Labs

Many lab tests are performed on a recurring basis to ensure you receive the care you need. These tests may be performed at different frequencies such as every other week, monthly, or quarterly.

Dialysis adequacy: Kt/V (Kt over V) and URR are tests designed to ensure enough dialysis is delivered to replace lost kidney function. These tests measure the amount of waste products removed from the body. Higher levels may indicate a need for additional dialysis.

Hemoglobin: Your red blood cells are responsible for carrying oxygen from your lungs to tissues throughout your body. Hemoglobin is what actually transports oxygen. Lower levels of hemoglobin mean your body is less able to carry the amount of oxygen required for you to have more energy.

Hematocrit: This is a measurement of the amount of red blood cells in the blood. Lower levels of hematocrit indicate a reduced ability for the blood to carry oxygen.

Bone Metabolism: These tests measure bone health. If the results show lower than normal levels, additional health complications can occur. These include calcium deposits forming in your blood vessels or other soft tissues and the development of open skin sores.

• Calcium: A mineral found in the body and important to bone health.
• Phosphorus: Another mineral found in the body that must be maintained in a careful balance with calcium.
• Calcium/Phosphorus Product: A measurement of that balance.
• Parathyroid Hormone (PTH): A hormone the body uses to regulate calcium and phosphorus levels.

Nutritional Status: Measures the impact of diet and nutrition.

• Albumin: Measures protein derived from eating food. Low levels indicate poor dietary protein intake.
• Potassium: Measures the amount of potassium in the body. Levels too high or low may lead to muscle weakness, irregular heart beat, and possible death.
• Sodium: Measures the amount of sodium in the body. High levels may lead to increased thirst resulting in additional fluid consumption which may result in high blood pressure and difficulty breathing. Low levels may result in low blood pressure.

Medications

Many medications are commonly used in dialysis. Each patient has individual prescription needs. Commonly used medications include:

Anemia medications: Help to increase red blood count and reduce fatigue and tiredness. Common anemia medications include Epogen (EPO) or Aranesp.

Iron: Iron is necessary to improve anemia and is used with the anemia medications. Common iron medications include Venofer and Ferrlecit.

Vitamin D: Improves bone health. Vitamin D medication ensures correct calcium and phosphorous levels. Common medications are Hectorol and Zemplar.

Phosphorous binders: Important to good bone health. They help reduce the amount of phosphorous your body absorbs from food.

Antibiotics: These treat bacterial infections. Most often, dialysis-related infections occur with the access, mostly with a catheter. These infections can be very dangerous.

Hepatitis B Vaccine: Hepatitis B is a viral infection that can be transmitted by blood or other body fluids. It was once a common infection in the dialysis facility but is now a rare occurrence due to advancements in infection control practices and the vaccine. Engerix is a commonly used vaccine.

Flu Vaccine: The flu virus can be very dangerous for dialysis patients because their immune systems are somewhat weakened already. It is given annually.

Diet and Nutrition

Diet is a critical part of well-being for patients with kidney failure. The body can no longer remove fluid, wastes and toxins that are a byproduct of the foods and liquids a person consumes. Fluid overload and certain foods will impact patient well-being and the dialysis process

Care Planning

Care planning involves you and the healthcare team and is used to develop a plan of action that leads to your improved well-being. There are two types of care planning; long term and short term.

• Long term care plans include discussing treatment options, selecting an option and developing a treatment schedule. These plans are developed when dialysis is initiated and then are revisited annually.
• Short term care plans examine the progress of treatment and current health issues. These plans are generally determined once every six months but may occur more frequently based on individual needs.

How Will I Feel on Dialysis?

That is a difficult question to answer as many factors play into how you will feel. Factors include:

• Overall medical condition
• Compliancy with physician orders and prescribed medications
• Diet and exercise
• Psychological adjustment to the disease

If you follow your physician’s orders, maintain your diet, and make the necessary lifestyle adjustments, you will do very well on dialysis and lead a productive life.

Many first time patients wonder if the dialysis procedure is painful. It is not. Hemodialysis patients generally require two needles inserted into their vascular access and stinging may occur. Over time this becomes less noticeable. Peritoneal dialysis patients may feel fullness in the abdomen caused by the solution that is filling their belly.

Some dialysis patients experience the following although many of the symptoms can be reduced or avoided by following your healthcare team’s recommendations:

• Dizziness, nausea and vomiting associated with low blood pressure can occur during hemodialysis. Problems associated with low blood pressure are often the result of large fluid losses during treatment. You can minimize this risk by following a reasonable diet that limits the amount of fluids you consume. The more you consume, the more that must be removed during treatment.
• Muscle cramps due to excessive fluid and too much sodium. Fluid intake and monitoring sodium can reduce cramping.
• Fatigue can be reduced by following a proper diet, taking medication and other recommendations you are provided. Some people may still feel tired for a while after treatment. The hemodialysis procedure occurs approximately twelve hours a week replacing a process that normally occurs twenty-four hours a day, seven days a week. People on peritoneal dialysis do not report this since it is a more continuous treatment occurring seven days a week.
• Some people will feel cold during their hemodialysis treatment. A typical dialysis room temperature is about 72 to 75 degrees. During your treatment, some of your blood is outside your body which may also cause the body to feel a little chilled.
• Depression is very common. Kidney failure impacts your life and your family’s life in many ways. Your social worker and kidney doctor can offer recommendations.

Electronic Medical Records

Many companies now use computerized medical records to integrate all facets of patient care. Advantages to using electronic medical records include:

• Patient information is readily available and accessible.
• Dialysis treatment data can be automatically downloaded into the patient record.
• Laboratory results can be downloaded directly into the record.