a manual for kidney and dialysis patients
Kidney Foundation of the Greater Chattanooga Area
printing for this publication has been provided by:
A Manual for
Kidney & Dialysis
THE KIDNEY FOUNDATION OF THE GREATER CHATTANOOGA AREA
printing for this publication has been provided by:
Table of Contents
Part 1 – Clinic Information
General Introduction .................................................................................................................. 2
A Typical Day On Dialysis ........................................................................................................ 3
Part 2 –Kidney Disease
The Normal Kidney ................................................................................................................... 7
Part 3 –Renal Failure and Dialysis
Causes of Kidney Failure ........................................................................................................... 11
Problems of Kidney Failure........................................................................................................ 13
Common Questions Asked About Complications ....................................................................... 15
Part 3 – Medical Needs
Medications .............................................................................................................................. 19
Lab Tests ................................................................................................................................... 24
Blood Chemistries...................................................................................................................... 26
The Renal Diet ........................................................................................................................... 29
Helpful Hints to Stay on your Diet ............................................................................................. 30
Hepatitis Vaccine ....................................................................................................................... 34
Vascular Access ......................................................................................................................... 35
Common Questions About Vascular Access............................................................................... 37
Part 4 – Treatment Options
Treatment Options...................................................................................................................... 41
Common Questions About Hemodialysis ................................................................................... 42
High Flux Dialysis and High Efficiency Dialysis ....................................................................... 45
Home Hemodialysis ................................................................................................................... 46
Continuous Ambulatory Peritoneal Dialysis (CAPD) ................................................................. 50
Continuous Cycling Peritoneal Dialysis (CCPD)........................................................................ 53
Transplantation .......................................................................................................................... 55
Part 5 – Social Services
Social Work Services ................................................................................................................. 63
Common Questions About Social Work Services....................................................................... 63
Other Facilities and Organizations of Interest to Kidney Patients................................................ 70
Part 6 – Definitions
EMERGENCY CONTACT INFORMATION
UNIT NAME: _____________________________________________________________________
UNIT PHONE NUMBER: ___________________________________________________________
HOSPITAL PHONE NUMBER: ______________________________________________________
DIALYSIS DAYS: _________________________________________________________________
DIALYSIS TIME: _________________________________________________________________
DOCTOR PHONE NUMBER:________________________________________________________
PRIMARY NURSE: ________________________________________________________________
PRIMARY NURSE PHONE NUMBER:________________________________________________
SOCIAL WORKER PHONE NUMBER: _______________________________________________
DIETITIAN PHONE NUMBER: ______________________________________________________
24-HOUR CALL NUMBER: ________________________________________________________
OTHER INFORMATION AND INSTRUCTIONS:
General Information about the Dialysis Clinic
Your dialysis treatments should not be skipped. Try not to schedule other appointments on the days
you have dialysis. If you are not able to come for your appointment, call the Dialysis Clinic and talk
to the nurse in charge.
Bradley Dialysis Cleveland, TN 423-476-6166
Chattanooga Kidney Center Chattanooga, TN 423-648-4900
Dialysis Clinic, Inc. Third Street, Chattanooga, TN 423-698-0927
Dialysis Clinic, Inc. Lyerly St. (Glenwood), Chattanooga, TN 423-698-6422
Dialysis Clinic, Inc. East Ridge, TN 423-894-8134
Dialysis Clinic, Inc. Hixson, TN 423-870-0020
Dialysis Clinic, Inc. Broad Street, Chattanooga, TN 423-756-8808
Dialysis Clinic, Inc. Dayton, TN 423-775-3386
Dialysis Clinic, Inc. Ft. Oglethorpe, GA 706-861-6668
Dialysis Clinic, Inc. Lafayette, GA 706-638-6553
Dialysis Clinic, Inc. Jasper, TN 423-942-9977
FMC Dialysis Clinic Athens, TN 423-507-9712
Woods Memorial Dialysis Etowah, TN 423-263-3666
Report for all your treatments ON TIME. Call if you will be more than one hour late. If you come
late, you may not receive all of your prescribed treatment. If you are late on a regular basis, you will
be scheduled for a conference with your doctor.
Please leave children at home. They are not allowed in the treatment area. There is no place for
them to stay while you are receiving dialysis.
Dress in comfortable clothes. You will sit in a reclining chair for your treatment. You may bring a
blanket, an extra pillow, and something to do (a book, handiwork, etc.) while you are here.
Unless you have problems with nausea and vomiting, it’s a good idea to eat something before
coming to dialysis. You are not allowed to bring food or drinks into the clinic.
No drugs are given out at the Dialysis Clinic. If you run out of a medicine, tell your nurse. He or
she will have your doctor prescribe a refill.
Only take medicines prescribed by your kidney doctor, even if they are over-the-counter drugs.
Aspirin, milk of magnesia, and other common medicines can have harmful effects on kidney
The clinic will give you Medical ID tags or order them if you ask.
Please make sure that the clinic has your correct address and telephone numbers. Let the clinic
know immediately of any changes. This allows your doctor or nurse to contact you if any significant
problems come up.
When you come for your first dialysis treatment, bring ALL your medicines, including any
medicines that you received when you were discharged from the hospital. These will be reviewed.
If necessary, changes might be made. Your nurse will check your medicines every month, so bring
ALL your medicines to the clinic the FIRST week of each month.
Please do not bring expensive items to the clinic. If they become lost or stolen, the clinic is not
responsible for them.
A Typical Day on Dialysis
You will receive detailed instructions during your first dialysis treatment. There are general steps to
follow for each time you receive dialysis. We have listed the things you need to do each dialysis to
familiarize you with the procedures of the clinic. You may want to come a little early on your first
day to sign forms and meet the staff.
1. When you arrive at the clinic, wait in the lobby until the nurse calls you.
2. When you are called into the dialysis area, first go to the scales. The nurse or a technician will
check and note your weight.
3. Find your name on the board and the number of the chair you are to sit in.
4. Get all necessary items (magazines) that you may need during dialysis.
5. When you get to your chair, make sure your name is correct on your artificial kidney.
6. If you have a graft, wash your arm or thigh with the Betadine scrub provided on the table next to
7. Several procedures will be carried out throughout the dialysis including:
• blood pressure reading
• pulse rate
• blood flow rates (how fast your blood is moving through the artificial kidney)
• machine adjustments
8. A nurse will take your blood pressure (sitting and standing), your pulse, and temperature and
note them on your chart.
9. The nurse will place a cleansing solution on your graft or fistula and let it set for three minutes.
10. If you have a graft or a fistula, the nurse will insert two special needles into your arm. A
medicine to numb your skin can be used, if you want.
11. Once the needles are inserted, the nurse will connect the blood lines to the needles and turn on a
pump. The pump pulls blood from your body, sends it through the artificial kidney, and returns
it to your body.
12. The machine alarms and equipment are checked to insure your safety. Don’t be frightened if you
hear the machine beep. This is a necessary test.
13. The machine is adjusted for your fluid weight.
14. While you are dialyzing, two blood samples are removed from the blood lines to test how fast
your blood clots. The results of this these tests determine how much medicine (Heparin) that
you need to prevent clotting of your blood within the artificial kidney.
15. Near the end of dialysis (15 minutes to an hour before the end of the process), the heparin is
turned off so your blood can return to its normal clotting time. This will keep you from bleeding
too long after your dialysis.
16. If you have a fistula or graft, the blood line carrying the blood from the body is disconnected
from the needle and the remaining blood in the machine is returned to you. The needles are then
removed, and pressure is placed over both needle holes. If you are able to hold pressure on your
needle sites, the nurse will instruct you on how to do this. Continue pressure on this area for 10
minutes or longer to make sure that all the bleeding is stopped. When the bleeding has stopped,
band-aids or pressure dressings are placed over the two needle holes.
17. Your blood pressure, pulse and temperature will be taken and recorded on your chart.
18. Have your nurse weigh you again.
19. Put away your magazines and place your linens in the laundry hamper. Gather your belongings
before you leave.
The Normal Kidney
To understand kidney failure, you need to know something about the kidneys and how they work.
The urinary tract contains two kidneys, two ureters, a bladder, and one urethra. The kidneys
are small. Each kidney is about the size of your fist. They are located in the middle of your back, on
each side of your spine just below the ribs.
When the blood enters the kidney, it is cleaned when it passes through lots of blood “filters,”
known as nephrons. The waste materials filtered out of the kidney go through the ureters--tubes that
connect the kidneys and the bladder. Urine is made in the kidneys and moves from the kidneys
through the ureters to the bladder, where it is stored. When this waste (urine) reaches the bladder, it
is stored and then sent out through the urethra, a tube that takes the urine from the bladder to outside
of your body.
Urine is constantly flowing from the ureters into the bladder. However, the urine goes out of
your body from the bladder through the urethra only when you go to the bathroom. Any remaining
urine is stored in your bladder. Since urine eventually leaves the body, it is a waste product.
The kidney is usually only thought of as producing urine. Actually, the kidney performs
many other extremely important functions.
1. Controls Blood Pressure
The kidneys play an important role in controlling blood pressure. When blood pressure is
high, the kidneys get rid of excess salt (sodium) and water. When blood pressure is low, the
kidney saves salt and water. The kidney also produces a hormone called renin. Renin affects
a protein in your bloodstream, which helps raise blood pressure.
2. Helps Produce Red Blood Cells
Another function of the kidneys is to control the formation of red blood cells, which are
usually produced in bone marrow. The kidneys produce erythropoietin that helps to produce
red blood cells by stimulating the bone marrow.
3. Helps in Absorbing Calcium
The kidneys also activate vitamin D, which is produced in the skin based on what you eat in
your diet and from sunlight. This vitamin is changed by the liver and by the kidneys. When
changed, vitamin D helps your body absorb calcium, which is important to prevent your
bones from becoming soft.
The kidneys are vital organs that play many roles. When kidney failure occurs, your body’s systems
are disturbed, causing many changes.
Causes of Kidney Failure
There are many causes for kidney failure: high blood pressure, diabetes, hereditary disease, drug
abuse and infection. A few of the more common ones are outlined in this booklet.
COMMON CAUSES OF KIDNEY FAILURE
Uncontrolled High Blood Pressure
Hereditary Polycystic Kidneys
There are two main types of kidney failure: acute and chronic. Acute failure usually
happens suddenly and often is reversible. In comparison, chronic renal failure develops over a
longer period of time, is usually not reversible. This means the kidneys will never regain their
function with chronic renal failure.
Acute renal failure can happen because of a trauma (such as a wound or an injury), disease,
ingestion of poison or drugs, shock, or infection. As a result of this trauma, the kidney is
temporarily damaged and stops producing urine. Poisons build up in the bloodstream, which causes
the person to become confused or unconscious, and overloaded with fluids. Often the patient is
placed on a special diet, fluid restrictions and temporary dialysis. After a few weeks, the patient’s
kidney function usually returns to normal.
Chronic renal failure usually requires dialysis treatment for the rest of a patient’s life. The most
common causes of chronic renal failure are: chronic glomerulonephritis, pyelonephritis, polycystic
kidney disease, diabetic renal failure, and hypertensive nephrosclerosis.
• Chronic glomerulonephritis — Glomerulonephritis, which has several causes, is an
inflammation of the glomeruli-small structures in the kidneys. The inflammation interferes with
how your urine is cleaned or filtered. As the disease develops, scar tissue replaces the inflamed
areas and causes the blood circulation to slow down. The nephron is starved of its blood and
• Chronic pyelonephritis — Pyelonephritis is an inflammation of the kidney that affects the
tubules of the nephron and eventually the glomerulus. The infection causes the kidney to lose its
ability to produce urine. The cause of the infection may be from the bloodstream or the bladder.
• Polycystic kidney disease — Cysts on the tubules is called polycystic kidney disease. The
tubules don’t develop properly and the cysts begin to grow. Over time, the cysts get bigger and
put pressure on the tissues close to them. This pressure can affect the job of the normal
nephrons. The kidneys soon stop producing enough urine to get rid of the body’s waste.
• Diabetic renal failure — Diabetic renal failure happens when diabetes causes the renal arteries
to scar. This interferes with the proper filtration of urine.
• Hypertensive nephrosclerosis — This type of renal failure happens when a patient has high
blood pressure over a long period of time. This causes the blood vessels of the kidney to scar.
When enough of the blood vessels are scarred, the kidneys can no longer filter enough of the
There are other causes of kidney failure and the above descriptions are by no means inclusive.
For more information about your type of kidney failure, talk with your doctor.
Problems of Kidney Failure
When kidney failure begins, you may see a number of signs and symptoms. Some of these are
alarming and baffling. Some of these problems are discussed here. We hope this will relieve any of
your concerns and increase your understanding of your condition.
As kidney failure progresses, the amount of urine you pass will probably go down. Because
the kidneys no longer filter as much fluid, the extra fluid remains in your bloodstream and tissues.
The increase in fluid in the bloodstream leads to high blood pressure and puts an increased workload
on your heart. An increased workload on the heart can cause an irregular heart rate and congestive
heart failure. After dialysis is started and the fluid is removed, your blood pressure may drop. Your
doctor may be able to decrease the blood pressure medicines you take. Symptoms of congestive
heart failure also improve with dialysis.
Kidney failure may also affect your heart by causing pericarditis, a swelling and redness of
the sac around the heart. Pericarditis can cause chest pain and weakness. Once dialysis is started,
pericarditis should get better. Occasionally, dialysis patients receiving regular kidney treatments
will get pericarditis. Usually increasing dialysis treats this condition.
Kidney failure can also cause shortness of breath and pulmonary edema (swelling of the
lungs), because of extra fluid in the bloodstream and lungs. This should go away once regular
dialysis treatments are started, but it may come back if you drink too many liquids between
Most kidney patients have low blood counts (anemia) due to three main reasons.
1. A decrease in a hormone that helps the body to produce red blood cells. This hormone is called
2. A decrease in how long the red blood cells live.
3. Loss of blood while on dialysis.
If your blood count stays low and causes you problems, your doctor may order a blood
transfusion. But, transfusions are avoided, if possible, because of the following reasons.
1. Transfusions may transmit hepatitis.
2. Although it has not been proven, a high number of transfusions may interfere with a future
transplant. However, they may also be beneficial to transplant patients.
3. Transfusions may prevent your body from making blood for itself.
Kidney failure also affects the stomach and G.I. tract in various ways:
1. Nausea and vomiting,
2. A decrease in appetite,
3. Weight loss,
4. Mouth and stomach ulcers.
These symptoms are caused by the build-up of waste (poisons) in the blood. These symptoms
improve with regular dialysis, but may occur off and on while you are on dialysis or in between your
Sometimes your feet may tingle or feel numb because your nerves are damaged. This is
called neuropathy (nerve damage used by kidney failure). These symptoms should get better with
dialysis. When nerve damage occurs, you may feel tried, drowsy, or excited. Or you may have
headaches, poor memory, confusion, seizures, or a coma. These symptoms should improve when
dialysis treatments start.
Itching is a common problem of dialysis patients. It usually is worse when the waste
products in the blood are very high. When phosphorus is high, itching may be much worse, and the
doctor will probably increase your binders. It’s important to take the binders correctly because a
high phosphorus level results in low calcium. When calcium is low, the bones become weak and
Other minor problems caused by renal failure include muscle cramps, arthritis, and blurred
vision. Psychological problems may include decreased ability to concentrate, depression, and
difficulty sleeping. Other problems may also occur. If you have any questions about these or other
problems, ask your doctor or nurse about them.
Common Questions Asked About Complications
1. What if I don’t feel like coming for my treatments?
If you think you are too sick to come for your dialysis treatment, it may be that you need the
treatment so much that you are beginning to be sick with uremia. Do not miss a treatment
because you feel sick. Call your nurse or doctor, and tell them about your symptoms. They may
want you to have an emergency treatment. If you must miss a treatment because of work, call
your nurse as soon as possible. This way the necessary laboratory tests can be done to make sure
your blood levels are still safe and another treatment time can be set up.
2. Why do kidney patients continue to have nausea and vomiting after they have been on
dialysis for some time?
Usually, nausea and vomiting improve after dialysis is started. However, some patients still have
occasional attacks of nausea and vomiting between treatments. This happens sometimes because
the kidney machine cannot keep their blood chemistries at normal levels by only working 9-12
hours a week. Many patients have nausea and vomiting while they are on dialysis because their
blood pressure falls suddenly or because their blood urea nitrogen (BUN) level drops quickly. A
drop in the BUN can also cause headaches. You can minimize these symptoms by following
your diet closely so that the BUN is not high at the beginning of dialysis.
3. Is constipation a problem for dialysis patients?
Yes. This is because vegetables and other sources of roughage are limited in the diet. Physical
activity is usually reduced and binders (such as Phos-Lo, used to control your phosphate levels)
can also cause constipation. If you are constipated, your doctor can prescribe a mild laxative.
4. Does blurred vision happen very often?
Yes, it is quite common before your first dialysis is performed. It may also happen near the end
of a dialysis treatment, especially if the level of waste products in your blood were high at the
beginning of your treatment. Vision usually clears up after the first several dialysis treatments.
5. Is it unusual to have problems falling asleep?
Not at all. Many patients with kidney failure have difficulty going to sleep. If this bothers you,
mention it to your doctor, who can prescribe a mild sedative.
6. What can I do for the itching?
• Regular dialysis.
• Take your binders regularly.
• Use skin lotions.
• Ask your doctor about medicines to relieve the itching.
7. Is there a reason why I might feel tired at times?
Most patients with kidney failure are anemic even after they start dialysis. Being anemic means
their red blood cell count is a lot lower than normal. This low blood count can make a patient
8. Will my sex life change?
Many patients on dialysis notice that their interest in and enjoyment of sex is decreased.
9. Can anything be done about this change in my sex life?
In some cases, hormone treatments will improve the situation. Like all other problems, mention
any difficulty you have to your nurse or doctor so that proper treatment can be started.
10. Can a woman dialysis patient have a baby?
A few such cases have happened. Most women do not ovulate while they are on dialysis, so it is
unlikely they can get pregnant. To be safe, we recommend that you continue to use your usual
means of birth control. We recommend that female dialysis patients do not try to have children.
11. Can a male dialysis patient still father children?
The sperm count is low in many male dialysis patients, and some have difficulty with impotence
(inability to have intercourse). However, many male dialysis patients do father children.
All kidney patients have to take some medicines. Most patients have to take vitamins and iron pills.
Some patients also need medicines to meet their specific needs. Because your pills are based on
what you need, take only the medicines prescribed for you by your kidney doctor.
If another doctor prescribes a medicine for you, check with your kidney doctor. Never take
pills that belong to your family, friends, or other patients. Kidney patients should never take over-
the-counter drugs without the asking their doctor first. These medicines may contain harmful
Follow all of the directions for each medicine. Each has a special purpose to meet your
special needs. Problems may occur if you don't take them as prescribed.
Learn the names of all your medicines and why you are taking them. This can help you, and
your doctor and nurses. You must bring ALL of your medicines to the dialysis clinic during the first
week of each month. The nurse will check each medicine and review the correct dosage and
schedule with you.
If you have not started on dialysis at the outpatient clinic, please bring your medicines with you
on your first clinic visit. The nurses will write down your medicines on your chart and make sure
you are taking them correctly. Kidney patients often ask the following questions about medications.
1. How long will I need to take medications?
You will have to take some of the medicines as long as you are on dialysis. All patients take
certain medicines, and some patients take additional medicines to meet their specific needs.
2. What happens if I don't take the medicine?
We will explain the purpose of each medicine and the effects of not taking them. In some cases,
not taking your medicines can destroy your bones and cause heart failure. In other cases, you
could become very anemic and weak. If you find that a certain drug bothers you in any way, do
not stop it. Instead, tell your nurses and doctors. Your doctor may be able to prescribe another
drug that works better for you.
3. Why must I take a binder?
You must take a binder to protect your bones from becoming weak and to avoid getting calcium
deposits in your heart and other vital organs. These are very serious problems. Take the binder
with your meals, so it mixes with your food and prevents the phosphorus in the food from being
4. Why must I take vitamins?
Vitamins are limited in the renal diet for kidney patients. Many vitamins are removed during
dialysis. All dialysis patients take vitamins.
5. Why must I take iron?
Some blood is lost during each dialysis. Iron tablets will replace the iron lost during the
MEDICATIONS THAT MOST PATIENTS TAKE
Medicine Reason Special Instructions
Phosphorus Binders Controls how much Take with meals and with
• Phos-Lo (calcium acetate) phosphorus is absorbed snacks (except a fruit snack).
• Os-Cal 500 (calcium from foods.
carbonate) Do not skip dosages.
• Tums carbonate Too much phosphorus can
• Tums E-X carbonate cause kidney-related bone Don’t take iron at the same
• Magnebind 400 disease. time.
• Renagel 800 mg
• Renagel 400 mg
Iron supplements Prevents iron deficiency. Take between meals.
• Ferrous sulfate
• Ferrous fummerate (various Helps build blood, replaces Do not take at the same time
brands) the iron lost with blood in as phosphorus binders.
• Niferex-150 the dialyzer and when blood
• Nu-Iron 105 samples are drawn. If stomach upset occurs, you
(polysaccharide-iron may need to change the type
complexes) of iron you take.
are usually tolerated best.
Vitamins Replaces the water-soluble Take any time.
• Nephrocap vitamins C and B-complex
• Nephrovite that can be lost during the
(These vitamins are specially
designed for patients with
MEDICATIONS THAT SOME PATIENTS TAKE
Medicine Reason Special Instructions Possible Side
Blood pressure Controls blood If blood pressure is low Tiredness,
medicine pressure when proper for you, do not take weakness dizziness,
control of sodium and blood pressure lightheadedness.
water does not bring medicine.
blood pressure down.
Digoxin or Lanoxin Increases the force of Take your pulse before Weakness,
the heart when it taking digoxin. hypotension,
contracts, increases nausea and
cardiac output. Do not take digoxin vomiting, diarrhea,
unless your pulse rate slow heart rate.
is 60 or higher.
Itching Medicines Decreases the amount Take as prescribed. Drowsiness, dry
• Benadryl of itching. mouth, dizziness.
Stool softeners Prevents constipation. Take as needed, Diarrhea.
• Metamucil usually one every day.
Pain reliever Relieves pain. Should be used only Taking too much
• Tylenol when necessary. may result in
• Darvon dependence.
Hormones To raise hematocrit Take as prescribed. Slightly increased
• Male hormones (blood count) risk of forming
• Nandrolone blood clots.
• DO NOT take any medicines not approved by your kidney doctor.
• Antibiotics are not given for colds. Some antibiotics cannot be used for people whose kidneys
• Over-the-counter drugs can be dangerous. Never take new medicines of any kind that are not
prescribed by your kidney doctor. Never take home remedies unless approved by your doctor.
• DO NOT change your dosages on your own.
• Some medications can be habit forming. Take only as directed.
• When having prescriptions filled, never allow the pharmacist to substitute a drug without first
talking to your physician.
HELPFUL HINTS ABOUT MEDICATIONS
• Learn the name of each medicine you take, the dose you should take, and its purpose. Ask your
nurses or doctors whenever you have questions about your medicines.
• Get all of your medicines at one drug store. The pharmacist will get to know you and your
medications and help you when you need it.
• Carry an updated list of your medications with you at all times. This is very important in
• Establish a routine. Pick specific times to take your medications.
Your Numbers -- Lab Tests
You will have lab work checked once a month in the dialysis clinic. This lab work is referred to as
your panel. The results of the lab work are called your “numbers.” The nurse or dietitian will
review results with you each month and explain them to you.
• Are done monthly.
• Tell if your diet is in order or if you are well dialyzed.
You will be especially interested in a few of the numbers that the doctors and nurses will check
closely. They might need to adjust your diet or dialysis to improve some of your lab test results.
The following tests will be covered in more detail:
B. BUN (blood urea nitrogen)
D. Hemoglobin and Hematocrit
Potassium is a particle in your cells and bloodstream. It is important to the function of your cells,
muscles, and heart. Most kidney patients have a high potassium level before dialysis because almost
all foods contain potassium, and the kidneys can't get rid of the excess. Potassium can collect in
your bloodstream and make your heart beat irregularly or even stop. Some foods that are high in
potassium are: oranges, bananas, chocolate, and potatoes. Many high protein foods are also high in
potassium and must be limited. Some foods must be totally eliminated due to their high potassium
content. The dietitian will tell you more about how much potassium you can have in your diet and
what foods to eat and not to eat.
BUN (Blood Urea Nitrogen)
BUN stands for blood urea nitrogen. Urea is the waste product that comes when your body
processes protein from what you eat. How much urea is in the blood is measured by the BUN test.
When you are off your diet, the BUN will usually be higher. If you follow your diet and dialyze the
right amount of time, your BUN should stay in a satisfactory range.
Phosphorus is usually excreted by the kidneys. Due to kidney failure, phosphorus builds up in the
blood and causes the calcium to drop. This leads to a breakdown of the bones. Phosphorus can be
controlled with adequate dialysis and medicine (binders) that bind the phosphorus so that it will be
excreted by your bowels. When your phosphorus goes up, the doctor will probably increase your
HEMOGLOBIN AND HEMATOCRIT
Kidney patients are usually anemic, so we will keep a close check on your hemoglobin and
hematocrit. These two tests measure the amount of oxygen and the number of red blood cells in
your blood. If your blood count gets too low, your doctor may order a blood transfusion for you. He
may want you to take iron pills or iron shots to build up your blood count. If you should need a
blood transfusion, you will get it while you are on the kidney machine.
There are other tests that are checked with your monthly panel. If you have questions about any of
your lab work, ask your doctor or nurse.
YOU WILL BE ENCOURAGED TO PARTICIPATE IN THE REVIEW OF YOUR NUMBERS.
(This guide was put together by the staff of Good Samaritan Hospital Chronic Dialysis Center, Bay Shore, New York)
Blood Normal Values Accepted Normals For Causes of Abnormal Signs and Symptoms
Chemistry Dialysis Patients Levels of Abnormal Values
(Refers to increases in,
Glucose 80-120mg/dL 80-120mg/dL Diabetes, persistent Excessive thirst
uremia. Will be
slightly higher within
1-3 hours after eating
BUN 10-26mg/dL 60 -100 Eating too much Fatigue, nausea,
Depends on how protein-containing insomnia, dry and
much protein you eat. food. itching skin, taste
and smell affected,
Or could indicate the urine-like body odor
need for more dialysis and breath.
time, higher blood flow
of a larger dialyzer.
CO2 Bicarb 21-30mEq/L Not less than 15-16 Eating too much Rapid breathing,
protein, creating a shortness of breath
more acid blood and
Sodium (Na) 133-145mEq/L 133-145mEq/L Eating too much salt, Thirst. Leads to
e.g., potato chips, drinking more fluid,
ham, pickles. causing fluid weight
gain, elevated blood
shortness of breath.
Chloride (CL) 95-108mEq/L 95-108mEq/L Same as Sodium Same as Sodium
Creatinine Below 10-20. Varies with Inadequate dialysis Non-specific
1.2mg/dL how much muscle time or addition of symptoms
mass you have. muscle associated with
Should remain about inadequate dialysis.
the same as at start
of dialysis from
Only the most
muscular of patients
should have values in
the upper range.
Potassium 3.5-5.4 mEq/L 4.0– 6.0 Eating too many foods Extreme weakness
(K) Few symptoms below high in potassium that can lead to a
7.0 in dialysis heart attack (cardiac
Blood Normal Values Accepted Normals For Causes of Abnormal Signs and Symptoms
Chemistry Dialysis Patients Levels of Abnormal Values
(Refers to increases in,
Calcium (Ca) 8.5-10.5 8.0-10.0 Low calcium: eating Low: Muscle
mg/dL Should be near upper too much high twitching and
range if normal to phosphorus food. Not cramping, seizures,
prevent overactive taking phosphate varying degrees of
parathyroid glands. binders. Calcium will depression, hair loss,
go down if phosphorus cataracts and
goes up. conjunctivitis.
High calcium: High: Muscle
Medications such as weakness, fatigue,
Rocaltrol may cause constipation,
sharp increase. Check abdominal cramps,
blood regularly. nausea, vomiting,
Parathyroid gland loss of appetite,
removal may be coma.
Phosphorus 3.0-5.0 mgldL 3.0 – 6.0 High: Not taking High: Causes
(Phosphate) phosphate binders, elevated parathyroid
(PO4) eating high- hormone by lowering
phosphorus foods, calcium.
e.g., milk, cheese,
organ meats, beans. High and low:
Breaking of bones
Low: Taking too much without specific
phosphate binder. injury (spontaneous
continuous bone pain
knees and ankles,
Calcium- Multiply calcium and High: calcification of
phosphate phosphorus blood blood vessels
product (Ca values—should not including coronary
XPO4) exceed 55. arteries.
Magnesium 1.7-2.3 mg/dL 1.7-2.3 mg/dL Elevations due to Decreased mental
(mg) taking phosphate function ranging
binders containing from drowsiness to,
magnesium or other in severe cases,
medications such as coma. Decreased
milk of magnesia or tendon reflex leading
citrate of magnesium. to paralysis. Nausea
hypotension due to
dilation of blood
Hematocrit 36-45% Will be lower varies Decreased production Fatigue, shortness of
(Hct) [% of total with patient of red blood cells, breath, chest pain on
blood volume blood loss during or exertion (if
made up by after dialysis, underlying heart
red cells] shortened survival of disease is present).
Enzymes Check normal Check with your Check with your Check with your
for your lab. doctor. doctor. doctor.
Blood Normal Values Accepted Normal For Causes of Abnormal Signs and Symptoms
Chemistry Dialysis Patients Levels of Abnormal Values
(Refers to increases in,
SGOT 10-50 U/mL 10-50 U/mL Hepatitis None, or nausea,
Some medicines vomiting, abdominal
cramping, fatigue if
severe liver damage.
SGPT 7-33 U/mL 7-33 U/mL Hepatitis None, or nausea,
Some medicines vomiting, abdominal
cramping, fatigue if
severe liver damage.
Alkaline 30-115 IU/L 30-115 IU/L Comes from bone or Painful joints,
Phosphatase liver weakened bones that
could lead to severe
From bone: A marker pain and or
for how bad deterioration
parathyroid-caused requiring surgery
bone disease might be. (hyperparathyroid-
From liver: Marker for
diseases involving the
liver or gall bladder.
Parathyroid Check normals 150- 300 Long-term imbalances Same as evaluated
Hormone for your lab. of calcium and phosphorous.
A brief explanation of other tests that are drawn monthly or quarterly.
Blood Normal Values Reason For Test
Australian Negative Test for serum hepatitis (Hepatitis B)
Hepatitis Negative Antibody test to determine if you have ever had hepatitis. Past
Antibody episodes of hepatitis would give a positive result. If you have
ever had a vaccine for hepatitis B, then you could also have a
Total Protein 6-8 gm/dL Observed for abnormally low levels due to intake of protein foods.
Albumin Above 4 gm/dL Measure of nutritional adequacy.
Red Blood Cells 4-6 Test for anemia due to decreased RBC production when there is
(RBCs) millionlmm3 little or no kidney function.
Ferritin 76-155 ng/mL A measure of “stored” iron.
Total Bilirubin 0.2-1 mg/dL Elevated level indicates liver damage, e.g., hepatitis, or
obstruction of bile ducts.
The Renal Diet
Managing your diet is an important part of the overall treatment of kidney disease. A special diet is
usually prescribed for renal patients to reduce the production of wastes (and the effects) on your
body. You will be on a special diet as long as you are on dialysis.
When the “wrong” foods or too much of the “right” foods are eaten, waste products can build
up in the blood and cause nausea, vomiting, itching, and weakness. Headaches, shortness of breath,
or swelling of the legs may occur also. These may be present some of the time in all patients. Many
occur most of the time in patients who do not follow their dietary and fluid restrictions. The kidney
machine cannot do as much work in three to four hours, two to three times a week, as your kidneys
did working 24-hours a day. You must reduce how hard the artificial kidney must work by
following a diet restricted in protein, sodium, potassium, and certain other nutrients. The dietitian
will carefully explain your diet to you. Following it is essential to your care because the diet helps
reduce production of wastes in the body.
Specific waste products that accumulate in the blood include excessive amounts of nitrogen
(BUN), phosphorus, sodium, potassium and fluids. Monthly lab values show which waste products
may be high in the blood and indicate how well you are following your diet.
Although there are some similarities among patients’ diets, each diet is set up specifically for
you. Your diet is made for your particular needs and the type of dialysis you are receiving. You
may have different diet restrictions or allowances from other patients. You must be responsible for
controlling your own diet. A dietitian will help you with what you should eat, how you can prepare
meals on the special diet, and will explain how blood chemistries are affected by sticking to your
diet. However, it is up to you to actually eat the correct amount and types of foods. No one can do
this but you.
HELPFUL HINTS TO STAY ON YOUR DIET
ß Learn about kidney disease so that the importance of the diet is clear. Talk with your
dietitian. It is easier to follow a diet if you understand it.
ß It is your responsibility to ask questions about your diet.
ß Get your family or close friends involved in learning about your diet. They can help and
support you if you need it.
ß You should be honest about food that you like or dislike. Your dietitian can help with
recipes and can adjust your diet so it includes food that you like.
ß Learn what foods to avoid, the proper amounts of foods you can eat, and how to measure
ß You should not adjust or change your diet without first talking with your dietitian.
ß Don’t compare your diets with other patients. Your size, weight, and diagnosis determine
which foods your can eat and how much you can eat.
Below is a list of questions that may help you. Remember: Talk with your dietitian if you have any
1. How much will I be able to drink on my diet?
If you have no urine output, you will be able to consume only 500-1,000 cc of fluid a day. If
your kidneys still produce urine, you can drink 500cc plus the amount your kidneys produce.
The doctor and dietitian will discuss your fluid intake with you.
2. I have been told to limit how much fluid I drink. How can I avoid being thirsty?
Excess salt is the main cause of thirst. You can limit how thirsty you are by limiting how
much salt you eat. Patients who do not eat too much salt (sodium) are not thirsty, even if
they are only allowed to drink 500-1,000 cc of fluid a day. Sweets also may make you thirsty
if you are a diabetic.
3. I just can’t eat food without salt. What can I do?
Patients say that it takes two to three months to get used to eating food without salt. After
that, food with salt tastes strange to them, just as salt-free food did at first. There are many
other spices that you can use to add flavor to food. Talk with your dietitian about spices that
might be good to use.
4. What is high-quality protein?
High-quality protein is protein of animal origin. It is called high quality because it has a
higher percentage of the components that are necessary to build strong muscles and other
tissue. High-quality protein produces fewer waste products than does low quality protein,
which is derived from vegetables sources such as beans, corn, and peas.
Hepatitis is a big danger to all dialysis and transplant patients, and for those who are in close contact
with them, such as family members and staff who work in the dialysis unit. We do not want to cause
excessive concern about this, but we want to see that you are fully informed about the dangers of
hepatitis and about the measures that you can take to prevent spreading it.
Hepatitis is a virus infection of the liver. In most cases, it causes an acute illness that
gradually clears up in two to three weeks or a month or two. In some cases—more often in dialysis
patients—hepatitis can lead to a chronic infection that can seriously damage the liver. It is important
that you try to prevent the spread of hepatitis.
The form of hepatitis most commonly seen in dialysis units is called serum hepatitis because
it was once believed that it could only be spread by the transfer of blood or blood products from one
person to another (for example, by blood transfusions). Now we know that this form of hepatitis can
be spread by other means but it occurs less easily than by contact with the blood.
To identify patients and/or staff who have been infected with hepatitis, we do a blood test
each month known as the Australian antigen test.
The Australian antigen is a factor that can be found in the blood of patients who have had
serum hepatitis. A positive test for this factor does not mean that the patient has a serious case of
hepatitis, but it does mean that he or she has been infected with the virus at some time and could
possibly spread the infection to someone else. Once an individual has had hepatitis, he or she cannot
be infected with the same type of hepatitis again, but may carry the virus and possibly can transmit it
to others several years after the initial infection.
Most kidney patients who develop hepatitis have mild cases. The most common symptom is
being more tired than usual. Other symptoms are: skin rash; pain in the hands or joints; yellow
color of the whites of the eyes or skin; dark yellow urine (almost brown) or light colored stools; loss
of appetite; and nausea, vomiting or diarrhea.
To protect patients as well as staff, the following safeguards against contracting hepatitis will be
followed at the clinic.
1. Contact with the blood of potentially infected patients should be avoided. Because the
test for Australian antigen is not 100 % perfect, we regard all blood as being potentially
infected with the hepatitis virus. Our personnel wear disposable gloves when working
with dialysis patients. This reduces the chance that blood will enter a small cut on their
hands or fingers, or be spread to other patients.
2. Use care when you handle used needles. This means discarding them in proper
containers and seeing that no one is carelessly stabbed with a used needle.
3. Avoid blood transfusions unless they are very necessary. Blood Assurance tests every
unit of blood for Australian antigen, but this testing is not 100 % perfect. Transfusions
should be kept to a minimum.
4. Use care when cleaning up or getting rid of vomit, urine, stool and other secretions from
all patients, particularly those who are known to have a positive Australian antigen test.
5. Patients who are known to be positive for Australian antigen will be isolated from those
who are negative. They will dialyze on a special machine set aside for only positive
We hope that all patients and visitors will understand the need for regulations that help increase
safety of all patients, visitors, and staff. Please understand that staff members are exposed to
hepatitis every working day, and that some rules are necessary to see that they, as well as the
patients, are protected from an accidental hepatitis infection. For this reason, patients should follow
the policies given to them.
You also can take the following precautions at home to protect yourself and your family from
becoming Australian antigen positive.
1. Wash dishes and eating utensils thoroughly with hot water and plenty of soap.
2. Wash pans or sheets contaminated by blood, vomit, or diarrhea, etc., thoroughly in hot
water and with plenty of soap before using them again.
3. Do not share razors, clippers, and personal articles used by a person who is positive for
4. Practicing personal cleanliness will decrease the chances of spreading hepatitis.
5. If you are positive for hepatitis, tell others who may come in contact with your blood
(e.g., dentists, barbers).
A positive Australian antigen is no cause for alarm. If you have a positive antigen, or if you have
questions about hepatitis, talk to the nurses and your doctor. They will explain more about how
important this problem is and the meaning of the tests that are done.
There is a vaccine that can help prevent you from getting hepatitis. Your doctor may order this
vaccine for you. The vaccine makes your body produce antibodies that kill the hepatitis virus. The
vaccine is a total of four injections at different times; one shot at the beginning, one shot after one
month, another after two months, and another shot six months from the first. After all the shots are
completed, your blood will be checked to see if you have the antibodies. The medicine does not
produce antibodies in everyone and if you are a kidney patient, you have a greater chance of not
developing antibodies. If you do not develop antibodies, your doctor will order another series of
shots for you. If you have more questions about this medicine or if you want to get it, talk with your
doctor or nurse.
To start you on dialysis, you need a vascular access to your blood. This is a way of getting your
blood from your body, through the artificial kidney, and back into your body. You need to have
special surgery to create an access. Your doctor will determine the type of access that is best for
you. The most common accesses are listed below.
• A-V Fistula
• Gortex Graft
• Dialysis Catheter
Each type of access has advantages and disadvantages. One will probably suit your needs better
than the others.
You may hear doctors and nurses refer to arteries and veins. Arteries are blood vessels that
carry blood from your heart to all parts of your body. Veins are blood vessels that carry blood back
to your heart. Veins are usually closer to the skin than arteries are.
During dialysis, you will hear the nurses using the words “arterial” and “venous.” An arterial
needle in a fistula or graft leads the blood away from the heart just as an artery does. A venous
needle takes blood toward the heart, as does a vein.
A fistula is a direct surgical connection between an artery and a vein that allows blood to flow
directly from the artery into the vein. Because of this fast flow of blood, the vein gradually gets
larger and becomes stronger and tougher. This allows the nurses to easily insert large needles to
remove blood from your body, pass it through the artificial kidney and return it to your body. An
ordinary vein would not be strong enough for this, since it would not provide the amount of flow
needed for efficient dialysis.
A fistula is created by first numbing your skin with a local anesthetic (similar to what the
dentist uses). The surgeon makes a small cut (usually about one inch long) over the artery and the
vein at the wrist. The surgeon then attaches the vein to the side of the artery and closes the incision.
Nothing is actually placed in your arm except the stitches that hold the vein to the side of the artery.
The Gortex graft is a man-made graft like plastic. The graft can be placed under the skin as a
substitute for your own blood vessels. The graft is connected to an artery at one end and to a vein at
the other, so that blood flows constantly from the artery into a vein. After the area has healed,
needles can be placed in the graft just like in a normal fistula.
One advantage of a graft is that it may be used soon after dialysis. The graft can be used
after a day or two, but we prefer to let it heal for at least two weeks.
When you first start on dialysis you may need to have a catheter placed. This is a temporary access
that involves putting a small catheter below your collarbone into the large blood vessel going to your
heart. The catheter is stitched in place and stays there until your permanent access is ready to use.
After the nurses start using your graft or fistula, the catheter can be removed. Sometimes, these
catheters may still clot or kink, or get infected, and it may be necessary to replace the catheter.
Common Questions About Vascular Access
1. After the access is created, what will happen to the rest of my hand?
The rest of your hand has plenty of blood supply from other arteries, so nothing will happen
to it. Some patients get numb over the thumb. This usually goes away in two to three weeks.
2. Can I use that arm?
After the incision heals--usually in 7-10 days--you can use the arm freely. You can do
anything with your fistula arm that you could do before the surgery. We suggest that you
exercise your fistula arm often.
3. What happens if I cut my arm?
If you should cut the fistula vein or the graft, it will bleed more than a normal vein. Putting
pressure over the cut will control this bleeding.
4. When can the fistula be used?
It can be used after five or six weeks. The vein can sometimes be used within a week, but we
prefer letting it develop for a longer period.
5. When can a graft be used?
Usually after two to four weeks.
6. What can I do to help the fistula vein develop more rapidly?
After the incision heals, you will be given a rubber tourniquet. The vein will develop faster
if you put the tourniquet on for three to four minutes several times a day. While the
tourniquet is on exercise the arm by squeezing a rubber ball or by lifting a moderately heavy
7. How is the access used?
One needle is placed in the vein to remove blood from your body, and a second needle is
used to return the blood to your body. The arterial needle takes blood away from your heart.
The venous needle returns blood toward your heart.
8. Does it hurt when the needles are put in?
A small amount of local anesthetic can be used to numb the skin where the needle will be
placed, so that it’s not very painful. In time, your skin will become less sensitive to the
9. Does it hurt during the time the needles are in?
Usually there is no discomfort once the needles are placed, although you must be careful
when moving your arm. If you feel pain, tell your nurse or doctor. Changing position will
usually stop the pain.
10. How long are the needles left in?
They are left in for the length of the dialysis treatment, which varies between three and five
hours depending upon your size, the blood flow rate, and a number of other factors.
Once the doctor tells you it is time to begin dialysis treatment, you may feel overwhelmed with all
the things happening to you, and all the decisions that you have to make. You may not know or
understand the different options possible to you. Once you start dialysis, you can decide what type
of treatment you would like to use. Not all of the treatments are right for everyone. Ask your doctor
or nurse to help you pick the one that best suits your medical situations, and takes into account your
lifestyle. Your doctor will tell you which treatments you will be able to do. It is up to you to make
the choices that will be best for you and your family.
YOUR CHOICES MAY INCLUDE:
• • Hemodialysis at a clinic
• • Home Hemodialysis
• • Continuous Ambulatory Peritoneal Dialysis (CAPD)
• Continuous Cycling Peritoneal Dialysis (CCPD)
Commonly Asked Questions About Hemodialysis
1. Does the artificial kidney machine have an effect on my kidneys?
No, it neither helps nor hurts your kidneys. Whether you put out urine or not, your kidneys
have failed. Kidney machine treatments will not fix your kidneys. The treatments will not
harm them either.
2. Will I always need to use a kidney machine?
Kidneys rarely recover after they have deteriorated to the point that dialysis is necessary.
The need for the kidney machine is permanent once dialysis has been started. In many cases,
a kidney transplant can be performed. If the transplant is successful, dialysis will no longer
3. Will dialysis make me feel any better?
Even though the artificial kidney will not make you well, it will make you feel much better.
Many patients actually say they feel normal between treatments, but most do still feel some
effects of kidney failure. Some of the effects you might feel are decreased strength and
4. How does dialysis feel? Is it painful?
The treatments are not painful. You may experience some discomfort. The first treatment
often causes a headache, and sometimes you may throw up or feel like you might. Some
patients have headaches, nausea, and vomiting even during later treatments. These
symptoms are less likely if you follow your diet closely and dialyze regularly for the right
length of time.
5. What can I do during a dialysis treatment?
You may read, watch television, knit or crochet, play checkers or cards, talk to the nurses and
the patients near you, or simply take a nap. Time will pass quicker if you plan some activity
during the dialysis treatment.
6. Can I have a normal life while using the kidney machine?
Your life may not be perfectly normal, but you can do most of the things you used to do
before you developed kidney failure. Reasonable amounts of work are suggested. You
should exercise as much as your physical strength will allow. The more you do, the better
you will feel.
7. When can I expect to feel better?
Improvement may be slow. Most patients find they feel a great deal better after the first three
months. Many patients continue to gain strength slowly for up to two years after dialysis is
8. How long can I live on an artificial kidney?
Patients have lived many years on dialysis. Some of the first patients treated by dialysis in
the early 1960s are still living. How long you live depends on how carefully you follow the
treatment program prescribed for you, and your overall medical condition.
9. Will I have to dialyze at the center from now on?
We encourage all patients to consider home dialysis. Many other patients have dialyzed at
home. Dialysis is more convenient at home than in the center, and you can arrange your
treatments when you desire. You will also begin to know that you are responsible for your
own treatment. If home training is not possible, you may wish to consider Continuous
Ambulatory Peritoneal Dialysis (CAPD). Refer to that section if you are interested.
10. Can I go back to work or school?
We encourage patients to return to work or to school, and we’ll make every effort to arrange
your dialysis schedule to accommodate your schedule.
11. Can dialysis patients travel?
Yes, we can help you set up dialysis in other cities, if you wish.
12. Will I always be under a doctor’s care?
Yes, although patients who go on home dialysis can become quite independent and require
occasional visits to the doctor. Patients who have a successful transplant eventually become
quite independent, also. Learning all about your condition can increase your level of
independence, so you can take some responsibility for your own care.
13. Is dialysis dangerous?
Dialysis is a complicated procedure. Some risks are involved. Nurses who perform dialysis
are trained especially in that area. They know the possible dangers and are careful to avoid
14. Is a wearable artificial kidney ready for use?
A lot of research has been done on several types of wearable artificial kidneys. When these
become available for regular use, they will be assessed for use by our patients.
15. Will I have cramps while I am on dialysis?
Some patients do have cramps during the dialysis treatment. This usually happens when
dialysis removes a lot of fluid. To keep from having cramps, avoid taking on large amounts
of fluid between treatments by staying within your fluid limits. If you do experience cramps,
your nurse can give you something to ease them.
High Flux Dialysis & High Efficiency Dialysis
High flux dialysis and high efficiency dialysis are fairly new procedures. These types of dialysis are
sometimes called shortened dialysis because the dialysis time can be reduced when started on this
type of therapy.
This type of dialysis works because a very large artificial kidney is used for the treatment.
The larger kidney needs a special machine to control the fluid removal so that too much fluid is not
taken off. This type of treatment is not right for everyone. Patients who have high flux dialysis
must have a good vascular access because very high blood flows are needed. The high blood flows
also present another problem. Some patients cannot physically bear rapid blood flows. Patients also
must be very good with his or her diet and fluid restriction. Since the dialysis time is shortened, the
nurse cannot take off large amounts of fluid safely with this treatment method.
How much this reduces dialysis is different from patient to patient. Some patients may be
able to run two hours while others require four hours. Dialysis time is very different for each
patient. Every patient does not have the same level of kidney failure. Also, your size, level of
activity, and diet affect the amount of time patients needs to dialyze. By evaluating you as an
individual, your doctor knows how much time you need to dialyze. If high flux or high efficiency
dialysis interests you, ask your doctor if you qualify for this type of treatment.
Once you have started on dialysis, you may want to do your own treatment at home. This is an
option that offers several advantages to the patient. If you select home hemodialysis, you would use
a kidney machine at home in the same way as your treatments are performed at the clinic. This
method of dialysis requires that you and a partner (usually a family member) learn how to work the
kidney machine. This training takes place over a period of six to eight weeks, and can be done while
you are receiving your dialysis treatments. You do not need to purchase your kidney machine.
Medicare will help pay for it. Once you take the machine home, you will need to come back to the
clinic once a month to have lab work drawn and to be assessed by your doctor. During this monthly
visit, you can ask your doctor or home training nurse questions about any problems you might have
with the process.
• You can do the procedure yourself with the help of a partner or friend.
• You use your own machine.
• You can dialyze at times that work for you.
• If you are eligible for Social Security, Medicare reimbursement begins the day you begin
• You don’t have to travel to the clinic for treatment.
• You can have more independence and control of your life.
• May cause additional family stress.
• Requires a partner or friend to help.
The following questions and answers will give you more information regarding home dialysis.
1. Who will dialyze me at home?
You dialyze yourself, with help as needed from your partner or friend. You should take
responsibility for your own treatment, because this will help you to be more independent.
However, we will train both you and a partner or family member, since it is important to
have proper assistance while performing home dialysis.
2. Why is the patient expected to be in charge of his or her own treatment?
It is important for you to feel independent. It is also important that you understand
everything related to your treatment. You have more reason than anyone to do things
correctly. It lightens the load on family members, and patients are happier and do better at
home if they learn to accept responsibility for their own treatment.
3. Can I learn home dialysis if I am not a nurse or doctor?
Yes. Very few of the home dialysis patients have any medical background. Despite this,
they learn the method in a short time, and most do quite well at home with help from their
4. What is the home dialysis training including?
The training has two parts: technical and medical. In the technical phase, you learn about the
equipment and the artificial kidney. You also learn how to carry out the dialysis safely and
efficiently. In the medical part of the training, you learn about any medical treatments you
need to stay in good health. The training sessions occur with your dialysis treatments.
5. How can I be sure that I am ready to go home with a machine?
During the training sessions, the nurses will gradually move the responsibility to you and to
your partner. Eventually, you will do all work involved in your dialysis, with help from your
assistant. You will be allowed to go home with your machine only after you have shown that
you can do the technique safely.
6. How do I handle emergency situations at home?
In your training, we teach you to avoid emergencies by following the proper and safe
technique. However, we also teach you to handle all emergencies that you may encounter.
We teach you and your assistant what to do immediately to protect you. After you have
stabilized the emergency, you may want to call the clinic or your doctor for additional
7. What happens if the machine breaks down?
If you think you are having trouble with your machine, call the Dialysis Clinic and talk with
the home dialysis nurse. Usually the machine can be fixed quickly, sometimes with simple
directions over the phone. The service person from the company that made your machine
may have to repair it.
8. What if my assistant gets sick?
If your assistant is sick or is not able to help you, you can come back to the Center on a
temporary basis for your dialysis.
9. Are home dialysis patients also on the transplant waiting list?
Yes. Home dialysis patients are on the transplant waiting list if they want a transplant and if
their medical condition would allow a transplant. We evaluate a patient’s suitability for a
transplant prior to training him or her for home dialysis and will contact the patient when the
first suitable kidney is available. One patient is as likely to be called as any other patient,
since the decision about who gets a kidney is based on tissue typing, not on where the patient
10. How can I find out more about home dialysis?
Talk with your doctor or nurse about home dialysis. We continually train patients to dialyze
at home, and will be happy to discuss this treatment method with you.
If you are interested in home training, you may want to talk with the home training nurse. Contact
information is listed below.
Dialysis Clinic, Inc.
1425 East Third Street
Chattanooga, Tennessee 37404
Continuous Ambulatory Peritoneal Dialysis (CAPD)
Continuous Ambulatory Peritoneal Dialysis (CAPD) is one of two treatment methods available for
end stage renal disease patients who want to do treatments at home. CAPD is a type of dialysis, or
blood cleansing. A liquid mixture is put into the abdominal cavity through a soft plastic tube—a
catheter—that has been permanently fixed in the abdomen by a surgeon. CAPD is a seven-day-a-
week, 24-hour-a-day procedure and provides continuous dialysis. The dialysis solution is always
present in the abdomen. It is a machine-and-needle-free form of dialysis. No assistants or helpers
The dialysis solution “runs into” the abdominal cavity and remains there for four to six hours
during the day and eight to twelve hours at night. The time the solution is in your system is called
the dwell time. After the “dwell” time, the solution is manually drained from abdomen and fresh
solution is again “run” into the abdominal cavity. This procedure is called “exchange” and is
performed four times a day. Each exchange usually takes about 30 minutes. The patient choosing
CAPD can plan to spend an average of two hours a day performing dialysis, or 14 hours per week.
To “run” the solution into the abdominal cavity, one end of a plastic tube is connected to the
catheter. This tube is called the “transfer tubing.” There are different kinds of “transfer tubing’s.”
Each has a spike or a connector that lets the solution go in for each exchange. The “bag” and the
“tube” are made of a soft, flexible plastic. Many of the new tubings allow connections from the
“bags” in between exchanges with only a short transfer tubing in place. This is easily hidden under
clothing. There are also tools to help patients that may have vision or manual dexterity problems.
Extra fluid and waste products are cleaned from the body continuously with CAPD. Because
of this, people doing this method of dialysis usually have a different diet than those using
hemodialysis. The diet usually lets you eat more fluids, potassium, sodium, and protein. But, each
patient is an individual and the dietitian creates a diet specifically for each CAPD patient.
• No machine
• No needles
• No helper or assistant needed
• Rise in hematocrit
• Improved taste and appetite
• Increase in strength
• Better control of blood pressure
• More stable blood chemistries
• Freedom to travel
• Shorter training period than for hemodialysis
• • Infection
• • Increase in body weight
• • Constipation
• • Muscle cramps
• • Occasional nausea/vomiting
• • Loss of appetite
• • Abdominal hernia
The greatest disadvantage of CAPD is the risk of infection. Performing each exchange is a
sterile procedure. If contamination occurs during the exchange, germs may get into the abdominal
cavity and cause an infection. This infection is called “peritonitis.” The CAPD technique is simple,
but must always be kept sterile, or germ-free. Peritonitis can be serious and painful, if it is not
treated. Therefore, you should always call your doctor if you see signs of an infection.
CAPD has many advantages; but it is not for everyone. The choice to use CAPD is reached only
after looking at the individual’s needs and emotional and physical capabilities.
For more information, contact:
Dialysis Clinic, Inc.
Continuous Cycling Peritoneal Dialysis
Continuous Cycling Peritoneal Dialysis (CCPD) is another kind of peritoneal dialysis, or a reversal
of CAPD exchanges. CCPD takes the exchanges normally done during the daytime and moves them
into the night, while the patient is sleeping.
CCPD is another kind of dialysis, or blood cleansing. A solution is put into the abdominal
cavity through a soft plastic tube (catheter) that has been permanently fixed in the abdomen by a
surgeon. CCPD is also a seven-night-a-week, 24-hour-a-day procedure. Dialysis solution is always
present in the abdomen. It is a needle-free form of dialysis. A machine is necessary, but an assistant
The procedure is done with a cycler (machine), which measures and warms the solution,
sends the solution to the patient and allows the solution to drain after the completion of the “dwell”
time. The cycler also watches each drain cycle to make sure it is drained enough. The cycler has
warning alarms to let the patient know if not enough solution is drained. The cycler uses gravity and
works quietly, offering the patient a non-threatening home dialysis treatment.
The procedure usually takes eight (8) hours each night. Within this eight-hour period, three
(3) exchanges are done during the night and the fourth (4) exchange is carried in the abdomen during
the day. After finishing dialysis each morning, the patient disconnects at the catheter end. There is a
short transfer tubing, but no bag is worn on the body.
Extra fluid and waste products are cleaned from the body continuously with CCPD. This
allows a more liberal diet, especially more protein, potassium, sodium and fluids. But each patient’s
diet will be different, and the dietitian prepares a diet specifically for each CCPD patient.
• No Needles
• No Helper
• Rise in Hematocrit
• Improved Appetite
• Better control Blood Pressure
• More stable Blood Pressure
• Freedom to travel
• Shorter Training Period than for Hemodialysis
• Fewer Connections than CAPD
• Increase in Body Weight
• Muscle Cramps
• Occasional nausea/vomiting
• Loss of Appetite
• Abdominal Hernia
The biggest problem with CCPD is the risk of infection. Performing each dialysis treatment is a
sterile procedure. If contamination occurs during first or last dialysis, germs get into the abdominal
cavity and can cause an infection. This infection is called “peritonitis.” The CCPD technique is
simple, but must always be kept germ-free.
Even though CCPD has many advantages, it is not for everyone. The choice to use CCPD is
made only after assessing the individual’s needs and emotional and physical capabilities. Usually,
this decision is one in which both the patient and the doctor agree upon and share.
Kidney transplantation is the process of placing a kidney from another person (donor) into a patient
with kidney failure using surgery. The donated kidney can perform all the functions that the
patient’s damaged organs are unable to do.
The transplanted kidney is put in near the patient’s hipbone rather in the location of the
patient’s kidneys, which are higher and more to the side. Sometimes, the patient’s own kidneys have
to be removed to control chronic infection or high blood pressure.
The patient with a functioning transplant kidney doesn’t need dialysis treatments. Because
kidney works more effectively than dialysis, the transplanted patient generally feels better and has
more energy. Some patients, whose sexual activity declined during dialysis, find their sexual
interest returning. Many limits are ended after transplantation, including food and liquid limits.
The transplanted kidney comes from a donor, who may be a living related member of the
patient’s family, or from a person who recently died. Needing a donor places some patients in an
uncomfortable position. Their need and desire is to be transplanted, but it is hard to ask another
person to make the sacrifice of donating a vital organ. Patients who must wait for a kidney from
someone who has died are placed on a waiting list. Usually these patients have to wait longer for a
kidney because it is harder to find a good “match.” Our kidney transplant programs maintain files of
patients wanting to be transplanted. When kidneys from people who have died become available,
patients who “match” the donor are called for transplantation.
The kidney transplant surgery is considered major, but low risk surgery. Rejection of the
kidney by the body is possible. The patient is treated with drugs to lower the body’s resistance to
foreign objects. If rejection does take place, the transplanted kidney is removed, and in most cases
the patient returns to dialysis.
The drugs that are needed to keep the body from rejecting a transplanted kidney cause some
problems. The renal patient may become prone to infections. There may be damage to the liver and
skeletal systems. Salt tends to be retained by the body; and the patient may develop ulcers. Some
cosmetic effects of drugs may cause the patient difficulties. These changes include fullness of the
face, weight gain, acne, facial hair, stretch marks, fat pads on the back, and darkened skin. Not all
patients have these problems. Most of the side effects can be made less noticeable through the use
of make-up, diet and other means. Most patients prefer the risk of side effects to having to be on the
A transplant allows kidney patients the chance to return to a normal lifestyle. Many transplant
patients return to work and to their pre-dialysis activities. Although there are risks involved, most
patients feel that the rewards are worth the risk. You must weigh your choices and decide what
option is best for you. Below is a list of questions frequently asked about transplantation.
1. How long will I have to wait for a kidney transplant?
You will receive a kidney as soon as a proper tissue match can be found. In some cases, the
wait is only a few weeks or a few months, but in other cases the wait may be one to two
years, or even as long as five years.
2. How many kidneys are transplanted?
Only one kidney is transplanted, because one good kidney is all you need to be healthy. In
this way, two patients can receive transplants when one cadaver donor becomes available.
3. How long do patients stay in the hospital after a transplant?
A transplant patient usually stays in the hospital for two to four weeks. Some may have to
stay longer if any problems develop.
4. How long does it usually take to recover from the operation?
The transplant patient is usually out of bed in two to three days. The incision usually heals
within 10-14 days. The patient will be completely able to walk and move around the hospital
before the incision completely heals.
5. Will the transplant make me normal again?
A successful transplant will provide you with essentially normal kidney function. However,
the extent to which you return to a normal life depends on you.
6. Will I need to use the kidney machine after the transplant?
About half of the patients who receive a kidney from someone who has died need dialysis
after their transplant while they wait for the kidney to begin working. This period of dialysis
can vary from one week to several weeks. Dialysis is only rarely needed for patients who
receive a kidney from a live donor.
7. Will I be on a special diet?
If the transplant is a success, you will be on a special diet that will give you large amounts of
protein to prevent muscle wasting from the medicine you will have to take. The diet will be
limited in carbohydrates and calories and will usually be limited in salt.
8. Will I be able to drink as much as I want?
If the transplant is successful, you will generally be able to drink all the water you want.
9. Will I have to take medicines?
Yes, you will have to take medicines to prevent rejection as long as you have your transplant.
10. What is rejection?
Rejection is when your body tries to get rid of any foreign tissue. Almost all transplanted
kidneys go through some rejection attempts, but usually they can be controlled with
11. Can more than one transplant be done?
Yes, if the first transplant fails, the kidney will be taken out and you will return to dialysis.
After you recover from that operation, you will be placed on the active transplant list again if
you wish, and a repeat transplant will be done. Some patients have had three or four
transplants before they receive one that is a success.
12. How long will the transplanted kidney last?
There is no known limit to how long a transplanted kidney will last. Many kidneys, both
from live donors and from cadaver donors, have lasted ten years or more and are still
13. What is a live-related transplant?
A live-related transplant is a kidney transplant in which the kidney is taken from a member of
your immediate family, or a relative. This could be a parent, brother or sister, or child.
14. Are there advantages to receiving a live donor kidney?
Yes, the two main advantages are that the success rate is better (because the kidney is more
nearly like your own tissues than an unrelated kidney would be), and the transplant can be
15. If I take a kidney from a relative, how will that affect my relative?
The donor’s health should not change. After recovery from surgery, he or she should be able
to return to work or school and be as strong as ever. The kidney that is left will do the same
work that two kidneys did.
16. How long will the donor be in the hospital?
Usually 5 to 7 days.
17. What about the costs of live donor transplantation?
Medicare covers most costs for both the patient and donor. The few patients not eligible for
Medicare should discuss questions about costs with their social worker.
18. How can I learn more about transplants?
Ask your doctor or nurse.