Research Updates in Kidney and Urologic Health

Vascular Access for Hemodialysis

If you will be starting hemodialysis treatments in the next several months, you will need to work with your health care team to learn how the treatments work and what you can do to get the most from them. One important step in getting ready for regular hemodialysis sessions is getting a vascular access, an enlarged, durable blood vessel that can be tapped easily and repeatedly to allow your blood to be circulated through the artificial kidney. There are several kinds of vascular accesses from which to choose.

For most people, the best kind of vascular access is an arteriovenous (AV) fistula. If you anticipate that you will be starting hemodialysis in 6 to 12 months, a surgeon can create an AV fistula by connecting an artery directly to a vein. The fistula is usually placed in the forearm. You will be given a local anesthetic so that any pain in your arm will be minimized during the procedure. You may need to stay in the hospital for a day or two, but in many cases the procedure can be performed on an outpatient basis. In a few months, the vein will grow thicker so that it can take repeated needle insertions and allow blood to flow quickly to the dialyzer.

Getting your AV fistula ready for use requires more planning compared with other kinds of accesses, since it takes time to develop. However, once the fistula has developed, it is less likely to form clots or get infected. Also, fistulas tend to last longer than other kinds of vascular accesses. A good fistula can last for up to 10 years or longer.

Some people have small veins that will not develop properly into a fistula. These people can still get a vascular access using either a plastic tube (a synthetic graft) or a transplanted vein from a cow (a bovine graft). A graft does not need to develop as a fistula does, so it can be used sooner after it has been placed, usually within 2 or 3 weeks. Compared with fistulas, grafts tend to have more problems with infection or clotting and need replacement sooner. But if you take care of your graft, it can last for several years.

If your kidney disease has progressed quickly, you may not have time to get a permanent vascular access before you start hemodialysis treatments. In your first few weeks, you can use a catheter as a temporary access. A catheter is a tube inserted into a vein either in the neck or in the leg near the groin. The catheter has two chambers to allow two-way flow of blood.

Catheters do not make good permanent accesses because they get infected easily and can make the veins narrow over time. But if you need to start hemodialysis before you have time to get a permanent access, you can be treated with a catheter for several weeks while your permanent access develops.

Whether you are getting ready for your first hemodialysis session or you have already started treatments, you can do several things to preserve or protect your access:

• Keep your access clean at all times.
• Avoid needles in your access site other than for dialysis.
• Do not let anyone put a blood pressure cuff on your access arm.
• Do not wear jewelry or tight clothes over your access site.
• Do not sleep with your access arm under your head or body.
• Do not lift heavy objects or put pressure on your access arm.

Your health care team will help you learn more about how to care for your access site. For a copy of the booklet, Getting the Most From Your Treatment: What You Need To Know About Hemodialysis Access, contact

National Kidney Foundation
30 East 33rd Street
New York, NY 10016
1–800–622–9010
www.kidney.org

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New Materials in CHID

Each quarter, NKUDIC adds about 150 items to the kidney and urologic diseases subfile of the Combined Health Information Database (CHID). The database contains abstracts and ordering information on professional resources and patient education materials—such as books, pamphlets, videos, journal articles, and manuals—on a variety of digestive disease topics. Following are descriptions of two recent patient education additions to the subfile.

Building Quality of Life:
A Practical Guide to Renal Rehabilitation

The Life Options Rehabilitation Program, sponsored by Amgen Inc., has published this manual designed to serve as a program planning tool to help renal professionals determine their patients' rehabilitation needs. The program includes six modules: an introduction and the "5 E's of renal rehabilitation"—Encouragement, Education, Exercise, Employment, and Evaluation. Each module includes an overview, how-to instructions, a checklist, self-assessment tools, references, and an appendix. For more information on this guide or other free rehabilitation materials, contact the Life Options Rehabilitation Resource Center at 1–800–468–7777, e-mail to lifeoptions@medmed.com, or visit the Life Options Internet home page at www.lifeoptions.org.

Adventure at Riverside Park:
A Story About Pediatric Dialysis

This children's book is designed to help pediatric renal patients and their families understand and discuss dialysis treatment. Adventure at Riverside Park tells the story of a young girl named Marcy and her experiences and emotions as a dialysis patient. The book introduces the members of the health care team and explains the role each plays in dialysis treatment. The book also helps children understand how important they themselves are as members of the team. Included are renal definitions and "My Dialysis Diary," space to write questions, concerns, thoughts, and feelings. The book is free to Indiana residents and costs $9 for those outside Indiana. For your copy, contact the National Kidney Foundation of Indiana Inc., 850 N. Meridian Street, Suite 203, Indianapolis, IN 46204–1108; phone: 1–800–382–9971.

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NKUDIC Releases Two New Fact Sheets

New fact sheets on your kidneys and urinary system and how they work are now available from the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

These fact sheets help physicians explain to their patients how the kidneys and urinary system work while also providing detailed explanations of several medical tests used to detect disease.

The progression of chronic kidney disease can be slowed, but it cannot be reversed. It is important for patients to understand how their kidneys function and why they sometimes fail. Your Kidneys and How They Work describes the important steps patients can take when they are in the early stages of kidney disease (e.g., controlling their blood sugar, blood pressure, and diet) and also provides additional information on dialysis and new research on transplantation.

Your Urinary System and How It Works explains how the urinary system functions and defines several associated disorders that affect both men and women, such as benign prostatic hyperplasia, interstitial cystitis, urinary tract infections, kidney stones, renal failure, and urinary incontinence. Additional resources for patients are also included.

A single copy of each fact sheet is available free of charge; packages of 25 are $5. To order these materials, call NKUDIC at 301–654–4415. Health care professionals are encouraged to duplicate the fact sheets as handouts for their patients or as an insert for newsletters. NIDDK's patient information materials are a public service and are not copyrighted.

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Upcoming NIDDK Meetings

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