Your New Responsibilities

Summary of Your New Responsibilities

You have many new responsibilities and a lot of information to process now that you are receiving dialysis treatments. This can be overwhelming at first, but remember, you are not alone. The renal team is here to support you and your family through this transition.

• Understanding your treatment
• Care of you hemodialysis access
• Monitoring yourself at home
• Taking your medication
• Pharmacy information
• Managing you diet
• Managing your fluid intake
• Exercise is important
• Maintaining a regular schedule

Understanding Your Treatment

It is important for you to understand as much as possible about your dialysis treatment, medications, dietary recommendations, and blood results. You can ask your doctor, nurse, pharmacist, or dietitian whenever you are unsure about any area of your care.

Care Of Your Hemodialysis Access

Your access site is the place where the blood is removed and then returned during dialysis. You may have a fistula, graft, temporary central line, or a permcatheter. You must take very good care of this access site. Call the dialysis unit if you have any concerns about your access. You must check your fistula or graft once daily to make sure it is working (you will know it is working if you can feel the buzzing).

Monitoring Yourself At Home

If you have problems with your blood pressure or blood sugar, consider learning how to monitor yourself at home. Patients can be referred by their family doctor or Nephrologist to the Diabetes Education Center. There you will learn more about diabetes and how to monitor your blood sugar. You can also monitor your blood pressure at home with an automatic blood pressure machine. Talk to your Nephrologist about your target blood pressure. You may be able to have the blood pressure machine covered under your benefit plan, ask your renal pharmacist.

Taking Your Medications

There are many medications you must take because you have kidney failure. These medications are important to help keep you in the best possible health. Be sure to notify your pharmacist and physician if you are not able to tolerate a certain medication or if you stop it for any reason. If you need any help regarding your medications, please contact your renal pharmacist.

It is a good idea to keep a list of your medications. As changes are made to your prescriptions, make the changes on your list and make your doctor and/or nurse aware of any changes. Bring your list with you to each dialysis treatment or when you see any other doctor. Also, bring your medications with you when you know you need more repeats or refills.

Pharmacy Information

It is important to use one retail pharmacy so all drug changes and interactions can be monitored. Doses of drugs, timing of medications, and interactions may be different for people on dialysis, so tell your pharmacist that you have kidney disease.

If you don't already use one pharmacy, you may wish to compare pharmacies to see which can offer the best service and choose what is best for you. For convenience, you may choose the retail pharmacy at Grand River Hospital, the Health Care Centre Pharmacy (HCCP). HCCP is open Monday to Friday 8:30 a.m. to 7:30 p.m. and on Saturday and Sunday from 9:00 a.m. to 5:00 p.m. The telephone number is (519) 749-4227 and it is located at the main entrance of the hospital on the 3rd floor. For Guelph patients you may wish to use The Prescription Place pharmacy located at 40 Baker Street. They offer free delivery to homes in Guelph and to the satellite unit. The telephone number is (519) 767-0040.

In addition to your retail pharmacist, our renal pharmacist is available to you for education, drug information, and to clarify your medications. You may wish to speak to the pharmacist about:

• information on medications (knowledge is the best medicine)
• when to take which drugs; this can be clarified with a medication list
• help with drug coverage
• ideas on ways to save money
• how to help make it easier to remember to take your medications

Over-the-counter medications like cold remedies, some antacids, or vitamins can actually be harmful to someone on dialysis. Never start a new non-prescription medication without first talking to your pharmacist or doctor. This includes herbal remedies. Just because they are "natural" does not mean they are safe. Talk to your pharmacist or doctor to make sure any herbal drug that you are thinking of taking is safe for you and doesn't interact with your current therapy.

When doctors write a prescription for a medication, they usually give one to three months supply. They also give a number of refills. If you have three refills or repeats, the pharmacist can dispense that supply three more times. After that, you require a new prescription even if the dose and directions have not changed. It is recommended that you request refills from the doctor whom originally prescribed that medication for you. If you are on hemodialysis, you will see your doctor quite frequently, which makes it easy for you to request a new prescription. Bring your almost empty bottle of medication with you so the doctor can easily clarify what you need. If you are on CAPD or are followed in the renal clinic, it is important to bring in your medications for your outpatient clinic visits. The renal team can then tell what medications you will need new orders for. Think ahead when you are running low on medications. This prevents delays and problems for you and your pharmacy and makes it easier for your doctor to assess your medications.

Managing Your Diet

Now that you are receiving hemodialysis, you will need to make changes in the types and quantity of foods that you eat. Your kidneys are not able to get rid of enough waste products and fluids from the food you eat and drink. Eating the right kind and amounts of food will help you to feel your best. Just like taking your medications, following your renal diet is an important part of your treatment.

Sometime during the first few weeks of treatment, the dietitian will meet with you to explain the importance of each nutrient and teach you about the changes that you need to make in your diet. Your dietitian will work with you to develop an individualized meal plan based on your needs, your bloodwork, and what you like to eat. You will receive a booklet called "The Renal Nutrition Guide". Some important nutrients that you and your dietitian may discuss are protein, fluid, sodium, phosphorus, and potassium. It is important that you have the right amount of protein, calories, fluid, vitamins, and minerals each day to feel your best and to keep your muscles, heart, and bones healthy.

Managing Your Fluid Intake

Your kidneys may no longer make enough urine to remove all the fluid you eat and drink. The weight you gain in between dialysis treatments is extra fluid that your kidneys are not able to get rid of and must be removed by dialysis. Your body can safely tolerate a weight gain of 2.0 kg to 2.5 kg of water between each treatment. Fluid gains larger than this can lead to damage to a person's heart. This occurs even in young people! If a large amount of fluid must be removed during a dialysis treatment you can develop very low blood pressure that may lead to serious problems. Symptoms of low blood pressure include feeling unwell, cramps, or nausea.

Drink one litre (4 cups or 32 ounces) per day plus an additional amount equivalent to your urine output to limit fluid gains. If a food is liquid at room temperature, it is considered a fluid. The following must be counted towards your daily fluid allowance:

• milk
• juice
• soup
• ice cream
• sherbet
• pop
• water
• wine
• popsicles
• jello
• tea
• coffee
• ice
• alcohol

Your renal dietitian can provide suggestions to help with meeting fluid targets.

Exercise Is Important

Exercise is important for everyone, including people on dialysis. Exercise may help you to feel less tired and keep your muscles strong. Do not be afraid to participate in a regular exercise program when you are on dialysis. You should FIRST let your Nephrologist know that you want to start to exercise. Your Nephrologist will tell you if it is safe for you to exercise.

A few points to keep in mind when exercising:

• Start slowly at five minutes and increase gradually by two minutes each week to 30 or 40 minutes.
• A daily walk to the mail box is a good way to start.
• Include stretching before starting an activity such as walking, swimming, biking, or light weight lifting.
• Look for ways to include exercise in your daily life - on a nice day walk to a neighbour's or the store instead of taking the car.
• You should be able to talk while exercising, if you can't, slow down.
• Do not exercise if it is extremely hot or cold outside.
• Stop exercising and consult your doctor if you experience any of these symptoms: feel very tired, develop shortness of breath, chest tightness, irregular heartbeats, dizziness, or nausea.

Maintaining A Regular Schedule

Missing a treatment is unsafe. Fluid and waste products will build up in your body and make you sick. The build up of potassium in your body may result in an irregular heartbeat, which can be very serious. If you cannot keep your scheduled dialysis treatment, contact the dialysis unit so your treatment can be changed.

Sometimes dialysis treatments are missed because of poor weather conditions, like snowstorms. If this happens please:

1. Notify the dialysis unit so that your missed treatment can be rescheduled.
2. Patients living outside the city may require a prescription for Kayexalate to keep at home. This medication controls your potassium until your next treatment. When you call the dialysis unit you will be given instructions on how to take this medication.
3. Limit your fluid intake to 500 ml (2 cups) per day so you do not become fluid overloaded.