lear more. 18 Natioal Kidey Foudatio

19 Where ca I get more iformatio? If you have questios, speak with your healthcare team. They kow you ad ca aswer questios about you. If you wat to read more about kidey disease, the Natioal Kidey Foudatio has more tha 50 other publicatios that cover may subjects, such as: CKD risk factors like hypertesio ad diabetes Complicatios of chroic kidey disease, such as cardiovascular disease, aemia or boe problems Nutritio for CKD patiets, with iformatio about carbohydrates, protei, sodium, phosphorus ad potassium Treatig kidey disease early Treatig kidey failure with trasplatatio or dialysis. 19

20 There are two ways to lear about the may free resources available to you: Call the Natioal Kidey Foudatio at Visit the Natioal Kidey Foudatio website ( (All publicatios are free, but there is a limit of five per perso.) Becomig a educated patiet is very importat to beig healthy! 20 Natioal Kidey Foudatio

21 Key poits to remember q Your kideys perform may importat jobs to keep you healthy. They are: gettig rid of wastes ad excess fluid, balacig fluids ad certai chemicals i your body, removig drugs ad toxis from your body ad releasig importat hormoes that help regulate blood pressure, make red blood cells ad keep your boes healthy. q q q q I chroic kidey disease, your kideys gradually lose the ability to do these importat jobs. The leadig causes of chroic kidey disease are diabetes ad high blood pressure. If you are at icreased risk for kidey disease (see Ca ayoe get chroic kidey disease? o page 9), visit your doctor or cliic ad get tested. You should have three simple tests: a blood pressure readig; a test for protei i your urie; ad a blood test for creatiie to estimate your glomerular filtratio rate (GFR), which tells your doctor how much kidey fuctio you have. Check with your local Natioal Kidey Foudatio Affiliate to fid out if the Kidey Early Evaluatio Program (KEEP ) screeig program is available i your commuity. Persistet protei i the urie is a early sig of chroic kidey disease. Two positive tests over several weeks idicate persistet protei i the urie. 21

22 q q q q q q If you have persistet protei i your urie, your doctor will eed to fid out why ad assess your kidey fuctio. You may eed to have your GFR estimated to fid your stage of kidey disease; a ultrasoud or CT sca; ad, i some cases, a kidey biopsy. Your glomerular filtratio rate (GFR) also helps your doctor determie your stage of kidey disease. Your GFR should be calculated from the results of your blood creatiie test, your age, race, geder ad other factors. If you are diagosed with chroic kidey disease, it s importat to lear all you ca about the disease ad its treatmet. You are a importat member of your healthcare team. How carefully you follow your treatmet pla may affect how well you do. Kow your umbers. Ask your doctor about importat test results like your GFR, ad keep track of them. Your treatmet depeds o your stage of chroic kidey disease ad other health problems you may have. (See If I have chroic kidey disease, what will my treatmet iclude? o page 13 for more details.) I may cases, early detectio ad treatmet may slow or stop the progressio of chroic kidey disease. However, if kidey disease gets worse ad kidey failure occurs evetually, two successful treatmets are available dialysis ad kidey trasplatatio. 22 Natioal Kidey Foudatio

23 Test your kowledge: Take this True or False quiz. 1. Your kideys oly job is to remove wastes ad excess fluid from your body. True False 2. People with diabetes or high blood pressure have a icreased risk of developig chroic kidey disease. True False 3. People with chroic kidey disease always have a lot of symptoms. True False 4. Africa Americas have a low risk of developig chroic kidey disease. True False 5. Chroic kidey disease ca be detected usig simple blood ad urie tests. True False 6. Early detectio ad treatmet ca ofte keep chroic kidey disease from gettig worse. True False 7. Persistet protei i the urie is a early sig of chroic kidey disease. True False 8. The best way to kow how your kideys are workig is to kow your glomerular filtratio rate (GFR). True False 9. Aemia ad boe disease are commo complicatios of chroic kidey disease. True False 10. People with chroic kidey disease have a low risk of developig heart disease. True False See aswers o page

24 Uderstadig your lab values Some or all of the followig tests may be used to check your utritio ad geeral health. Ask your doctor ad dialysis care team which tests you will have ad how ofte they will be doe. If your umbers are ot i the ormal rage, ask how to improve them. Serum Albumi: Albumi is a type of protei made from the protei you eat each day. A low level of albumi i your blood may be caused by ot gettig eough protei ad calories from your diet. A low level of albumi may lead to health problems, such as difficulty fightig off ifectios. Ask your dietitia how to get the right amout of protei ad calories from your diet. Blood Pressure: Ask your doctor what your blood pressure should be. If your blood pressure is high, make sure to follow all the steps i your prescribed treatmet. These steps may iclude takig high blood pressure medicaios, cuttig dow o the amout of salt i your diet, losig weight if you are overweight ad followig a regular exercise program. 24 Natioal Kidey Foudatio

25 Blood Urea Nitroge (BUN): Body Weight: Urea itroge is a ormal waste product i your blood that comes from the breakdow of protei from foods you eat. Healthy kideys remove BUN from your blood, but whe kidey failure occurs, your BUN rises. BUN is also removed from your blood by your dialysis. Your BUN rises from ot gettig eough dialysis or from eatig too much protei. It ca fall from gettig more dialysis or from eatig the right amout of protei recommeded by your doctor ad dietitia. Maitaiig a healthy weight is importat to your overall health. If you are losig weight without eve tryig, you may ot be gettig the right utritio to stay healthy. Your dietitia ca suggest how to safely add extra calories to your diet. O the other had, if you are slowly gaiig uwated weight, you may eed to reduce calories ad icrease your activity level. A sudde weight gai may also be a problem. If it is accompaied by swellig, shortess of breath ad a rise i blood pressure, it may be a sig of too much fluid i your body. You should check your 25

26 weight at home every morig. Speak to your doctor if your weight chages suddely. Calcium: Calcium is a mieral that is importat for strog boes. Ask your doctor what your calcium level should be. To help balace the amout of calcium i your blood, your doctor may ask you to take calcium supplemets or a special prescriptio form of vitami D. Take oly the medicatios recommeded by your doctor. Cholesterol: Total HDL Cholesterol is a fat-like substace foud i your blood. A high cholesterol level may icrease your risk of havig heart ad circulatio problems. However, a cholesterol level that is too low may mea you are ot eatig well eough to stay healthy. Ask your doctor if your cholesterol level is i the right rage. HDL cholesterol is a type of good cholesterol that protects your heart. For may dialysis patiets, the target level for HDL cholesterol is above Natioal Kidey Foudatio

27 LDL Serum Creatiie: Creatiie Clearace: LDL cholesterol is a type of bad cholesterol. A high LDL level may icrease your chace of havig heart ad circulatio problems. For may dialysis patiets, the target level for LDL cholesterol is below 100. If your LDL level is too high, your doctor may recommed chagig your diet ad icreasig your activity level. Creatiie is a waste product i your blood that comes from the ormal fuctio of your muscles. Healthy kideys remove creatiie from your blood, but whe the kideys are ot workig, your creatiie level rises. Your dialysis also removes creatiie from your blood. Not gettig eough dialysis ca cause your creatiie level to rise, while gettig more dialysis causes it to fall. Your creatiie level ca also fall from ot eatig well over a log period of time. Creatiie clearace is aother measure of how well your dialysis clears wastes from your blood. Your dialysis care team will check your weekly creatiie clearace about oce every four moths to make sure you are gettig the right amout of dialysis. 27

28 Hematocrit: Hemoglobi: Your hematocrit is a measure of the red blood cells your body is makig. A low hematocrit ca mea you have aemia ad eed treatmet with EPO ad extra iro. You will feel less tired ad have more eergy whe your hematocrit is at least 33 to 36 percet. Hemoglobi is the part of red blood cells that carries oxyge from your lugs to all the tissues i your body. Measurig your hemoglobi level tells your doctor if you have aemia, which makes you feel tired ad have little eergy. To treat your aemia, you may eed to take a hormoe called EPO alog with iro. The goal of aemia treatmet is to reach ad maitai a hemoglobi level of at least 11 to 12. Iro: TSAT ad Serum Ferriti Your TSAT (proouced "tee sat") ad serum ferriti (proouced "ferry ti") are measures of iro i your body. Your TSAT should be above 20 percet, ad your serum ferriti should be above 100. This will help you build red blood cells. Your doctor will recommed iro whe eeded to reach your target levels. 28 Natioal Kidey Foudatio

29 Kt/V PNA Parathyroid Hormoe (PTH): Kt/V (proouced "kay tee over vee") is a measure of the amout of dialysis you receive. Gettig the right amout of dialysis is importat to your overall health ad ca also affect how well you eat. Your target weekly Kt/V should be at least 2.0 for CAPD, 2.1 for CCPD ad 2.2 for NIPD. Your PNA (ormalized Protei Nitroge Appearace) is a test that may tell if you are eatig eough protei. This measuremet comes from lab studies that iclude urie collectio ad blood work. Your dietitia may ask for a accurate food record to go with this test. High levels of parathyroid hormoe (PTH) may result from a poor balace of calcium ad phosphorus i your blood. This ca cause boe disease. Ask your doctor if your PTH level is i the right rage. Your doctor may order a special form of vitami D to help lower your PTH. Cautio: Do ot take over-the-couter vitami D uless ordered by your kidey doctor. 29

30 Phosphorus: Potassium: A high phosphorus level i your blood ca lead to weak boes, itchig, boe pai ad hardeig of blood vessels. Ask your doctor what your phosphorus level should be. If your level is too high, your doctor may ask you to reduce your itake of foods that are high i phosphorus ad take a phosphate bider with all your meals ad sacks. Potassium is a mieral that helps your heart ad muscles work properly. A potassium level that is too high or too low may weake muscles ad chage your heartbeat. Whether you eed to chage your itake of highpotassium foods varies with each perso o peritoeal dialysis. Ask your doctor or dietitia what your potassium level should be. Your dietitia ca help you pla your meals to get the right amout of potassium. 30 Natioal Kidey Foudatio

31 Subjective Global Assessmet (SGA): Triglyceride: Urea Reductio Ratio (URR): Your dietitia may use SGA to help check for sigs of utritio problems. The dietitia will ask you some questios about your daily diet ad check your weight ad the fat ad muscle stores i your face, hads, arms, shoulders ad legs. Ask your dietitia about your score o the SGA. If your score is too low, ask how to improve it. Triglyceride is aother type of fat foud i your blood. A high triglyceride level, alog with high levels of total ad LDL cholesterol, may icrease your chace of havig heart ad circulatio problems. URR is aother measure of how well your dialysis treatmets are workig to clear wastes from your blood. It uses blood tests but does ot iclude urie collectio. Your target URR should be 65 percet or higher. Aswers to Quiz o Page F 6. T 2. T 7. T 3. F 8. T 4. F 9. T 5. T 10. F 31

32 Natioal Kidey Foudatio The Natioal Kidey Foudatio (NKF) is dedicated to prevetig kidey diseases, improvig the health ad well-beig of idividuals ad families affected by these diseases ad icreasig the availability of all orgas for trasplatatio. With offices atiowide, the NKF provides early detectio screeigs ad other vital patiet ad commuity services. The Foudatio coducts extesive public ad professioal educatio, advocates for patiets through legislative actio, promotes orga doatio ad supports kidey research to idetify ew treatmets. I 2009 NKF lauched a groudbreakig multifaceted collaborative iitiative to END THE WAIT! for a kidey trasplat i the Uited States i 10 years by usig prove strategies to elimiate barriers to doatio ad istitute best practices across the coutry. The NKF relies o idividual ad corporate doatios, foudatio ad govermet grats, membership ad special evets to support its rage of programs, services ad iitiatives. Natioal Kidey Foudatio 30 East 33rd Street New York, NY We proudly state that this publicatio is prited o recycled paper that cotais 10% post-cosumer waste. The paper is also Forest Stewardship Coucil (FSC) certified which guaratees it is made from trees that come from carefully maaged ad resposibly harvested forests that adhere to strict evirometal ad socioecoomic stadards. Please recycle this publicatio whe you are fiished with it Natioal Kidey Foudatio, Ic. All rights reserved _FBA