Best Care For Best Outcome

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01 Jun 2009

Itching Symptoms

The renal itch affects 50-90% of patients undergoing dialysis. Symptoms may start before, at the time of the start of dialysis, or many months thereafter. It may be localized or rather generalized. The mechanisms underlying itching are poorly understood, but may be high levels of calcium, phosphorus or parathyroid hormone, dry skin, allergic reactions mostly to sterilizing agents used for dialysis, too much vitamin A or iron deficiency.

The cornerstone of therapy is regular, intensive, efficient dialysis. This translates into 4-5 hours of dialysis three times per week. This would be particularly important in your case, if you still had some residual kidney function until one of your kidneys was removed.

There are many treatment options and you should seek the advice from your Nephrologist what measure would suit you best. And as hope springs eternal: In up to 20% of symptomatic patients itching disappears spontaneously and it would be definitely gone after a successful renal transplantation

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30 May 2009

Caring For Your Access

Whether your access is a fistula, graft or catheter, you should make sure to take good care of it. Your dialysis care team will teach you the steps of good access care. The chart below gives you some general tips about everyday access care and how to prevent problems.

Fistula or Graft

  • Wash with an antibacterial soap each day, and always before dialysis.
  • Do not scratch your skin or pick scab.
  • Check for redness, a feeling of excess warmth or the beginning of a pimple on any area of your access.
  • Ask your dialysis care team to rotate the needles when you have your dialysis treatment.

Catheter

  • Keep catheter dressing clean and dry.
  • Make sure the area of the access is cleaned and the dressing is changed by your care team at each dialysis session.
  • Keep an emergency dressing kit at home in case you need to change your dressing between treatments.
  • Never open your catheter to the air.

Keeping Your Access Working

Your dialysis care team will check your access often to make sure it is working well. An access that is not working well can decrease the amount of dialysis you receive. Your dialysis care team will teach you how to check your fistula or graft at home each day. Here are some tips you should follow to help keep a fistula or graft working longer:

  1. Check the blood flow several times each day by feeling for a vibration, also called a pulse or thrill. If you do not feel this, or if there is a change, call your doctor or your dialysis center.
  2. Do not wear tight clothes or jewelry on your access arm.
  3. Do not carry anything heavy or do anything that would put pressure on the access.
  4. Do not sleep with your head on the arm that has your access.
  5. Do not let anyone use a blood pressure cuff on your access arm.
  6. Do not let anyone draw blood from your access arm.
  7. Do not be afraid to ask your dialysis care team to rotate needle sites.
  8. Apply only gentle pressure to the access site after the needle is removed. Too much pressure will stop the flow of blood through the access.
  9. If you have breakthrough bleeding after you have dialysis, apply gentle pressure to the needle site with a clean towel or gauze pad. If the bleeding does not stop in 30 minutes, call your doctor or your dialysis center.

If Access Problems Occur

Sometimes, even when you are very careful, your access may clot or become infected. If an infection occurs, your doctor will order antibiotics for you. If your access develops a clot, you may need to go to the hospital for treatment. Removing the clot can usually be done on an outpatient basis, and you will not need to stay overnight.

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15 May 2009

What Is URR

URR (Urea Reduction Ratio) is one way to find out how much cleaner your blood is after dialysis. This is known as dialysis adequacy. A blood test that measures the blood urea nitrogen (BUN) is done at the beginning and at the end of your hemodialysis treatment.

The amount of urea in these two blood samples is compared to see how much was removed during dialysis. Although urea is just one of the body’s waste products, how effectively it is removed indicates how well other waste products have been removed. So, if you have a URR of 65%, it means your blood is 65% cleaner than when you started this dialysis treatment.

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01 May 2009

What is Kt/V

Kt/V (pronounced kay tee over vee) is a number used to quantify hemodialysis and peritoneal dialysis treatment adequacy (to measure how effective a haemodialysis treatment is). It is based on tests of blood urea, by measuring the levels before and after treatment, to show how much has been removed.

The minimum target for Kt/V is 1.2. This applies to patient who receive dialysis three times each week. A slightly lower value may be OK if you still have some function from your own kidneys.

Causes of low Kt/V include:

  • Dialysis treatment too short (less than four hours)
  • Problems with blood flow or recirculation at vascular access
  • Artificial kidney (dialyzer) too small

How to improve Kt/V and/or dialysis dose – possibilities include

  • Longer dialysis
  • Better access (fistula or line)
  • A larger artificial kidney may help if blood flow is good
  • More frequent dialysis (e.g. 4 times per week instead of 3)
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30 Apr 2009

Dialysis Measurement

To ensure that you are getting enough dialysis:

  • your Kt/V should be at least 1.2
  • your URR should be at least 65 percent
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15 Apr 2009

Complications In Dialysis

One of the most common complications related to hemodialysis is trouble with vascular access. Other complications are infection, blockage of the tubes from blood clotting and poor blood flow. All of these can disrupt the process of hemodialysis, especially if accessing veins and arteries becomes a problem because that can take time and surgery to correct.

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01 Apr 2009

How Does The Dialyzer Work

A dialyzer is an artificial kidney designed to provide controllable transfer of solutes and water across a semi permeable membrane separating flowing blood and dialysate streams. The transfer processes are diffusion (dialysis) and convection (ultrafiltration*).

Blood cells, protein and other important things remain in your blood because they are too big to pass through the membrane. Smaller waste products in the blood, such as urea, creatinine, potassium and extra fluid pass through the membrane and are washed away.

*Ultra filtration: All excess fluid must be removed from the bloodstream as the patient’s blood flows through the dialyzer. The process of water removal from the bloodstream is called ultra filtration, and the amount of fluid removed is the ultra filtrate.

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30 Mar 2009

Hemodialysis Treatments

The time needed for your dialysis treatments depends on:

  • how well your kidneys work
  • how much fluid weight you gain between treatments
  • how much waste you have in your body
  • how big you are
  • the type of artificial kidney used

In hemodialysis, your blood is allowed to flow, a few ounces at a time, through a special filter (dialyzer) that removes wastes and extra fluids. The clean blood is then returned to your body. Removing the harmful wastes and extra salt and fluids helps control your blood pressure and keep the proper balance of chemicals like potassium and sodium in your body. One of the biggest adjustments you must make when you start hemodialysis treatments is following a strict schedule.

Most patients go to a dialysis center— three times a week for four hours each visit. For example, you may be on a Saturday – Monday – Wednesday schedule or a Sunday – Tuesday – Thursday schedule. You may be asked to choose a morning, afternoon, or evening shift, depending on availability and capacity at the dialysis unit. Your dialysis center will explain your options for scheduling regular treatments.

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15 Mar 2009

Venous Catheter

A catheter is a tube inserted into a vein in your neck, chest, or leg near the groin. It has two chambers to allow a two-way flow of blood. Once a catheter is placed, needle insertion is not necessary.

Catheters are not ideal for permanent access. They can clog, become infected, and cause narrowing of the veins in which they are placed. But if you need to start hemodialysis immediately, a catheter will work for several weeks or months while your permanent access develops.

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01 Mar 2009

Arteriovenous Grafts

AV (arteriovenous) grafts are much like fistulas in most respects, except that an artificial vessel is used to join the artery and vein. The graft usually is made of a synthetic material, often PTFE, but sometimes chemically treated, sterilized veins from animals are used. Grafts are inserted when the patient’s native vasculature does not permit a fistula. They mature faster than fistulas, and may be ready for use several weeks after formation (some newer grafts may be used even sooner).

However, AV grafts are at high risk to develop narrowing, especially in the vein just downstream from where the graft has been sewn to the vein. Narrowing often leads to clotting or thrombosis. As foreign material, they are at greater risk for becoming infected. More options for sites to place a graft are available, because the graft can be made quite long. Thus a graft can be placed in the thigh or even the neck (the ‘necklace graft’).

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Latest Posts

Itching Symptoms

The renal itch affects 50-90% of patients undergoing dialysis. Symptoms may start before, at the time of the (more…)

Caring For Your Access

Whether your access is a fistula, graft or catheter, you should make sure to take good care of (more…)

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