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| Kidney Treatments with Modern Medicine |
Kidney Failure: Choosing a Treatment That's Right for You
Note: In February 2005, I was reading the May 2004 edition of Reader's Digest and came across the following: on page 124 is an article on Dean Kamen. Yes that is the gentleman who invented the "Segway Human Transporter". The article states he has 150 patents to his name. The article also says that he and his colleagues devised a VCR-sized dialysis machine to spare kidney patients (I think it means dialysis patients) the indignity of being tethered to one larger than a dishwasher.
For more info, visit - ( http://www.rd.com/boa )
On this page:
Your kidneys filter wastes from your blood and regulate other
functions of your body. When your kidneys fail, you need treatment
to replace the work of healthy kidneys to survive.
Developing kidney failure means that you have some decisions to make
about your treatment. If you choose to receive treatment, your
choices are hemodialysis, peritoneal dialysis, and kidney
transplantation. Each of them has advantages and disadvantages. You
may also choose to forgo treatment. By learning about your choices,
you can work with your doctor to decide what's best for you. No
matter which treatment you choose, you'll need to make some changes
in your life, including how you eat and plan your activities. But
with the help of your health care team, family, and friends, you can
lead a full, active life.
When Your Kidneys Fail
Healthy kidneys clean your blood by removing excess fluid, minerals,
and wastes. They also make hormones that keep your bones strong and
your blood healthy. When your kidneys fail, harmful wastes build up
in your body, your blood pressure may rise, and your body may retain
excess fluid and not make enough red blood cells. When this happens,
you need treatment to replace the work of your failed kidneys.
Back to top of page
Treatment Choice: Hemodialysis
Purpose
Hemodialysis cleans and filters your blood using a machine to
temporarily rid your body of harmful wastes, extra salt, and extra
water. Hemodialysis helps control blood pressure and helps your body
keep the proper balance of important chemicals such as potassium,
sodium, calcium, and bicarbonate.
How It Works
Hemodialysis uses a special filter called a dialyzer that functions
as an artificial kidney to clean your blood. During treatment, your
blood travels through tubes into the dialyzer, which filters out
wastes and extra water. Then the cleaned blood flows through another
set of tubes back into your body. The dialyzer is connected to a
machine that monitors blood flow and removes wastes from the blood.
Hemodialysis.
Hemodialysis is usually needed three times a week. Each treatment
lasts from 3 to 5 or more hours. During treatment, you can read,
write, sleep, talk, or watch TV.
Getting Ready
Arteriovenous fistula.
If you choose hemodialysis, several months before your first
treatment, an access to your bloodstream will need to be created.
You may need to stay overnight in the hospital, but many patients
have their access placed on an outpatient basis. This access
provides an efficient way for blood to be carried from your body to
the dialysis machine and back without causing discomfort. The two
main types of access are a fistula and a graft.
A surgeon makes a fistula by using your own blood vessels; an
artery is connected directly to a vein, usually in your forearm.
The increased blood flow makes the vein grow larger and stronger
so that it can be used for repeated needle insertions. This is the
preferred type of access. It may take several weeks to be ready
for use.
A graft connects an artery to a vein by using a synthetic tube. It
doesn't need to develop as a fistula does, so it can be used
sooner after placement. But a graft is more likely to have
problems with infection and clotting.
Needles are placed into the access to draw out the blood. You'll be
given a local anesthetic to minimize any pain during dialysis.
Graft.
If your kidney disease has progressed quickly, you may not have time
to get a permanent vascular access before you start hemodialysis
treatments. You may need to use a catheter, a tube inserted into a
vein in your neck, chest, or leg near the groin, as a temporary
access. Some people use a catheter for long-term access as well.
Catheters that will be needed for more than about 3 weeks are
designed to be placed under the skin to increase comfort and reduce
complications.
Catheter for temporary access.
For more information about vascular access, see the National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) fact
sheet Vascular Access for Hemodialysis.
Who Performs It
Hemodialysis is usually done in a dialysis center by nurses and
trained technicians. In some parts of the country, it can be done at
home with the help of a partner, usually a family member or friend.
If you decide to do home dialysis, you and your partner will receive
special training.
Possible Complications
Vascular access problems are the most common reason for
hospitalization among people on hemodialysis. Common problems
include infection, blockage from clotting, and poor blood flow.
These problems can keep your treatments from working. You may need
to undergo repeated surgeries in order to get a properly functioning
access.
Other problems can be caused by rapid changes in your body's water
and chemical balance during treatment. Muscle cramps and
hypotension, or a sudden drop in blood pressure, are two common side
effects. Low blood pressure or hypotension can make you feel weak,
dizzy, or sick to your stomach.
You'll probably need a few months to adjust to hemodialysis. Side
effects can often be treated quickly and easily, so you should
always report them to your doctor and dialysis staff. You can avoid
many side effects if you follow a proper diet, limit your liquid
intake, and take your medicines as directed.
Diet for Hemodialysis
Hemodialysis and a proper diet help reduce the wastes that build up
in your blood. A dietitian is available at all dialysis centers to
help you plan meals according to your doctor's orders.
When choosing
foods, you should remember to:
- Eat balanced amounts of high-protein foods such as meat, chicken,
and fish.
- Control the amount of potassium you eat. Potassium is a mineral
found in salt substitutes, some fruits (bananas, oranges),
vegetables, chocolate, and nuts. Too much potassium can be
dangerous.
- Limit how much you drink. When your kidneys aren't working, water
builds up quickly in your body. Too much liquid makes your tissues
swell and can lead to high blood pressure, heart trouble, and
cramps and low blood pressure during dialysis.
- Avoid salt. Salty foods make you thirsty and make your body hold
water.
- Limit foods such as milk, cheese, nuts, dried beans, and dark
colas. These foods contain large amounts of the mineral
phosphorus. Too much phosphorus in your blood causes calcium to be
pulled from your bones, which makes them weak and brittle and can
cause arthritis. To prevent bone problems, your doctor may give
you special medicines, which you must take with meals every day as
directed.
For more information about choosing the right foods, see the NIDDK
booklet Eat Right to Feel Right on Hemodialysis.
Pros and Cons
Each person responds differently to similar situations. What may be
a negative factor for one person may be positive for another. See a
list of the general advantages and disadvantages of in-center and
home hemodialysis below.
In-Center Hemodialysis
Pros
- Facilities are widely available.
- You have trained professionals with you
at all times.
- You can get to know other patients.
Cons
- Treatments are scheduled by the center and are
relatively fixed.
- You must travel to the center for treatment.
Home Hemodialysis
Pros
- You can do it at the times you choose (but you still
must do it as often as your doctor orders).
- You don't have to travel to a center.
- You gain a sense of independence and control
over your treatment.
Cons
- You must have a helper.
- Helping with treatments may be stressful to
your family.
- You and your helper need training.
- You need space for storing the machine
and supplies at home.
Working With Your Health Care Team
Questions you may want to ask:
- Is hemodialysis the best treatment choice for me? Why?
- If I'm treated at a center, can I go to the center of my choice?
- What should I look for in a dialysis center?
- Will my kidney doctor see me at dialysis?
- What does hemodialysis feel like?
- What is self-care dialysis?
- Is home hemodialysis available in my area? How long does it take
to learn? Who will train my partner and me?
- What kind of blood access is best for me?
- As a hemodialysis patient, will I be able to keep working? Can I
have treatments at night?
- How much should I exercise?
- Who will be on my health care team? How can these people help me?
- Whom can I talk with about finances, sexuality, or family
concerns?
- How/where can I talk to other people who have faced this decision?
For more information about hemodialysis, see the NIDDK booklet
Treatment Methods for Kidney Failure: Hemodialysis. Or see the chart
that summarizes three treatment options.
Back to top of page
Treatment Choice: Peritoneal Dialysis
Purpose
Peritoneal dialysis is another procedure that removes extra water,
wastes, and chemicals from your body. This type of dialysis uses the
lining of your abdomen to filter your blood. This lining is called
the peritoneal membrane and acts as the artificial kidney.
How It Works
A mixture of minerals and sugar dissolved in water, called dialysis
solution, travels through a soft tube into your abdomen. The sugar,
called dextrose, draws wastes, chemicals, and extra water from the
tiny blood vessels in your peritoneal membrane into the dialysis
solution. After several hours, the used solution is drained from
your abdomen through the tube, taking the wastes from your blood
with it. Then you fill your abdomen with fresh dialysis solution,
and the cycle is repeated. Each cycle is called an exchange.
Peritoneal Dialysis.
Getting Ready
Before your first treatment, a surgeon places a small, soft tube
called a catheter into your abdomen. The catheter tends to work
better if there is adequate time--usually from 10 days to 2 or 3
weeks--for the insertion site to heal. This is another way in which
planning your dialysis access can improve treatment success. This
catheter stays there permanently to help transport the dialysis
solution to and from your abdomen.
Types of Peritoneal Dialysis
There are three types of peritoneal dialysis.
- Continuous Ambulatory Peritoneal Dialysis (CAPD)
CAPD is the most common type of peritoneal dialysis. It requires no
machine and can be done in any clean, well-lit place. With CAPD,
your blood is always being cleaned. The dialysis solution passes
from a plastic bag through the catheter and into your abdomen, where
it stays for several hours with the catheter sealed. The period that
dialysis solution is in your abdomen is called the dwell time. Next,
you drain the dialysis solution back into the bag for disposal. You
then use the same catheter to refill your abdomen with fresh
dialysis solution so the cleaning process can begin again. With
CAPD, the dialysis solution stays in your abdomen for a dwell time
of 4 to 6 hours (or more). The process of draining the used dialysis
solution and replacing it with fresh solution takes about 30 to 40
minutes. Most people change the dialysis solution at least four
times a day and sleep with solution in their abdomen at night. With
CAPD, it's not necessary to wake up and perform dialysis tasks
during the night.
- Continuous Cycler-Assisted Peritoneal Dialysis (CCPD)
CCPD uses a machine called a cycler to fill and empty your abdomen
three to five times during the night while you sleep. In the
morning, you begin one exchange with a dwell time that lasts the
entire day. You may do an additional exchange in the middle of the
afternoon without the cycler to increase the amount of waste removed
and to reduce the amount of fluid left behind in your body.
- Combination of CAPD and CCPD
If you weigh more than 175 pounds or if your peritoneum filters
wastes slowly, you may need a combination of CAPD and CCPD to get
the right dialysis dose. For example, some people use a cycler at
night but also perform one exchange during the day. Others do four
exchanges during the day and use a minicycler to perform one or more
exchanges during the night. You'll work with your health care team
to determine the best schedule for you.
Who Performs It
Both types of peritoneal dialysis are usually performed by the
patient without help from a partner. CAPD is a form of
self-treatment that needs no machine. However, with CCPD, you need a
machine to drain and refill your abdomen.
Possible Complications
The most common problem with peritoneal dialysis is peritonitis, a
serious abdominal infection. This infection can occur if the opening
where the catheter enters your body becomes infected or if
contamination occurs as the catheter is connected or disconnected
from the bags. Peritonitis requires antibiotic treatment by your
doctor.
To avoid peritonitis, you must be careful to follow procedures
exactly and learn to recognize the early signs of peritonitis, which
include fever, unusual color or cloudiness of the used fluid, and
redness or pain around the catheter. Report these signs to your
doctor immediately so that peritonitis can be treated quickly to
avoid serious problems.
Diet for Peritoneal Dialysis
A peritoneal dialysis diet is slightly different from a hemodialysis
diet.
- You'll still need to limit salt and liquids, but you may be able
to have more of each, compared with hemodialysis.
- You must eat more protein.
- You may have different restrictions on potassium.
- You may need to cut back on the number of calories you eat because
there are calories in the dialysis fluid that may cause you to
gain weight.
Your doctor and a dietitian who specializes in helping people with
kidney failure will be able to help you plan your meals.
Pros and Cons
Each type of peritoneal dialysis has advantages and disadvantages.
CAPD
Pros
- You can do it alone.
- You can do it at times you choose as long as you
perform the required number of exchanges
each day.
- You can do it in many locations.
- You don't need a machine.
Cons
- It can disrupt your daily schedule.
- This is a continuous treatment, and all exchanges
must be performed 7 days a week.
CCPD
Pros
- You can do it at night, mainly while you sleep.
Working With Your Health Care Team
Questions you may want to ask:
- Is peritoneal dialysis the best treatment choice for me? Why? If
yes, which type is best?
- How long will it take me to learn how to do peritoneal dialysis?
- What does peritoneal dialysis feel like?
- How will peritoneal dialysis affect my blood pressure?
- How will I know if I have peritonitis? How is it treated?
- As a peritoneal dialysis patient, will I be able to continue
working?
- How much should I exercise?
- Where do I store supplies?
- How often do I see my doctor?
- Who will be on my health care team? How can these people help me?
- Whom do I contact with problems?
- Whom can I talk with about finances, sexuality, or family
concerns?
- How/where can I talk to other people who have faced this decision?
For more information about peritoneal dialysis, see the NIDDK
booklet Treatment Methods for Kidney Failure: Peritoneal Dialysis.
Or see the chart that summarizes three treatment options.
Dialysis Is Not a Cure
Hemodialysis and peritoneal dialysis are treatments that help
replace the work your kidneys did. These treatments help you feel
better and live longer, but they don't cure kidney failure. Although
patients with kidney failure are now living longer than ever, over
the years kidney disease can cause problems such as heart disease,
bone disease, arthritis, nerve damage, infertility, and
malnutrition. These problems won't go away with dialysis, but
doctors now have new and better ways to prevent or treat them. You
should discuss these complications and treatments with your doctor.
Back to top of page
Treatment Choice: Kidney Transplantation
Purpose
Kidney transplantation surgically places a healthy kidney from
another person into your body. The donated kidney does the work that
your two failed kidneys used to do.
How It Works
A surgeon places the new kidney inside your lower abdomen and
connects the artery and vein of the new kidney to your artery and
vein. Your blood flows through the donated kidney, which makes
urine, just like your own kidneys did when they were healthy. The
new kidney may start working right away or may take up to a few
weeks to make urine. Unless your own kidneys are causing infection
or high blood pressure, they are left in place.
Kidney transplantation.
Getting Ready
The transplantation process has many steps. First, talk with your
doctor, because transplantation isn't for everyone. Your doctor may
tell you that you have a condition that would make transplantation
dangerous or unlikely to succeed.
You may receive a kidney from a member of your family (living,
related donor), from a person who has recently died (deceased
donor), or sometimes from a spouse or a very close friend (living,
unrelated donor). If you don't have a living donor, you're placed on
a waiting list for a deceased donor kidney. The wait for a deceased
donor kidney can be several years.
The transplant team considers three factors in matching kidneys with
potential recipients. These factors help predict whether your body's
immune system will accept the new kidney or reject it.
- Blood type. Your blood type (A, B, AB, or O) must be compatible
with the donor's. This is the most important matching factor.
- Human leukocyte antigens (HLAs). Your cells carry six important
HLAs, three inherited from each parent. Family members are most
likely to have a complete match. You may still receive a kidney if
the HLAs aren't a complete match as long as your blood type
matches the organ donor's and other tests are negative.
- Cross-matching antigens. The last test before implanting an organ
is the cross-match. A small sample of your blood will be mixed
with a sample of the organ donor's blood in a tube to see if
there's a reaction. If no reaction occurs, the result is called a
negative cross-match, and the transplant operation can proceed.
The Time It Takes
How long you'll have to wait for a kidney varies. Because there
aren't enough deceased donors for every person who needs a
transplant, you must be placed on a waiting list. However, if a
voluntary donor gives you a kidney, the transplant can be scheduled
as soon as you're both ready. Avoiding the long wait is a major
advantage of living donation.
The surgery takes 3 to 4 hours. The usual hospital stay is about a
week. After you leave the hospital, you'll have regular followup
visits.
If someone has given you a kidney, the donor will probably stay in
the hospital about the same amount of time. However, a new technique
for removing a kidney for donation uses a smaller incision and may
make it possible for the donor to leave the hospital in 2 to 3 days.
Between 85 and 90 percent of transplants from deceased donors are
working 1 year after surgery. Transplants from living relatives
often work better than transplants from deceased donors because
they're usually a closer match.
Possible Complications
Transplantation is the closest thing to a cure. But no matter how
good the match, your body may reject your new kidney. A common cause
of rejection is not taking medication as prescribed.
Your doctor will give you drugs called immunosuppressants to help
prevent your body's immune system from attacking the kidney, a
process called rejection. You'll need to take immunosuppressants
every day for as long as the transplanted kidney is functioning.
Sometimes, however, even these drugs can't stop your body from
rejecting the new kidney. If this happens, you'll go back to some
form of dialysis and possibly wait for another transplant.
Immunosuppressants can weaken your immune system, which can lead to
infections. Some drugs may also change your appearance. Your face
may get fuller; you may gain weight or develop acne or facial hair.
Not all patients have these problems, though, and diet and makeup
can help.
Immunosuppressants work by diminishing the ability of immune cells
to function. In some patients, over long periods of time, this
diminished immunity can increase the risk of developing cancer. Some
immunosuppressants can cause cataracts, diabetes, extra stomach
acid, high blood pressure, and bone disease. When used over time,
these drugs may also cause liver or kidney damage in a few patients.
Diet for Transplantation
Diet for transplant patients is less limited than it is for dialysis
patients, although you may still have to cut back on some foods.
Your diet will probably change as your medicines, blood values,
weight, and blood pressure change.
- You may need to count calories. Your medicine may give you a
bigger appetite and cause you to gain weight.
- You may have to eat less salt. Your medications may cause your
body to retain sodium, leading to high blood pressure.
Pros and Cons
Kidney transplantation has advantages and disadvantages. See the
list below.
Kidney Transplantation
Pros
- A transplanted kidney works like a normal kidney.
- You may feel healthier or "more normal."
- You have fewer diet restrictions.
- You won't need dialysis.
- Patients who successfully go through the selection
process have a higher chance of living
a longer life.
Cons
- It requires major surgery.
- You may need to wait for a donor.
- Your body may reject the new kidney, so one
transplant may not last a lifetime.
- You'll need to take immunosuppressants,
which may cause complications.
Working With Your Health Care Team
Questions you may want to ask:
- Is transplantation the best treatment choice for me? Why?
- What are my chances of having a successful transplant?
- How do I find out whether a family member or friend can donate?
- What are the risks to a family member or friend who donates?
- If a family member or friend doesn't donate, how do I get placed
on a waiting list for a kidney? How long will I have to wait?
- What symptoms does rejection cause?
- How long does a transplant work?
- What side effects do immunosuppressants cause?
- Who will be on my health care team? How can these people help me?
- Whom can I talk to about finances, sexuality, or family concerns?
- How or where can I talk to other people who have faced this
decision?
For more information about transplantation, see the NIDDK booklet
Treatment Methods for Kidney Failure: Kidney Transplantation. Or see
the chart that summarizes three treatment options.
Back to top of page
Treatment Choice: Refusing or Withdrawing From Treatment
For many people, dialysis and transplantation not only extend life
but also improve quality of life. For others who have serious
ailments in addition to kidney failure, dialysis may seem a burden
that only prolongs suffering. You have the right to refuse or
withdraw from dialysis if you feel you have no hope of leading a
life with dignity and meaning. You may want to speak with your
spouse, family, religious counselor, or social worker as you make
this decision.
If you withdraw from dialysis treatments or refuse to begin them,
you may live for a few days or for several weeks, depending on your
health and your remaining kidney function. Your doctor can give you
medicines to make you more comfortable during this period. Should
you change your mind about refusing dialysis, you may start or
resume your treatments at any time.
Even if you're satisfied with your quality of life on dialysis, you
should think about circumstances that might make you want to stop
dialysis treatments. At some point in a medical crisis, you might
lose the ability to express your wishes to your doctor. An advance
directive is a statement or document in which you give instructions
either to withhold treatment or to provide it, depending on your
wishes and the specific circumstances.
An advance directive may be a living will, a document that details
the conditions under which you would want to refuse treatment. You
may state that you want your health care team to use all available
means to sustain your life. Or you may direct that you be withdrawn
from dialysis if you become permanently unresponsive or fall into a
coma from which you won't awake. In addition to dialysis, other
life-sustaining treatments that you may choose or refuse include:
- cardiopulmonary resuscitation (CPR)
- tube feedings
- mechanical or artificial respiration
- antibiotics
- surgery
- blood transfusions
Another form of advance directive is called a durable power of
attorney for health care decisions or a health care proxy. In this
type of advance directive, you assign a person to make health care
decisions for you if you become unable to make them for yourself.
Make sure the person you name understands your values and is willing
to follow through on your instructions.
Each State has its own laws governing advance directives. You can
obtain a form for an advance medical directive that's valid in your
State from Partnership for Caring (see the Resources section).
Back to top of page
Paying for Treatment
Treatment for kidney failure is expensive, but Federal health
insurance plans pay much of the cost, usually up to 80 percent.
Often, private insurance or State programs pay the rest. For more
information, see the NIDDK fact sheet Financial Help for Treatment
of Kidney Failure.
Back to top of page
Conclusion
Deciding which type of treatment is best for you isn't easy. Your
decision depends on your medical condition, lifestyle, and personal
likes and dislikes. Discuss the pros and cons of each treatment with
your health care team and family. You can switch between treatment
methods during the course of your therapy. If you start one form of
treatment and decide you'd like to try another, talk to your doctor.
The key is to learn as much as you can about your choices first.
With that knowledge, you and your doctor will choose the treatment
that suits you best.
Back to top of page
Resources
Organizations That Can Help
Additional Reading
If you would like to learn more about kidney failure and its
treatment, you may be interested in reading
AAKP Patient Plan
This is a series of booklets and newsletters that cover the
different phases of learning about kidney failure, choosing a
treatment, and adjusting to changes.
- American Association of Kidney Patients
3505 East Frontage Road
Suite 315
Tampa, FL 33607
Phone: 1-800-749-2257
Email: info@aakp.org
Internet: www.aakp.org
- Kidney Disease: A Guide for Patients and Their Families
American Kidney Fund
6110 Executive Boulevard
Suite 1010
Rockville, MD 20852
Phone: 1-800-638-8299 or (301) 881-3052
Email: helpline@akfinc.org
Internet: www.kidneyfund.org
- Medicare Coverage of Kidney Dialysis and Kidney Transplant Services
Publication Number CMS-10128
U.S. Department of Health and Human Services
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244-1850
Phone: 1-800-MEDICARE (1-800-633-4227)
TDD: 1-877-486-2048
Internet: www.medicare.gov/publications/pubs/pdf/esrdcoverage.pdf
- National Kidney Foundation (NKF) Patient Education Brochures
(includes materials based on NKF's Dialysis Outcomes Quality
Initiative)
National Kidney Foundation Inc.
30 East 33rd Street
Suite 1100
New York, NY 10016
Phone: 1-800-622-9010 or (212) 889-2210
Internet: www.kidney.org
- Newsletters and Magazines
Family Focus Newsletter (published quarterly)
National Kidney Foundation Inc.
30 East 33rd Street
Suite 1100
New York, NY 10016
Phone: 1-800-622-9010 or (212) 889-2210
Internet: www.kidney.org
- For Patients Only (published six times a year)
ATTN: Subscription Department
18 East 41st Street
20th Floor
New York, NY 10017-6222
- Renalife (published quarterly)
American Association of Kidney Patients
3505 East Frontage Road
Suite 315
Tampa, FL 33607
Phone: 1-800-749-2257
Email: info@aakp.org
Internet: www.aakp.org
Back to top of page
Acknowledgments
The National Institute of Diabetes and Digestive and Kidney Diseases
thanks these dedicated health professionals for their careful review
of this publication.
- William Owen Jr., M.D.
Duke University Medical Center
- Richard D. Swartz, M.D.
University of Michigan Health System
The individuals listed here facilitated field testing for this
publication. NIDDK thanks them for their contribution.
- Kim Bayer, M.A., R.D., L.D.
BMA Dialysis
Bethesda, MD
- Cora Benedicto, R.N.
Clinic Director
Gambro Health Care
N Street Clinic
Washington, DC
The U.S. Government does not endorse or favor any specific
commercial product or company. Trade, proprietary, or company names
appearing in this document are used only because they are considered
necessary in the context of the information provided. If a product
is not mentioned, this does not mean or imply that the product is
unsatisfactory.
Back to top of page
About the Kidney Failure Series
You and your doctor will work together to choose a treatment that's
best for you. The publications of the NIDDK Kidney Failure Series
can help you learn about the specific issues you will face.
Booklets
- Kidney Failure: Choosing a Treatment That's Right for You
- Treatment Methods for Kidney Failure: Hemodialysis
- Treatment Methods for Kidney Failure: Peritoneal Dialysis
- Treatment Methods for Kidney Failure: Transplantation
- Eat Right to Feel Right on Hemodialysis
- Kidney Failure Glossary
Fact Sheets
- Vascular Access for Hemodialysis
- Hemodialysis Dose and Adequacy
- Peritoneal Dialysis Dose and Adequacy
- Amyloidosis and Kidney Disease
- Anemia in Kidney Disease and Dialysis
- Renal Osteodystrophy
- Financial Help for Treatment of Kidney Failure
Learning as much as you can about your treatment will help make you
an important member of your health care team.
NIDDK will develop additional materials for this series as needed.
Please address any comments about this series and requests for
copies to the National Kidney and Urologic Diseases Information
Clearinghouse. Descriptions of the publications in this series are
available at
http://kidney.niddk.nih.gov/kudiseases/pubs/kidneyfailure/index.htm
on the Internet.
National Kidney and Urologic Diseases Information Clearinghouse
3 Information Way
Bethesda, MD 20892-3580
Email: nkudic@info.niddk.nih.gov
The National Kidney and Urologic Diseases Information Clearinghouse
(NKUDIC) is a service of the National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the
National Institutes of Health under the U.S. Department of Health
and Human Services. Established in 1987, the clearinghouse provides
information about diseases of the kidneys and urologic system to
people with kidney and urologic disorders and to their families,
health care professionals, and the public. NKUDIC answers inquiries,
develops and distributes publications, and works closely with
professional and patient organizations and Government agencies to
coordinate resources about kidney and urologic diseases.
Publications produced by the clearinghouse are carefully reviewed by
both NIDDK scientists and outside experts.
This e-text is not copyrighted. The clearinghouse encourages users
of this e-pub to duplicate and distribute as many copies as desired.
NIH Publication No. 03-2412
April 2003
The NKUDIC Clearinghouse is a service of the National Institute of
Diabetes and Digestive and Kidney Diseases, National Institutes of Health
National Kidney and Urologic Diseases Information Clearinghouse
3 Information Way
Bethesda, MD 20892-3580
Phone: 1-800-891-5390
Fax: 703-738-4929
Email: nkudic@info.niddk.nih.gov
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