Understanding Treatment Options for Renal Therapy
Kidney failure happens to many different people for many different reasons 1
What causes kidney failure? Diabetes Chronic infection High blood pressure Heredity Glomerulonephritis Other Polycystic kidneys How do you treat patients with kidney failure? Diet/fluid restrictions Medication Kidney Dialysis Kidney transplantation Non-treatment Take care of yourself! 2
Why is diet important? Most waste and excess fluid comes from the food you eat As kidney function declines, less waste is filtered out of your blood Waste and fluid build-up can make you ill Diet can help control the problems caused by kidney disease 3
Main parts of the diet for kidney disease Protein Calcium/Phosphorus Potassium Fluid Sodium Calories How do you know if your diet is working? Weight loss or gain Swelling of hands and feet Blood pressure Blood tests 4
Know your numbers Blood/Urine Test Serum Creatinine Creatinine Clearance (24 hour urine) BUN (Blood Urea Nitrogen) Potassium (K+) Phosphorus Calcium Albumin Hematocrit/Hemoglobin Your Value Normal for You 5
What do the kidneys do? Clean the blood Remove extra fluid Filter out waste products Keep your body chemicals in balance Control blood pressure and red blood cells 6
What is anemia? A low red blood cell and oxygen level that is common in patients with kidney disease Feeling tired Constantly feeling cold Shortness of breath Feeling dizzy Symptoms Rapid, irregular heart beat Impotence Trouble concentrating How is anemia of kidney disease treated? Epogen Iron supplements Measurements of Hematocrit/Hemoglobin 7
What is uremia? The result of a build-up of waste products that damaged kidneys don t filter out of the bloodstream very well Loss of appetite Headache Bad taste in your mouth Symptoms Trouble concentrating Nausea/vomiting Drowsiness As kidney function decreases, uremic symptoms will worsen. Dialysis can relieve many of these symptoms 8
You need to take an active role in your own care and in helping to choose which treatment option is best for you. 9
Treatment options Kidney dialysis A way to remove waste products and excess fluid from your blood. The two forms of kidney dialysis treatments are: Hemodialysis Peritoneal dialysis Kidney transplantation An operation which places a healthy kidney into your body. Non-treatment While an option, the non-treatment choice could eventually lead to death. 10
What is hemodialysis? The word hemo refers to blood. Hemodialysis is a process which balances blood chemistry (electrolytes) and filters wastes and fluids from the blood. The blood travels outside the body through tubing and passes through a filter on a dialysis machine. The filter cleans the blood. The clean blood is returned to your body. 11
What happens during hemodialysis? Dialysis Machine Dialyzer Blood to Dialyzer Blood Back to Body The dialysis machine pumps the blood through the filter - called a dialyzer. Two needles are inserted into a permanent access, usually in your arm for each hemodialysis treatment. One withdraws the blood; the other needle returns the filtered blood to your body. 12
How is blood removed and replaced? From machine To machine A fistula is the surgical linking of an artery to a vein providing permanent access to blood vessels. Artery Vein Artery Vein Graft A graft is tubing surgically placed under the skin, linking an artery to a vein. The "graft" is another type of permanent access to blood vessels. Another type of access used for hemodialysis is called a central venous access. A small soft tube called a catheter is placed into a large vein in the neck or shoulder or groin areas allowing access or entry to the blood stream. This type of access is usually temporary. 13
Advantages In-Center Hemodialysis Disadvantages trained professionals perform treatment for you maintain regular contact with other hemodialysis patients and staff 3 treatments per week; 4 days off keep no equipment/supplies at home medical help is available quickly in an emergency travel to center 3 times a week on a fixed schedule need a permanent access, usually in your arm insert 2 needles for each treatment restricted diet/limited fluid intake possible discomfort like headache, nausea, leg cramps, tiredness 14
Advantages Home Hemodialysis Disadvantages same person always helps you more control over when you dialyze no travel to a clinic must have a trained partner to help you you need to be trained need room to store equipment/supplies need to call paramedics for help in an emergency 15
What is peritoneal dialysis? Just like in hemodialysis, peritoneal dialysis (PD) uses a filter to clean the blood and remove excess fluids. With PD, the blood is cleansed inside the body using one of the body's own membranes, the peritoneum, as the filter. PD is performed primarily as a home therapy. 16
How does peritoneal dialysis work? PD uses your peritoneal membrane - the lining of your abdomen - as the filter. Solution is placed in the abdomen in contact with the peritoneal membrane for several hours. Wastes and fluids pass through the peritoneal membrane or filter into the solution. Later, the solution and waste are drained from your abdomen. 17
Peritoneal dialysis catheter For PD, a tube called a catheter is surg i c a l l y placed trough the wall of your abdomen. It is your permanent access for PD. The catheter is usually placed about an inch below and to the side of the navel. About 2-4" of the catheter extends out of the body. The catheter is usually used 10-14 days after placement for the initiation of Peritoneal Dialysis therapy. 18
There are two kinds of peritoneal dialysis Continuous Ambulatory Peritoneal Dialysis (CAPD) A manual method performed by you usually 4 times throughout the day. Automated Peritoneal Dialysis (APD) An automated method of PD, performed by a machine primarily at night while you sleep. 19
How do I perform a CAPD treatment? CONNECT DRAIN FILL DISCONNECT/DWELL 20
Where can I perform a CAPD exchange? You can do CAPD in any clean area at home, at work, at school or even on vacation. 21
How do I perform an APD treatment? You attach the tubing and solution bags to the machine. Before going to sleep, you connect the tubing to the peritoneal catheter. During the night the machine performs dialysis. For extra therapy, dialysis solution remains in the peritoneal cavity during the day. The peritoneal cavity of most adults can hold about two to three quarts of fluid. 22
Advantages a flexible lifestyle and independence few diet restrictions usually visit clinic just once a month doesn t use needles gives better blood pressure control is continuous therapy which is gentler and more like your natural kidneys don t have to travel to dialysis unit for treatment easy to take your therapy with you when you travel therapy occurs while you sleep (APD) Peritoneal Dialysis Disadvantages need to schedule exchanges into your daily routine, 7 days a week have a permanent, external catheter run some risk of infection may gain weight/have a larger waistline very large people may need extra exchanges need storage space in your home for supplies need space in your bedroom for equipment (APD) 23
What is kidney transplantation? A kidney transplant is an operation in which a healthy kidney from another person is placed into your body. This new kidney performs the functions of your own non-working kidneys. Dialysis will probably be required will awaiting your transplant. 24
Sources of transplanted kidneys Living Donors family members make the closest tissue matches. Cadaver Donors from people who decide to donate their organs when they die. 25
Where is the new kidney located? During the operation, a healthy kidney is placed deep under the muscle of the abdomen near your hipbone. In rare cases, the non-working kidneys may be removed to control infection or high blood pressure. 26
How do you take care of a transplanted kidney? Take your medicine every day Visit regularly with your physician Follow your physician's guidelines Control your diet Keep yourself active Watch for problems 27
Transplantation Advantages feels closest to having your own kidneys no dialysis treatments required lets you maintain a normal schedule and visit a clinic less often fewer fluid and diet restrictions feel healthier and have more energy work full-time without worrying about any dialysis schedule Disadvantages the stress of waiting for a match risks associated with major surgery risk of rejection your transplant may not last a lifetime take medications every day which can have side effects you are more susceptible to illness possible changes in your appearance 28
Who pays for treatment? For most people in the U.S., treatment is paid for by Medicare, private insurance, health maintenance organizations (HMOs), state medical assistance programs, state renal programs and supplemental local programs. Ask your social worker about which programs apply to you. Or, contact any of the patient associations listed in the back of this flipchart. 29
Commonly asked questions 1 Will dialysis cure me? 2 What if I decide I don't like my treatment choice - can I change? 3 When I am a dialysis patient, are there activities that I'll no longer be able to do? 4 Can I still work while on dialysis? 5 Will I feel good all the time? 6 What effect will my general health or visual or manual impairment have on my choice of treatment? 30
How do I select which treatment is best for me? Learn the facts about each treatment option. Discuss each option with your renal health-care team - your doctor, nurse, nutritionist or dietician, and other medical team members - to determine which option(s) best suits your medical requirements. Discuss each option with your family, and review which option best fits your lifestyle. It is quite common for patients to change treatments. You can have several methods of treatment throughout your life. Patients may change from one treatment to another as their health or needs change. 31
You are the most important member of your renal care team You are not alone - many other people have kidney disease and have learned to live happy, active productive lives. By understanding your condition and the important role you play in your treatment, you have taken the first step towards a healthier life. 32
To learn more ask your doctor and renal care team members for information about dialysis. You can also contact such groups as: American Association of Kidney Patients (AAKP) 1-800-749-2257 http://www.aakp.org This patient membership group provides education and support programs for the kidney patient. American Kidney Foundation (AKF) 1-800-638-8229 http://www.akfinc.org This group serves as a financial resource for kidney dialysis and transplant patients who need help. National Kidney Foundation (NKF) 1-800-622-9010 http://www.kidney.org This national voluntary health agency is dedicated to wiping out kidney and urological disease, and providing programs and services to patients and their families. Your Social Security office has people who can help as well. Call 1-800-772-1213 to find the nearest Social Security office. 33
To learn more about staying healthy with kidney disease, enroll now in Stay in Touch, a free kidney education program. Call 1-877-543-6394 to enroll by phone Go to www.kidneydirections.com to enroll via the internet Ask your physician or healthcare team to enroll you 2002 Baxter Healthcare Corporation 5L 0328 11/02. 34