What does this mean? How can you stay healthy?

YOUR KIDNEYS AREN’T WORKING PROPERLY.”

“ When you’re born, everything works perfectly. Then something goes wrong and you ask:

“HOW DO I DEAL WITH THIS?”“WHAT ROLE DO KIDNEYS PLAY IN MY HEALTH?” “WHAT ARE MY OPTIONS?” “WHAT IS BEST FOR ME AND MY LIFESTYLE?”“WHO CAN I TURN TO?”

Kidneys:

YOUR BODY’S FILTERING SYSTEM

NORMAL HEALTHY KIDNEYS PLAY AN IMPORTANT ROLE IN YOUR HEALTH> Kidneysclean your bloodandremove extra fluidto

formurine.

> Theykeep minerals(sodium,calcium,potassium,andphosphorus)in balance.

> Theyhelpcontrol blood pressure.

> Theyhelpmake red blood cells.

> Theyproduce vitamin Dtokeepboneshealthy.

THREE TYPES OF KIDNEY DISEASE: CHRONIC KIDNEY FAILURE, ACUTE KIDNEY DISEASE, END-STAGE RENAL DISEASE> Chronic kidney failure:Agraduallossofkidneyfunction

thatresultsfromalong-termdisease.Itisthemostcommontypeofkidneyfailure.Itcannotbereversed,butitcanbetreated.

> Acute kidney failure:Asuddenlossofkidneyfunctionresultingfromaninjuryorpoison.Itcanusuallybereversedwithinafewweeksiftreatedquickly.

> End-stage renal disease (ESRD):Aconditionwherethekidneysdonotwork,orverylittlekidneyfunctionremains.

WHEN YOUR KIDNEYS AREN’T WORKING PROPERLY, YOU MAY BE DEVELOPING KIDNEY FAILURE When this happens:

> harmfulwasteandfluidcanbuildupinyourbody;

> yourbloodpressuremayrise;and

> yourbodymaynotbeabletomakeenoughredbloodcells.

> Kidneysareshapedlikekidneybeans.

> They’rethesizeofasmallfist.

> Theyweighabout1/4poundor114grams.

Allyouneedtostayhealthyis one kidney that works at 20%.

CAUSES OF KIDNEY FAILURE: SEVERAL DISEASES OR CONDITIONS MAY BE RESPONSIBLE

Diabetesisthemostcommoncauseofkidneyfailure.Highlevelsofbloodsugar(glucose)inpeoplewithdiabetescandamagethesmallbloodvesselsinthenephronsandcausethekidneystofail.

What can you do?

> Reviewyourbloodsugarlevelseachtimeyouvisityournurseordoctor.

> Knowyournumbers:strivefor“normal”bloodsugarlevels.

KIDNEY DISEASE IS SOMETIMES CALLED A “SILENT” DISEASE Somepeoplemaynotfeelsickornoticetheirsymptomsuntiltheirkidneysnolongerremovewaste.

Asthediseaseprogressesandkidneyfunctionslows,mostpeopleexperiencesymptomsofuremia:

> Feelingtiredand/orweak

> Swellingofthehandsandfeet

> Shortnessofbreath

> Appetiteloss,abadtasteinthemouth,vomiting,nausea,andweightloss

> Difficultysleeping,itching,musclecramps,anddarkeningoftheskin

Be sure to tell your doctor or nurse if you experience any of these symptoms.

High blood pressure,orhypertension,canalsodamagethesmallbloodvesselsinyourkidneys’filters,causingthemtofail.Uncontrolledhighbloodpressurecanmakekidneydiseaseprogressevenfaster.

What can you do?

> Medication,healthydiet,andexercisecanhelpkeepyourbloodpressurewithinahealthyrangetoprotectyourkidneys.

> Writedownyourbloodpressureeachtimeyouvisityournurseordoctor.

OTHER FACTORS THAT CAN LEAD TO KIDNEY FAILURE:

Lupus(animmunesystemdisease)

Polycystic kidney disease(multiplecystsinthekidneys)

Glomerulonephritis (aninflammationofthekidney’sfilteringmechanism)

Injury or traumafromanaccident,and poisons,suchasstreetdrugsorlargequantitiesofcertainover-the-countermedicines

Nephronsaretinyfiltersinsidethekidneysthatcleantheblood.Mostkidneydiseasesaffectthenephrons.

Uremiameanshavingureaorwasteintheblood.

Dialysisisaprocessthatremovesthewasteandextrafluidfromyourbloodbyfilteringthemthroughamembrane/filter,thewayhealthykidneyswould.

KIDNEY FAILURE IS MANAGEABLE Thereareseveraltreatmentsforkidneydiseasethatcanhelpyouliveahealthy,activelife:

> Medicationsandtreatmentproceduresexistthataredesignedtoslowdownyourkidneydisease.

> Dialysis,aprocedurethattemporarilyremoveswasteandextrafluidfromyourbody,mimicsthefunctionofanormalkidney.

> Eventually,youmayrequirekidneytransplantation,asurgicalprocedurethatplacesanewdonorkidneyintoyourbody.

MONITOR YOUR KIDNEY FUNCTION TO REMAIN HEALTHY Kidney functioniswhatpercentageofyourkidneysisstillworking(e.g.100%=fullyfunctioning).Monitoringhowslowlyorquicklyyourkidneydiseaseisprogressingisdonebykeepingaclosewatchonyourserum creatinine,awasteproductfoundinyourbloodthatischeckedwithasimplebloodtest.

Peoplewithkidneyfailurecandevelopcomplicationssuchasanemiaandbonedisease.

To stay healthy, it is important to:> regularlyfollowupwithyourhealthcareteam;and

> haveteststhatwillhelpfindtheseproblemsearlysothebesttherapycanbestarted.

STAY IN TOUCH WITH YOUR FEELINGS WHEN LEARNING ABOUT YOUR NEW HEALTH PROBLEM Itiscommontoexperiencemanyemotions,especiallyifyougenerallyfeelwellandthenewsofahealthissuecomesasasurprise.

Feelingscanrangefromshock(perhapsthisnewsisverysuddenandunexpected)tosadness,depression,andanger.

It is not uncommon to feel this way. Youshouldspeakwithyournurseanddoctor,whocanconnectyouwithothermembersofthehealthcareteam.Theywillalsoguideyoutoresourceswhocanhelpyouworkthroughyourfeelingsandhelpyoumakedecisionsthatarebestforyou.

Dialysis for kidney disease:

DOING THE WORK OF THE KIDNEYS

As your kidneys slow down and stop working normally, you will need to decide on a treatment. Whilethereisnocureforkidneyfailure,therearetreatmentsthatcantakeoverthefunctionsthatyourkidneyscannolongerperform,makingyoufeelbettersothatyoucanliveahealthylife.

Theperitoneumisathinlayeroftissuethatlinesyourabdomenandcoversyourabdominalorgans.

HOW DOES DIALYSIS WORK TO CLEAN MY BLOOD ?Duringdialysis,bloodisononesideofthemembrane/filter,andaspecialfluidcalleddialysateisontheother.

Smallwasteproductsinyourbloodflowthroughthemembrane/filterandintothedialysate.Largerparticles,likeredbloodcells,remaininyourblood.Thisishowyourbloodiscleaned.

Blood Dialysate

Membrane/filter

Largerparticles,suchasredbloodcells,remaininblood;this

ishowyourbloodiscleaned.

Smallwasteproducts

TWO KINDS OF DIALYSIS: THEY DIFFER IN HOW AND WHERE THEY ARE DONE> Peritoneal dialysisusesthenaturalmembraneofthebody,

calledtheperitoneum,asthefiltertoremovewasteandfluid.

> Hemodialysisusesamachineandanexternalman-madebloodfilter,calledadialyzer,toremovewastefromthebody.

PERITONEAL DIALYSIS (PD) FILTERS YOUR BLOOD INSIDE YOUR BODY.

PDusesthenaturalmembraneofyourownperitoneumasthefilter.

Two types of PDContinuous ambulatory peritoneal dialysis (CAPD)

> Cleansandfiltersyourbloodcontinuously

> Doesnotrequireamachine

> Requiresthatyouexchange(infuseanddrain)fluidfourtimesadaythroughapermanentcatheterinsertedinyourabdomen

Automated peritoneal dialysis (APD)

> Usesamachinecalledaperitoneal dialysis cyclertoperformtheprescribedexchangestoclean/filteryourbloodeachdaythroughapermanentcatheter

> Doneathomeduringthenightwhileyousleep

Yourdoctorwillrecommendthedialysisprescription(thenumberofexchangesandthedialysissolution)thatisbestforyou.

HEMODIALYSIS FILTERS YOUR BLOOD OUTSIDE YOUR BODY.

Duringhemodialysis,yourbloodisremovedfromyourbodyandpumpedthroughamanufacturedfiltercalledadialyzer.

Hemodialysis

> Performedduringascheduledtimeatthehospitalinadialysisclinic

> Donethreetimesaweek.Eachtreatmentsessionlastsaboutfourhours,dependingonthedialysisprescriptionrecommendedbythedoctor.

Anurseortechnicianinsertstwoneedlesintoaspecialpermanentaccesscalledafistula,usuallylocatedinyourarm.Thefistulaiscreatedsurgically.Theneedlesthatareinsertedintothefistulaareconnectedtotubesthatareusedtoremoveyourblood.Oncethewasteinyourbloodhasbeenremovedthroughthefilter,thebloodisreturnedtoyourbody.

Withpropertrainingandthehelpofapartner,hemodialysiscanbedoneathome.Itmaybedonedailyorthreetimesaweek,dependingonthedialysisprescription.

Onceyouhavebeenfullytrainedbyyourdialysisnurse,youwillbeabletoperformPDyourselfathome,orevenwhiletravelling.

CHOOSING THE TYPE OF DIALYSIS THAT’S RIGHT FOR YOU: MEDICAL OR LIFESTYLE REASONS MAY MAKE ONE TYPE OF DIALYSIS BETTER FOR YOU THAN ANOTHER. Herearesomethingstoconsiderwhenmakingyourdecision.

Withthehelpofyournurse,doctor,healthcareteam,andfamily,youcanchoosethetreatmentthat’sbestforyouandyourlifestyle.

TYPE OF DIALYSIS BENEFITS POINTS TO CONSIDER

Peritoneal dialysis (PD)

> Fitsyourtreatmentaroundyourlifestyle> Portableandflexible—easytotakeyourtherapy

withyouwhentravellingorgoingtothecottage> Continuoustherapyisgentlerandmorelikeyour

naturalkidneyfunction> Fewervisitstothedialysisunitfortreatment> Noneedles> Independence—youmostlyperform

therapyyourself> Therapycanoccurwhileyousleep

> Exchangesneedtobemadedaily> Needforapermanentaccess> Somechanceofinfection> Mayshowaslightlylargerwaistline(dueto

carryingfluid)> Storagespacerequiredinyourhome> Somefluidanddietrestrictions

In-centre/hospital hemodialysis (ICHD)

> Regularcontactwithotherhemodialysispatientsandstaff

> Threetreatments/week(fourdaysoff)> Noneedtostoreequipment/suppliesathome> Immediateaccesstomedicalhelpduringtherapy

> Traveltocentre/unitthreetimesaweek,onafixedscheduleforanaverageoffourhourspertreatment

> Needforapermanentaccess> Insertionoftwoneedlesforeachtreatment> Somefluidanddietrestrictions> Possiblediscomfort,suchasheadache,nausea,leg

cramps,andfatigue

Home hemodialysis (HHD)

> Helpfromfamilymembers> Morecontroloverwhenyoudialyze> Noneedtotraveltoaclinicorhospital

fortreatment> Worksduringsleep(forsomepeople)

> Needforpermanentaccess> Someriskofinfection> Insertionoftwoneedlesforeachtreatment> Somefluidanddietrestrictions> Trainingmaytakeaminimumoffourtosixweeks> Storagespacerequiredforequipmentandsupplies

DIALYSIS SIDE EFFECTS: KNOW WHAT THEY ARE AND HOW TO PREVENT THEM

Peritoneal dialysis (PD)MostpeopleenjoytheflexibilityofbeingonPD,andcomplicationsdonotoccuroftenwithtoday’snewtechnology.However,onecomplicationofPDisperitonitis,anabdominalinfectionthatmayoccurifproceduresandhygienearenotfollowedcarefully.

You can stay healthy while doing PD by doing the following:

Followingtheprocedurestaughtbyyournurse

Learningtorecognizetheearlysigns of infection

Gettingimmediateantibiotic treatment

Thesesymptomsarerelatedtoyourbody’sresponsetotherapidchangesinfluidandelectrolytebalanceduringthetreatment.Theyaremanageable,sobesuretoreportthemtoyourdialysisnurseortechnician.

Hemodialysis side effects also include:

> Musclecramps

> Headaches

> Lowbloodpressure(whichcanmakeyoufeeldizzy,weak,ornauseated)

Hemodialysis Commoncomplicationsofhemodialysisthatcanpreventyourhemodialysistreatmentfromworkingwellandthatcanbecomeseriousifnottreatedquicklyincludethefollowing:

> Infection of your access (fistula) site

> Blockagefrombloodclots

> Poorbloodflow

> Vascularaccessproblems

Learningtorecognize these complications and getting treatment quicklywillalsoletyouremainhealthywhiledoinghemodialysisathomeorintheclinic.

KEEPING YOUR DIABETES AND BLOOD PRESSURE UNDER CONTROL WHEN YOU ARE ON DIALYSIS OR HAVE A TRANSPLANTED KIDNEYManagingtheseconditionsiscritical.Yourhealthcareteamwillroutinelycheckyourbloodglucoselevelsandyourbloodpressureduringmedicalvisits.Yourdoctormaychangeyourmedicationsorthedose,dependingonhowyourkidneyfailureisbeingtreated.

YOU CAN TAKE CONTROL: IT IS UP TO YOU TO REGULARLY MONITOR YOUR BLOOD GLUCOSE LEVELS AND BLOOD PRESSURE Highlevelsofbloodglucosecancomplicatedialysisanddamagethesmallbloodvesselsinthekidneys.

If you have diabetes:

takeyourmedicationsasprescribed;

sticktoyourrecommendeddiet;and

monitoryourbloodglucoselevelregularly.

Highbloodpressurecanalsodamagethekidneysanddisruptdialysis.

If you have high blood pressure:

takeyourmedicationsevenifyoufeelfine;

watchwhatyoueatanddrink;and

checkyourbloodpressureregularly

You are not alone:

MANAGING YOUR KIDNEY DISEASE TO STAY HEALTHY IS A TEAM EFFORT

UNDERSTAND THE ROLE OF EACH PERSON ON YOUR TEAM Your healthcare teamincludesdoctors,nurses,dieticians,pharmacists,socialworkers,andpsychologists.Eachteammemberhasindividualresponsibilities,buttheyallworktogethertomakesureyougettheverybestcare.

Your family and friendsalsoplayanimportantroleinhelpingyouandyourkidneysstayashealthyaspossible.

Neverbeafraidtotaketheleadby:

> askingquestions;

> reportingsymptoms;

> readingonyourown;and

> reachingouttoanotherteammember.

Dietician:Arenaldieticianisanutritionalexpertwhocanprovidedietandnutritionaladvicetohelpyoulivewellwithkidneydisease.Yourdieticianmaycreateamealplanorspecialdietthatwillhelpyourkidneysstayhealthylonger.

Social worker:Atrainedcounsellorwhocanprovidesupportandpracticaladviceonlivingwithachronicillnessandadjustingtolifewithdialysisoratransplantation,asocialworkerisaresourceforinformationonissuessuchasfinancesortransportation.

Pharmacist:Apharmacistworkswithyouandtheteamofnursesanddoctorstoprovideeducationaboutyourmedicationsandcananswerquestionsabouttypesofherbaltherapiesthatcouldbeharmfultoyourkidneys.Apharmacistmonitorsmedicationprescriptionsforpossibledruginteractionsandprovidessuggestionstotheteamaboutthebesttypesofmedicationsbasedonyourkidneyhealthatagiventime.Nephrologist:Adoctorwhospecializesinkidney

diseasesandoverseesallthemedicalcarerelatedtoyourkidneys,includingprescribingmedications,orderingandevaluatingtests,anddesigningyourtreatmentplan.

Nurse (dialysis nurse):Aregisterednursewhospecializesinkidneycareandworkswiththenephrologistandhealthcareteamtocoordinateyourcare,performtests,andprovideeducationtosupportyouinmakinginformeddecisionsaboutthetreatmentplanthatisbestforyouandyourfamily.

Conservative care or non-treatmentmayalsobeanoptionasitoffersbothphysicalandemotionalcomfortcare.

Pleasespeaktoyourhealthcareteamaboutconservativecare,asthispathwaymayeventuallyleadtodeathfromkidneydisease.

Learnmoreatwww.ckmcare.com.

A kidney transplant:

THE CLOSEST THING TO YOUR OWN HEALTHY KIDNEY

Akidneytransplantisamajorsurgicalprocedureinwhichahealthykidneyfromahumandonorisplacedinsideyourlowerabdomen.

Ahealthydonorkidneycancomefromseveralsources:

> Alivingperson,suchasafamilymember,friend,orunrelatedindividualcanbeadonor.Thisoptionrequiresproceduresandteststohelpyourdoctordetermineifyoucanacceptthelivingdonorkidney.

> Arecentlydeceasedperson(acadaver).Thisoptionalsorequiresproceduresandtestswhileyouareonsomeformofdialysisasyouwaitforthetransplantprocedure.

About70%ofalltransplantedkidneysarefromcadavers;inCanada,thewaitformostindividualscanvaryduetothelimitedavailabilityofdonors.

No more dialysis –Followingtheoperation,thehealthykidneytakesovertheworkthatyourkidneyscannolongerdo.Dialysisisnolongernecessary.

Living with a new kidney –Asuccessfulkidneytransplantisprobablytheclosestthingtoacureforkidneyfailure,asitmayallowyoutoleadamore“normal”life—onewithfewerdailydisruptionsorremindersofyourkidneydisease.

Avoiding rejection–Patientswhohavereceivedatransplantneedtotakeimmunosuppressivedrugseverydaytopreventthebodyfromrejectingthetransplantedkidney.Rejectionoccursbecausethebodynaturallytriestogetridofforeignsubstancesorobjects—inthiscase,thenewkidney.

Immunosuppressantsworkbyweakeningthebody’simmunesystem.Theyloweryourresistancetootherillnesses,particularlyinfections.

Sideeffectsincludethefollowing:

> Weightgain

> Skinchanges

> Moodswings

> Upsetstomach

Complications of transplantation –Rejectioncanbeamajorcomplicationofkidneytransplantation.Unfortunately,sometimesevendrugscannotstopthebodyfromrejectingatransplantedkidney.Whenthishappens,youwillneedtogobackondialysisandpossiblywaitforanotherdonorkidney.

Are you a candidate for transplantation? Noteveryoneiseligibleforakidneytransplant.Yourdoctorandhealthcareteamcanhelpdetermineiftransplantationisrightforyouorifyourconditionmakesthisoptiontooriskyortoounlikelytosucceed.

WHAT TO EXPECTThe operation–Duringthetransplantoperation,yourarteriesandveinsareconnectedtothetransplantedkidney.Theoperationusuallytakesthreetofourhours.Aftersurgery,youwillneedtospendseveraldaysinthehospitalandseveralweeksrecoveringathome.

KIDNEY RESOURCES Therearemanyonlineresourcesavailabletohelpyoulearnaboutlivingwithkidneydisease.Also,sometimeshearingfromotherpatientswhoarelivinglifetothefullestwithkidneydiseasecanbehelpful.

Online resources KidneyFoundationofCanada:www.kidney.ca

CanadianDiabetesAssociation:www.diabetes.ca

HeartandStrokeFoundationofCanada:www.heartandstroke.ca

AGIR(Frenchkidneypatientconnection–Québec):www.agir.qc.ca

ConservativeKidneyManagement:www.ckmcare.com

OntarioRenalNetwork:www.ontariorenalnetwork.ca

BCRenalAgency: www.bcrenalagency.ca

ManitobaRenalProgram:www.kidneyhealth.ca/wp

NovaScotiaRenalProgram:www.nshealth.ca/renal-program

HomeDialysisCentral:www.homedialysis.org

YOUR FRIENDS AND FAMILY PLAY A KEY ROLE ON YOUR TEAM Learningmoreaboutkidneydiseaseanddialysiscanhelpthembetterhelpyou.Referthemtokidneydialysis.caandkidneycampus.caformoreinformation.

Patient stories Rememberthatyouarenotalone.

Visitwww.kidneycampus.ca/patient-storiestohearpatientsandfamiliestelltheirstoriesaboutlivingwithkidneydiseaseanddialysis.

Thank you to the centres that helped put this material together.ProvidedbyBaxterCorporationasaservicetohealthcareprofessionalsandtheirpatients.

Baxter CorporationMississauga,OntarioL5N0C2|www.baxter.ca

©2018Baxter.Allrightsreserved.BaxterisatrademarkofBaxterInternationalInc. CAMP/MG232/18-000701/2019

Reference:SteinAndy,andJanetWild.Kidney failure explained: Everything you always wanted to know about dialysis and kidney transplants but were afraid to ask.London,England:ClassPublishing,1999.

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