See: Catheter, Fistula, Graft, Vascular access

Acute is sudden. Renal means kidney. ARF is sudden kidney failure that can be due to blood loss, clots that reach the kidneys, or toxins. ARF is a crisis. Someone who has ARF may be on life support. Other organs may fail, too. Those who survive ARF may get their kidney function back right away. They may need dialysis for up to a year, until their kidneys get better. Or, the kidneys may not get better. After ARF, there is a higher risk of chronic kidney failure later in life.

We take in vitamin D from some foods, sun on our skin, or supplements. Kidneys help turn that vitamin D into an active, hormone form that lets our guts absorb calcium from food. We need this for healthy bones. If your kidneys do not make enough, your doctor can prescribe a medicine. Zemplar®, Hectorol®, and Calcijex® are some forms of active vitamin D.

Just enough. The least dose of treatment that will keep you alive—but not enough to keep most people feeling well and doing the things they enjoy.

Forms that tell others what you want for your healthcare in case you can’t speak for yourself. All adults need to have one. Give a copy to your loved ones, your clinic, and your doctor(s). Advance directives are legal in all states.

Fibrils of a protein called beta-2 microglobulin (β2M) form lumps in soft tissues, joints, and bones. (The wrists are a common spot.) These lumps can cause pain and limit motion. Long, slow dialysis takes the most β2M out of the blood.

Too few red blood cells in the blood. Kidneys make the hormone (erythropoietin, or EPO) that tells our bone marrow to make red blood cells. Failing kidneys make less EPO. So, anemia is common in kidney disease. Since red blood cells bring oxygen to all of our cells, anemia can cause symptoms. You might feel tired, short of breath, cold all the time, or like you can’t think as clearly as you did. You might look pale, too. There are treatments that can help you feel better.

A weak spot in a blood vessel that balloons out. When dialysis needles are put in the same small spot at each treatment (area cannulation) aneurysms can form. These can cause bumps that you can see. There is a risk that an aneurysm can burst, or rupture. A fistula aneurysm that is tight or shiny—even if it is small—must be fixed. If your skin is dark and the skin on an aneurysm is pink, it is too thin to be safe. Do not place needles in an aneurysm. See: Area cannulation, Buttonhole technique, Rope ladder cannulation.

Automated peritoneal dialysis (PD). This type of PD is done with a cycler machine at night. See: Peritoneal dialysis.

The wrong way to put needles in a fistula or graft. Two needles are used at each dialysis treatment. Often the staff will choose a small area for each needle and use it over and over. This poor technique can cause aneurysms. You can learn to put in your own needles. This is called self-cannulation. Or, you can tell the technician where on your access you want the next needles to go. See: Self-cannulation.

One of two needles used in hemodialysis (HD). Arteries bring blood from your heart to the rest of your body. During HD, an arterial needle takes blood from your body to the dialyzer. A venous needle brings blood back to your body.

A way to link an artery and a vein together to reach the blood for hemodialysis. See: Fistula.

A protein found on the surface of all of the cells in our bodies except red blood cells. Healthy kidneys filter out excess β2M. When the kidneys don’t work, β2M can build up in the body, and form long strands, called fibrils. See: Amyloidosis.

How fast blood is pumped out of the body for hemodialysis (HD). Japan has the best dialysis survival in the world, with blood flow rates less than 300 mL/min. In the U.S. blood flow rates may be as high as 500 mL/min. Slower blood flow rates are much more gentle, which can help a graft or fistula last longer. Some people have chest pains during HD if the blood flow rate is too fast.

The whooshing sound blood makes as it flows through a hemodialysis fistula or graft. It may sound like a snare drum: Boom! Boom! Boom! Using a stethoscope to listen to the bruit each day can help make sure a fistula or graft is healthy. A bruit that grows higher in pitch over time (like a tea ketle whistle) can mean stenosis (narrowing) that may need repair. A bruit that stops can mean a blood clot that must be fixed right away. See: Fistula, Graft.

A waste that forms in the blood after we digest protein from food. BUN levels are one way to see how well dialysis is taking wastes out of the blood. See: Urea.

One of two right ways to put needles in a fistula. Done right, it can reduce pain and the chances of aneurysms. Needles are placed in the exact same holes at the exact same angle for eight or ten treatments in a row. Tunnel tracts form, like pierced earring—or button—holes. The tracts guide the needles to the right spots. Once tracts form, blunt needles are used. Infection is a risk with this technique. Those who use it must take great care to clean off the needle sites at each treatment. It is best if the same person forms the tracts and puts in the needles. It is also best if that person is the one who needs the dialysis. The buttonhole technique is not safe to use in a graft. Fistulas are made of veins and arteries that have muscles in their walls that will close the hole after the needle is removed. Grafts do not have any muscles. See: Aneurysm, Rope ladder technique, Self-cannulation.

A build up of bone minerals (calcium and phosphorus). When this happens in our bones, it makes them stronger. When it happens in blood vessels, fat, or muscle, it can cause pain and damage.

Damage caused by calcium deposits that block blood flow. This is rare, but can cause limb loss or death. Painful purple skin sores on both sides of the body at the same time may be a sign. The problem is more likely in those with diabetes and in those whose calcium and phosphorus levels are too high.

A mineral in dairy foods and leafy greens. Calcium helps make up your bones and teeth. In your blood, calcium is an electrolyte. It helps your muscles and nerves work, and helps your blood clot. When your kidneys don’t work, your body may steal calcium out of your bones so you have the right amount in your blood. See: Active vitamin D, Electrolytes.

To place needles in a fistula or graft for hemodialysis. Those who place their own say it hurts much less than when someone else does it. The fewer people who put needles in, the longer an access may last. There are three ways to put in needles into a fistula or graft. Two of these ways are safe, but one can harm your access. See: Area cannulation, Buttonhole technique, Fistula, Graft, Rope ladder technique.

Continuous Ambulatory PD. This option is done by hand a few times a day. See: Peritoneal Dialysis

Someone who is on hand when a dialysis treatment is done. The care partner may be an extra pair of hands—or may do the whole treatment. It is best for the person on dialysis to do as much of the treatment as he or she can. Here is a tool to help you agree on who will do what

A tube placed in the body. In hemodialysis (HD), a catheter can be a blood access. The tube goes in a vein in the neck, chest, or groin—and threads into the heart. A peritoneal dialysis (PD) catheter goes through the chest wall or belly and into the abdomen. Catheters must be kept clean and dry. Germs in an HD catheter can cause sepsis (blood poisoning), which can be fatal. Germs in a PD catheter can cause peritonitis (infection of the belly lining). This can cause pain, and scarring so PD will no longer work. See: Hemodialysis, Peritoneal dialysis.

Continuous cycling PD. This type of PD is done with a cycler machine at night. See: Peritoneal Dialysis.

Slow, progressive loss of kidney function. If it is not treated, CKD may lead to kidney failure. Treatment may be able to slow CKD, depending on the cause. Those with CKD may or may not have symptoms that they notice. There are five stages of CKD. See: eGFR.

See: Muscle Cramps.

A waste that forms each time we move our muscles. Healthy kidneys remove creatinine from the blood, so high levels mean that there may be kidney damage.

A machine used to do peritoneal dialysis. Most cyclers weigh about 25-35 lbs. and can be brought in a car or plane for travel. Or, those who use a cycler at home may choose to do their treatments by hand for a short trip.

A disease in which excess sugar gums up blood vessels, including those in the eyes, limbs, kidneys, and brain. In type 1 (T1) diabetes, the body attacks and kills the beta cells in the pancreas that make insulin. Without insulin, sugar cannot enter the cells to be used for energy. In type 2 diabetes (T2), beta cells wear out and make less insulin. And, at the same time, cells grow resistant to insulin and will not let sugar in. (A high sugar diet seems to be part of the problem.) T2 is the main cause of kidney failure in the U.S. Gestational diabetes when a woman is pregnant is a risk for later T2.

A mix of water and minerals used in dialysis. The water is purified to meet Medicare standards. Wastes and excess water flow out of the blood through pores in a membrane and into the dialysate. The used fluid goes to a drain.

A way to remove some water and wastes to keep someone alive when his or her kidneys fail. During a treatment, blood goes through a membrane filter. Wastes and excess water in the blood diffuse through pores in the filter and pass into a fluid called dialysate. Once used, the dialysate goes to a drain. There are two main types. Peritoneal dialysis (PD) uses blood vessels in the lining of the belly as the filter. Hemodialysis (HD) uses a man-made filter (dialyzer). Since wastes and water build back up, treatments must be done at least a few times each week. While no one wants these treatments, getting more hours and days of cleaning feels much more like having healthy kidneys did. There are two ways to do PD and five ways to do HD. Each choice has a different impact on daily life. This tool can help match a treatment to your lifestyle and values: https://mykidneylifeplan.org. See: Dialyzer, Diffusion, Hemodialysis, Peritoneal dialysis

Swelling of the brain that can cause headaches, confusion, and coma. DDS is rare, and most likely to occur in someone who is new to dialysis. The reasons for DDS are not known. Some doctors believe DDS may occur if wastes are removed from the blood too quickly.

Artificial kidney for hemodialysis. A dialyzer is a clear plastic sleeve filled with thousands of hollow fibers. Each fiber is as thin as a hair. Blood enters the dialyzer at the top and flows through the insides of the fibers and out the bottom. Dialysate enters the dialyzer from the side. The fluid flows around the outsides of the fibers, and then back out the side. Water and wastes in the blood pass through pores in fiber walls and into the dialysate. The used dialysate goes to a waste drain. See: Dialysate, Diffusion.

Dissolved substances will pass through pores in a membrane until levels on both sides of the membrane are the same. (Think of a tea bag as a membrane. The tea leaves are on one side, while the hot water is on the other.) We use this principle to take wastes out of the blood with dialysis. Dialysate has less (or none) of the wastes in the blood, so wastes will pass into it.

See: Target Weight

How long peritoneal dialysis fluid stays in the belly to let wastes and water flow into it. The doctor prescribes dwell time. Once the dwell time is done, the used fluid is drained and fresh fluid is added.

Swelling from water that builds up in the tissues. This can occur when the kidneys do not take out enough water. It may affect the face, hands, feet, and ankles. Those on dialysis can have edema if they drink too much fluid or don’t remove enough.

Mineral salts that form ions—charged molecules—when they dissolve in water. They are sodium, chloride, potassium, magnesium, calcium, and phosphate. Each one has key tasks in the body. They bring nerve signals to muscles. They support enzymes. They make the energy cycle in your cells work. They help blood clot. They control water balance. Healthy kidneys keep the balance of electrolytes in the blood. When the kidneys don’t work well, the balance is thrown off. This can stop the heart.

A prescription numbing cream with lidocaine in it that can help reduce or remove the pain of putting in dialysis needles. To use it, wash your arm to remove skin oils. Put on the cream 1-2 hours before treatment in a 1/8” thick layer. Cover the cream with plastic wrap or a bandage to hold it in place. Wash it off before treatment. Over the counter lidocaine creams are also on the market.

A hormone made by healthy kidneys that tells the bone marrow to make red blood cells. Failing kidneys make little or no EPO. This can lead to a shortage of red blood cells (anemia). Man-made EPO is used with iron to treat the anemia of kidney failure.

A drug like EPO that tells the bone marrow to make red blood cells. Those who need a high ESA dose may be at more risk of strokes and heart attacks. So, those on dialysis who have anemia are given the lowest ESA dose that will work. See: Anemia, Erythropoietin.

A task done in peritoneal dialysis (PD). Someone on PD washes his or her hands and puts on a face mask. S/he drains used PD fluid out of the belly. Then, s/he drains fresh fluid in. PD exchanges can be done by hand a few times a day or with a cycler at night. See: Cycler, Dialysate, Peritoneal dialysis.

The spot on the body where a catheter comes out. Exit sites must be kept clean and checked for signs of infection. See: Catheter.

Normal water volume. This is the state of the body with healthy kidneys: the same amount of fluid comes in and goes out. So, the blood always has the same amount of water in it.

Outside of and between the cells. The extracellular “space” is one of three spots where water is found in the body. About 1/3 of body water is outside of your cells as a sort of “soup” that your cells float in. If your hands, feet, or face swell up, that water is extracellular. See: Intracellular, Intravascular.

A buildup of bone minerals in the skin, blood vessels, joints, and soft tissues.

A way to reach the blood to remove wastes and water. A surgeon sews an artery to a vein under the skin of an arm. (You may hear it called an arteriovenous fistula.) Strong, fast blood flow from the artery makes the vein grow enough to use for hemodialysis. Two needles are placed in the fistula at each treatment. A fistula is the best type of access. It uses only body tissues and is under the skin, where it is least prone to infection and blood clots. A fistula can last for years or even decades. See: Cannulate, Vascular access.

A kidney disease that scars parts of some the glomeruli, which help filter the blood. FSGS tends to affect young people, and the cause is not always known. There are many treatments that can be tried. FSGS can cause the kidneys to fail, and may recur in a transplant.

A tiny blood vessel formed into a ball. Part of a nephron (filter) inside a kidney. See: Nephron.

A difference. In dialysis, a gradient is formed on purpose. Blood has a high level of wastes, and dialysate has none. The difference forces wastes in the blood to move into the dialysate.

A way to reach the blood to remove wastes and water. A surgeon links an artery to a vein under the skin of an arm using a piece of man-made (or cow) vein. (You may hear it called an arteriovenous graft.) The vein is large enough to use for hemodialysis. Two needles are placed in the graft at each treatment. A graft is the second best type of access. It uses foreign tissue, but is under the skin, where it is less prone to infection and blood clots. A graft should be replaced at least every 5 years or so, even if it seems to be working. Too many needle holes in the same place could cause a graft to burst—with severe bleeding. See: Cannulate, Vascular access.

A form of dialysis. HD cleans the blood outside your body. Blood goes from a vascular access into a tube, through a filter, and back to your body. With each pass through the filter, a bit more water and wastes are removed. HD can be done in a clinic three times a week. But, healthy kidneys work seven days a week, and this is what your body is used to. If you go four days a week with no treatment, you must follow strict diet and fluid limits to reduce water and wastes in your blood. At home, you can do HD more often, or even at night during sleep, and you can eat and drink more of what you like. Since water and wastes build up each day, more treatment helps people to feel better, and live longer. They have more energy to work or travel. There are five ways to do HD:

It can be hard to choose a type of dialysis when you wish you did not have kidney failure. My Kidney Life Plan can help. Visit this free tool to help match a treatment option with what matters most to you in your life. See: Dialysis, Dialyzer, Graft, Fistula, Peritoneal dialysis, Vascular access.

The protein in red blood cells that carries oxygen and gives these cells their red color. Low levels of Hgb in the blood are a sign of anemia. See: Anemia.

A blood-thinner used during hemodialysis to prevent blood clots.

A weak spot in a muscle that can let out or trap part of an internal organ. Hernias can occur in the groin, belly button, upper thigh, or abdomen. A hernia can be fixed with surgery.

See: Hemodialysis, Peritoneal dialysis

A constant balance in the body. Healthy kidneys help keep many substances in tight control. When kidneys fail, treatments that keep the balance help people feel better—and live longer. A kidney transplant is one such treatment. Some types of home dialysis can help, too.

A needle used for hemodialysis (HD) punctures the back wall of a fistula or graft. Blood leaks out into the tissues, which leads to pain and bruising. The leaked blood can squeeze the access and raise the risk of a blood clot, too. Infiltration is far less likely when you learn how to put in your own needles. You are the only one on earth who can feel both ends of an HD needle. And, the needles hurt less when you put them in. See: Fistula, Graft.

The interstitium is the extracellular space. See: Extracellular.

Inside cells. The intracellular “space” is one of three places where water is found in the body. About 2/3 of body water is inside your cells. See: Extracellular, Intravascular.

Inside the blood vessels. The intravascular “space” is one of three places where water is found in the body. Blood is about 8% of your body water. But, dialysis can remove water only from the blood. Water that is in or between cells cannot be reached until it shifts into the bloodstream—which takes time. See: Intracellular, Extracellular.

A measure of the dose of dialysis. Kt/V is a formula. K = how much urea (a small protein waste) is removed. t = time (minutes of dialysis). V = the volume of water in your body. To test Kt/V, blood is drawn before and after a treatment to see how much change there has been. A “good” Kt/V number for “adequate” treatment is at least 1.2 for hemodialysis or at least 1.7 per week for peritoneal dialysis. But, Kt/V relies on urea, which is cheap and easy to measure. Urea does not tell us how well dialysis removes other, larger wastes that can cause short or long-term harm. So, having “good” numbers should not mean that you cut your treatment time short. More dialysis can help you feel more like you did when your kidneys were healthy. See: Hemodialysis.

See: Advance directive

The left ventricle is the heart’s main pumping chamber. In LVH, the muscle wall grows too thick (hypertrophy) and takes up space in the heart. The heart cannot pump out all of the blood that enters it, which can lead to heart failure. Organ stunning can cause LVH in those on hemodialysis. Anemia and gaining too much water weight can also be factors. See: Anemia, Organ stunning.

A mineral found in many foods. In your blood, magnesium is an electrolyte. It helps your body use sugar and protein. And, it helps you have the energy you need. Magnesium helps your muscles and nerves work, too. See: Electrolytes.

A thin tissue. In dialysis, a membrane helps to clean the blood. The membrane holds in blood cells and protein. Wastes and water from the blood pass through pores in the membrane and into the dialysate. For peritoneal dialysis, the lining of the belly is the membrane. For hemodialysis, thousands of hair-thin fibers in the dialyzer are the membrane. See: Dialysate, Dialyzer.

The 90 or so wastes in the blood come in small, middle, and large molecule sizes. Small wastes are easy to remove with dialysis. Middle (or large) wastes take more time to remove. Some of these, such as beta-2 microglobulin, can cause long-term health problems in those on dialysis. Longer treatments remove more of these wastes. See: Amyloidosis, Beta-2 microglobulin.

A side effect of too much or too fast water removal during hemodialysis. Muscle cramps can be very painful. Gaining less water weight can help if the cause is too much weight gain. Slower, gentler treatments can help if the cause is too fast water removal. See: Organ stunning.

A doctor who specializes in kidney disease.

A filtering unit in the kidneys. Each kidney has about a million nephrons.

Non-steroidal anti-inflammatory drugs. Most are over-the-counter pain pills; some are prescribed by a doctor. NSAIDs can cause kidney damage or even kidney failure. The risk is higher when NSAIDS are taken for a long time.

Nerve damage that may cause burning or pain in the feet and hands. Diabetes is the most common cause. Those who are on dialysis and do not get enough treatment can also have nerve damage. More dialysis may help. Doctors can prescribe drugs to treat nerve pain.

See: Hemodialysis

The NxStage System One is an HD machine that was designed for home use. Most standard HD machines are about the size of a four drawer file cabinet and weigh 200–300 lbs. The NxStage System One is about the size of a microwave oven and weighs 70 lbs. It has a handle, so with help to carry, it can be put in the trunk of a car and taken on trips.

Damage to the heart, brain, gut, and kidneys that can occur with standard hemodialysis (HD). During HD, water is pulled out of your blood (ultrafiltration). But, most of your body water is not in your blood. It is in and between your cells. When HD pulls out too much water—or the right amount too quickly—your blood pressure can drop. When this happens, you may feel dizzy or your ears may ring. You may have painful muscle cramps. At the same time, your organs do not get enough blood and oxygen. Your body makes fibers to patch the damage. These fibers do not work the way your organs did. Stunning can lead to heart failure. Pulling less water or doing a longer HD treatment can help prevent stunning. Or, other types of dialysis are more gentle and do not cause stunning. Use this calculator to see if your HD treatments are safe. https://homedialysis.org/ufr-calculator. See: Hemodialysis, Peritoneal dialysis, Ultrafiltration, Ultrafiltration rate

In dialysis, this is one process used to pull water out of the blood. The dialyzer is used as the semipermeable membrane. It lets some things pass through and holds others in. Water will pass through pores in the membrane until the water levels on both sides are the same. We use osmosis as one way to pull water out of the blood with dialysis.

A hormone made by four parathyroid glands in your neck. When kidneys fail, they do not make enough active Vitamin D. Without it, your gut cannot absorb calcium from food. So, your blood calcium level drops. Each time it drops, PTH is released. PTH tells your bones to let some calcium go into your blood to raise the level back up. Your glands can enlarge so much that they cannot shut off. A blood test for PTH will tell your doctor if this is a problem for you. You may have bone pain if your PTH levels are too high. Your doctor can prescribe medicines to lower your PTH. Or, you may need surgery to take out the glands. See: Active vitamin D, Electrolytes, Parathyroidectomy

Surgery to remove the parathyroid glands.

A form of dialysis. PD cleans your blood inside your body. To allow you to do PD, a surgeon will place a soft silicone tube (catheter) through the wall of your belly.* The tube is used to fill the belly with sterile PD fluid. Water and wastes flow out of tiny blood vessels in the peritoneum, which lines the inside of the belly, and into the fluid. After a few hours of “dwell” time, you drain the used fluid out. Then, you add fresh fluid. This process is called an “exchange,” and each exchange takes about 20-30 minutes. You can do exchanges by hand at breakfast, lunch, dinner, and bedtime. Or, most people who do PD use a cycler machine at night to do the exchanges while they sleep. Some people may need a daytime exchange, too. PD is a gentle treatment. Healthy kidneys work seven days a week, and this is what your body is used to. When you do PD every day, you may not need many limits to what you can eat or drink. PD is also work-friendly, since you can do it on your own schedule. It can be hard to choose a type of dialysis when you wish you did not have kidney failure. My Kidney Life Plan can help. Visit this free tool to help match a treatment option with what matters most to you in your life. See: Dialysis.

A shiny membrane that starts under your diaphragm and goes down into your pelvis where your bladder and lower bowel are. It holds all of the loops of bowel, liver, spleen, and kidneys in place. The membrane is one cell layer thick. Under it is a layer of tissue rich in small blood vessels that are used to clean the blood during PD.

Infection of the lining of the belly that is the main health risk for those who do PD. Hand washing, a face mask, and use of sterile technique can prevent the problem. Signs to watch for are cloudy PD drain bags and belly pain. Antibiotics are used for treatment, and may be given into the peritoneum. Even one bout of peritonitis can cause scars so PD may no longer work. See: Peritoneal dialysis, Peritoneum.

A test (PET) that can suggest how long the PD fluid should stay in your belly to give the best results. A PET measures the amount of water and wastes removed by your PD treatment.

Medicines used to remove excess phosphorus from the blood. Binders attract phosphorus in the gut and remove it in the stool. When needed, binders must be taken with meals and snacks so they are in the gut at the same time as the food. The less dialysis you get, the more likely it is that you will need to take binders. See: Phosphorus.

A mineral in most foods that helps make up your bones and teeth. In your blood, phosphate (a salt) is an electrolyte. It helps give you energy, and maintains and repairs your cells. When you have too much phosphate in your blood, healthy kidneys remove it. But, most dialysis does not remove much phosphate. Long, slow hemodialysis (HD) removes the most. Those who do nocturnal HD may need phosphate supplements—not binders. See: Dialysis, Electrolytes.

Something that works the way your body does.

A mineral found in many fruits and vegetables. In your body, it is an electrolyte that plays a key role in nerve and muscle function. Precise levels must be kept in the blood at all times. So, those who do standard in-center HD have strict potassium diet limits. Fewer (or no) limits are needed with more dialysis. See: Electrolytes

Looking at something in a new way. There is always more than one way to look at an event or a challenge. Choosing to put a positive “spin” on things can help with coping.

A nerve problem that causes a powerful urge to move the legs. The skin may feel as if something is crawling on it, but moving the legs helps. RLS can cause poor sleep, both for the person who has it and for a partner. The problem is more common among those with kidney failure, perhaps due to a buildup of wastes in the blood.

One of two right ways to put needles in a fistula or graft. Two needles are used at each dialysis treatment. This technique is a way to rotate needle sites all the way up and down the top and sides of a fistula or graft. Since a fistula or graft is one line, the needle sites look like knots on a rope ladder. Using this technique can help prevent aneurysms. See: Aneurysm, Buttonhole technique, Self-cannulation

Putting your own needles into a fistula or graft. Medicare gives you the right to put in your own needles. While dialysis needles are large and can be scary, it hurts much less to put them in yourself. You are the only one who can feel both ends of the needles, so you are much less likely to infiltrate. And, your access can last much longer if only one person puts in the needles. You can ask your care team to teach you.

Caring for yourself when you have a chronic disease, with help from your care team. With kidney failure, this means that you:

• Learn all you can.
• Take an active role in your care.
• Notice and report symptoms.
• Be alert to prevent errors.
• Make a treatment plan with your care team and then follow it.

A membrane that lets some substances pass through its pores—but not all. A dialyzer membrane lets small and some mid-sized wastes pass through. At the same time, it keeps in larger cells, like protein and red blood cells. See: Dialyzer, Membrane.

A serious blood infection. Sepsis can lead to organ failure and death.

See: Hemodialysis.

Sodium is a mineral found in salt. In your body, it is an electrolyte that plays a key role in water balance and blood pressure. Precise levels must be kept in the blood at all times. So, those who do standard in-center HD have strict sodium diet limits. Fewer (or no) limits are needed with more dialysis. See: Electrolytes

See: Hemodialysis.

A narrow spot in a fistula or graft. Since stenosis slows the blood flow, it makes a blood clot more likely. If you have stenosis:

• You may have higher arterial pressure during dialysis.
• Your bruit may have a higher pitch (like a tea kettle).
• You may bleed around the needle at dialysis.
• You may take a long time to stop bleeding after dialysis.
• You may have bleeding that starts again after dialysis.

A surgeon or radiologist may be able to open up a narrow spot. See: Bruit

A patient’s weight without excess water. A patient can lose a few pounds of water weight at a dialysis session. How well someone feels at dialysis depends on how gently the water is removed. Getting the target weight right is the first step to a good hemodialysis treatment. See: Organ stunning.

The buzzing vibration that can be felt in a healthy fistula or graft. Feel for the thrill at least once each day. If the thrill stops, call the dialysis clinic or the surgeon’s office right away. A doctor may be able to fix your fistula or graft if you act quickly.

The removal of excess water by dialysis. See: Organ stunning.

How fast in milliliters per minute (ml/min) excess water is removed by dialysis.

Unlike normal body function. Standard in-center HD is unphysiologic. It is done only 3 days per week, while healthy kidneys work 24 hours a day, 7 days per week.

A small waste that is not, in and of itself, harmful. Urea is easy and cheap to measure. For this reason, it is used in formulas to measure the dose of dialysis. But, urea is very easy to remove, so it can overestimate the value of a treatment.

A formula to measure the dose of dialysis. URR is based on how much urea is removed at a treatment. Blood is drawn before and after a treatment. A formula compares the levels. “Adequate” dialysis means the URR is at least 65%.

Symptoms due to a build up of wastes in the body when the kidneys fail. These may include:

• Fatigue
• Swelling
• A metallic taste in the mouth
• Loss of appetite
• Nausea and/or vomiting
• Itching
• Shortness of breath
• Feeling dizzy

A tube that carries urine from a kidney to the bladder.

A way to reach the blood so dialysis can clean it. A surgeon will need to put in or make an access. Each type of dialysis has its own access options, and some are better and safer for you. See: Catheter, Fistula, Graft.

One of two needles used in hemodialysis (HD). Veins bring blood back to your heart. During HD, an arterial needle takes blood from your body to the dialyzer. A venous needle brings blood back to your body.