General FAQ
Peritoneal Dialysis FAQ
- How is access to the peritoneal cavity established?
- How does my diet change once I’m on peritoneal dialysis?
- When Should I Call for Help?
Hemodialysis FAQ
- Does hemodialysis hurt?
- What can I do to stay healthy on hemodialysis?
- How do I take care of my fistula?
- How do I care for my fistula after treatments?
- How do I take care of my dialysis line?
- When Should I Call for Help?
- What tests can I expect to have?
- What can I do while I am having my treatments?
- Can I eat while I am having treatments?
- Can I have visitors while I am having Hemodialysis?
- Will I need to change the way I eat or drink?
- Will I need to reduce the amount of fluids I drink?
- How can I reduce the amount of fluid that I drink?
- Is it OK to travel?
- Should I wear a Medic Alert bracelet?
- Do I Need Vaccinations?
- What do I need to know about taking my medications?
- How do I deal with common problems?
- How can I gain so much weight if I don't drink anything?
- What effects may I see in by body during and after treatment?
- I am getting erythropoietin (Eprex®, EPO). Why is my hemoglobin still low?
- Why is my potassium level always high? I don't eat food with much potassium in it.
General FAQ:
How close am I to needing dialysis?
Typically, when your GFR is ≤ 10mL/min, meaning that your kidney function is at approximately 10% of what is normal, dialysis is initiated. However, the decision to start dialysis is individualized based on your signs and symptoms as well as your blood work results.
What do the bloodwork results mean?
- Creatinine- creatinine is a waste product of muscle activity, and your serum creatinine level is used to indicate how well your kidneys are filtering the blood. A high serum creatinine level indicates decreased kidney function. This means that your kidneys aren’t able to remove waste products from your blood the way they should.
- Urea- a waste product from the breakdown of protein
- GFR (Glomerular Filtration Rate)- An accurate measure of the ability of your kidneys to filter your blood. Your GFR is used to determine the severity of kidney disease and allows the doctor to plan your management accordingly. If your GFR number is low, your kidneys are not working as well as they should.
- eGFR (estimated Glomerular Filtration Rate)- an estimate of the ability of your kidneys to filter your blood using a calculation involving creatinine, age, body size and gender.
- Albumin- a protein that is not normally present in the urine. Albumin found in urine may indicate damage to the kidneys.
Peritoneal Dialysis FAQ:
How is access to the peritoneal cavity established?
A permanent catheter (soft plastic tube) is surgically inserted in your belly to allow for safe, consistent and easy access to your abdominal cavity.
After your doctor and your peritoneal dialysis team have assessed your situation, they will work with you to decide on which type of catheter is best for you. Catheters are inserted either at the bedside using local anesthetic, or in the operating room.
How does my diet change once I’m on peritoneal dialysis?
The Ontario Renal Network suggests the following nutrients in foods to be avoided or added: phosphorus, sugar, salt potassium, protein, fiber, fluids.
- Phosphorus
- limit eating foods that are high in phosphorus such as dairy products (milk, cheese, yogurt, ice cream), nuts and seeds, fast food, soft drinks, seasoned meats.
- Sugar
- eat fewer sweets and starchy food such as baked goods, rice, corn or potatoes.
- the PD dialysis fluid contains sugar which can make it difficult to control your blood sugar levels if you have diabetes, speak to your diabetes team to review your blood sugar regularly.
- Salt
- limit the amount of salt in your diet, avoid fast foods, packaged and processed foods.
- Potassium
- depending on the frequency of your dialysis treatments, your healthcare team will help you determine whether you need to follow a high or low potassium diet.
- Protein
- proteins may be filtered out with dialysis, so you will likely need to eat more protein. High protein food choices include meat, poultry, fish, eggs, tofu, and cottage cheese.
- Fiber
- add high fiber foods to your diet, including apples, pears, blackberries, raspberries, oatmeal, barley, corn bran cereal, peas, green or yellow beans, carrots, cabbage, etc.
- Fluid
- while you are on peritoneal dialysis, you may have to limit fluid intake depending on your weight, blood pressure and symptoms.
- Fluid includes anything that pours or becomes liquid at room temperature such as water, soup, juice, milk, ice cream, popsicles, alcoholic beverages and gelatin. Your healthcare team will help you determine your daily fluid allowance.
- For more information on diet changes while you are on peritoneal dialysis, please visit: https://www.ontariorenalnetwork.ca/sites/renalnetwork/files/assets/pdfactsheet-diet.pdf
When Should I Call for Help?
- If you are not sure what solutions to use for your treatment
- Cycler issues or alarms call Baxter technical support
- If you have cloudy drain bags or wet contamination come to KGH site Emergency Department or your nearest Emergency Department if you are not able to get to KGH
Baxter Technical Support: 1-800-553-6898
Peritoneal Dialysis Unit
Phone: 613-548-1310 or 1 800-567-5722
Fax: 613-548-1394
Hours: 7am to 5pm Monday to Friday (We are closed weekends & holidays)
After 5pm for Emergencies only: 613-548-3232 Press ”0” & ask to speak to PD Nurse on-call
Hemodialysis FAQ:
- Dialysis itself should not hurt. When the needles are put into your fistula it may hurt. However, this sensation does lessen over time. Once the needles are placed in your fistula, you should not experience any pain. If you do, you must tell your nurse so that the problem can be fixed.
- Sometimes, people have symptoms such as cramps, headaches, nausea or dizziness during dialysis. Your nurse may slow down the rate of fluid removal or increase your time on the machine. You can help yourself to avoid these symptoms by following your fluid and diet plan. Having to remove too much fluid during a dialysis treatment is one of the things that may make you feel uncomfortable during dialysis.
- Make sure you tell your nurse if you are having any pain or even just feeling ‘funny’ during your treatment.
What can I do to stay healthy on hemodialysis?
- Take an active role in learning about kidney disease and treatment
- Consider home hemodialysis and discuss with your healthcare team
- Follow your prescribed diet and fluid plan
- Take your medications as prescribed and tell your kidney doctor about any side effects
- Lead a healthy lifestyle—stop smoking, exercise, maintain a healthy weight
How do I take care of my fistula?
- Your fistula is your lifeline for dialysis. It’s important that you know how to take care of it and how to check that it’s still working. Your fistula should feel as if it is buzzing or purring. It also makes a swishing sound called a bruit. These are normal. If they stop, call the Renal Unit right away. It may mean that your fistula is clotted. We must act quickly to save your fistula.
- Don’t let anyone use your fistula except the dialysis nurses and doctors. It’s your lifeline, so you must be responsible for protecting it.
- Don’t let anyone
- take blood from your fistula arm
- start an intravenous (IV) in your fistula arm
- take your blood pressure on your fistula arm
- Don’t carry bags or purses over your fistula arm.
- Don’t sleep on your fistula arm.
- Don’t wear clothes with tight sleeves.
- If you think your fistula is infected, tell your nurse at your next dialysis. Your fistula may be infected if it:
- Looks red
- Feels tender or warm/hot
- Swells
- Hurts
- Has fluid oozing from it
- Protect your fistula when lifting, playing sports, or working. If you think you regularly do some activity that may result in your fistula getting ‘knocked about’, please talk to your nurses or doctors about it. They can advise you as to the best way to protect your fistula during your activities.
How do I care for my fistula after treatments?
- You may wear a tensor bandage on your fistula arm after dialysis. Take it off when you get home, or sooner if it feels too tight.
- We put a bandage over your fistula after your treatment. Remove the bandage 4 hours after your treatment. The bandage may stick to your fistula. If it does, try soaking it with warm water. To avoid infection, you must remove the bandage and keep your fistula clean.
- If a needle site bleeds after you leave the unit, put pressure on the site until the bleeding stops. It is a good idea to carry a few sterile gauze squares with you. Use the gauze squares to cover the site before you apply pressure. If the bleeding does not stop, go to the nearest emergency department.
How do I take care of my dialysis line?
- You may have a dialysis line inserted to allow for dialysis until you have a fistula created and it is ready to use.
- You may hear your dialysis line called by many names—Perm-Cath, central venous catheter (CVC), central line etc.
- The skin around the area where your dialysis line enters your body will be covered with a dressing. You must keep the dialysis line and the dressing dry, so you will need to have a tub or sponge bath while it is in place. Your dialysis line dressing should only be changed by your hemodialysis nurse.
- If there is any bleeding (Apply pressure. If bleeding does not stop, call the hemodialysis unit).
- If you feel ill, get chills, become feverish, or see any drainage around your CVC or dressing
- If your dressing becomes loosened (secure it with tape then call)
- If the CVC falls out (apply pressure for 10 to 15 minutes, cover it with clean gauze, tape and call)
*Hemodialysis Unit phone number: (613) 548-3232 x4401
24hr Emergency number: (613) 548-3232 - ask the Operator to page the Nephrologist on call
*Home Hemodilaysis nurses (613) 549-6666 x 7125
When appropriate, call 911 first.
What tests can I expect to have?
- We take blood from your fistula or dialysis line regularly for routine blood tests. We may need to test your blood more often if you have other problems.
- Your care team will talk with you about the test results and when necessary, will assist you in making changes to your medications, dialysis prescription or meal plan.
- There may be other tests that your doctors will request from time to time, depending on your health. Please keep the team informed of any tests that other doctors order for you.
What can I do while I am having my treatments?
You can do some activities while having dialysis. For example, you may wish to:
- Watch TV
- Read
- Knit
- Do a crossword
- Listen to a radio, with earphones
- Play cards
- Work on your laptop computer
- Keep in mind that you cannot stand up during your treatments. Your nurse will talk to you about how active you can be during your dialysis.
Can I eat while I am having treatments?
- Plan to eat your meals before or after your dialysis treatment. Eating a lot of food during dialysis may cause your blood pressure to drop quickly. This may affect the amount of fluid and waste products that can be removed.
- Also, if your blood pressure drops you may feel faint. If this happens while you are eating, you may choke. We recommend that you have, at most, a small snack during your dialysis treatment. Your dietitian can provide you with suggestions for acceptable snacks.
Can I have visitors while I am having Hemodialysis?
- We follow the KHSC Outpatient Visitor policy, which is updated regularly due to local COVID public health guidelines:
- Children under the age of 14 must be accompanied, and supervised, by another adult at all times.
- Visitors that are feeling unwell, have infection, respiratory illness or flu-like illness should not come to the hemodialysis unit.
- There may be interruptions to family presence to protect the privacy rights of other patients or to maintain safety and security
- We request that visitors and drivers wait in the waiting room to keep hallways clear and accessible for safety reasons.
Will I need to change the way I eat or drink?
- Hemodialysis is intermittent, unlike healthy kidneys, which work continuously. You may need to restrict the type and amounts of food and fluids you eat and drink in between dialysis treatments.
- You and your dietitian will work together to come up with a diet that includes food you like and limits foods which are higher in sodium (salt) and phosphorus. Your dietitian will determine if you need to adjust the amount of potassium you eat and ensure you’re getting sufficient protein.
- Be careful when you buy low sodium (salt) food products and salt substitutes. Some contain potassium instead of sodium. Read the labels carefully. Salt substitutes like NoSalt®, Half Salt® and Nu-Salt® should not be used, because these products are high in potassium. Herb based alternatives like Mrs. Dash® and Club House Salt- Free Seasonings® are better choices for you to use. Your dietitian can give you a list of ideas for low sodium seasonings to flavour your foods.
Will I need to reduce the amount of fluids I drink?
- If you are retaining fluids (swollen feet or hands, trouble breathing, etc.) and/or your urine output decreases, you will need to reduce your fluid intake.
- Reducing your fluid will:
- Help control your blood pressure and support your heart.
- Reduce fluid build-up in the lungs and makes it easier to breath.
- Keep you comfortable during dialysis. You will be less likely to feel nauseated and experience muscle cramping
- A fluid is anything that is liquid at room temperature.
- Jell-O®, ice cream, soup, popsicles, sherbet, ice and sauces
How can I reduce the amount of fluid that I drink?
- Here are a few tips:
- Eat less salt and salty foods so you do not get as thirsty
- Measure fluids to learn how much fluid is in cups, glasses and bowls
- Use smaller cups and glasses
- Drink only if you are thirsty
- Use crushed ice mixed with very small amounts of fluid
- Suck hard candies or chew gum
- Rinse your mouth and brush your teeth often
- Eat frozen grapes and other fruits that are low in potassium
- Count frozen foods that melt when they are at room temperature as part of your fluid intake
- If you have diabetes, keep blood sugars under control
- There are hemodialysis units across Canada and in many parts of the world. However, you must plan several months in advance due to limited space and staff. There is likely to be a charge for hemodialysis outside of Ontario.
- If you plan to travel, speak to your nurse/care team as soon as possible. They can provide assistance and medical documentation. Remember, arrangements must be made well in advance.
Should I wear a Medic Alert bracelet?
- It is a good idea to wear a Medic Alert bracelet. This lets others know that you are a kidney patient. You can get an application form online, from the Hemodialysis Unit, Kidney Foundation, or your family doctor.
- When you fill out the application, make sure you include
- your medical conditions such as kidney disease, diabetes
- medications
- allergies
- your fistula location
- Vaccinations not only protect you from diseases, they protect others around you. Older adults, people with chronic illnesses and children could become seriously ill if exposed to certain diseases. Because you are on hemodialysis, you have a higher risk of some illnesses. You can receive vaccinations against some of them:
- Hepatitis B - This is a virus that infects the liver. The Hepatitis B vaccine is given in a series of injections. When your body gets the vaccine, it makes antibodies. These antibodies attack the Hepatitis B virus if it gets in your body. Some people already have the antibodies and do not need the vaccine, so before we give you the vaccine, we must take a sample of your blood to see if you already have antibodies.
- Influenza (flu) Vaccination - Your kidney doctors strongly recommend that you get your flu shot every year. You can get it from your family doctor, at a flu shot clinic or from your hemodialysis nurse on a treatment day.
- Pneumococcal Vaccination - The pneumococcal vaccine is recommended for people with certain medical conditions, including chronic kidney disease and people 65 years of age and older. It is very important to receive this vaccine to protect yourself from infections caused by the Streptococcus pneumonia bacteria. Please speak to your renal team or family doctor about receiving this vaccine. You should get this shot every five years to protect yourself against this kind of pneumonia.
What do I need to know about taking my medications?
- Your doctor prescribes medications for you to take. You need to know:
- the reasons for taking the medications
- how and when to take them
- their side effects
- which ones you can’t take right before dialysis
- If you take any other medications, tell your nurse, pharmacist or kidney doctor about all other medications that you take. This includes:
- Vitamins and supplements
- herbal products and remedies
- medications that other doctors prescribe for you
- medications that you buy without a prescription such as allergy, pain and cold pills. These are called over-the- counter medications.
- Talk to your pharmacist and/or kidney doctor before you take any over-the counter medications or any herbal products. Some herbal products can create serious problems for people with kidney disease, and can interact with medications.
- Your medications are routinely reviewed by the renal team. Please remember to bring in all your medications every 6 weeks.
How do I deal with common problems?
- The following are common problems which can be controlled or reduced by trying the tips that are suggested under each item. Tell your nurse or doctor if you have any of these problems.
- Constipation: This may be caused by some of your medications or because of some of the changes to what you eat and drink. Ask your dietitian for suggestions of foods which are higher in fibre that can be included in your diet. If you have been less active, try to gradually increase your activity. If these tips don’t help talk to your doctor/ pharmacist about laxatives that are safe for you to take.
- Too much fluid in your body: If you have too much fluid in your body, you may get
- swollen or puffy legs, ankles, face or hand
- high blood pressure
- shortness of breath
How can I gain so much weight if I don't drink anything?
- Without knowing it, you may eat too much salt. This makes your body retain fluid and increase your thirst, so that you drink more. You may also eat foods that have hidden water such as Jell-O®, soup, gravy and frozen foods like ice cream or sherbet that are fluid at room temperature.
What effects may I see in by body during and after treatment?
- Cramps: You may get muscle cramps in your feet, lower legs and hands during or after your treatments. This happens when fluid is removed too quickly or your calcium or phosphorus are out of balance. Follow your fluid and salt restrictions to keep your fluid gains in the best range. To reduce the cramps, your nurse may make changes to your treatment. If you get cramps during or after your treatment, a light massage or a warm cloth on the cramp may help. After treatment, try light exercise such as walking. Remember that you can’t stand up during your treatment.
- Itchy skin: Your skin can get itchy if there is too much phosphate in your blood. Many foods contain phosphorus. Please look at your diet information to help you decide which foods to limit. To lower your phosphate, you may need to take medications such as calcium carbonate (Tums®), sevelamer (Renagel®), and lanthanum (Fosrenol®). These are called ‘phosphate binders’ because they bind with phosphate so that less is absorbed by your body. In order for them to work, they must be taken during your meals & snacks as prescribed. Dry skin also causes itchiness, try using mild soap, bath oil and skin cream to stop the itching. Special creams are available by prescription from your kidney doctor.
- Bone Pain: When your phosphorus, calcium and parathyroid levels are out of normal range, they can lead to problems with your bones and joints. These levels are monitored closely. Your doctor, nurse, pharmacist and dietitian will talk with you about how to control these levels.
- Low blood pressure: You may get low blood pressure near the end of your treatment. This may make you yawn or make you feel dizzy, tired and cold, or as if people are talking to you through a tunnel. If you have these feelings, or feel "funny" tell your nurse. Your nurse will stop or slow down fluid removal tilt your head back and your feet up so that more blood gets to your brain give you saline or a drink. To help prevent low blood pressure, it is important to follow your sodium and fluid restrictions and to limit food intake during dialysis.
- Change in appetite: When you first start dialysis, you may not feel like eating very much. As the dialysis removes the waste products from your body, your appetite should return. Your dietitian can provide you with ideas for foods or supplements which may appeal more while your appetite is decreased. It may be easier to eat several small meals/snacks instead of three regular meals.
- Changes in your energy level: When you first start dialysis, your energy level may be low. Having less hemoglobin (a protein that carries oxygen throughout your body) in your blood, or high waste products in your body may make you feel this way. As the dialysis removes these wastes, your energy should return. Many people feel tired right after dialysis, but feel better about 2 hours later. Many people return to their former activities, at work and at home after they start dialysis.
I am getting erythropoietin (Eprex®, EPO). Why is my hemoglobin still low?
- If you have an infection, low iron or lose too much blood, your hemoglobin can drop even if you take erythropoietin. Additionally, it takes 4-6 weeks for the EPO to work.
Why is my potassium level always high? I don't eat food with much potassium in it.
- Almost all foods have potassium—serving size is very important. If you have diabetes, high blood glucose can make your potassium high. If you cannot determine why your potassium level is higher, ask to see your dietitian. Your dietitian will help you to learn which foods need to be limited due to high potassium content and other practical tips to help reduce potassium in your diet.
- Potassium is removed while you are on hemodialysis, so it is very important that you stay for your full treatment time. If you leave before 240 minutes have passed, you are missing out on valuable ‘removal’ time.
