Kidney failure: choosing a treatment that's right for you.Introduction When Your Kidneys Fail Treatment Choice: Hemodialysis hemodialysis /he·mo·di·al·y·sis/ (-di-al´i-sis) removal of certain elements from the blood by virtue of the difference in rates of their diffusion through a semipermeable membrane while being circulated outside the body; the process Treatment Choice: Peritoneal Dialysis peritoneal dialysis n. The removal of soluble substances and water from the body by transfer across the peritoneum, utilizing a solution which is intermittently introduced into and removed from the peritoneal cavity. Treatment Choice: Kidney Transplantation Kidney Transplantation Definition Kidney transplantation is a surgical procedure to remove a healthy, functioning kidney from a living or brain-dead donor and implant it into a patient with non-functioning kidneys. Treatment Choice: Refusing or Withdrawing From Treatment Paying for Treatment Conclusion Resources Acknowledgments About the Kidney Failure kidney failure or renal failure Partial or complete loss of kidney function. Acute failure causes reduced urine output and blood chemical imbalance, including uremia. Most patients recover within six weeks. Series Introduction 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 Red blood cells Cells that carry hemoglobin (the molecule that transports oxygen) and help remove wastes from tissues throughout the body. Mentioned in: Bone Marrow Transplantation red blood cells . When this happens, you need treatment to replace the work of your failed kidneys. 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 bicarbonate or hydrogen carbonate, chemical compound containing the bicarbonate radical, -HCO3. The most familiar of such compounds is sodium bicarbonate (baking soda). See carbonate. . How It Works Hemodialysis uses a special filter called a dialyzer dialyzer /di·a·lyz·er/ (di´ah-liz?er) hemodialyzer. di·a·lyz·er n. 1. A machine equipped with a semipermeable membrane and used for performing dialysis. 2. that functions as an artificial kidney artificial kidney: see kidney, artificial. 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. [ILLUSTRATION OMITTED] 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 If you choose hemodialysis, several months before your first treatment, an access to your bloodstream blood·stream n. The flow of blood through the circulatory system of an organism. bloodstream the blood flowing through the circulatory system in the living body. 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 dialysis (dīăl`ĭsĭs), in chemistry, transfer of solute (dissolved solids) across a semipermeable membrane. Strictly speaking, dialysis refers only to the transfer of the solute; transfer of the solvent is called osmosis. machine and back without causing discomfort. The two main types of access are a fistula fistula (fĭs`ch  lə), abnormal, usually ulcerous channellike formation between two internal organs or between an internal organ and the skin. and a graft.* A surgeon makes a fistula by using your own blood vessels Blood vessels Tubular channels for blood transport, of which there are three principal types: arteries, capillaries, and veins. Only the larger arteries and veins in the body bear distinct names. ; an artery is connected directly to a vein, usually in your forearm forearm /fore·arm/ (for´ahrm) antebrachium; the part of the arm between elbow and wrist. fore·arm n. The part of the arm between the wrist and the elbow. . 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. [ILLUSTRATION OMITTED] * 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 clotting /clot·ting/ (klot´ing) coagulation (1). clotting the formation of a jellylike substance over the ends or within the walls of a blood vessel, with resultant stoppage of the blood flow. . Needles are placed into the access to draw out the blood. You'll be given a local anesthetic local anesthetic n. An agent that, when applied directly to mucous membranes or when injected about the nerves, produces loss of sensation by inhibiting nerve excitation or conduction. to minimize any pain during dialysis. [ILLUSTRATION OMITTED] If your kidney disease Kidney Disease Definition Kidney disease is a general term for any damage that reduces the functioning of the kidney. Kidney disease is also called renal disease. has progressed quickly, you may not have time to get a permanent vascular access vascular access Clinical medicine The ability to enter the vascular system; the ease with which the vascular system can be entered for administering therapy or obtaining blood for testing before you start hemodialysis treatments. You may need to use a catheter catheter /cath·e·ter/ (kath´e-ter) 1. a tubular, flexible surgical instrument that is inserted into a cavity of the body to withdraw or introduce fluid. 2. urethral c. , 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. [ILLUSTRATION OMITTED] For more information about vascular access, see the National Institute of Diabetes and Digestive and Kidney Diseases About NIDDK The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), of the U.S. National Institutes of Health, conducts and supports research on many of the most serious diseases affecting public health. (NIDDK NIDDK National Institute of Diabetes and Digestive and Kidney Diseases ) 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 hospitalization /hos·pi·tal·iza·tion/ (hos?pi-t'l-i-za´shun) 1. the placing of a patient in a hospital for treatment. 2. the term of confinement in a hospital. among people on hemodialysis. Common problems include infection, blockage blockage of intestine, urethra, etc. See obstruction under anatomical location, e.g. intestinal, urethral. blockage Wax, see there 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 hypotension or low blood pressure Condition in which blood pressure is abnormally low. It may result from reduced blood volume (e.g., from heavy bleeding or plasma loss after severe burns) or increased blood-vessel capacity (e.g., in syncope). , or a sudden drop in blood pressure, are two common side effects Side effects Effects of a proposed project on other parts of the firm. . 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 dietitian /di·e·ti·tian/ (di?e-tish´in) one skilled in the use of diet in health and disease. di·e·ti·tian or di·e·ti·cian n. A person specializing in dietetics. is available at all dialysis centers to help you plan meals according to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. your doctor's orders "Doctor's Orders" is the title of an episode from the third season of the television series . Its episode number is 068, and it first aired on 18 February 2004. Plot summary This is a summary of the beginning portion of the episode. . 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 salt·y adj. salt·i·er, salt·i·est 1. Of, containing, or seasoned with salt. 2. Suggestive of the sea or sailing life. 3. Witty; pungent; earthy: salty humor. foods make you thirsty thirst·y adj. thirst·i·er, thirst·i·est 1. Desiring to drink. 2. Arid; parched: thirsty fields. 3. Craving something: thirsty for news. 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 phosphorus (fŏs`fərəs) [Gr.,=light-bearing], nonmetallic chemical element; symbol P; at. no. 15; at. wt. 30.97376; m.p. 44.1°C;; b.p. about 280°C;; sp. gr. 1.82 at 20°C;; valence −3, +3, or +5. . Too much phosphorus in your blood causes calcium to be pulled from your bones, which makes them weak and brittle (jargon) brittle - Said of software that is functional but easily broken by changes in operating environment or configuration, or by any minor tweak to the software itself. Also, any system that responds inappropriately and disastrously to abnormal but expected external stimuli; e. 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 pros and cons Noun, pl the advantages and disadvantages of a situation [Latin pro for + con(tra) against] 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 Home hemodialysis (HHD), is the provision of hemodialysis at the home of the patient with end-stage renal failure. In most centres, it is for patients who are not candidates for a renal transplant, but fit enough to manage a hemodialysis machine at home. 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. 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 abdomen, in humans and other vertebrates, portion of the trunk between the diaphragm and lower pelvis. In humans the wall of the abdomen is a muscular structure covered by fascia, fat, and skin. to filter your blood. This lining is called the peritoneal peritoneal /peri·to·ne·al/ (per?i-to-ne´al) pertaining to the peritoneum. peritoneal pertaining to the peritoneum. 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 dextrose: see glucose. , 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. [ILLUSTRATION OMITTED] 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. 1. Continuous Ambulatory Peritoneal Dialysis continuous ambulatory peritoneal dialysis See Peritoneal dialysis. (CAPD CAPD Continuous/chronic ambulatory peritoneal dialysis. See Dialysis, Peritoneal dialysis. ) 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 The time cargo remains in a terminal's in-transit storage area while awaiting shipment by clearance transportation. See also storage. . Next, you drain the dialysis solution back into the bag for disposal. You then use the same catheter to refill refill noun A second allotment of a prescription agent obtained from a pharmacy, which is allowed by the original prescription verb Pharmacology To obtain more of a particular drug, after the initially prescribed amount of the agent has been used or 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. 2. Continuous Cycler-Assisted Peritoneal Dialysis (CCPD CCPD Continuous cycling peritoneal dialysis, see there ) 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. 3. Combination of CAPD and CCPD If you weigh more than 175 pounds or if your peritoneum peritoneum (pĕrətənē`əm), multilayered membrane which lines the abdominal cavity, and supports and covers the organs within it. The part of the membrane that lines the abdominal cavity is called the parietal peritoneum. filters wastes slowly, you may need a combination of CAPD and CCPD to get the fight 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 peritonitis (pĕr'ĭtənī`tĭs), acute or chronic inflammation of the peritoneum, the membrane that lines the abdominal cavity and surrounds the internal organs. , a serious abdominal infection. This infection can occur if the opening where the catheter enters your body becomes infected in·fect tr.v. in·fect·ed, in·fect·ing, in·fects 1. To contaminate with a pathogenic microorganism or agent. 2. To communicate a pathogen or disease to. 3. To invade and produce infection in. 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. See a list below. 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. Cons - You need a machine. 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 infertility, inability to conceive or carry a child to delivery. The term is usually limited to situations where the couple has had intercourse regularly for one year without using birth control. , and malnutrition malnutrition, insufficiency of one or more nutritional elements necessary for health and well-being. Primary malnutrition is caused by the lack of essential foodstuffs—usually vitamins, minerals, or proteins—in the diet. . 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. 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. [ILLUSTRATION OMITTED] 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 (cadaveric ca·dav·er n. A dead body, especially one intended for dissection. [Middle English, from Latin cad 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 cadaveric kidney. The wait for a cadaveric 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 immune system Cells, cell products, organs, and structures of the body involved in the detection and destruction of foreign invaders, such as bacteria, viruses, and cancer cells. Immunity is based on the system's ability to launch a defense against such invaders. will accept the new kidney or reject it. * Blood type. Your blood type (A, B, AB, or O) must match the donor's. This is the most important matching factor. * Human leukocyte antigens human leukocyte antigens See HLA. (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 cadaveric 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 follow-up 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 incision /in·ci·sion/ (in-sizh´un) 1. a cut or a wound made by cutting with a sharp instrument.incis´ional 2. the act of cutting. in·ci·sion n. 1. 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 cadaveric donors are working 1 year after surgery. Transplants from living relatives often work better than transplants from cadaveric 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 immunosuppressants, n.pl the agents that lower or reduce immune response; useful in organ transplant surgery to prevent organ rejection. Corticosteroid hormones given in large amounts; cytotoxic drugs, including antimetabolites and alkylating agents; 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 acne, common inflammatory disease of the hair follicles and sebaceous glands characterized by blackheads, whiteheads, pustules, nodules and, in the more severe forms, by cysts and scarring. The lesions appear on the face, neck, back, chest, and arms. or facial hair Noun 1. facial hair - hair on the face (especially on the face of a man) hair - a covering for the body (or parts of it) consisting of a dense growth of threadlike structures (as on the human head); helps to prevent heat loss; "he combed his hair"; "each 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 Cataracts Definition A cataract is a cloudiness or opacity in the normally transparent crystalline lens of the eye. This cloudiness can cause a decrease in vision and may lead to eventual blindness. , diabetes, extra stomach acid, high blood pressure, and bone disease. When used over time, these drugs may also cause liver or kidney damage kidney damage Kidney injury Nephrology A structural or functional compromise in renal function due to external–eg, athletic, occupational, or other trauma, resulting in bruising or hemorrhage, which can be profuse and life threatening Etiology Vascular 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. 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 Advance Directive A document expressing a person's wishes about critical care when he or she is unable to decide for him or herself. However, it does not authorize anyone to act on a person's behalf or make decisions the way a power of attorney would. 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 unresponsive Neurology adjective Referring to a total lack of response to neurologic stimuli or fall into a coma coma, in medicine coma, in medicine, deep state of unconsciousness from which a person cannot be aroused even by painful stimuli. The patient cannot speak and does not respond to command. from which you won't awake. In addition to dialysis, other life-sustaining treatments that you may choose or refuse include * Cardiopulmonary resuscitation cardiopulmonary resuscitation (CPR), emergency procedure used to treat victims of cardiac and respiratory arrest. CPR can be done in a hospital with drugs and special equipment or as a first-aid technique. (CPR Cardiopulmonary Resuscitation (CPR) Definition Cardiopulmonary resuscitation (CPR) is a procedure to support and maintain breathing and circulation for a person who has stopped breathing (respiratory arrest) and/or whose heart has stopped (cardiac ) * Tube feedings Tube Feedings Definition Nutrients, either a special liquid formula or pureed food, are delivered to a patient through a tube directly into the gastrointestinal tract, usually into the stomach or small intestine. * Mechanical or artificial respiration artificial respiration, any measure that causes air to flow in and out of a person's lungs when natural breathing is inadequate or ceases, as in respiratory paralysis, drowning, electric shock, choking, gas or smoke inhalation, or poisoning. * Antibiotics * Surgery * Blood transfusions blood transfusion, transfer of blood from one person to another, or from one animal to another of the same species. Transfusions are performed to replace a substantial loss of blood and as supportive treatment in certain diseases and blood disorders. Another form of advance directive is called a durable power of attorney durable power of attorney A legal document conveying authority to an individual to carry out legal affairs on another person's behalf. for health care decisions or a health care proxy health care proxy End-of-life A power of attorney for health-care decision-making in which a person designates another to make medical decisions in the event that he/she becomes too incapacitated to make such decisions. See Advance medical directive, Living will. . 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 advance medical directive Advance directive, see there that's valid in your State from Partnership for Caring (see the "Resources" section). 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. 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. Resources Organizations That Can Help American Association of Kidney Patients 100 South Ashley Drive Suite 280 Tampa, FL 33602 Phone: 1-800-749-2257 or (813) 223-7099 Email: AAKPnat@.aol.com Internet: www.aakp.org 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.akfinc.org Life Options Rehabilitation Program 603 Science Drive Madison, WI 53711-1074 Phone: 1-800-468-7777 or (608) 232-2333 Email: lifeoptions@medmed.com Internet: www.lifeoptions.org National Kidney Foundation, Inc. 30 East 33rd Street New York, NY 10016 Phone: 1-800-622-9010 or (212) 889-2210 Email: info@kidney.org Internet: www.kidney.org Partnership for Caring: America's Voices for the Dying 1035 30th Street, NW. Washington, DC 20007-3823 Phone: 1-800-989-9455 Internet: www.partnershipforcaring.org 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 100 South Ashley Drive Suite 280 Tampa, FL 33602 Phone: 1-800-749-2257 or (813) 223-7099 Email: AAKPnat@aol.com Internet: www.aakp.org Financing Transplantation: What Every Patient Needs To Know, 2nd edition, 1996 United Network for Organ Sharing 1100 Boulders Parkway Suite 500 P.O. Box 13770 Richmond, VA 23225-8770 Phone: 1-888-894-6361 to order single copies (804) 330-8541 to order bulk copies Internet: www.unos.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.akfinc.org Medicare Coverage of Kidney Dialysis and Kidney Transplant Services: A Supplement to Your Medicare Handbook Publication Number HCFA-10128 U.S. Department of Health and Human Services Health Care Financing Administration 7500 Security Boulevard Baltimore, MD 21244-1850 Phone: 1-800-MEDICARE (1-800-633-4227) TDD: 1-877-486-2048 Internet: http://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 New York, NY 10016 Phone: 1-800-622-9010 or (212) 889-2210 Internet: www.kidney.org What Every Patient Needs To Know, 1997 United Network for Organ Sharing 1100 Boulders Parkway Suite 500 P.O. Box 13770 Richmond, VA 23225-8770 Phone: 1-888-894-6361 to order single copies (804) 330-8541 to order bulk copies Internet: www.unos.org Newsletters and Magazines Family Focus Newsletter (published quarterly) National Kidney Foundation, Inc. 30 East 33rd Street New York, NY 10016 Phone: 1-800-622-9010 or (212) 889-2210 Email: info@kidney.org Interact: 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 100 South Ashley Drive Suite 280 Tampa, FL 33602 Phone: 1-800-749-2257 or (813) 223-7099 Email: AAKPnat@aol.com Internet: www.aakp.org 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. 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 inform you 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 Amyloidosis Definition Amyloidosis is a progressive, incurable, metabolic disease characterized by abnormal deposits of protein in one or more organs or body systems. and Kidney Disease * Anemia in Kidney Disease and Dialysis * Renal Osteodystrophy renal osteodystrophy n. A bone disease characterized by softening and fibrous degeneration of bone and the formation of cysts in bone tissue, caused by chronic renal failure. * 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 as needed prn. See prn order. . 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 www.niddk.nih.gov/health/kidney/pubs/kidney-failure/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 NKUDIC National Kidney and Urologic Diseases Information Clearinghouse ) 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 Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979 Health and Human Services, HHS . Established in 1987, the clearinghouse provided information about diseases of the kidneys and urologic system to people with kidney and urologic disorders urologic disorder Any condition affecting the kidneys, often understood to be of the collecting tubules and southward. Cf Kidney disease. and to their families, health care professionals, and the public. NKUDIC answers inquiries, develops and distributes publicatuions, 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. 01-2412 April 2001 Posted: May 2001 |
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