What You Need to Know - National Kidney Foundation

[Pages:28]HEMODIALYSIS:

What You Need to Know



National Kidney Foundation's Kidney Disease Outcomes Quality Initiative

Did you know that the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (NKF-KDOQITM) offers guidelines and commentaries that help your doctor and healthcare team make important decisions about your medical treatment? The information in this booklet is based on those recommended guidelines.

Stages of Kidney Disease

There are 5 stages of kidney disease. They are shown in the table below. Your doctor determines your stage of kidney disease based on the presence of kidney damage and your glomerular filtration rate (GFR), which is a measure of your level of kidney function. Your treatment is based on your stage of kidney disease. Speak to your doctor if you have any questions about your stage of kidney disease or your treatment.

STAGES OF KIDNEY DISEASE

Stage Description

Glomerular Filtration Rate (GFR)*

1

Kidney damage (e.g., protein in the urine) with normal GFR

90 or above

2

Kidney damage with mild decrease in GFR

60 to 89

3 Moderate decrease in GFR

30 to 59

4 Severe reduction in GFR

15 to 29

5 Kidney failure

Less than 15

*Your GFR number tells your doctor how much kidney function you have. As chronic kidney disease progresses, your GFR number decreases.

TABLE OF CONTENTS

When will I need to start treatment for kidney failure?. . . . . . . . 5

What does dialysis do to keep me healthy?. . . . . . . . . . . . . . . 6

How does hemodialysis work? . . . . . . 6

How does the dialyzer clean my blood?. . . . . . . . . . . . . . . . . . 8

Where is hemodialysis done? . . . . . . . 9

How long will each hemodialysis treatment last?. . . . . . . . 9

How do I know if I am getting the right amount of dialysis?. . . . . . . . 10

Can hemodialysis be done at home?. 12

Home hemodialysis versus a center: Pros. . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Cons. . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Can dialysis cure my kidney disease?.17

I have heard I might have to reuse my dialyzer for each treatment. Is this safe?. . . . . . . . . . . . . . . . . . . . . . 19

Will I need to follow a special diet? . . 19

What insurance coverage is available for dialysis? . . . . . . . . . . . . 21

Will dialysis change my lifestyle? . . . 22

Can people on dialysis travel?. . . . . . 22

Can people on dialysis continue to work?. . . . . . . . . . . . . . . . 23

Understanding your lab values. . . . . 24

My dialysis care team. . . . . . . . . . . . . 26

Where can I get more information? . 26

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Healthy kidneys clean your blood and remove extra fluid in the form of urine. They also make hormones your body needs for some important functions. When kidney failure occurs, treatment is needed to replace some of the important jobs your kidneys do. The treatments for kidney failure are hemodialysis, peritoneal dialysis, and kidney transplant. Learn all you can and speak to your doctor about which is the best choice for you.

This booklet is about hemodialysis. It is written for people who are already receiving hemodialysis, and for those who soon may need to start treatment for kidney failure. Information is based on recommendations from the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (NKFKDOQITM) Clinical Practice Guidelines.

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When will I need to start treatment for kidney failure?

Treatment is needed when someone has stage 5 chronic kidney disease (CKD), or kidney failure. Your doctor can tell your stage of kidney disease by checking your glomerular filtration rate (GFR). Your GFR can be estimated from the results of a blood test for creatinine, a waste product from muscle activity.

If your GFR falls below 15, you have kidney failure (CKD stage 5), and you will need to have a kidney transplant or dialysis treatment to replace the function of your kidneys.

If your GFR is less than 30, your doctor should talk to you about the different treatments for kidney failure. Ask about information classes in your area where you can learn more about treatment options for kidney failure. Learn all you can to make the best treatment choices for yourself and your family.

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What does dialysis do to keep me healthy?

Both hemodialysis and peritoneal dialysis do the following:

? Remove waste and extra fluid to

prevent them from building up in your blood

? Help to regulate blood pressure

How does hemodialysis work?

A hemodialysis machine has a special filter called a dialyzer (also called an artificial kidney) to clean your blood. To get your blood to the dialyzer, a surgeon will make an access, or entrance, into your blood vessels. This is done with minor surgery, usually to your arm.

Two main types of access can be made--a fistula or a graft.

A fistula is the first choice for an access. It is made by joining an artery to a nearby vein under your skin to make a bigger blood vessel. This type of access is preferred because it has fewer problems and lasts longer. You should be evaluated by a special doctor called a vascular surgeon at least six months before you will need to start dialysis. A fistula should be placed early (several months before

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starting dialysis) so it has plenty of time to heal and be ready by the time you need treatment.

If your blood vessels are not suitable for a fistula, a graft may be used. This involves joining an artery and nearby vein with a small, soft tube made of synthetic material, placed under your skin.

After the fistula or graft has healed for at least several months, it can be used for dialysis. Two needles will be placed every time you go for treatment. The needles are connected to plastic tubes. One tube carries your blood to the dialyzer where it is cleaned and the other tube returns the cleaned blood to you.

A third type of access, called a catheter, is a soft tube inserted into a large vein in your neck or chest. This type of access is generally used when you need dialysis for only a short period of time. Catheters may be used as a permanent access when a fistula or a graft cannot be placed. Catheters can be connected directly to the dialysis tubes and needles are not used. Catheters have more health complications than other types of access.

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How does the dialyzer clean my blood?

Inside the dialyzer, or filter, there are two sides--one for your blood and the other for a fluid called dialysate. A thin membrane separates these two sides. Blood cells, protein and other important things remain in your blood because they are too big to pass through the membrane.

Main Parts of the Hemodialysis System

Fistula or graft access

Smaller waste products, such as urea and creatinine, and extra fluid, move from your blood through the mem brane, and are removed. The composition of the dialysate, or cleansing fluid, is made for your special needs according to your doctor's prescription.

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