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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.