Access
An access {vascular access) is a route into the bloodstream that allows enough blood flow for hemodialysis. For permanent access, a surgeon connects a vein to an artery. This can be done directly (fistula) or with a piece of synthetic tubing (graft). For short-term access, a catheter may be placed in a large central vein. (See also: Arteriovenous Fistula, Catheter, Graft.)

Acute Kidney Failure
Acute kidney failure has a sudden onset most often caused by an illness, injury, or toxin that stresses the kidneys. Some patients who survive acute kidney failure can recover kidney function. Others may go on to develop chronic kidney failure.

Air Embolism
An air embolism occurs when air bubbles enter the bloodstream and flow into a vessel small enough to be blocked by the air. The air in the vessel acts like a clot, blocking the flow of blood.

Dialysis machines have an air detector on the venous bloodline to help prevent this problem, which can be fatal.

Albumin
Albumin is a blood protein. Low serum albumin levels (<3.5 g/dL) may mean a patient is undernourished. Malnutrition is common in dialysis patients and raises their risk of death.

Alum
Alum is an aluminum compound. It is often added to city water supplies to remove sediment and make the water clearer. Aluminum can build up in the bodies and brains of dialysis patients. Aluminum in dialysis water must be kept at low levels with water treatment.

Aluminum-Related Bone Disease (ARBD)
ARBD is caused by long-term exposure to aluminum. Aluminum builds up in the tissues at the point where new bone forms and can be seen on X-ray. Sources of aluminum include dialysis water, medications, and Cookware. Phosphate binders with aluminum are also a source, but these are rarely used today. Symptoms of ARBD can include deep bone pain, muscle weakness, and fractures.

Amyloidosis
Amyloidosis occurs when a protein called beta- 2-microglobulin builds up in soft tissues, bones, and joints. The deposits can cause joint and/or bone pain. High-flux membranes and/or nocturnal hemodialysis remove more 2-microglobulin, which may help prevent or treat this problem.

Anaphylaxis
Anaphylaxis is a fast, severe immune response to an allergen. Hives, itching, or wheezing may occur. Anaphylactic shock may cause a blood pressure drop; change in heart rhythms or arrest; spasms of the breathing passages; and swelling of the lips, tongue, and throat. This problem can be fatal.

Anastomosis
Anastomosis is a surgical connection between two blood vessels. Dialysis needles should not be inserted into the area of the anastomosis in a fistula or graft.

Anemia
Anemia is a shortage of oxygen-carrying red blood cells. It causes severe fatigue, trouble with mental focus, reduced immune function, and many other problems. Anemia is common in kidney failure due to less erythropoietin, iron deficiency, and loss of blood through tests and dialysis itself.

Aneurysm
An aneurysm is a ballooning or bulging of a weak spot in a blood vessel. Severe bleeding can occur if an aneurysm ruptures, so great care must be taken with a patient who has one, Aneurysms can occur if needles are placed too often into the same small area of a fistula.

Angioplasty
Angioplasty is a procedure to open a narrowed blood vessel (stenosis). It may be used for vascular access repair. A small balloon is threaded through the vessel into the access and gently inflated to push the walls of the vessel open. (See also: Stenosis.)

Anticoagulant
An anticoagulant is a blood-thinning drug used to keep clots from forming. Anticoagulants, such as heparin, are used to prevent clotting in the extracorporeal circuit during hemodialysis.

Antiseptics
Antiseptics slow or stop the growth of bacteria and viruses. They are used to kill microbes to prevent infection.

Apical Pulse
The apical pulse is felt on the chest wall over the heart.

Arterial Pressure
In hemodialysis, arterial pressure is measured in the extracorporeal circuit between the arterial needle and the dialyzer. Pre-pump arterial pressure is measured from the patient’s access to the blood pump. Post-pump arterial pressure is measured after the blood pump, but before the dialyzer.

Arterialize
When a fistula is made, strong arterial blood flow causes the vein to arterialize–it dilates (widens), thickens, and becomes more muscular, like an artery.

Artery
A blood vessel that carries blood away from the heart at high pressure.  Arteries bring oxygenated blood to each part of the body.

Ascites
Ascites is a build-up of fluid in the abdomen caused by liver damage, heart failure, malnutrition, or infection. Special ultrafiltration and other methods (i.e., drainage) may be needed to remove it.

Aseptic
Aseptic means sterile or germ-free.

Aseptic Technique
Aseptic technique is a series of steps used to maintain a germ-free environment. The steps include washing .hands before touching things in sterile packages, touching sterile objects only to other sterile objects, cleaning blood ports or the patient’s skin with disinfectant before placing a needle, and throwing out any sterile supplies in wet, damaged, or torn packages. Peritoneal dialysis exchanges must be done using aseptic technique to prevent infection.

Blood Pump
The blood pump is part of the hemodialysis delivery system. It pushes the patient’s blood through the extracorporeal circuit at a fixed rate of speed.  During a treatment, the blood tubing is threaded between the pump head and rollers. The rollers move blood through the circuit and back to the patient.

Blood Urea Nitrogen (BUN)
Urea is a waste product of protein metabolism. It is measured as blood urea nitrogen (BUN). Failed kidneys cannot remove urea, which builds up in the body between treatments. BUN is easy and low-cost to measure, so it is used as a stand-in for other wastes that are harder to identify or measure. BUN levels are the basis of the urea reduction ratio and urea kinetic modeling methods used to assess the adequacy of dialysis.

Brachiocephalic Fistula
A brachiocephalic fistula is the most common type of AV fistula of the upper arm. It is created by surgically joining the brachial artery to the cephalic vein.

Bruit
A bruit is a buzzing or swooshing sound caused by the high-pressure flow of blood through a patient’s fistula or graft. The bruit can be heard through a stethoscope at the· anastomosis, and for some length along the access. A high-pitched bruit may mean there is stenosis of the access.

Buttonhole Technique
In the Buttonhole technique, dialysis needles are placed in a fistula (not a graft) into the same holes at the same angle, Over 3–4 weeks, this creates pierced earring-like tracts that guide the needles to the right spots. The patient or the same staff person should place the needles. Once the tracts are formed, special bl.unt needles are used to avoid cutting new tracts. Buttonhole cannulation is quick to do, less likely to infiltrate, and largely painless for the patient.

Calcium
Calcium is an element that exists as a cation (positively-charged ion). In the body, calcium is an electrolyte needed for nerves and muscles to form normal bone. It is partly bound to protein in the blood. Too much or too little calcium in dialysate can cause severe health problems or death for patients. Patient blood levels of calcium are checked once a month. Calcium in a dialysis feed water supply can combine with other substances to form scale that can clog equipment.

Cannulate
Cannulate means to put dialysis needles into a fistula or graft.

Catheter
A catheter is a plastic tube. In hemodialysis, a catheter can be placed in a large, central vein for short-term or longer-term access. In peritoneal dialysis, a catheter is placed in the abdomen or chest. It is used to infuse fresh dialysate into the peritoneum and drain used dialysate.

Central Venous Stenosis
Central venous stenosis is narrowing of a central vein. It can damage vessels in the arm on the affected side so a patient can’t have a fistula or graft.

Chloride
Chloride is a salt concentrate needed in dialysate and in the human body. Chloride combines with other elements to form sodium chloride, potassium chloride, magnesium chloride, and calcium chloride.

Chronic
Chronic means long-term.

Congestive Heart Failure (CHF)

Congestive heart failure occurs when the heart can’t pump out enough of the blood it receives.

Excess fluid backs up into the lungs. Fluid overload from too much fluid intake or not enough fluid removal at dialysis may lead to CHF in dialysis patients.

Continuous Ambulatory Peritoneal Dialysis (CAPD)
CAPD is peritoneal dialysis with manual exchanges done four or five times each day. The exchanges can be done at home or work while the patient goes about his or her day. Each one takes about 30 minutes. CAPO is continuous, so large amounts of wastes do not build up between treatments. This means the diet and fluids tend to be less restricted for CAPD than for standard in-center hemodialysis. Because the patient can dialyze on his or her own schedule, this treatment is work friendly.

Continuous Cycling Peritoneal Dialysis (CCPD)
CCPD, or automated peritoneal dialysis (APD), is PD using a cycler machine to do exchanges at night while the patient sleeps. Because the patient’s days are free, this treatment is work friendly. Some patients may use a cycler at night and do one exchange by hand at mid-day.

Creatinine
Creatinine is a waste product of muscle use that healthy kidneys remove from the blood. Larger people with more muscle tend to have higher creatinine levels in their blood. Higher-than-normal creatinine levels may be a sign of kidney disease.

Creatinine Clearance
Creatinine clearance is a urine test that measures how well the kidneys remove creatinine from the blood in a certain amount of time. As kidney disease worsens, creatinine clearance will fall to 10% of normal or less.

Chronic Kidney Disease (CKD)
Chronic kidney disease is a long, slow loss of nephrons-and thus kidney function. CKD can take many years to progress. It is divided into stages based on the glomerular filtration rate (GFR). Stage 1 CKD is mild kidney dysfunction. Stage 5 CKD is the most severe form.

Cuffed Tunneled Catheters
Cuffed tunneled catheters are placed into a large, central blood vessel through a tunnel formed under the skin. Inside the tunnel, tissue grows into an attached cuff. The cuff makes the catheter more stable and is a physical barrier against bacteria.

Diabetes
There are two main types of diabetes, and both can harm the kidneys. In type 1, the immune system kills the pancreas cells that make insulin. In type 2, the pancreas does not make enough insulin, or the body can’t use what it does make.

Diabetic Nephropathy
Diabetic nephropathy is kidney disease that results from diabetes. In Type 2 diabetes, a shortage of or resistance to insulin is the number one cause of kidney failure in the US. In Type 1 diabetes, the immune system destroys the pancreas cells that make insulin. Diabetes is a disease of the blood vessels. It causes heart disease and nerve damage. Diabetes is also the leading cause of blindness and loss of limb in the US.

Dialysis
Dialysis is a process of removing wastes and excess water from the blood of people whose kidneys have failed. It may be done using a dialyzer (hemodialysis) or the patient’s own peritoneum (peritoneal dialysis) as a filter.

Dialyzer
A dialyzer is a semi-permeable membrane in a plastic cylinder. Dialyzers are used in hemodialysis to filter wastes and water out of the blood of patients with kidney failure. Ports on the cylinder let blood and dialysate flow in and out. The membrane keeps blood and dialysate apart, but allows an exchange of water and some· solutes to occur.

Dry Weight
Dry weight is the patient’s weight without excess fluid. When dry weight is reached, there are no signs of fluid overload or dehydration. Breathing is normal, with no signs of fluid in the lungs. And, blood pressure is normal for the patient (nor too high or too low). “Target weight” is the goal weight for a given dialysis treatment and is most often determined by the dry weight.

Edema
Edema is water retention with swelling in body tissues. It occurs as a result of fluid overload or other health problems, such as congestive heart failure. This swelling may be seen 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. Report this to the nurse if you see it.

End-Stage Renal Disease (ESRD)

ESRD is a legal term for complete and permanent loss of kidney function. This occurs during the last stage (stage 5) of chronic kidney disease, when dialysis or a transplant is needed for the patient to live. Patients have ESRD when their glomerular filtration rate has dropped to less than 15.

Erythropoietin (EPO)
Erythropoietin is a hormone made by healthy kidneys that tell the bone marrow to make red blood cells.

Ferritin
Ferritin is an iron storage protein. It is measured with a blood test. Ferritin stores are needed as a building block for red blood cells. KDOQI anemia guidelines say dialysis patients’ ferritin levels should be greater than 200 ng/mL. Most patients need intravenous iron to keep their ferritin levels at this level.

Glomerular Filtration Rate (GFRJ

GFR is the volume of blood filtered by the glomeruli each minute, in mL/min. A normal GFR is about 120 to 130 mL/min.  Chronic kidney disease is divided into stages based on the level of GFR.

Glomerulonephritis
Glomerulonephritis is an inflammation that damages the glomeruli. It can be slow and progressive or rapid in onset. It may occur as an immune response to a strep infection. Hypertension often occurs with it.

Glomerulosclerosis
Glomerulosclerosis is a hardening of the glomeruli.

Glomerulus

A glomerulus is a tangled ball of capillaries in each nephron. It is held together by a membrane called a Bowman’s capsule. Water and small solutes are forced through filtration slits in each glomerulus by the pressure of the beating heart. The fluid that results is called glomerular filtrate.

Graft
To graft is to join one thing surgically to another. In hemodialysis, a graft is a piece of man-made vessel that is used to create a vascular access. One end of the graft is connected to the patient’s artery the other to the vein.

Hematocrit
Hematocrit (Hct) is a measure of red cells in the blood.  It is stated as a percentage of red blood cells per total blood volume.  Routine checks of Hct levels were used to assess anemia in the past.

Hemodialysis
Hemodialysis removes excess water and wastes from the blood by passing it through a dialyzer. Blood goes to the dialyzer and back to the patient’s body through tubing connected to needles that are placed in a vascular access. Water and wastes pass through the semi-permeable dialyzer membrane and into the dialysate. Alarms and monitors help ensure a safe treatment. Treatments can be done in a center or at home, during the day or at night while the patient sleeps.

Hemodialysis Adequacy
Hemodialysis adequacy is the least amount of treatment patients need to live.  It is measured with urea kinetic modeling (Kt/V) or the urea reduction ratio (URR).  KDOQI guidelines say the delivered Kt/V must be at least 1.2.  A minimum delivered URR must be about 65%.

Hemodialysis Adequacy
Hemodialysis adequacy is the least amount of treatment patients need to live. It is measured with urea kinetic modeling (Kt/V) or the urea reduction ratio (URR). KDOQI guidelines say the delivered Kt/V must be at least 1.2 (with a prescribed Kt/V of 1.4). A minimum delivered URR must be about 65% {with a prescribed URR of about 70%).

Hemoglobin
Hemoglobin (Hgb) is the red, oxygen-carrying pigment of red blood cells. Routinely checking Hgb levels lets the care team follow the patient’s response to anemia treatment and alerts them to any chronic blood loss. (See also: Anemia.)

Heparin
Heparin is a blood thinner used during dialysis so blood will flow freely through the extracorporeal circuit. It can be given as a bolus (single dose), intermittently (on and off), or continuously. Continuous infusion uses a pump to slowly inject heparin into the circuit at a prescribed rate during a treatment.

Hepatitis
Hepatitis is inflammation of the liver. It can be caused by one of three viruses (A, B, or C). Hepatitis B and C are spread through contact with infected blood or other body fluids, and are a concern for dialysis patients and staff. Hepatitis can cause permanent liver damage or death. Vaccination against the hepatitis B virus should be offered to all staff and patients. Infection control is used to prevent the spread of hepatitis and other diseases.

Hormones
Hormones are chemical messages made in one organ or gland that act on another part of the body.  Healthy kidneys make a hormone (erythropoietin)that tells the bone marrow to make red blood cells and other hormones that control blood pressure and use of calcium in the body.

Hypercalcemia
Hypercalcemia means too much calcium {an electrolyte) in the blood. Patients with this problem may have muscle weakness, fatigue, constipation, loss of appetite, abdominal cramps, nausea and vomiting, and coma.

Hyperglycemia
Hyperglycemia means high blood sugar levels. Thirst may be a symptom of hyperglycemia in a patient who has diabetes.

Hyperkalemia
Hyperkalemia means too much potassium (an electrolyte) in the blood. Patients with this problem may have muscle weakness, heart arrhythmia, cardiac arrest, or may die. Hyperkalemia can occur if a patient eats too many high-potassium foods or if dialysate with too much potassium is used. Bleeding, hemolysis, surgery, or fever can also cause this problem because as tissue breaks down potassium is released from cells into the bloodstream.

Hypermagnesemia
Hypermagnesemia means too much magnesium (an electrolyte) in the blood. Magnesium is needed for muscle and nerve function. Patients with hypermagnesemia may feel sleepy or have nerve problems, low blood pressure, and slower breathing. In severe cases, cardiac arrest may occur.

Hyperphosphatemia
Hyperphosphatemia means too much phosphorus in the blood. It is most often found in patients who eat a lot of protein or dairy foods and don’t take enough phosphate binders. Phosphorus is a component of bones. It is key to energy transfer between cells. Hyperphosphatemia can cause severe itching in the short term and bone damage in the long term. When it occurs with hypercalcemia, hypercalcemia can cause fractures, bone pain, and sharp calcium phosphate crystals in the soft tissues.

Hypertension
Hypertension is high blood pressure. It can be a cause or result of kidney failure and is the second most common cause of kidney disease in the US. High blood pressure can raise the risk of a stroke and damage the kidneys, heart, blood vessels, eyes, and .other organs. Patients on standard in-center hemodialysis often take more than one blood pressure drug to control hypertension.

Hypocalcemia
Hypocalcemia means not enough calcium (an electrolyte) in the blood. Hypocalcemia can cause tetany-spasms and twitching of the muscles-or seizures. Low blood calcium can occur in kidney disease due to the loss of calcitriol production by the failing kidneys. Calcitriol lets the body absorb calcium from the diet.

Hypoglycemia
Hypoglycemia means below-normal levels of sugar in the blood. In a patient with diabetes, this can cause hunger, nervousness, shaking, weakness, swearing, dizziness, sleepiness, confusion, or trouble speaking. The treatment is a fast-acting carbohydrate, like juice.

Hypokalemia
Hypokalemia means below-normal levels of potassium (an electrolyte) in the blood. This is rare in dialysis patients. It can occur if there is too little potassium in the diet or in the dialysate. Hypokalemia can also be caused by a loss of potassium due to vomiting, diarrhea, use of potassium exchange resins, and use of diuretics that increase the loss of potassium in the urine (if the patient makes urine).

Hypophosphatemia
Hypophosphatemia means below-normal levels of phosphorus in the blood. This is rare in dialysis patients, as phosphorus is found in most foods. It may occur if a patient has a poor diet and takes too many phosphate binders, or in patients who do nocturnal HD. Low levels of phosphorus can suggest malnutrition. Hypophosphatemia can cause heart arrhythmias or muscle weakness.

Hypotension
Hypotension is low blood pressure, in dialysis patients, low blood pressure occurs most often when too much fluid is removed during dialysis or when patients take too many blood pressure drugs. Symptoms include severe muscle cramps; headaches; feeling warm, restless, dizzy, faint, or nauseated; or having visual disturbances. The Trendelenburg position (raising the feet higher than the heart) and giving fluids (i.e., normal saline) help return blood pressure to normal.

Infection
An infection is an invasion of the body by a pathogen.

Interdialytic
Interdialytic means between dialysis treatments.

Intermittent
Intermittent means periodically or not continuously.  Heparin can be given intermittently during dialysis.

Internal Jugular (IJ) Catheter
Dialysis catheters may be placed in the internal jugular vein in the neck. This site is less likely to cause central venous stenosis than placement in the subclavian vein.

Intradermal
Intradermal means within the skin.  Local anesthetics may be injected intradermally.

Intramuscular
Intramuscular means within a muscle

Intravenous (IV)
Intravenous means within a vein.  Many medications are injected intravenously.

Iron Deficiency
Iron deficiency is a lack of iron in the body to make red blood cells. Without iron, the bone marrow can’t make red blood cells, even if erythropoietin is present. Low levels of iron can cause a form of anemia.

Ischemia
Ischemia is a lack of oxygen in the tissues due to reduced blood flow. It can be painful. Ischemia of the heart can cause angina pain. Steal syndrome (Ischemia of the hand) may cause hand pain; a cold, clammy feeling; and, in extreme cases, painful, non-healing skin ulcers.

KDOQI
KDOQI stands for Kidney Disease Outcomes Quality Initiative.

KDIGO
KDIGO stands for Kidney Disease:  Improving Global Outcomes.  It is a program started by the National Kidney Foundation in 2003 to improve care and outcomes of kidney patients around the world by writing and implementing clinical practice outcomes.

Kidney Transplant
A kidney transplant replaces the failed kidneys with a healthy kidney from a donor. It is possible to receive a living donor kidney from a relative, spouse, friend, or unrelated person. Deceased donor kidneys come from people who have had died. Blood type and other tissue factors are used to “match” a recipient after a medical work-up has been done.

Kt/V
See: Urea Kinetic Modeling

Lumen
The lumen is the inside diameter of a blood vessel or a rube, such as a catheter or needle. In stenosis, the lumen of the vascular access becomes narrower, which limits blood flow.

Magnesium
Magnesium is a metallic mineral. It is found in the body as an electrolyte in the intracellular fluid. A small trace of magnesium in body fluids is vital to the nervous system.

Malnutrition
Malnutrition is a lack of proper nutrition. Many people on dialysis don’t get enough protein, which is a risk factor for death. Protein levels are checked with a blood test for serum albumin. This level should be 4.0 g/dL or higher.

Metabolism
Metabolism is the sum of chemical processes that occurs when some substances are broken down and others are formed.

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

Myalgia
Myalgia is muscle pain.

Needle Site Rotation
Needle site rotation is used with fistulae and grafts. Its aim is to prevent damage that can occur when needles are placed many times in the same small area. Needles are always placed at least 1.5 inches away from the anastomosis and away from the sites used at the last treatment. At each treatment, needle placement then moves up and down the full length of the access.

Nephrologist
A nephrologist is a licensed doctor who specializes in kidney diseases.

Nephrology
Nephrology is the study of kidneys.

Nephron
A nephron is a tiny blood purification filter in the kidney. It is made up of a glomerulus and a tubule. Nephrons filter wastes from the body and keep electrolyte and fluid balance. Each kidney has about a million nephrons.

Nocturnal Home Hemodialysis (NHHD)
NHHD treatments are done for 8 hours at night, while the patient sleeps at home, 3 to 6 nights per week. Most home hemodialysis programs require the patient to have a partner. Both must successfully complete a few weeks of training. Dialysis needles and bloodlines are carefully taped to avoid line separation. Bedwetting alarms may be used to detect blood. A few programs monitor treatments over the Internet. Longer NHHD treatments mean that patients have fewer fluid and diet limits. Most need few or no blood pressure drugs. Since the patient’s days are free.  NHHD is work-friendly. Studies show that survival with this treatment is about the same as with deceased donor transplant.

Nocturnal In-Center Hemodialysis
Nocturnal in-center treatments are done for 8 hours at night while the patient sleeps at the center. They are done by the center staff 3 nights per week, often from about 8 pm m about 4 am. The longer treatments allow for fewer fluid and diet limits. Most patients need few or no blood pressure drugs. Since the patient’s days are free, nocturnal in-center hemodialysis is work-friendly. Studies find fewer hospital stays and better survival with this treatment than with standard in-center hemodialysis.

Normal Saline
Normal saline is a sterile salt water solution with 0.9% sodium chloride. This level is equal to the concentration of sodium chloride found in the blood. In hemodialysis, normal saline is used to prime and prepare the extracorporeal circuit. It may also be used for fluid replacement during the treatment.

Opportunistic Illness
An opportunistic illness is one that tends to occur only when a patient’s immune system is impaired. Patients with AIDS, for example, are prone to these illnesses because their immune systems are weakened.

Orthostatic Hypotension
Orthostatic hypotension is a drop in blood pressure of 15 mmHg or more that occurs when a person rises from sitting to standing.

Parathyroid Hormone (PTH)
PTH is a hormone produced by the four parathyroid glands in the neck. PTH is released into the bloodstream in large amounts when calcium levels are low or phosphorus levels are high. Too much PTH can cause hone disease.

Patent
Patent means open or not blocked.  Before each dialysis treatment, patency of the patient’s access is checked by listening for the bruit and feeling for the thrill.

Peripheral
Peripheral means away from the center of the body. For example, peripheral vascular disease affects the limbs, not the core, of the body.

Peripheral Neuropathy
Peripheral neuropathy is nerve damage in the hands and feet. It can cause numbness, tingling, burning, pain, and weakness. Diabetes is a common cause of neuropathy. In dialysis patients, neuropathy may be caused by uremic toxins that are not well removed by standard in-center hemodialysis. It can also be caused by vascular access problems, which may lead to waste build up due to poor dialysis. Getting more dialysis may help.

Peritoneal Dialysis (PD)
PD uses the peritoneum as a semi-permeable membrane to clean the blood. A surgeon places a catheter in the patient’s abdomen or chest wall. The patient is taught to use the catheter to fill the abdomen with sterile dialysate. Wastes and excess water move from the blood and into the dialysate by diffusion and osmosis during a “dwell” time of a few hours.

Peritoneal Dialysis Adequacy
Peritoneal dialysis (PD) adequacy is a measure of the treatment dose. The intent is to ensure that

PD patients receive at least the minimum amount of treatment they need to live. The KDOQI guidelines set standards for adequacy and give tips for attaining them.

Peritoneum
The peritoneum is a smooth, thin layer of blood-vessel- rich tissue that covers the inside of the abdominal walls. The peritoneum forms a closed sac. Thus, it can be used as a semi-permeable membrane and container for dialysate in PD.

Peritonitis
Peritonitis is an infection of the peritoneum. It can occur when aseptic technique is not used during a PD exchange. Peritonitis may cause scarring that can make further PD impossible.

Phosphate Binders
Phosphate binders are drugs that bind with phosphorous in food. They keep phosphorus from being absorbed in the gut. The bound phosphorus is then eliminated in the stool. Patients should take more binders with larger meals and fewer binders with smaller meals or snacks.

Phosphorus
Phosphorus is a non-metallic element. It is found in dairy products, meat, poultry, fish, nuts, chocolate, and colas-so many foods that it is hard to avoid. Too much phosphorus in the blood can cause itching, secondary hyperparathyroidism, and bone disease. Phosphorus levels are checked once a month before dialysis. Most patients who do standard in-center hemodialysis need to take phosphate binders. More dialysis removes more phosphorus. Those who do nocturnal home hemodialysis may need phosphate supplements instead of binders.

Platelets
Platelets are blood cells that promote dotting by dumping together when “activated” by signals sent by injured cells.

Polycystic Kidney Disease (PKD)
PKD is a genetic disease that causes large, fluid filled cysts to grow in the kidneys, liver, and sometimes the brain. The cysts can become so large and numerous that they crowd out normal kidney tissue. This can cause kidney failure.

Positional
Positional means affected by the patient’s body position. When hemodialysis catheters are positional, blood flow can change when the patient moves. If the patient coughs or moves again, blood flow may improve if the catheter moves in the blood vessel.

Potassium
Potassium is a metallic element and an electrolyte in the body. Levels of potassium that are too high or too low can cause illness or death.

Proteinuria
Proteinuria means protein in the urine. When the kidneys are damaged, protein can leak through the glomeruli into the renal tubules, and then into the urine.

Pruritus
Pruritus is itching. Itching may occur in patients with kidney failure due to dry skin or a build-up of calcium phosphate crystals in the skin. Good dialysis, managing calcium and phosphorus, limiting bathtub soaks (which dry out skin), and use of some lotions or creams can help reduce pruritus.

Pseudoaneurysm
A pseudoaneurysm is a false aneurysm: a bulging pocket of blood most often around a graft. It can occur if a graft has been damaged by repeated punctures in the same small area. A graft with a pseudoaneurysm may need to be repaired or replaced; rupture is a medical emergency.

Radiocephalic Fistula
A radiocephalic fistula connects the radial artery and cephalic vein in the forearm. This is the most common type of AV fistula.

Renal Osteodystrophy
Renal Osteodystrophy is bone disease that is caused by too-high or too-low levels of PTH.

Rinse back
Rinseback means using saline to flush the patient’s blood back into the body after dialysis to minimize blood loss.

Secondary Hyperparathyroidism
Secondary hyperparathyroidism is the release of too much parathyroid hormone (PTH). It can lead to bone disease. With too much PTH in the blood, calcium is withdrawn from the bones, making them weak. The condition is treated with phosphate binders and calcitriol to reduce PTH, calcium, and phosphorus levels.

Seizures
Seizures are involuntary muscle spasms and loss of consciousness. Some patients may have seizures as a dialysis side effect (severe hypotension). Seizures may occur during dialysis as a reaction to a problem, such as the use of the wrong dialysate. Patients may have a seizure disorder and be prone to having seizures.

Serum
Serum is the clear liquid that can be separated from blood. Many blood tests are run on serum, such as tests for calcium and phosphorus.

Short Daily Home Hemodialysis
Short daily home hemodialysis is 2.5-4 hour treatments done at home 5-7 days per week. Most home programs require the patient to have a partner. Both must successfully complete a few weeks of training. The more frequent treatments mean that patients have fewer fluid and diet limits. Most need few blood pressure drugs. Because the treatments are done on the patient’s own schedule, short daily home hemodialysis is work-friendly. Studies show that survival with this treatment is about the same as with deceased donor transplant.

Shunt
A shunt is a tube that is inserted into the body. A shunt was the first permanent vascular access- used for dialysis in 1960 by Drs. Scribner and Quinton. A Teflon® tube was used to connect a length of Silastic® tubing to a patient’s artery and vein. This created a vascular access that could be used for multiple treatments. For the first time, patients with chronic kidney failure could receive dialysis. Since the shunt was outside the skin, it easily became infected or cloned, and is no longer used.

Sodium
Sodium is an element and an electrolyte in the body. It causes fluid to move across the cell membranes between the intracellular and extracellular spaces. Sodium is present in dialysate, and the amount must be correct. Too little can cause hemolysis; too much can cause crenation.

Sodium Modeling
Sodium modeling is changing the level of sodium in the dialysate during the treatment to remove more water. A doctor’s prescription is needed.  Most often, the patient starts treatment at a high sodium level, which is then slowly reduced. If the ultrafiltration rate is higher than about 400 mL/hour (the “capillary refill rate”), blood pressure will drop in most patients.

Solution
A solution is a combination of a solvent (fluid) and a solute.

Standard In-Center Hemodialysis
Standard in-center treatments are done in a hospital or center three times a week. Center staff does the treatments, though some patients may take their own vital signs, place their own needles, and monitor their own treatments. Leading doctors now say that standard treatments should always be at least 4 hours long. They replace only 12–15% of normal kidney function, which is stage 5 chronic kidney disease.

Standard Home Hemodialysis
Dialysis treatments are done three days a week or every other day by the patient and a partner at home. The patient and partner are trained for a few weeks. Since the patient can dialyze on his or her schedule, this treatment is work-friendly.

Steal Syndrome
Steal syndrome occurs when a fistula or graft “steals” too much blood away from the distal part of the limb (hand or foot). When the access is in use, some of the patient’s blood bypasses the hand or foot and goes through the extracorporeal circuit instead. The loss of blood flow (ischemia) can harm tissue. Signs of this problem include coldness, poor function, and even gangrene if it is not treated promptly.

Stenosis
Stenosis is narrowing of a blood vessel. Stenosis slows the flow of blood and causes turbulence inside the vessel. This sets the stage for more serious problems, such as thrombosis.

Stents
Stents are small, expanding metal rings that can be placed in blood vessels to help keep the lumen open. A stem may be used to help keep a fistula or graft patent.

Sterilant
A sterilant is a germ-killing solution. Sterilants are used in reprocessing dialyzers.

Subclavian Catheter
A subclavian catheter is placed in the subclavian vein. According to KDOQI Clinical Practice

Guidelines for Vascular Access, the subclavian vein should not be used for a catheter. The internal jugular vein is preferred, because it is less likely to cause central venous stenosis.

Systolic
Systolic pressure is the pressure inside the arteries during a heartbeat. It is the top number of a blood pressure reading.

Thrill
The thrill is the vibration of blood flowing through the patient’s fistula or graft. It can be felt by touching a patient’s access.

Thrombectomy
A thrombectomy is the surgery or drug treatment (i.e., with a clot-dissolving drug) to remove a thrombus, or blood clot.

Thrombolysis
Thrombolysis is the process of injecting a drug to dissolve a thrombus. Surgery may be needed after thrombolysis.

Thrombosis
Thrombosis-formation of a thrombus or blood clot is the most common cause of access failure. Early thrombosis in a graft or fistula is most often caused by surgical problems with the anastomosis. Or, it can be caused by twisting of the vessel or graft.

Thrombus
A thrombus is a clot formed in a blood vessel or a blood passage. A clot may occur when platelets are activated by contact with damaged blood vessel walls, dialyzer materials, or turbulence inside a blood vessel.

Urea Kinetic Modeling (UKM)
Urea kinetic modeling is used to assess if a patient’s dialysis is adequate, based on change in the level of urea in the blood.  The results of UKM are described as It/V.  K is the dialyzer urea clearance in the mL/min, t is treatment time in minutes and V is the volume of blood in the body.

Urea Reduction Ratio (URR)
URR is a way to estimate the delivered dose of dialysis by comparing urea levels before and after a treatment.  It does not provide all of the information a doctor needs to prescribe a treatment.

Uremia
Uremia is a build-up of wastes in the blood.  It occurs in the last stage of kidney failure or in patients who are not getting enough dialysis.  Patients with uremia may have yellow-gray skin, edema, high blood pressure, flu-like symptoms, trouble breathing, fatigue, weakness, and mental changes.  If a patient on dialysis has these symptoms, more dialysis is needed.

Vascular Access
The vascular access is a way to gain repeated entry to the patient’s bloodstream for hemodialysis.  A vascular access must permit high-enough blood flow rates to ensure effective dialysis.  There are three types of access.  A fistula is a surgical connection between a patient’s artery and a vein.  A graft connects an artery and vein with a piece of man-made vein.  A catheter is a plastic tube placed into a central vein.  The vascular access is the patient’s lifeline.  Great care must be taken to protect it through good cannulation and either needle site rotation or use of the Buttonhole technique.

Vein
A vein is a blood vessel that carries blood back to the heart.

Venipuncture
Venipuncture is inserting a needle into a blood vessel.  Skilled and gentle venipuncture prolongs access life, enhances comfort, and helps ensure that the patient will get a good treatment.  It is vital to rotate sites or use the Buttonhole technique to avoid aneurysms or pseudoaneurysms.

Venous Pressure
Venous pressure is the measurement of the extracorporeal circuit pressure after the dialyzer and before the blood goes back into the patient’s body.

Virus
A virus is a microorganism that must obtain energy and food from other living cells.  Many diseases, such as the common cold and HIV, are caused by viruses.

Weights and Measures