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Why is Monitoring Phosphorus Important in
Chronic Kidney Disease (CKD), End Stage Renal Disease (ESRD) and Dialysis?
10 Things ESRD CKD and Dialysis patients need to know about Phosporus:
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Phosphorus is a very common and important mineral element in the body, symbol P.
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Phosphorus is found in meat, dairy products, dark cola (non translucent), beans, nuts, and in some food additives, especially in processed foods.
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Phosphorus is important in bone metabolism and in maintaining the proper pH (acidity) of the blood stream.
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When Phosphorus is combined with oxygen, it is called phosphate.
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Healthy kidneys maintain a proper level of blood Phosphorus by eliminating excessive Phosphorus in the urine.
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Patients with ESRD and CKD can retain too much phosphorus, called hyperphosphatemia.
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High levels of phosphorus combine (bind) with Calcium. Calcium can come out of the bones and lead to weak bones (renal osteodystrophy). The Phosphorus-Calcium complexes can also be deposited into organs and blood vessels, leading to hardening of these organs.
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CKD, ESRD, Dialysis and Hemodialysis patients are counseled to follow a diet that limits the amount of phosphorous-containing foods they eat.
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CKD, ESRD, Dialysis and Hemodialysis patients are often prescribed phosphorus-binding medications. Phosphorus-binding medications are usually taken before meals to help prevent phosphorus from being absorbed from the intestines.
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Dialysis patients have their blood level of phosphorus measured every month to keep the phophorus level in the appropriate range.
If you are a
CKD, ESRD, Dialysis and Hemodialysis, talk to your renal dietician and kidney health care providers about ways to control your phosphorus levels.
Phosphate Binders | Phosphorus | Phosphate | Studies in ESRD CKD and Dialysis
Michel Chonchol1, Rudolf P. Wüthrich, Viatcheslav Rakov, Sylvain Gaillard, James A. Tumlin.
University of Colorado, CO, USA
Spring 2012 NKF Meeting
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National Kidney Foundation Spring Clinical Meetings 2012
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Helen Vlassara, Jaime Uribarri, Weijing Cai, Susan Goodman, Renata Pyzik,James Post, Fabrizio Grosjean, Mark Woodward, and Gary E. Striker
CJASN CJN.12891211; published ahead of print March 29, 2012,doi:10.2215/CJN.12891211
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03/30/2012 |
Tokyo, March 30, 2012 - Astellas Pharma Inc. ("Astellas Pharma"; Tokyo:4503; President and CEO: Yoshihiko Hatanaka) announced that Kiklin® Capsules (development code: ASP1585, generic name:Bixalomar) were granted Japanese marketing approval today for the indication of hyperphosphatemia in patients on dialysis with chronic kidney disease.
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Wang, M., Li, H., Liao, H., Yu, Y., You, L., Zhu, J., Huang, B., Yuan, L., Hao, C. and Chen, J. (2012), Phosphate removal model: An observational study of low-flux dialyzers in conventional hemodialysis therapy. Hemodialysis International. doi: 10.1111/j.1542-4758.2012.00678.x
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Stasios M, Reeves S, Porter B, Pesich A, Griffin, D.
DaVita, Denver, CO, USA
Annual Dialysis Conference 2012
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Biagio Di Iorio, Lucia Di Micco, Serena Torraca, Maria Luisa Sirico, Luigi Russo, Andrea Pota, Francesco Mirenghi, and Domenico Russo
Acute Effects of Very-Low-Protein Diet on FGF23 Levels: A Randomized StudyCJASN CJN.07640711; published ahead of print February 23, 2012,doi:10.2215/CJN.07640711
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Shutto Y , Shimada M , Kitajima M , Yamabe H , Razzaque MS ,
PLoS ONE 6(12): 2011
e29105. doi:10.1371/journal.pone.0029105
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Author Interview: Jamie Heise Pharm. D, BCPS
ASN Abstract: [FR-PO1205] Phosphorus (P) Management Trends of Hemodialysis Patients in a Large Dialysis Organization
Jamie Heise, PharmD, Kamyar Kalantar-Zadeh, MD, PhD, FASN, John Brian Copley, MD, FASN, Moshe Fridman, PhD, Rajnish Mehrotra, MD, FASN. Medical Affairs, Shire Pharmaceuticals, Chesterbrook, PA; Nephrology, Harbor- UCLA Medical Center, Torrance, CA; Statistics, AMF Consulting, Los Angeles, CA.
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Author Interview: Dr. Kuo-Cheng Lu, MD
Decreased blood lead levels after calcitriol treatment in hemodialysis patients with secondary hyperparathyroidism.
Lu KC, Wu CC, Ma WY, Chen CC, Wu HC, Chu P.
Bone. 2011 Oct 1. [Epub ahead of print]
Division of Nepheology, Department of Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan; Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Parathyroid hormone and phosphorus overload in uremia: impact on cardiovascular system
Melani R. Custódio, Marcia K. Koike, Katia R. Neves, Luciene M. dos Reis, Fabiana G. Graciolli, Carolina L. Neves, Daniella G. Batista, Andrea O. Magalhães, Philippe Hawlitschek, Ivone B. Oliveira, Wagner V. Dominguez, Rosa M.A. Moysés, and Vanda Jorgetti
Nephrol. Dial. Transplant. (2011)first published online August 8, 2011 doi:10.1093/ndt/gfr447
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Author Interview: Dr. Ken-ichi Miyamoto Ph.D
Sodium-dependent phosphate cotransporters: Lessons from gene knockout and mutation studies.
Miyamoto KI, Haito-Sugino S, Kuwahara S, Ohi A, Nomura K, Ito M, Kuwahata M, Kido S, Tatsumi S, Kaneko I, Segawa H.
J Pharm Sci. 2011 May 12. doi: 10.1002/jps.22614 |
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Phosphorus dynamics during hemodialysis.
Hemodial Int. 2011 Feb 25. doi: 10.1111/j.1542-4758.2011.00538.x.
Kjellstrand CM, Ing TS, Kjellstrand PT, Odar-Cederlof I, Lagg CR.
Hines VA/Loyola University Chicago, Chicago, Illinois, USA Karolinska Institute, Stockholm, Sweden Department of Biology, Lund University, Lund, Sweden Northwest Kidney Centers, University of Washington, Seattle, Washington, USA
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Author Interview: Dr. Takatoshi Kakuta:
Effect of sevelamer and calcium-based phosphate binders on coronary artery calcification and accumulation of circulating advanced glycation end products in hemodialysis patients
Am J Kidney Dis. 2011 Mar;57(3):422-31.
Kakuta T, Tanaka R, Hyodo T, Suzuki H, Kanai G, Nagaoka M, Takahashi H, Hirawa N, Oogushi Y, Miyata T, Kobayashi H, Fukagawa M, Saito A.
Division of Nephrology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan. |
Serum phosphorus predicts incident chronic kidney disease and end-stage renal disease.
Nephrol Dial Transplant. 2011 Feb 8.
O'Seaghdha CM, Hwang SJ, Muntner P, Melamed ML, Fox CS.
1National Heart, Lung and Blood Institute's Framingham Heart Study and the Center for Population Studies, Framingham, USA.
BACKGROUND: Elevations in serum phosphorus are associated with renal decline in animal models and progression of established chronic kidney disease (CKD) in human observational studies. We examined whether serum phosphorus levels increase the risk of incident CKD or end-stage renal disease (ESRD) in two population-based prospective cohort studies.
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Phosphate-binding efficacy of crushed vs. chewed lanthanum carbonate in hemodialysis patients.
Hemodial Int. 2010 Dec 7.
doi: 10.1111/j.1542-4758.2010.00509.x.
How PP, Anattiwong P, Mason DL, Arruda JA, Lau AH.
Departments of Pharmacy PracticeMedicine, Section of Nephrology, University of Illinois at Chicago, Chicago, Illinois,
Lanthanum carbonate, a chewable noncalcium-containing phosphorus (P) binder, is useful for treating secondary hyperparathyroidism in patients who have hypercalcemia and cannot swallow whole tablets
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CUTTING DIETARY PHOSPHATE DOESN’T SAVE DIALYSIS PATIENTS’ LIVES
Doctors’ Recommendation Needs Reconsideration
Washington, DC (Monday, December 6, 2010) — Doctors often ask kidney disease
patients on dialysis to limit the amount of phosphate they consume in their diets, but this
does not help prolong their lives, according to a study appearing in an upcoming issue
of the Clinical Journal of the American Society Nephrology (CJASN). The results even
suggest that prescribing low phosphate diets may increase dialysis patients’ risk of
premature death
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Clin Exp Nephrol. 2010 Sep 4
Shigematsu T; The Lanthanum Carbonate Research Group.
Division of Nephrology and Blood Purification Medicine, Department of Medicine, Wakayama Medical University, 881-1 Kimiidera, Wakayama, Wakayama, 641-8509, Japan
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Nephrol Dial Transplant. 2010 Aug 24.
Veighey K, Booth J, Davenport A.
UCL Center for Nephrology, Royal Free Campus, University College London Medical School, Rowland Hill Street, London NW3 2PF, UK.
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Clin J Am Soc Nephrol. 2010 Aug 5.
Eddington H, et al
Salford Royal NHS Foundation Trust, Salford, United Kingdom; and.
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Author Interviews: hemodialysis
- Dialysis - ESRD - CKD |
| Characterizing Missed Dialysis Sessions in the ESRD Patient population |
| Hemoglobin Recovery following Hospitalization in ESRD patients |
| Association of Serum Sodium Levels with Mortality in Non-Dialysis Dependent Chronic Kidney Disease |
| Talking Control Support in Hemodialysis Results in Higher Patient Satisfaction Survey Response |
| Use of Fondparinux in Severe Renal Impairment & Hemodialysis |
| Contribution of CA, phosphorus & 25-VitD to the excessive severity of sPTH in African-Americans with CKD |
| Comparison of Risk Prediction Using the CKD-EPI Equation & the MDRD Study Equation for eGFR |
| Iron-Based Phosphate Binder PA21: Effective and Well Tolerated in CKD Hemodialysis Patients |
| Hemoglobin Recovery following Hospitalization in ESRD patients |
| Disease Management Program ESRD Patients Have Lower Overall Medical Costs |
Crit-Line Monitor Use in Incident Hemodialysis Patients Improves Dry Weight and Adequacy,
While Reducing Epoetin Alfa Dose: A Propensity Score Matched Study |
| Perceptions & Roles of Nephrology Social Worker Within the Suicide Continuum of Care |
| Reduced Use of ESAs and IV Iron with Ferric Citrate: A Medicare Bundle Cost-Offset Model |
| Video Education Increases Patient Knowledge About Phosphorus Control |
| Effect of a plasma sodium biofeedback system applied to HFR on the intradialytic cardiovascular stability |
| Hemodialysis Access and Age-related Postoperative Outcomes: Which Fistula First? |
| Coronary Artery Calcification & Pre-Hemodialysis Bicarbonate Levels in Hemodialysis |
| Protein/omega-3 supplementation during regular dialysis sessions & inflammatory indices in hemodialysis |
| VDRA and improved survival in dialysis patients with serum intact PTH ≤150 pg/mL |
| Relation of social support to mental health and locus of control in Chronic Kidney Disease |
| Depression and anxiety in patients with chronic renal failure |
| Self -esteem in Greek dialysis patients: The contribution of health locus of control |
| Medication adherence in Greek hemodialysis patients: Contribution of depression and health cognition. |
| Association of insomnia with kidney disease quality of life reported by patients on maintenance dialysis |
| Comorbidities/ inactivity & long-term outcomes of CABG in small number of men on chronic hemodialysis |
| Complete Recovery From Acute Kidney Injury With Incident CKD Stage 3 and All-Cause Mortalit |
| Outcomes of patients with ESRD under chronic hemodialysis requiring CRRT & in AKI requiring CRRT |
| Radiologically Placed Tunneled Hemodialysis Catheters: Pediatric Institutional Experience of 120 Patients |
| Preload dependence of gated cardiac SPECT-derived ventricular volumes in hemodialysis |
| Effect of Hemoglobin Target on Progression of Kidney Disease |
| eGFR at Reinitiation of Dialysis & Mortality in Failed Kidney Tranplant Recipients |
| Biomarkers Determining Cardiovascular Risk in Kidney Disease |
| Rural and Micropolitan Residence & Mortality in Dialysis |
| Urinalysis is more specific & urinary NGAL is more sensitive for early AKI detection |
| Vascular Klotho Deficiency Potentiates Development of Arterial Calcification & Mediates FGF23 Resistance |
| Efficacy of preventing hemodialysis catheter infections with citrate lock: Hemodialysis Int'l |
| Learn about dialysis options from a Home Dialysis Therapy Nurse |
| Optimal fluid control can normalize CV risk markers and limit LV hypertrophy in thrice weekly dialysis |
| LDL, atherosclerosis and mortality in hemodialysis |
| Pulmonary hypertension in chronic kidney disease on dialysis/ without dialysis |
| Predictors of steal syndrome in hemodialysis Hemodialysis Int'l |
| Sodium intake and blood pressure in renal transplant recipients Nephrology Dialysis Transplant |
| HIV-associated nephropathy patients with & without apolipoprotein L1 gene variants Kidney International |
| Depression and nonadherence predict mortality in hemodialysis treated ESRD patients Hemodialysis Int'l |
| Serum Metabolite Concentrations and Decreased GFR in the General Population AJKD |
| High Volume Peritoneal Dialysis in Acute Kidney Injury CJASN |
| Trial of Catheters of Different Lengths to Achieve Right Atrium vs SVC Placement for CRRT AJKidneyDs |
Pre-kidney transplant ESA agence responsiveness with post-transplant outcomes
Nephrology Dialysis Transplant |
| Prognostic Value of 48-Hour Ambulatory BP & CV Mortality in Hemodialysis Kidney Blood Press Res |
| Darbepoetin-α Cardiovascular Geometry and CKD -Cardiorenal Med |
| Influenza Vaccine Effectiveness in Patients on Hemodialysis Arch Intern Med |
| Bioelectrical Impedance Analysis & Skinfold Thickness Sum in Body Fat Mass in Dialysis J.Renal Nutrition |
| Pre-Diabetes after Renal Transplantation Nephrology Dialysis Transplant |
| Essential trace element status and clinical outcomes in long-term dialysis |
| End-of-Life Decision-Making Confidence in Surrogates of AA Dialysis Patients Is Overly Optimistic |
| Comparison of Cardiac PET Perfusion Defects During Stress Induced by Hemodialysis vs Adenosine AJKD |
| Mental Health over Time & Cardiac Outcomes in HEMO Study CJASN |
| Cholesterol Synthesis, Cholesterol Absorption, & Mortality in Hemodialysis CJASN |
| Statins, Risk & Outcome in Acute Kidney Injury in Community-Acquired Pneumonia CJASN |
| Dialysis-Dependent Changes in Ventricular Repolarization |
| High Burden of Kidney Disease in Youth-Onset Type 2 Diabetes Diabetes Care |
| Late Start Dialysis & Outcomes in Japanese Dialysis: Therapeutic Apheresis & Dialysis |
| Pica in Pediatric Dialysis - J.Renal Nutrition |
| Elemental Concentrations in Scalp Hair in Hemodialysis Patients Therapeutic Apheresis & Dialysis |
Health-related QOL was not improved by targeting higher hemoglobin in the Normal Hematocrit Trial
Kidney Int'l |
| Sevelamer on HbA1c, Inflammation, & Advanced Glycation End Products in Diabetic Kidney Disease CJASN |
| Increasing organ donation via anticipated regret proposed protocol |
| Statins on Chronic Inflammation and Nutrition status in Renal Dialysis |
| Emergency Department Use of Urinary Biomarkers of Nephron Damage |
| Preemptive renal transplant survival, access to care, & renal function at listing Nephrology Dialysis Transplant |
| Effect of Diuretic Use on 30-Day Postdialysis Mortality in Critically Ill Patients Receiving Acute Dialysis Dr. Ko |
| FGF23 predicts incident cardiovascular event before but not after the start of dialysis Dr. Isaka |
| Mortality Prediction by Surrogates of Body Composition: An Examination of the Obesity Paradox in Hemodialysis Using Composite Ranking Score Analysis: Drs. Miklos Z Molnar & Kamyar Kalantar-Zadeh |
| Plasma Sodium & Blood Pressure in Hemodialysis J.Human Hypertension |
| Increased Risk of Death in Young African American Dialysis Patient: Dr. Norman |
| Nutritional Management of Stage 5 CKD J. Renal Nutrition |
A proposed management algorithm for fistulae between hemodialysis access circuits and adjacent veins
Vasc Access |
| Percutaneous approach in maintenance & salvage of dysfunctional autologous vascular access for dialysis |
| The Kidney Disease Quality of Life Cognitive Function Subscale and Cognitive Performance in Maintenance Hemodialysis Patients Amer. J Kidney Diseases |
| Absolute Interdialytic Weight Gain is more important than Percent Weight Gain for Intradialytic Hypotension in heavy hemodialysis patients: Dr. Chen Nephrology |
| Postdialysis BP rise predicts outcomes in hemodialysis: Dr Yang BMC Nephrology |
| APOL1 allelic variants are associated with lower age of dialysis initiation Nephrology Dialysis Transplant |
| Effects of Six versus Three Times per Week Hemodialysis on Physical Performance, Health, and Functioning: Frequent Hemodialysis Network (FHN) Randomized Trials Dr. Hall CJASN |
| Variability of blood pressure in dialysis patients: a new marker of cardiovascular risk Dr. Di Iorio |
| Assessment of Body Composition Using Dry Mass Index and Ratio of Total Body Water to Estimated Volume Based on Bioelectrical Impedance Analysis in CKD J. Renal Nutrition |
| Potential Role of Active Vitamin D Treatment in Telomere Length in Hemodialysis: Dr Valdivielso |
| CKD, severe arterial & arteriolar sclerosis & kidney neoplasia MELAS syndrome Dr. Piccoli BMC Nephrology |
| Pedometer-Assessed Physical Activity in Children and Young Adults with CKD |
| Effect of Frequent or Extended Hemodialysis on Cardiovascular Parameters Amer J. Kidney Ds |
| Exposure to bisphenol A is associated with low-grade albuminuria in Chinese adults Dr. Guang Kidney Int'l |
| Increased dietary sodium and greater mortality in hemodialysis Kidney Int'l |
| Sonography Characteristics of the Intra-Dialysis-Graft Thrombus Dr. Cheng |
Featured Hemodialysis Interviews |
Home Dialysis Summit Recommends Policy Changes to Increase Home Dialysis Usage
WASHINGTON, April 25, 2012 /PRNewswire -- On the heels of the first National Summit on Home Dialysis Policy, Summit organizers released a report reflecting the views of the delegates -- leaders in the kidney disease patient, clinician, facility and industry communities -- on federal policy steps to improve utilization of home dialysis for patients who can benefit from this often advantageous form of treatment. Many of the organizers also announced they have formed a new alliance, called the Alliance for Home Dialysis, to advance the recommendations identified at the Summit.
The Summit's "Report of the Delegates" highlights key findings from a March 29th meeting in Washington, DC where experts probed why, despite widely accepted and well-documented benefits of home dialysis -- improved outcomes, enhanced patient satisfaction, improved quality of life, and lower costs-- fewer than ten percent of the more than 390,000 current U.S. dialysis patients receive treatment at home. Current rates of home dialysis utilization reflect a steep decline from the 1970s, when almost 40% of U.S. dialysis patients were treated in-home.
Specifically, delegates found that policymakers should work with stakeholders in the dialysis community to confront three areas:
Accessibility: Patients and clinicians face array of hurdles in education, training, and infrastructure that hinder equalized access to home dialysis.
Accountability: Utilization of home dialysis can be improved through measures within government programs that are designed to recognize and support excellence in the delivery of home dialysis services.
Aligning Incentives: Reimbursement policies, regulation of new technologies and other policy incentives can be realigned to better support federal policy goals of expanding access to home dialysis.
The Report includes 15 recommendations to serve these goals, including that federal policymakers should:
Maintain parity for home and in-center dialysis in Medicare reimbursement;
Support home dialysis mentoring programs, particularly those that use existing patients as mentors; and
Align federal and state regulatory requirements for home therapies, such as revising the Centers for Medicare and Medicaid Services Conditions for Coverage requirements, to reflect differences in home and in-center dialysis.
Summit supporters will begin work through the new Alliance to dialogue with federal policymakers and advance policy improvements in the three consensus areas that emerged at the Summit.
SOURCE National Summit on Home Dialysis Policy
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National Kidney Foundation's Top 10 Things Every Dialysis Patient Should Know.
- You have treatment choices. Options exist for how, where and when you dialyze. Dialysis can be done in a hospital, in a dialysis unit that is not part of a hospital, or at home. You and your doctor will decide which place is best, based on your medical condition and your wishes. There are different types of dialysis - peritoneal and hemodialysis. Work with your health care team to determine a treatment plan that makes you feel comfortable. Recent studies show that the majority of patients beginning in-center hemodialysis (HD) know very little, if anything, about the option to dialyze at home. Once informed, 40% or more of patients are interested in this treatment option, and yet less than 10% actually begin home dialysis. If you're dissatisfied with the type of dialysis treatment that you're receiving, ask your healthcare team if another type of dialysis treatment would be better.
- You can compare in-center dialysis facilities online. Information on over 5,600 US-based dialysis centers is available online through the Medicare website. To help you make choices about your care, you can compare different facilities side-by-side and evaluate each facility based upon clinic characteristics and quality measures. You can search for dialysis facilities by name or geographic proximity. After completing an initial facility comparison to determine which facilities best meet your needs - such as the number of hemodialysis stations at a particular location and whether there are evening shifts available - visit the facilities that you're most interested in. Talk to the staff and other patients, as well as your doctor to ensure that this dialysis facility is a good fit for you.
- There are ways to prepare ahead for an emergency. Ask your dialysis facility about their emergency plan in case of a snow storm, fire, power outage or other natural disaster. As back up, make sure you have the names, locations and phone numbers of other dialysis units and hospitals in your area. Since regular community transportation services may not be working in an emergency, be prepared to make other arrangements for getting to dialysis. You may need to contact the police and Emergency Medical Services (EMS) for assistance. If you dialyze at home, make sure you have at least two weeks' worth of unexpired supplies on hand. If you have to miss a dialysis treatment, begin your emergency meal plan.
- There is an easy way to transfer patient records between clinics. There is an easy, secure way for your health care team to transfer your treatment records online. In 2009, the Centers for Medicare and Medicaid Services (CMS) created a centralized web-based data collection system called CROWNWeb to help reduce and eliminate patient treatment interruptions. This central system helps to streamline patient care regardless of the reason for changing dialysis centers. For example, if you've been admitted to the hospital, or if you needed to relocate during an emergency evacuation, your doctors and health care team can access up-to-date information about your dialysis so that you continue to receive appropriate care no matter where you are.
- You can travel while on dialysis.
Dialysis centers are located in every part of the United States and in many foreign countries. The treatment is standardized, but you need to plan ahead by making an appointment for dialysis at another center before you go. The staff at your center may help you make these appointments.
- You can be your own best advocate. Know what key questions to ask your doctor or other healthcare professionals. Take notes so that you can refer back to them later. Partner with your doctor and decide on a treatment plan together. Advocate for yourself and share how you're feeling.
- You have many rights. You as a patient have a great deal of control over your treatments. Patients have a bill of rights which includes receiving quality care, counseling about your medical information, and an expectation of privacy.
You also have responsibilities. Once you decide on a course of treatment, it's important to follow the recommendations of your health care team. If you decide to receive in-center dialysis, arrive at dialysis on time so that you can receive the full treatment without delays.
- You can receive insurance coverage. If you have end stage renal failure, you are likely eligible for Medicare insurance coverage. Speak with your health care team and social worker for help filling out insurance paperwork.
- You may need to follow a special diet. When your kidneys are not working properly, you may not be able to eat everything you like, and you may need to limit how much you drink. Your diet may vary according to the type of dialysis you receive. It is important to speak with a renal dietitian so that you are able to understand what you can and cannot eat based on your full health history.
- Dialysis patients can work. Many dialysis patients can go back to work or school after they have gotten used to dialysis. After establishing a dialysis routine, many patients have more energy and find that they are able to time to work around this new schedule. Some patients even find creative ways to work remotely from dialysis with the use of a laptop or cell phone, depending on their field of expertise.
More from National Kidney Foundation Press Releases
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New Book to Help Educate Patients with Chronic Kidney Disease who may be facing Dialysis or Hemodialysis: |
Help, I Need Dialysis!
How to have a good future with kidney disease
By Dori Schatell, MS and Dr. John Agar
An internationally known nephrologist and life-long kidney patient educator explain how dialysis works, each of the ways to do it, and how your treatment choice may affect your diet, energy level, work, travel, sexuality and fertility, sleep, and survival. Comprehensive and fully referenced, this book is a must-read if you face the life-changing choices that come with kidney failure. |
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