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Matching Dialysis Modality to Patient Lifestyle. In Control. 3(1): S1-S2, S8. March 2006.

There are many different dialysis modalities available for kidney disease patients, including manual and automated peritoneal dialysis as well as short daily and long nocturnal hemodialysis (done at home or in-center). This article considers the importance of matching dialysis modality to patient lifestyle. The author notes that most of the present options are underused, however, the author describes the reasons that the dialysis community has focused on modality options besides standard in-center hemodialysis, including quality of life, patient satisfaction, employment, and patient preference. The barriers to change modality options may play a part in the current delivery of dialysis care. The author concludes by encouraging health care providers to provide thorough, unbiased education about treatment options, to welcome patient participation in modality choice, and to make a full menu of modalities available in more clinics. One sidebar briefly describes the full array of seven dialysis options. 12 references.

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Mortality Difference by Dialysis Modaility Among New ESRD Patients with and Without Diabetes Mellitus. Dialysis and Transplantation. 35(4): 234-244. April 2006.

This article reports on a study that investigated mortality difference by dialysis modality (hemodialysis versus peritoneal dialysis) among new end stage renal disease (ESRD) patients with and without diabetes mellitus. The authors completed a retrospective analysis of data obtained from the China Medical University Hospital in Taiwan on all new ESRD patients undergoing hemodialysis (HD, n = 219) or peritoneal dialysis (PD, n = 226) for more than 3 months between January 2000 and December 2003. Of these patients, 102 HD patients and 96 PD patients also had diabetes. Their average age was 60 years (plus or minus 13 years) for the HD group and 57 years (plus or minus 16 years) for the PD patient group. Among these 445 patients, PD patients were associated with a significantly lower risk of death compared with the HD patients. Older age, diabetes mellitus as the cause of ESRD, co-morbidity of ischemic heart disease, congestive heart failure, cerebral vascular accident (CVA, stroke), peripheral artery occlusive disease, or liver cirrhosis, and HbA1c levels greater than 8 percent were associated with a significantly high risk of mortality. 4 figures. 4 tables. 20 references.

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Peritoneal Dialysis Dose and Adequacy. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2006. 4 p.

This fact sheet describes the need to determine the adequacy of peritoneal dialysis (PD) used to treat chronic kidney failure, also known as end-stage renal disease (ESRD). In PD, a soft tube or catheter is used to fill the abdomen with dialysis solution, made up of dextrose, salt, and other minerals dissolved in water; the lining of the abdomen serves as a membrane to allow waste products and extra fluid to pass from the blood into the dialysis solution. These wastes and fluid then leave the person’s body when the dialysis solution is drained. Many factors affect how much waste and extra fluid are removed from the blood, including the person’s capacity for dialysis solution and the permeability of the person’s abdominal lining, also called the peritoneum. Controllable factors include the number of daily exchanges and the dwell time, which is how long the fluid stays in the abdomen. The fact sheet describes the three types of PD and the tests that are used to determine if the exchanges are removing enough wastes and fluid. The PD prescription usually also considers the amount of residual kidney function the person has. Patients sometimes do not perform all of the exchanges recommended by their medical team; this lack of compliance can increase the risk of hospitalization and death. The fact sheet concludes with a description of current research efforts in this area and a summary of activities of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) that provides information about diseases of the kidneys and urologic system to patients and their families, the general public, and health care professionals. Readers are referred to the Centers for Medicare and Medicaid Services at www.cms.hhs.gov or 1–877–267–2323 and to the National Kidney Foundation at www.kidney.org or 1–800–622–9010 for more information. 1 figure.

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Starting and Managing an Intradialytic Exercise Program. Nephrology News & Issues. 20(9): 47-49. August 2006.

Despite many recent studies showing the benefits of exercise for patients on dialysis, most dialysis clinics have not incorporated exercise programs for their patients into their regular regimen of care. This article addresses this problem, offering advice for starting and managing an intradialytic exercise program. The author hypothesizes that perhaps clinic administrators are not able to access information about getting a program started. The author describes how the University of Virginia Renal Services facility added an exercise program. The greatest obstacle to such a program is the lack of federal and local reimbursement for such programs. However, funds can be raised through hospital or medical center grants, patient memorial funds, patient donations, and community events to pay for exercise equipment such as floor pedalers, hand or leg weights, treadmills, and other equipment. To keep the program going, the dialysis staff members must be consistent and diligent in encouraging the patients to exercise. The author concludes that, with proper commitment from the administration and staff, an exercise program for ESRD patients can become a reality and a standard treatment of care for dialysis patients. 14 references.

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Summary Report of the End Stage Renal Disease (ESRD) Networks' Annual Reports, 2005. Midlothian, VA: Forum of ESRD Networks. 2006. 110 p.

The Medicare End Stage Renal Disease (ESRD) Program, established in 1972, is a national health insurance program for people with irreversible kidney failure. There are 18 ESRD Networks that support the Federal Government in assuring appropriate care for patients who receive treatment through dialysis facilities and kidney transplant centers certified by Medicare. The Networks' responsibilities include: quality monitoring and improving the care ESRD patients receive, collecting data to administer the national Medicare ESRD program, providing technical assistance to patients who have ESRD and providers, and addressing patient grievances. This report provides a summary of the ESRD Networks' Annual Reports. Much of the data is presented in charts and tables, including some full-color graphs. Approximately half of the Summary Report is in the appendices which provide statistical information on incident and prevalent patients by network, age and network, dialysis prevalence patients by age, race and network, a list of the primary causes of end stage renal disease, patients by primary diagnosis and network, dialysis patients by gender and network, in-center dialysis patients by modality and network, and home dialysis patients by modality and network. Other appendices list acronyms used in the Summary Report as well as a list of renal organization web addresses. 3 figures. 20 tables.

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Treatment Methods for Kidney Failure in Children. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2006. 12 p.

The kidneys play an important role in a child’s growth and health, including removing wastes and extra water from the blood, regulating blood pressure, balancing chemicals like sodium and potassium, making a hormone that signals bone marrow to make red blood cells, and making a hormone to help bones grow and keep them strong. This fact sheet reviews treatment methods for kidney failure in children. A successful kidney transplant can give a child with chronic kidney disease (CKD) the best chance to grow normally and lead a full, active life. Dialysis can help a child survive an acute episode of kidney failure or stay healthy until a donated kidney becomes available. Families are encouraged to work closely with their team of health care providers. Topics include problems specific to children with kidney failure, treatment details, deceased donor kidneys, living donor kidneys, preemptive transplantation, keeping a transplanted kidney healthy, peritoneal dialysis, continuous ambulatory peritoneal dialysis (CAPD), continuous cycling peritoneal dialysis (CCPD), hemodialysis, the various members of the health care team and the duties of each one, anemia, bone problems, growth failure, and financial help for treatment of kidney failure. The fact sheet concludes with a list of resource organizations, websites, and publications for readers wanting additional information. Also included is a brief summary of the activities of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) that provides information about diseases of the kidneys and urologic system to patients and their families, the general public, and health care professionals. 4 figures.

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Treatment Methods for Kidney Failure: Peritoneal Dialysis. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2006. 28 p.

This booklet describes the option of peritoneal dialysis (PD) as a treatment for people with advanced and permanent kidney failure, also called end-stage renal disease (ESRD). Healthy kidneys clean the blood by removing excess fluid, minerals, and wastes. They also make hormones to keep the bones strong and the blood healthy. In kidney failure, medical treatments must be used to perform these functions of the kidneys. This booklet describes how PD works, getting ready for PD, the different types of PD, customizing PD to the individual, preventing problems, equipment and supplies for PD, testing the effectiveness of the dialysis, conditions related to kidney failure and their treatments, and the psychosocial adjustments that occur as one learns to cope with kidney failure. In PD, a soft tube, or catheter, is used to fill the abdomen with dialysis solution; the lining of the abdomen serves as a membrane to allow waste products and extra fluid to pass from the blood into the dialysis solution. These wastes and fluid then leave the person’s body when the dialysis solution is drained. The most common form of PD, continuous ambulatory peritoneal dialysis (CAPD), does not require a machine; other forms use a cycler to perform the exchanges. Infection is the most common problem for people on PD, but equipment advances and strict adherence to infection control measures can reduce this complication. Monitoring tests include those performed on the used solution, urine tests, and blood tests, all of which are done to determine whether the dialysis is adequate. Conditions related to kidney failure and their treatments include anemia; renal osteodystrophy, which is bone disease associated with kidney failure; itching, also called pruritus; sleep disorders; and dialysis-related amyloidosis. The booklet concludes with a description of current research efforts devoted to improving treatment for people with progressive kidney disease and permanent kidney failure. The booklet also includes a list of resources—organizations and instructional materials—and a summary of the activities of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) that provides information about diseases of the kidneys and urologic system to patients and their families, the general public, and health care professionals. 6 figures.

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Why Exercise Can Make a Difference. Nephrology News & Issues. 20(9): 50-52. August 2006.

Despite many recent studies showing the benefits of exercise for patients on dialysis, most dialysis clinics have not incorporated exercise programs for their patients into their regular regimen of care. This article reminds readers of the benefits that can be attained from an intradialytic exercise program. The author notes that the recently published Kidney Disease Outcome Quality Initiative clinical practice guidelines on management of cardiovascular disease mandate that all dialysis patients should be counseled and regularly encouraged by nephrology and dialysis staff to increase their levels of physical activity. This article also serves as an introduction to another article in this same journal that describes an ongoing dialysis exercise program at the University of Virginia. The author calls for more research to demonstrate exactly how to assess functioning and encourage physical activity within the routine care of end-stage renal disease (ESRD) patients. 1 figure. 8 references.

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You Decide! Choosing a Treatment that Fits Your Life. In Control. 3(1): S3, S6. March 2006.

There are many different dialysis modalities available for kidney disease patients, including manual and automated peritoneal dialysis as well as short daily and long nocturnal hemodialysis (done at home or in-center). This article helps patients consider the importance of matching dialysis modality to patient lifestyle. The author outlines the different types of treatment options for kidney failure, including transplant, peritoneal dialysis (CCPD and CAPD), home hemodialysis (including short daily home hemodialysis, conventional home hemodialysis, or nocturnal home hemodialysis), and in-center hemodialysis (conventional or nocturnal). The author then discusses some of the factors that might make patients reluctant to change from dialysis center-based therapy. Readers are advised to check two websites for more information about kidney treatment options: www.kidneyschool.org and www.homedialysis.org.

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Acid-Base Homeostasis in Dialysis Patients. In: Clinical Dialysis. 4th ed. New York, NY: McGraw-Hill. 2005. pp. 553-576.

Many of the enzymes that constitute the body’s metabolic system depend on a stable pH within the body. Because acid is continually added to the body as a result of normal metabolic processes, a sophisticated system of checks and balances is required to prevent the pH from drifting outside the desired range. This chapter on acid-base homeostasis is from a textbook on the clinical management of patients on dialysis. The authors begin with a discussion of how acidosis contributes to severe chronic kidney disease, through protein catabolism, and its role in bone disease. The authors continue to discuss sources of acid, the magnitude of the daily acid burden, disposition of the acid burden, requirements of dialysis, base repletion by dialysis, hypoxemia, vascular and nervous system stability, highly efficient dialysis, selection of a dialysate base concentration, supplemental base, base repletion in peritoneal dialysis, biocompatibility, and base repletion in hemofiltration. The authors conclude by noting that the question of adequacy of base repletion remains unresolved. Use of bicarbonate results in a greater transfer of base to the patient than was obtained with acetate. They caution that high-flux and high-efficiency dialysis greatly exaggerate solute fluxes, thereby stressing all the systems involved in acetate metabolism and consequent bicarbonate generation. All new dialysis equipment is capable of delivering bicarbonate-containing dialysate and essentially all patients are now treated with this type of dialysate. 3 figures. 2 tables. 262 references.

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