Download end stage renal disease media fact pack

END STAGE RENAL DISEASE
MEDIA FACT PACK
March 2003
ADV 2329. Baxter Healthcare Ltd. Wallingford Road, Compton, Newbury Berkshire, RG20 7QW Tel: 01635 206000 Fax: 01635 206295
TABLE
OF
CONTENTS
Section One
FAST FACTS
AND
UK STATISTICS
Quick reference on kidney disease prevalence, demographics, causes
and treatment
Section Two
HOW
THE
KIDNEY WORKS
The important role kidneys play in overall health and body function
Section Three
PREVALENCE
OF
KIDNEY DISEASE
The prevalence and scope of the problem, populations most affected
and major risk factors
Section Four
DIAGNOSING KIDNEY DISEASE
Types of kidney failure and tests that can detect kidney disease
Section Five
OTHER CAUSES, SYMPTOMS
AND
CONDITIONS
OF
KIDNEY DISEASE
Additional causes, possible symptoms and negative physical effects
Section Six
TREATING KIDNEY DISEASE
Treatment options including diet and lifestyle modifications,
medications, dialysis options, transplantation and CRRT
Section Seven
WHO TREATS KIDNEY DISEASE?
Medical professionals involved in kidney disease treatment
Section Eight
THIRD-PARTY REFERENCES
Contact information for kidney-related agencies,
organisations and patient associations
Section Nine
GLOSSARY
Definitions of kidney-related terms
Section Ten
IMAGES
FAST FACTS
AND
UK STATISTICS
Section 1
THE KIDNEYS
■ An
■
average kidney is about the size of a fist and about 12cm long.
Each day, the kidneys process and "clean" roughly 1,700 litres of blood, removing waste
and excess fluid.
■
Every day, the kidneys produce about 200 litres of fluid. About two litres leave the
body in the form of urine, while the remainder is retained in the body.
■
Every time the heart beats, 20 percent of the blood flow goes directly to the
kidneys, so they receive more blood flow than any other organ.
■ There
are at least 100 elements and electrolytes in the body that the kidneys regulate.
■A
patient is diagnosed with kidney failure, or End-Stage Renal Disease (ESRD)
when they have less than 20 percent of kidney function.
GENERAL PREVALENCE
■ At
OF
KIDNEY DISEASE
least 1 in 2000 people in the UK may be at risk of developing ESRD.
■ Approximately
34,000 people in the UK are being treated for ESRD.
■ Worldwide, three
million people suffer from kidney failure, and the number of people
with ESRD is growing at about seven to eight percent annually.
■ Approximately
■
19,000 ESRD patients in the UK are on dialysis.
In England and Wales there was a 4.5 percent increase in the number of patients with
kidney failure in 2001.
■ Approximately
35 percent of people on dialysis carry out their treatment at home. Most of these are
on a form of dialysis known as peritoneal dialysis (PD).
■ The
main causes of ESRD are diabetes, hypertension and glomerulonephritis
(an inflammatory disease of the kidney).
■ Asians
and Afro-Caribbeans are three times more at risk of developing chronic kidney failure than Caucasians.
TREATMENT
■
OF
KIDNEY DISEASE
Dialysis
Worldwide, more than one million people suffering from chronic kidney failure are treated with some form of
dialysis therapy.
There are approximately 19000 people in the UK on dialysis using the following modality options :
■
■
■
Hospital haemodialysis (HD):
Home haemodialysis:
Peritoneal dialysis (PD):
69%
3%
28%
There are approximately 83 hospital based haemodialysis units and 82 satellite haemodialysis units in England and Wales.
■
Transplantation
Transplantation is the treatment which most closely replaces normal kidney function. Approximately 15,000
people in England and Wales have a functioning transplant.
■ About
■
1,700 kidney transplants are performed in the UK each year.
In 2002, approximately 6,000 people were awaiting a kidney transplant.
PATIENT SURVIVAL RATES
Probability of patients surviving on dialysis therapy
1 year:
80%
2 years: 68%
5 years: 37%
10 years: 21%
Probability of patients surviving following a cadaver transplant
1 year:
94%
2 years: 92%
5 years: 80%
10 years: 56%
Probability of patients surviving following a living-donor transplant
1 year:
97%
2 years: 96%
5 years: 89%
10 years: 77%
HOW THE KIDNEY WORKS
Section 2
REMOVING WASTE
As part of the body’s waste-removal system, healthy kidneys work primarily to clean the blood of
wastes produced through food intake and metabolic function. Kidneys work 24 hours a day, seven
days a week, filtering out waste products, as well as excess water and acid.
Kidneys play
a major role in
a person’s
overall health.
Most people
have two
kidneys: each
is about the size
of a fist. They
are located on
either side of
the backbone,
just above the
small of the
back.
Blood travels from the heart to the kidneys to "get cleaned." Every time the heart beats, 20
percent of the blood flow goes directly to the kidneys, so they receive more blood flow than
any other organ. Millions of tiny filters (glomeruli) in the kidneys remove waste and extra
fluid that the body does not need. The cleaned blood – containing the right amounts of vital
chemicals like sodium and enzymes - returns to the body via the heart, while the wastes and
excess fluid are taken out to produce urine. The urine travels from the kidneys to the
bladder, which holds the fluid until it can be passed out of the body.
Two normal, healthy kidneys can clean 2000 litres of blood each day and about two litres of
urine are excreted out of the body daily.
BALANCING CHEMICALS
IN THE
BODY
Kidneys also help keep body chemicals in balance.They are responsible for maintaining
healthy levels of elements and electrolytes like potassium, sodium, calcium and phosphorus,
in the blood. Kidneys have sensors that monitor for excess amounts of a given electrolyte.
If excess is detected, the kidneys can increase excretion of that electrolyte.There are at least
100 elements and electrolytes that the kidneys regulate.
REGULATING BLOOD PRESSURE
Healthy kidneys produce a hormone called renin, which helps regulate blood pressure.The
kidneys also regulate the amount of fluid in the body which maintains normal blood pressure.
MAINTAINING HEALTHY RED BLOOD CELL LEVELS
Kidneys produce a hormone called Erythropoietin (EPO) that stimulates bone marrow to make red
blood cells. Red blood cells help carry oxygen through the body. Sensors in the kidneys monitor the
oxygen content of the blood. If the sensors detect low levels of oxygen, the kidneys produce a
hormone that increases the bone marrow's production of red blood cells.
If the kidneys cannot increase red blood cell production, the body becomes deficient and develops
anaemia, which can cause the patient to experience debilitating side effects such as excessive
fatigue, weakness and shortness of breath.
PRODUCING VITAMIN D
The kidneys help the body use Vitamin D, which is obtained from food and produced in the skin through
the action of sunlight.The kidneys convert Vitamin D into its physiologically active form (calcitrol). This
form of Vitamin D performs several important tasks in the body, such as regulating the body’s absorption
and use of calcium and phosphorus – both vital for growth and development of bones and teeth.
People do not usually experience symptoms of kidney failure until their kidney function falls to below
10 percent of its normal capacity. It is important for people to take care of their kidneys as kidney
disease often develops without obvious symptoms.
PREVALENCE
OF
KIDNEY DISEASE
Section 3
It is estimated that 1.2 million people worldwide – including more than 34,000 in the UK – suffer
from End-Stage Renal Disease (ESRD), which means the kidneys do not work well enough on their
own to keep a person alive. The number of people worldwide with ESRD is growing at about
seven to eight percent annually.
Globally, an estimated one million people suffering from ESRD are treated with some form of
dialysis therapy.
WHO GETS KIDNEY DISEASE?
Older People – The number of older patients starting dialysis in the UK is increasing.
As baby boomers age and the population older than 55 continues to grow, so does the
incidence of kidney disease.
■
Diabetics – Diabetes is the leading cause of kidney disease, accounting for more than 15
percent of patients. Diabetes creates high levels of blood glucose (sugar). If glucose levels
remain consistently high, this can damage the tiny blood vessels (glomeruli) that are the
kidneys’ blood-cleaning filters.
■
■ Hypertensives – Hypertension (high blood pressure) that goes untreated is a common
cause of kidney failure. Hypertension often causes no symptoms. However, it can damage
the glomeruli, and if it continues untreated, the kidneys may fail. Conversely, kidney failure
can cause high blood pressure.
■ Non-Caucasians – Kidney disease is three to five times more prevalent among
Afro-Caribbeans and Asians than Caucasians.
This higher incidence among Afro-Caribbeans is attributed to the disproportionate incidence of
both hypertension and diabetes in this population. Afro-Caribbeans have high blood pressure
twice as frequently as Caucasians, and the prevalence of diabetes is 1.6 times that of Caucasians.
■
Children –ESRD affects more than 800 children in the UK.
DIAGNOSING
OF
KIDNEY DISEASE
Section 4
SYMPTOMS THAT MAY INDICATE KIDNEY DISEASE
Acute kidney failure - A sudden loss of kidney function that usually occurs in response to an injury
or poison. A person with acute kidney failure needs treatment very quickly to stay alive, but the failure
can reverse itself within weeks and the kidneys can function again at a healthy level.
■
Chronic kidney failure - Progression of chronic kidney failure to End-Stage Renal Disease
(ESRD), where the kidneys do not work well enough to keep a person alive, can be a gradual
process. Individuals do not usually experience symptoms of kidney failure until their kidney
function falls to below 10 percent.
■
TESTING
FOR AND
DIAGNOSING KIDNEY DISEASE
Blood and urine tests help to determine how well an individual’s kidneys are working. A
doctor may decide to run such tests regularly on people known to be at risk for kidney
disease, even if they feel fine.
The tests described below can assess how well the normal kidneys are functioning – or, for
people who have started dialysis, the tests can measure the treatment’s effectiveness.
URINE TESTS
There are two types of tests for the urine that can help measure kidney function:
■ Dipstick test – A small amount of urine is tested in clinic using a reagent strip. This helps the
physician detect the presence of blood, infection or protein in the urine.
■ 24-hour collection – All the urine produced over a 24-hour period is collected by the patient for
analysis in the laboratory.The test shows:
■
How much urine a patient’s kidneys produce in one day.
■
How much protein is passed from the kidneys into the urine in one day. If too much protein
is present, the kidneys may not be working properly.
■
The amount of waste from muscle cells (called creatinine) or waste from dietary protein
(called urea) present in the urine. If the kidneys are not working properly, the urine does
not remove sufficient amounts of these waste products.
BLOOD TESTS
Blood tests determine whether waste products are building up in a person’s blood. The part of the blood
called serum is tested for:
■
Creatinine – Healthy kidneys normally filter creatinine from the blood and out of the body through
urine. Serum level of creatinine is the most common test used to determine kidney function.
Creatinine levels in the blood can vary depending on age, race and body size.A creatinine above the
normal range 60-120µmols/l indicates some degree of kidney failure.
■
Creatinine Clearance – Creatinine clearance can be determined from a blood test together with a
urine test, which provides a measure of how well the kidneys are removing creatinine.
■
Urea – Urea is a waste product from protein breakdown. Healthy kidneys filter this waste out of the
blood.An increase in urea levels in the blood indicates a decline in kidney function.
■
Potassium – Potassium build-up can occur if kidneys are not functioning properly. High levels of
potassium can adversely affect the heart rhythm, muscles, and nerves.
■
Calcium and Phosphorus – These are the two most abundant minerals in the body. They maintain
good teeth and bones and keep muscles and nerves working properly. Blood tests indicate whether
the body is absorbing sufficient calcium. If the kidneys are damaged, they are not producing adequate
calcitrol (the active form of Vitamin D that helps maintain adequate blood calcium levels), so the body
cannot absorb sufficient levels of calcium.
■
Haemoglobin – Healthy kidneys help manufacture red blood cells, which contain haemoglobin to
transmit oxygen throughout the body. If the body is unable to produce enough red blood cells,
haemoglobin levels drop, causing anaemia, which can cause debilitating side effects such as excessive
fatigue, weakness and shortness of breath.
OTHER CAUSES , SYMPTOMS AND
CONDITIONS OF KIDNEY DISEASE
Section 5
In addition to diabetes and high blood pressure other conditions may lead to the development of
kidney disease, including:
Glomerulonephritis - an inflammation of the small blood vessels, or filtering units
(nephrons) in the kidneys.This disease may be hereditary. It usually affects both kidneys and
causes progressive damage.
■
Blockages make it difficult for the kidneys to remove wastes and extra fluids. Obstructive
uropathy is a blockage of urine flow out of the kidney, which may be caused by kidney
stones (made up of minerals like calcium) or a birth defect.
■
Pylonephritis - a kidney infection. Someone who has this infection may or may not feel
sick. Possible symptoms include fever, back pain and chills.
■
Polycystic kidney disease - a hereditary condition in which cysts grow and damage the
kidneys.The kidneys enlarge and eventually stop working.
■
SYMPTOMS THAT MAY INDICATE KIDNEY DISEASE
Symptoms of kidney failure vary from person to person. People can have significant kidney
damage and not feel a thing, even as the disease progresses. Unfortunately, symptoms are
usually felt when kidney damage is so severe that the kidneys are functioning at less than 10
percent capacity. This is because of toxic waste building up in the blood.The most common
symptoms include:
■
Nausea
■ Trouble
■
Loss of appetite
■
Puffiness around the eyes
■
Fluid retention/swollen legs
■
Loss of sex drive
■
Feeling weak, cold, tired (anaemia)
■
Itchy skin
■
Drowsiness or confusion
concentrating
THE EFFECTS
OF
KIDNEY DISEASE
Kidney failure has a number of major effects on a patient’s overall health which can result in:
■
Uraemia – Illness resulting from toxin build-up in the blood, causing nausea, weakness, weight loss,
memory loss or confusion, and insomnia.
■
Metabolic acidosis – This occurs when the kidneys can no longer eliminate acids digested from the
diet.These acids accumulate, causing malnutrition – chiefly, a lack of adequate protein to help build
and restore body tissues.Therefore, the body begins to break down and digest its own muscle as a
source of protein, leading to muscle wasting.
■
Fluid rentention – The kidneys may produce less urine, which causes extra fluid to build up in the
body.This is called oedema. Individuals may have swollen hands and ankles.They may accumulate
fluid in the lungs leading to shortness of breath even during non-strenuous activities, like walking or
climbing a few stairs.
■
Hyperkalemia – Potassium build-up in the blood results in this condition that can cause cramps,
stiffness, cardiac arrhythmias (irregular heartbeat) and even cardiac arrest. Potassium must be
monitored closely in kidney patients.
■
Anaemia – Kidneys produce a hormone to help the bone marrow make optimal levels of red blood
cells. If the kidneys fail, a shortage in red blood cells can cause anaemia.This can result in debilitating
side effects such as excessive fatigue, weakness and shortness of breath. Red blood cells carry oxygen
to the body. If red blood cell levels drop, the heart needs to work harder and can sustain damage or
begin to beat at an irregular rhythm (arrhythmia).
■
Bone Disease – Healthy kidneys help control the amount of calcium and phosphorus in the blood.
When the kidneys are not working properly, they cannot produce enough of the active form of
Vitamin D (calcitrol) and slows calcium absorption. Healthy kidneys help regulate levels of
phosphorous in the blood. With kidney failure, the kidneys are unable to maintain adequate levels of
phosphorous, which can contribute to bone disease. Over time, bones can become brittle and weak
due to the loss of calcium.
TREATING KIDNEY DISEASE
Section 6
There is currently no cure for End-Stage Renal Disease (ESRD). However, patients do have a choice of
effective treatments that can help them manage the various stages of kidney disease.
If kidney disease is diagnosed and addressed early, certain lifestyle and dietary changes, along with
certain medications, can help patients feeling healthy, prevent complications in other body
systems and protect the kidneys from overexertion and further damage.
Such changes and mediations can also improve the overall health and condition of patients who
are experiencing chronic kidney failure, where the kidneys do not work well enough to keep a
person alive. For these patients, treatment options include dialysis or transplantation.
MEDICATIONS , LIFESTYLE
AND
DIET
Anti-hypertensives help lower blood pressure to protect the kidneys. Drug categories include
ACE inhibitors, calcium channel blockers and angiotensin II receptor blockers.
■
Phosphate binders remove excess phosphate from the blood. Diseased kidneys cannot properly
remove phosphte. High phosphate levels can contribute to bone disease. Phosphate binders bind
with phosphorus from the diet in a patient’s intestines and help it pass out of the body as waste.
■
Vitamin D helps absorb calcium and maintain healthy bones. Blood levels of vitamin D are
usually low in people with kidney failure and ESRD patients may require supplemental vitamin D.
■
Diuretics or water pills help rid the body of excess salt and water. A clinician may prescribe this
in addition to recommending a lower-salt diet.
■
■ Erythropoietin is a hormone produced by healthy kidneys that helps the body produce red blood
cells. Red blood cells are vital because they carry and deliver oxygen to tissues and organs throughout
the body. When kidneys are not functioning well, they may not be able to produce enough
erythropoietin.This causes red blood cell levels to drop resulting in anaemia.
■ Iron supplements can help combat anaemia (feeling weak, cold and tired because of low red blood cell
levels).
EXERCISE
AND
DIET
■
Exercise is important for patients with kidney damage. It strengthens the heart and other muscles. It also
helps to reduce blood pressure, and to control diabetes by moving the body toward a healthier muscle-to-fat
ratio (muscle cells use more sugar, improving blood sugar levels).
■
Diet - Monitoring the diet in the early stages of kidney dialysis can help slow the progression of kidney failure.
People on dialysis need to take an active role in managing their diet and fluid intake, in particular, protein,
phosphate, sodium and potassium.
DIALYSIS
■
Dialysis helps to eliminate waste and fluids from the bloodstream when the kidneys can no longer do the job
well enough to keep the patient alive.
■
Due to the limited number of donor kidneys, the vast majority of people with ESRD rely on dialysis.
■
During a patient’s lifetime different forms of dialysis may be appropriate at different stages in their life.
HAEMODIALYSIS
HOW IT WORKS
The prefix "haemo" means blood. During haemodialysis
(HD), blood is removed from the body through a
needle inserted into a specially enlarged blood vessel.
The blood is pumped through a machine containing a
filtering system called a dialyser.The dialyser acts
somewhat like an artificial kidney, filtering the blood
and returning it back to the body.
The dialyser is a semipermeable membrane, or thin
divider with tiny holes that let small particles (waste,
water) pass through, but keeps larger particles (blood
cells) back. Only about half a pint (250ml) of blood is
outside the body at any one time. Just as people are
not normally aware of blood moving through the body,
patients cannot feel the blood being pumped through
the machine.
HD requires a minor surgical operation to create an
access site – usually in the arm, near the collarbone or
in the leg. To create the access, called a fistula, an
artery and a vein are joined together forming a large
blood vessel which makes it easier to remove blood
from the patient.
Most HD patients receive treatment in hospital or at a
satellite unit, about three times a week for three to five
hours each session.A trained renal nurse handles the
administration of therapy during sessions.
Some patients are able to do HD in the comfort of their
homes, with help from a partner. Before patients can
self-administer the therapy, they will attend several
training sessions along with a partner or family
member.
HOW IT AFFECTS LIFESTYLE
■ Since HD is usually not administered on a daily
basis, people often feel tired or nauseated
between sessions due to toxin build-up in the
bloodstream.
■ Because HD patients gain fluid weight between
sessions, they must limit fluid intake and modify
their diets.
■ If HD is administered in hospital, a patient must
arrange for travel to and from the unit and will
often have to manage a fixed treatment schedule.
■ Patients are still able to travel on holiday if they
make arrangements in advance to have their
therapy administered at their destination.
■ Patients can exercise and participate in most
sports.
■ Many patients prefer to be treated in hospital.
■ On haemodialysis patients have free “non-dialysis”
days.
PERITONEAL DIALYSIS
HOW IT WORKS
HOW IT AFFECTS LIFESTYLE
In peritoneal dialysis (PD), extra fluids and waste are
removed from the blood inside the body, using the
body’s own peritoneal membrane, or abdominal
lining, as the filter. This membrane lines the area that
holds the stomach, spleen, liver and intestines.
In this form of dialysis, blood never leaves the body.
Dialysis fluid (dialysate) enters the peritoneal cavity
through a small, soft plastic tube called a catheter.
The catheter is surgically inserted in the abdomen.
Extra fluid and waste travels across the peritoneal
membrane into the dialysis fluid, which is then
drained from the abdomen.
Unlike HD, the patient does not need to travel to a
dialysis center to perform the therapy. Instead,
patients are trained to do dialysis at home, on their
own schedule.
■ People on PD can lead fairly flexible, independent lives.
They can easily adjust their treatment according to
work, school, or travel since they are in control.
■ A patient may have few or no restrictions in his/her
diet with PD, although maintaining recommended
protein intake is important.
■ Patients can travel with their CAPD supplies or APD
cycler and a dialysis company can ship supplies to a
destination ahead of time.
■ Many PD patients can enjoy most sports and exercise.
■ Patients can arrange their own dialysis treatments since
they are taught how to self-administer the therapy.
■ Patients need to have room to store their dialysis
supplies at home.
■ Patients will need to do dialysis exchanges on CAPD
everyday, or every night on APD.
THERE
ARE TWO FORMS OF
PD:
Continuous ambulatory peritoneal dialysis (CAPD) is a manual, gravity-based form of PD. It is a continuous dialysis
process—24 hours a day, seven days a week. The patient is ambulatory (able to walk around) during exchanges, because
CAPD requires only a solution bag, hung above the patient’s abdomen, and tubing that connects to the
catheter. One exchange takes about 30 minutes, and most people need four exchanges each day.
Automated peritoneal dialysis (APD) is performed at home with the help of a cycler, or machine that
performs dialysis exchanges automatically, over eight to 10 hours, usually while a patient sleeps at night. APD
is sometimes called Continuous Cycling Peritoneal Dialysis, or CCPD. Patients who need or want more freedom
during the day, such as those who need to attend work or school, may prefer APD.
PERITONEAL DIALYSIS — THE STEPS
1. Dialysis fluid enters the peritoneal cavity (“Fill”).
2.While the fluid is in the peritoneal cavity (“Dwell”), extra fluid and waste travel across the peritoneal membrane into the
dialysis fluid.
3.After a few hours, the dialysis fluid is drained (“Drain”) and replaced with new fluid.
PERITONEAL DIALYSIS
TRANSPLANTATION
Kidney transplantation involves major surgery. An ESRD patient who is on dialysis goes through a process to become a
transplant candidate. Doctors and transplant coordinators consider eligibility factors like the patient’s general health,
lifestyle and compliance with diet and exercise.
If the patient is a good candidate, he or she is registered with the National Transplant Waiting List which determines the
best possible "matches" as kidneys become available. For example, the kidney must be of a compatible blood and tissue
type that will not be rejected by the patient’s body. Relatives of the patient may also be able to donate a compatible
kidney.
It can take years to find a suitable match, due to a limited supply of healthy kidneys. Approximately 1,700 kidney
transplants are performed in the UK each year – but about 6,000 people remain on the waiting list.
HOW IT WORKS
A surgeon implants a healthy kidney in a person’s
abdomen, near the hipbone. The healthy kidney
comes from another person or a cadaver (person
who has died). Eighty percent of all transplanted
kidneys come from cadavers.
Usually, the person’s own, non-working kidneys
remain in the body. In rare cases, the non-working
kidneys may be removed to control infection or high
blood pressure.
HOW IT AFFECTS LIFESTYLE
A kidney transplant is the treatment that is most similar
to having a healthy kidney(s). Most people feel as well
as they did before their kidneys failed.
A patient must follow his/her doctor’s orders and take
medications to prevent the body’s rejection of the new
organ (immunosuppressive medication). This
medication usually must be taken daily for the life of
the transplant. It can cause side effects and also can
lower a patient’s resistance to illness.
Transplantation can be a long-term solution, unless the
new kidney develops disease. Patients need to remain
under a clinician’s care and follow a healthy lifestyle
that includes specific dietary modifications as well as
physical activity.
As long as the new kidney remains healthy, no dialysis
is required.
The average life span for a kidney transplant is eight years.
CONTINUOUS RENAL REPLACEMENT THERAPY (CRRT)
In cases of acute kidney failure, when there is sudden, usually reversible loss of kidney function (often occurring in
response to an injury or poison), treatment is needed very quickly for the person to stay alive. In these cases, Continuous
Renal Replacement Therapy, or CRRT, can be administered, usually in a hospital’s Intensive Care Unit (ICU). CRRT is a
continuous therapy that supports a patient over a prolonged period of time.A range of CRRT therapies are available,
enabling professionals to modify treatment modes and parameters according to the patient’s condition while in the ICU.
WHO TREATS KIDNEY DISEASE?
Section 7
A number of different healthcare professionals specialise in treating patients with kidney disease.
Which specialists become part of a patient’s medical team depends on the source and severity of
their kidney disease.
These specialists include:
Nephrologist: a medical doctor who specialises in disorders of the kidneys, regardless of
their cause. Nephrologists are responsible for medical care pre-dialysis and during dialysis.
They also may be responsible for patient care before a kidney transplant, and afterwards for
long-term follow-up care.
■
Transplant surgeon: a medical doctor and surgeon with advanced training in general
surgery or urology, who specialises in transplanting organs.
■
Renal dietitian: a trained and certified health-care professional who specialises in the
effects of diet on the health of kidney disease patients. Renal dietitians are qualified to
provide comprehensive nutrition assessments and education, and to help address nutrition
problems.They are skilled in tailoring solutions to meet each patient's unique needs.The
overall goal is to promote the best nutritional intake to ensure the patient's optimal health.
■
■ Dialysis specialists: renal nurses and other healthcare professionals who have
specialised in caring for patients who require kidney dialysis. These professionals may
provide assistance at a dialysis centre, and/or train patients to perform home haemodialysis
or peritoneal dialysis.
THIRD-PARTY REFERENCES
AGENCIES
Section 8
AND
ORGANISATIONS
National Kidney Federation
6 Stanley Street, Worksop, Nottinghamshire S81 7HX
Tel: 01909 487795, Fax: 01909 481723, Helpline: 0845 601 02 09
Website: www.kidney.org.uk
Aims to promote throughout the UK, the welfare of people suffering from kidney disease
or renal failure, and relatives and friends who care for them
National Kidney Research Fund
King’s Chambers, Priestgate, Peterborough PE1 1FG
Tel: 01733 704 650, Fax: 01733 704 692, Helpline: 0845 300 1499
Website: www.nkrf.org.uk
Funds research into kidney disease, its causes and treatment.
Works to raise awareness of kidney disease
British Kidney Patient Association
Bordon, Hampshire GU35 9JZ
Tel: 01420 472 021, Fax: 01420 475 831
Website: www.bkpa.org.uk
Provides information and advice to people with kidney illnesses throughout the UK
Kidney Patient Information Websites
www.kidney.org.uk
www.kidneydirections.com
www.kidneypatientguide.org.uk
www.kidneywise.com
Renal Registry of the United Kingdom
Southmead Hospital, Southmead Road, Bristol BS10 5NB
Tel: 0117 959 5665, Fax: 0117 959 5664
Website: www.renalreg.com
GLOSSARY
Access, Vascular Access
ACE Inhibitors
Acute Kidney Failure
Section 9
The vascular access is where needles are placed to remove blood from the
body and return it to the body after it is filtered by a dialysis machine.
The access is created surgically, usually joining an artery to a vein (creating a
fistula) in the forearm, near the collarbone or in the leg.
An angiotensin-converting enzyme (ACE) inhibitor is a type of drug used to
lower blood pressure.ACE inhibitors reduce the production of angiotensin, a
chemical that can constrict blood vessels and cause the kidneys to retain salt
and water.ACE inhibitors help increase blood flow and decrease stress on the
heart. Studies indicate that ACE inhibitors may also help prevent or slow the
progression of kidney disease in people with diabetes and high blood pressure.
A form of kidney failure that happens quickly. It may be caused by injury or
drugs.With proper treatment, kidneys may return to normal function following
acute kidney failure.
Adequacy
Receiving a minimally acceptable level of dialysis (dialysis effectiveness and
nutritional status) to prevent uraemic symptoms like poor appetite and nausea.
Adrenaline
(or epinepherine)
Chemical produced by the adrenal glands, which causes vasoconstriction,
rapid heart rate and increased blood pressure.
Albumin
A protein. In patients whose kidneys are damaged by diabetes, the kidneys
leak more albumin into the urine (a condition called microalbuminuria,
detected by a urine test).
Serum (blood) albumin levels are also monitored in kidney patients.
This protein is an indicator of nutritional status.
Anaemia
Decreased ability of the red blood cells to provide adequate oxygen supplies to
body tissues. People with a low red blood cell count due to kidney disease can
develop this condition, causing them to experience debilitating symptoms such
as excessive fatigue, weakness and shortness of breath
GLOSSARY
.Angiotensin II receptor
These receptors of angiotensin in the body play a role in vasoconstriction, which leads to an
increase in blood pressure.
Angiotensin II receptor
Drugs known as “angiotensin II receptor blockers” help to lower blood blockers pressure by
blocking the action of angiotensin II.
APD or Automated
Peritoneal Dialysis
A term used to describe a method of PD that uses a machine (cycler) for installation and
drainage of the dialysis solution.
Artery
A blood vessel that carries blood away from the heart.
Bladder
An organ that holds the urine excreted by the kidneys.
Beta Blockers
Drugs used to control high blood pressure. Beta-blockers block the effects of adrenaline (now
called epinepherine), thus easing the heart's pumping action and widening blood vessels.
Blood Pressure
The pressure of the blood in the blood vessels. Blood pressure varies with health, age and
stress levels.
Bone Marrow
A soft,fatty tissue that is found inside bones and produces blood cells. Kidneys produce a
hormone to help the bone marrow make red blood cells.
Calcium Channel Blockers
A drug for heart failure and high blood pressure. Calcium channel blockers affect the
movement of calcium into the cells of the heart and blood vessels.As a result, calcium
channel blockers relax blood vessels and increase the supply of blood and oxygen to the
heart, while reducing its workload.
Calcium
The body’s most prevalent mineral, found mainly in the bones, but also in the teeth and body
tissue.
Calcitriol
Healthy kidneys and the liver convert Vitamin D from food or sun sources into its active
form,the hormone calcitriol.This hormone performs several important tasks in the body, such
as regulating the body’s absorption and use of calcium and phosphorus.
GLOSSARY
CAPD or Continuous
Ambulatory Peritoneal
Dialysis
One method of peritoneal dialysis that is performed using a gravity-based technology instead
of a cycler.
Catheter
A slender tube inserted into a body passage or blood vessel for passing or removing fluids.
A flexible plastic catheter is used to remove or instill dialysis solution into the peritoneal
cavity.
Clearance
The rate at which a given substance is removed from a solution (e.g., the clearance of wastes
from the blood by the natural or artificial kidney). Defined as the number of milliliters of
solution that would be completely cleared of a given solute in a preferred time period.
Chronic Kidney Failure
Less than 10 percent of kidney function.
Creatinine
A bi-product of normal muscle metabolism that is produced at a fairly constant rate in the
body and normally filtered by the kidneys and excreted in the urine. Measuring creatinine in
the blood is the simplest way to monitor kidney function.
Cycler
A machine that performs peritoneal dialysis solution exchanges in regular cycles.
Diabetes
A disease that causes an abnormally high level of glucose (sugar) to build up in the blood.
The body is unable to use and store glucose normally because of inadequate insulin
production.
Dialysate
A fluid/solution used during peritoneal dialysis (PD) and haemodialysis (HD). During
PD,dialysate is placed in the abdomen for about four hours.The peritoneum filters waste and
fluids from the blood into the dialysate, which is then drained from the abdomen.
Dialysis
A treatment option for patients with kidney failure that replaces the blood-cleaning function
of the kidneys (removal of waste products and excess fluid).There are two general types of
dialysis: haemodialysis (HD) and peritoneal dialysis (PD).
Dialyser
A filter,or semipermiable membrane,on a haemodialysis machine that separates waste
substances from the blood of kidney failure patients.
Diastolic
A measure of pressure in the heart and blood vessels when the heart is at rest (the “bottom”
number in blood pressure measurement).Together with a systolic measure, it indicates a
patient’s overall blood pressure.
GLOSSARY
Diffusion
A principle of chemistry that says dissolved particles in a solution will spread from a solution of
high concentration to one of lower concentration.This takes place during dialysis.
Diuretic
An agent that promotes urine excretion. Diuretics can be certain common substances such as
tea, coffee and water, as well as medications. Used to help remove extra salt and water from the
body, which helps control blood pressure and reduce oedema (swelling).
Dwell time
The amount of time dialysis solution remains in the abdominal cavity during peritoneal dialysis.
Oedema
Swelling due to extra fluid in body tissue.
Electrolytes
A chemical substance present in body fluids. Examples include sodium,potassium,calcium,
magnesium, chloride, bicarbonate and phosphate.These electrolytes are involved in metabolic
activities and are essential to the normal function of all cells.The kidneys play an important role
in balancing and regulating electrolytes in the body.
Enzymes
Proteins produced naturally in the body that catalyze or promote essential chemical reactions
and metabolic processes. Enzymes are given names usually ending in “-ase.”
Epinepherine
(or adrenaline)
A chemical produced by the adrenal glands, which causes vasoconstriction, rapid heart rate
and increased blood pressure.
Erythropoietin (epo)
A hormone produced in the kidney. Erythropoietin stimulates red blood cell production.
ESRD or End-Stage
Renal Disease
Kidney failure, which requires dialysis or a kidney transplant to live.
Exchange
In peritoneal dialysis, the procedure of discarding the used dialysis solution and instilling fresh
dialysis solution into the abdominal cavity.
Fistula
The preferred type of access for haemodialysis.The access is where the needles are placed to
remove blood from the body and return it to the body after it is filtered by the dialysis machine.
A fistula is created surgically by connecting an artery to a vein to strengthen the vein in the
forearm or in the leg.
Gallbladder
A muscular, walled sac located under the liver in the upper right side of the abdomen. It stores
and concentrates a substance called bile, which the liver makes to help digest dietary fat.
GLOSSARY
GFR
Glomerular Filtration Rate, or GFR, is a measure of how much filtered liquid is produced by the
kidneys over a specific unit of time.
Glomeruli
Tiny blood vessels in the kidneys that filter the blood of waste and excess fluid.
Glomerulonephritis
Inflammation of the glomeruli (small blood vessels, or filtering units, in the kidneys).
This disease may be hereditary. It usually affects both kidneys and can cause progressive damage.
Glucose
A simple sugar, also known as dextrose, that is found in the blood and is used by the body for
energy. Diabetes is a disease in which the body is unable to use and store glucose normally
because of a decrease or lack of insulin production. In some forms of diabetes, patients can’t
use insulin they produce.
Haematocrit
A measure of how much of a person’s blood is composed of red blood cells. Normal levels are
between 33 and 35 percent.
Haemo
The prefix “haemo”means “blood.”
Haemodialysis (HD)
A modality for treating renal failure that cleans the blood by taking it outside of the body and
pumping it through a filter called a dialyser.
Haemoglobin
The part of red blood cells that transmit oxygen throughout the body. If the body is unable to
produce enough red blood cells,haemoglobin levels drop.The levels can be measured by a
blood test.
Home haemodialysis
A haemodialysis treatment done in the comfort of the patient’s home,usually with the help of a
partner.This option frees the patient from needing to travel frequently to a dialysis center for
haemodialysis.
Hormone
A biochemical substance formed by glands, organs or cells and carried by body fluid to another
organ or tissue, where it causes a specific biological change or activity to occur.
Hyperkalemia
Potassium build-up in the blood. Diseased kidneys often cannot sufficiently remove potassium
from the blood.
Hypertension
Blood pressure that is higher than normal, causing the heart to work too hard to pump blood. It
can lead to heart disease and stroke.Typically, hypertension has no symptoms and must be
diagnosed from a blood pressure reading.
GLOSSARY
Hypotension
Low blood pressure, which can mean inadequate blood flow to the heart, brain and other vital organs.
Immunosuppressive
Describes drugs that inactivate the body's natural defenses against something foreign.
Immunosuppressive drugs "suppress" the body from attacking a kidney transplant.
Insulin
A hormone made by the pancreas that helps move glucose from the blood to the cells. Kidney
stones A hard mass developed from crystals that separate from the urine and build up in the
kidney.They can cause sudden, extreme pain when they move into the urinary tract, causing
irritation or blockage.
Liver
The body’s largest organ, the liver performs many vital functions such as processing the body’s
nutrients,including proteins,glucose,vitamins and fats.The liver manufactures bile,the greenish
fluid stored in the gallbladder that helps digest fats. It also processes potentially toxic substances,
including alcohol, ammonia, nicotine, drugs, and harmful by-products of digestion.The liver works
with the kidney to convert Vitamin D into its active form.
Nephrologist
A doctor who specialises in the diagnosis and treatment of diseases of the kidney.
Nephron
The structural and functional unit of the kidney.
Nutrients
Dietary proteins, vitamins and minerals that cannot be made by the body, but are required for
normal growth and development, as well as organ system and cell function.
Obstructive Uropathy
A blockage in which urine cannot flow out of the kidney, making it difficult to remove wastes and
extra fluids. It may be caused by kidney stones or a birth defect of the kidney or ureter.
Osmosis
The passage of liquid through a semipermeable membrane separating solutions of different
concentrations; the liquid moves from a solution of low concentration to one of higher concentration.
Ureter
A thick-walled tube that moves the urine from the kidney to the bladder.
Urine
Excess fluid and waste products excreted from the body by the kidneys.
Vitamin D
Vitamin D is obtained from food and produced in the skin through the action of sunlight.
The kidneys convert Vitamin D into its physiologically active form (the hormone calcitriol).
This hormone performs several important tasks in the body, such as regulating the body’s
absorption and use of calcium and phosphate – both vital for growth and development of bones
and teeth.