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Kidney failure that happens quickly-within days or a week. It is often caused by injury or drug interactions. Acute renal failure usually can be reversed.

Anemia is a shortage of oxygen-carrying red blood cells. Because red blood cells bring oxygen to all the cells in the body, anemia causes severe fatigue, heart disorders, difficulty concentrating, reduced immune function, and other problems. Anemia is common among renal patients, caused by insufficient erythropoeitin, iron deficiency, repeated blood losses, and other factors. Anemia can be detected with a blood test for hemoglobin or hematocrit. Anemia is treated with EPOGEN , (Epoetin alfa), a synthetic form of Erythropoietin, and with iron supplements. (See also: Erythropoietin, Hematocrit, Hemoglobin.)

A treatment option for anemia associated with chronic renal failure, including patients on dialysis and patients not on dialysis.

A fistula is the surgical linking of an artery to a vein, providing access to blood vessels.

To graft is to join one thing surgically to another. In hemodialysis, a graft is a piece of artificial vessel that can be used to create an access. One end of the graft is connected to the patient's artery, the other to the vein.

Blood Urea Nitrogen. A waste product, or toxin, that appears in the blood as protein from food is digested. BUN levels are a measure of how well dialysis is removing wastes from the blood. Normal ranges of BUN in healthy people are 5-18 mg/dL in children, 7-18 mg/dL in adults, and 8-20 mg/dL in adults over 60 years old. Higher levels are present in patients with kidney failure.

Continuous Ambulatory Peritoneal Dialysis. (Home Dialysis) Patients using this form of dialysis put dialysate fluid into the abdomen through a surgically placed catheter, or tube. This fluid comes in contact with the peritoneal membrane, a thin layer of tissue around the abdominal organs. Some of the toxins in the blood pass from blood vessels in the wall of the peritoneal membrane into the dialysate. The fluid, which may change from clear to slightly yellow, is then drained out of the body through the catheter. The process is usually repeated four or five times per day.

Continuous Cycling Peritoneal Dialysis. Like CAPD, dialysate fluid is drained into the abdomen through a catheter. Instead of changing the fluid several times each day as in CAPD, a machine changes the fluid several times each night while the patient sleeps.

Kidney failure that takes place over a long period of time. Chronic renal failure is usually not reversible.

Creatinine is a waste product of creatine and creatine phosphate, an energy-storing molecule in the muscles normally excreted in urine. Creatinine is produced in proportion to muscle mass, that is, larger people with more muscle have higher creatinine levels. Elevated creatinine levels may indicate kidney failure.

Dialysis is a process of removing wastes and excess fluid from the blood that damaged kidneys can no longer remove. To maximize the patient's health, the physician will usually prescribe a special renal diet, medications, and other treatments that serve as a supplement to dialysis therapy. Dialysis may be performed using an artificial kidney, or dialyzer (hemodialysis) or the patient's own peritoneum (peritoneal dialysis). A dialyzer (containing a semipermeable membrane) dialysate, and a delivery system are needed to perform hemodialysis. (See also: Dialysate, Hemodialysis, Hemodialysis Delivery System, Peritoneal Dialysis, Semipermeable Membrane.)

Dialyzer

The dialyzer, or hemodialyzer (also known as an artificial kidney), is a manufactured semipermeable membrane encased in a plastic support structure. Dialyzers are used in hemodialysis to remove wastes and fluid from the blood of patients with kidney failure. The semipermeable membrane keeps blood and dialysate separate, but allows an exchange of certain solutes and fluid to occur. (See also: Hollow Fiber Dialyzer, Semipermeable Membrane.)

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Edema

Edema is water retention/swelling in body tissues that occurs as a result of fluid overload or other conditions. This swelling may be observed in the patient's eyelids, ankles, feet, hands, abdomen, or lower back area. "Pitting" edema is present when a finger pushed against the skin of the ankle leaves a dent. This condition should be reported to the nurse. (See also: Dry Weight, Pulmonary Edema.)

EPOGEN® (EPOETIN ALFA)

EPOGEN® is a recombinant form of erythropoietin, a hormone that stimulates the bone marrow to form red blood cells. EPOGEN , injected intravenously (into a vein) or subcutaneously (into the tissue beneath the skin), is used to treat the anemia of chronic renal failure, eliminating the need for most blood transfusions in dialysis patients and improving their quality of life. Common side effects include hypertension and flu-like symptoms. (See also: Anemia, Erythropoeitin, Recombinant.)

End-Stage Renal Disease

End-stage renal disease, or permanent kidney failure. ESRD occurs when kidney function is approximately 10% to 15% of normal or less, and the patient needs dialysis or a kidney transplant to live.

Exchange

The process of draining used peritoneal dialysate from the abdomen and putting in fresh dialysate. An exchange may be done by the patient or by a cycling machine.

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Fistula

See Arteriovenous (AV) fistula.

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Graft

See Arteriovenous graft.

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Hematocrit (Hct)

Hematocrit is a measure of red cells in the blood, stated as a percentage of red blood cells per total blood volume. Normal hematocrit is from 37% to 47% for women and from 42% to 52% for men. Routinely checking hematocrit levels allows clinicians to assess anemia, follow the patient's response to EPOGEN®, and alert the staff to any chronic loss of blood. NKF-DOQI guidelines recommend a target hematocrit level for dialysis patients of 33% to 36%. The EPOGEN , package insert recommends a target hematocrit range of 30% to 36%. Without enough red blood cells to carry oxygen to the tissue, patients feel tired and listless. (See also: Anemia, EPOGEN®, Hemoglobin.)

Hemodialysis

Hemodialysis is a process that cleans the blood of waste products by passing the blood through an artificial kidney, or dialyzer. Blood and dialysate are separated by the semipermeable dialyzer membrane. Excess water and wastes move out of the patient's blood through the membrane, and into the dialysate, according to the principles of diffusion and osmosis. Hemodialysis is the most commonly chosen treatment modality for patients with end-stage renal disease.

Hypertension

High blood pressure. This can be caused by too much salt intake, fluid build-up, or too much of the hormone renin, produced by the kidneys. Hypertension can cause headache, blurred vision, blindness, heart damage, and stroke.

Hypotension

Low blood pressure. This can occur if large amounts of fluid are removed from the blood vessels too quickly during dialysis. Hypotension can cause a fast pulse, dizziness, and sometimes nausea, vomiting, or fainting.

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Kidney Failure

Loss of the ability of the kidneys to remove fluid and toxins from the body. The two most common causes of kidney failure are diabetes and high blood pressure. It may also be caused by other viral or hereditary disorders. Kidney failure is less often caused by damage related to medications, or by other conditions such as kidney stones or injuries.

Kidney Transplant

A kidney transplant is replacement of a diseased kidney with a healthy kidney from a donor. Only one healthy kidney is needed to live. It is possible to receive a donor kidney from a relative, spouse or friend, or cadaver. Blood type and other tissue factors are used to "match" a recipient after a medical work-up has been done.

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Modality

A modality is a type of treatment, such as hemodialysis, peritoneal dialysis, or transplantation.

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Nephrology

Nephrology is the study of kidneys. As a medical specialty, nephrology deals with information, care, and knowledge of kidneys. A nephrologist is a doctor of internal medicine who specializes in nephrology. A pediatric nephrologist is a pediatrician who specializes in the care of children and adolescents with kidney disease. A nephrology nurse has special training in the care of people with renal failure. A nephrology technician has training in the care of people with renal failure and the technology that supports their care.

Nephrologist

A nephrologist is a doctor who specializes in kidney disease.

Nephrons

Microscopic units inside the kidney that filter blood to remove wastes and excess fluid; balance the amount of fluid and chemicals your body need; and discards what your body does not need as urine.

Neuropathy

Nerve damage. It can be caused by diabetes. It can also be caused by uremia, or a build-up of toxins in the body. Too little dialysis over time can lead to nerve damage. Neuropathy can cause weakness, burning, tingling, and numbness, especially in the feet and lower legs, but also in the hands.

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Peritoneal Dialysis

A form of dialysis that uses the body's own peritoneal cavity to hold dialysate fluid. The peritoneal membrane acts like a filter to allow toxins, excess chemicals, and fluid to move into dialysate. Peritoneal dialysis "exchanges" fresh dialysate for used dialysate, often several times a day. Exchanges can be done by the patient (see CAPD) or by a machine (see CCPD), or in some cases both types of exchanges are combined to help the patient get enough dialysis.

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Renal

Related to the kidneys.

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Toxins

Chemical waste products produced by metabolic processes in the body like digesting food, breathing, and mental and physical activity.

Transplantation

See kidney transplant.

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Uremia

Uremia is a build-up of wastes in the blood that occurs in the last stage of kidney failure or in patients who are not receiving adequate dialysis. Patients with uremia may have yellow-gray skin, edema, hypertension, anorexia, restlessness, dyspnea, fatigue and weakness, and mental changes. If uremic symptoms appear when a patient is on dialysis, it means that the patient is not receiving adequate dialysis, and that more dialysis is needed. (See also: Hemodialysis Adequacy.)

UREA REDUCTION RATIO (URR)

URR is the simplest method for estimating the delivered dose of dialysis, but it does not provide all the information needed to prescribe a dialysis treatment. BUN levels are measured before and after treatment, and the difference indicates how much urea was removed during dialysis, as a percentage of urea reduction. NKF-DOQI™ guidelines for hemodialysis adequacy recommend a minimum delivered URR of 65% (prescribed URR of 70%) for adequate dialysis. BUN levels must be drawn using the slow flow or stop pump technique to ensure accuracy of the URR result. (See also: Hemodialysis Adequacy.)

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Venous Line

In hemodialysis, the tubing that returns the clean blood from the dialyzer back to the patient through the access.

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For Further Information, contact:

Andrea Balish, RN, CNN
710 Park Place
Mishawaka, IN 46545
574-273-6787, ext 1102

Copyright 2007, Nephrology, Inc. All Rights Reserved.