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RENALIFE

Volume 25 · Number 3

Bonus Issue!

November 2008

The Voice Of All Kidney PatientsTM

Sleep, Do You Daydream About It?

Patients Declare AAKP Convention A Success! Taking the Cruise Plunge Bonus: aakpDelicious! Step Away From the Buffet Table!

A Publication of the American Association of Kidney Patients

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Contents

5 8

November 2008

14

FEATURES

5 Cover Story

Sleep, Do you Daydream About it?

we take a look back at the Convention highlights and give you a preview of what's to come next year!

COLUMNS

President's Message .............4 In the News ............................4 Cover Story ...........................5 Feature Article ......................8 Patient Profile .....................20 Washington Update ...........16

By Reena Mehra, MD, MS, FCCP, DABSM

Not getting enough sleep at night? You're not alone. According to the U.S. Department of Health and Human Services, nearly 40 million Americans suffer from some form of sleep disorder every year. For patients with chronic kidney disease (CKD), it can be detrimental to your health, making your diabetes or high blood pressure worse. Getting treatment for your sleep disorder can improve your overall health.

22 Dear Doctor

Does Every Dialysis Patient Stop Urinating?

By James Bailey, MD & Tejas Desai, MD

8 Feature Article

Your kidneys produce urine from the wastes and fluids they remove from the blood. But the development of chronic kidney disease (CKD) can affect your urine output. In this article, Drs. James Bailey and Tejas Desai explain just how kidney disease can affect your urine output.

Dear Doctor ........................22

DEPARTMENTS

Life Membership ................20

Patients Declare AAKP Convention A Success Three hundred patients, family members and renal professionals joined AAKP in Washington, D.C., for its 35th Annual Convention. In this article

Bonus Issue with: aakpDelicious!

Step Away from the Buffet Table!....................................... 11 Recipe Roundup: Holiday Treats.........................................13 Dear Dietitian.................................................................................... 14

aakpRENALIFE is published six times a year by the American Association of Kidney Patients (AAKP). It provides articles, news items and information of interest to kidney disease patients and their families, as well as individuals and organizations in the renal healthcare field.

aakp

Kim Buettner Jerome A. Bailey Acting Executive Director Editor

RENALIFE

Stephen Z. Fadem, MD, FACP, FASN Thomas G. Peters, MD, FACS, FASN

Emily Carbone Associate Editor

aakpRENALIFE is distributed in January, March, May, July, September and November and is a membership benefit. Patient or family membership is $25 per year. Opinions expressed in aakpRENALIFE by authors are not necessarily those held by AAKP, its Board of Directors or publisher. Contrasting views of readers are welcome. All letters to the editor received by AAKP will be treated as having been submitted for publication unless otherwise noted in writing. AAKP reserves all rights to reject, edit and/or condense unsolicited material for reasons of space and clarity. Non-profit postage paid at Tampa, Fla., and additional mailing offices. © The American Association of Kidney Patients is a national non-profit organization. AAKP's mission is to improve the lives of fellow kidney patients and their families by helping them deal with the physical, emotional and social impact of kidney disease. All rights reserved. For reprint requests or information on advertising, please contact the AAKP National Office at (800) 749-2257 or [email protected]

Medical Editors

Officers of AAKP

Roberta Wager, RN, MSN President Stephen Z. Fadem, MD, FACP, FASN Vice President Carolyn G. Price Vice President Amy L. Friedman, MD, FACS Secretary Kelly M. Mayo, MS Treasurer

American Association of Kidney Patients 3505 E. Frontage Rd., Suite 315 · Tampa, Florida 33607-1796 (813) 636-8100 · (800) 749-AAKP Visit our Web site www.aakp.org · [email protected] Design and Production DebraRobertsDesign, LLC

ADVERTiSiNG PoLiCy STATEMENT

The acceptance of advertising in this publication does not constitute or imply endorsement by the American Association of Kidney Patients (AAKP) or its Chapters of any advertised product or service. People with kidney disease should consult their physicians before using any medication or therapy. AAKP accepts no responsibility for any claims made in advertisements in this publication.

president's message

It is with sadness I announce the resignation of Kris Robinson as Executive Director/CEO of the American Association of Kidney Patients (AAKP). In her resignation, Kris said it was time to pursue other opportunities. It was a difficult decision for her, but one she felt she needed to make. We are positive Kim will do a wonderful job during this transition. I want to thank all the patients, renal professionals, sponsors and exhibitors who participated in the 35th Annual Convention. The Convention was a great success! I had several patients approach me over the four-day event to tell me what great fun they were having and to rave about the information available to them. I am also excited to announce AAKP is "Going the Extra Mile," hosting next year's Annual Meeting in the Mile High City, Denver, ear's Annual Meeting in the Mile High City, Denver. The Convention will be held Sept. 3-6. I encourage you all to join us for another exciting event! Enjoy,

Bobbi Wager, RN, MSN

This is a loss for the Association. During the last 18 years, Kris has been instrumental in many of AAKP's achievements. She strongly believes in AAKP's mission and knows the Association will continue to do great work. We thank Kris for her service to the Association and to the kidney community. We wish her the very best. Kim Buettner is serving as the Acting Executive Director. Kim has held a variety of positions with the Association over a 10 year period. Before the AAKP Board of Directors asked her to step in as Acting Executive Director, Kim served as the Association's Assistant Director.

Roberta Wager, RN, MSN AAKP President & Two-time Kidney Transplant Recipient

In the News

Updated Educational Books: AAKP's Kidney Beginnings: A Patient's Guide to Living with

Reduced Kidney Function and AAKP Patient Plan, Phase 1 have been updated. Both books can be downloaded from the AAKP Web site, www.aakp.org/brochures.

In a written letter to all U.S. Senators, AAKP asked lawmakers to support the bill which would amend the National Organ Transplant Act to allow states to compensate donors for offering a kidney for transplant. To read AAKP's letter to U.S. Senators visit www.aakp.org/public-policy/publiccomments-correspondence.

AAKP Urges Senate Support of the Organ Donation Clarification Act of 2008:

AAKP HealthLines Archived Calls Online: Past AAKP HealthLine calls are archived on the AAKP Web site at www.aakp.org/events/HealthLine/archived. AAKP HealthLine is a FREE, one-hour conference call designed to educate you on a variety of topic affecting kidney patients and their families.

aakpRENALIFE · NOVEMBER 2008 · 4

CoVER SToRy

Sleep, Do You Daydream About It?

By Reena Mehra, MD, MS, FCCP, DABSM

The prevalence of sleep disorders in the United States is exceedingly high. Sleep disorders cause a high number of health problems, are associated with high healthcare costs and are frequently linked with cuts in quality of life that negatively impact social and work relationships. In particular, chronic kidney disease (CKD) is extremely common in older individuals affecting up to one in five Americans over 65 years of age, and we know there is also an increasing prevalence of sleep disorders, such as insomnia and sleep apnea, with increasing age. Traditional cardiovascular risk factors such as diabetes, hypertension, hyperlipidemia (elevation of fats in the bloodstream) and smoking explain part of this risk. Factors resulting in sleep disruption, such as sleep apnea, are commonly associated with CKD and may also play a role. It is reasonable to consider the treatment of sleep disorders, such as sleep apnea, in CKD may improve morbidity and mortality in this setting.

Sleep disturbances and sleep disruption are very commonly observed in patients with CKD. Most studies and investigations to date have examined patients with end-stage renal disease (ESRD) on dialysis. Sleep complaints have been noted

to occur in up to 80 percent of dialysis patients, and literature supports reduced sleep, sleep fragmentation and increased wakefulness after falling asleep is common in those on dialysis. Data in one study also shows approximately 50 percent of the dialysis patients complained of problems with sleep, as opposed to only 12 percent of healthy individuals. Some of the most common sleep complaints reported include nighttime awakenings in 67 percent, early morning awakenings in 80 percent, restless legs syndrome (RLS) symptoms in 72 percent, jerking legs in 83 percent and daytime sleepiness in 28 percent of patients. Dialysis patients also experience changes in their recorded sleep architecture. Polysomnographic (record of sleep pattern) features include reduced total sleep time, reduced sleep efficiency (total sleep time/time in bed, normal >90 percent) as low as 66 percent, and increased amounts of wake time during the sleep period. In addition, specific sleep disorders such as sleep apnea, RLS and insomnia have been reported to be very common in the setting of CKD. Polysomnographic studies have also demonstrated that sleep architecture (the composition of sleep stages during sleep) is

Cover Story, continued on next page aakpRENALIFE · NOVEMBER 2008 · 5

Cover Story, continued from previous page

usually abnormal, with increased amounts of stage 1 (lighter stage of sleep) and 2 sleep, and decreased amounts of stage 3, 4 (deep sleep) and REM sleep (the latter thought to play a role in memory consolidation). The progression of kidney disease has also been associated with the progression and worsening of sleep difficulties and sleep quality. Interestingly, in a recent study published this year, the prevalence of sleep disorders as ascertained by a questionnaire within two months of the diagnosis of mild renal dysfunction (mean creatinine level=2) was 89 percent, suggesting even those patients with mild kidney disease not on dialysis are prone to having sleep difficulties.

CKD and Sleep Apnea

Patients who have ESRD also have a high prevalence of RLS and periodic limb movements. RLS is characterized by unpleasant, restless sensations in the legs, arms, hands or feet and an irresistible urge to move those body parts. Not all patients experience the same symptoms with some noting an itchy sensation while others note a creeping or crawling feeling. In some cases symptoms may consist of painful burning, prickling or aching. These symptoms are typically worse in the evening and with prolonged immobility (such as during dialysis), and can often be improved by movement. Up to 80 percent of patients who have ESRD Nocturnal hemodialysis has been shown to experience symptoms consistent with RLS. improve sleep apnea in those with ESRD with some data supporting mechanisms of an increase In addition, sleep study recordings of sleep patterns have demonstrated a high prevalence in pharyngeal airway size. It is thought ESRD of period limb movement disorder (PLMD), a is associated with increased narrowing of the

Sleep apnea is a disorder characterized by repetitive, intermittent upper airway collapse resulting in upper airway obstruction. The prevalence of sleep apnea in the United States population is estimated to range from 2-4 percent with higher prevalence in men compared to women. Typical symptoms observed in sleep apnea include snoring, witnessed apneas (episodes of breathing cessation) noted by the bed partner and excessive daytime sleepiness.

airway likely due to pharyngeal edema (fluid in the tissues of the airway) which may increase the likelihood of sleep apnea. Treatment with nocturnal hemodialysis may help decrease this fluid and therefore improve sleep apnea. The relationship of sleep apnea with CKD is thought to be bi-directional, meaning CKD-associated changes in fluid shift, acid-base balance and chemoreflexes may predispose someone to sleep apnea. Conversely, sleep apnea-related hypoxia, increased carbon dioxide levels and increased sympathetic nervous system activity (fight or flight response) could lead to worsening kidney disease. Sleep apnea through the mechanisms described is also a risk factor for cardiovascular disease by increasing systemic inflammation, oxidative stress and vascular (blood vessel) function. The recognition and treatment of sleep apnea in CKD must be emphasized in order to reduced cardiovascular risk and potentially minimize progression of renal disease in CKD.

CKD and Restless Legs Syndrome (RLS)

In pre-dialysis patients the prevalence of sleep apnea is very common (50 percent), and affects up to 80 percent of individuals on dialysis.

aakpRENALIFE · NOVEMBER 2008 · 6

condition during sleep characterized by episodic limb movements in association with disrupted sleep. PLMD affects up to 70 percent of the dialysis population. What leads to RLS and PLMD remain unknown, although it has been speculated that iron, folate and vitamin B12 deficiencies could predispose hemodialysis patients to these disorders. In addition, low plasma levels of tyrosine, which is the amino acid precursor of dopamine, have been observed in uremic patients, and it is widely believed RLS may result from dopamine deficiencies in the central nervous system. Disorders that commonly coexist with CKD such as anemia and diabetes mellitus may also represent the cause for RLS symptoms.

could also represent another sleep disorder such as sleep apnea presenting as sleep maintenance insomnia due to sleep disruption or RLS presenting as sleep onset insomnia.

Conclusion

Sleep disruption and sleep difficulties as well as specific sleep disorders such as sleep apnea, RLS and insomnia are common in those with CKD. It is important to note that the recognition, diagnosis and treatment of these disorders are extremely important to improve cardiovascular and overall health status as well as quality of life. Reena Mehra, MD, MS, FCCP, DABSM, is an Assistant Professor of Medicine in the Division of Pulmonary and Critical Care Medicine and the Division of Clinical Epidemiology and the Medical Director of the Adult Sleep Laboratory of the University Hospitals of Cleveland.

CKD and Insomnia

Chronic insomnia is a common sleep disorder estimated to occur in 10-15 percent of the population. In one study based upon selfreported questionnaire data, close to 43 percent of individuals with mild CKD had sleep onset insomnia defined as a sleep latency of greater than 30 minutes (meaning it took 30 minutes or longer to fall asleep) and 63 percent reported sleep maintenance insomnia symptoms characterized by repetitive nocturnal awakenings disrupting sleep. Insomnia symptoms in CKD

aakpRENALIFE · NOVEMBER 2008 · 7

FEATURE ARTiCLE

AAKP National Convention

35 Years and Still a Success!

The American Association of Kidney Patients' (AAKP) 35th Annual Convention was a great success, as the Association reflected on its past and looked toward the future. An estimated 300 patients, renal professionals and friends of the kidney community joined AAKP in Washington, D.C., Aug. 28-31 at the Grand Hyatt Washington. The AAKP National Convention is the largest convention of its kind where patients can get valuable one on one contact with renal professionals and fellow patients. The educational sessions were well attended. Sessions included, Considering It All: Your Dialysis Options, How Does the Transplant Waiting List Work?, I Have Chronic Kidney Disease, Now What? and Straight Talk about Diet: Explaining the Difference Between the Pre-Dialysis and Dialysis Diet. more than 20 exhibitors who participated in the Annual Convention. Fun social events gave attendees the opportunity to meet fellow patients and win fantastic prizes. Ironman® triathlete Shad Ireland surprised guests at the AAKP Board of Directors' Welcome Reception. Ireland is the first dialysis patient to compete in and complete a triathlon. Through his foundation, the Shad Ireland Foundation and Team Ireland, he travels the country talking to kidney patients about the importance of exercise and encouraging patients to live their best life possible. Ireland has been a dialysis patient for more than 25 years. During the AAKP Annual Banquet and Awards Ceremony, AAKP honored Ireland with the AAKP Patient Comeback of the Year Award. The award is given to a kidney patient who has overcome major obstacles and has gone on to live a productive life.

Attendees received valuable information on kidney disease products and services from the

AAKP also recognized other individuals and organizations that have made significant contributions to AAKP and the kidney community throughout the year. Nominations were received from across the country from both renal professionals and patients. Winners were selected by a panel of judges. Kelly Mayo, MS ­ Winner of the Samuel J. Orenstein Award AAKP honored Kelly Mayo, MS, with this award for her extraordinary service toward the achievement of AAKP's goals and objectives. Ms. Mayo has shown a vested interest in AAKP and in the kidney community at-large. She's shown great leadership within AAKP, serving as

35th Annual Convention Committee Members from left include: Carolyn G. Price (Chairperson), Brenda Dyson and Kelly Mayo, MS. aakpRENALIFE · NOVEMBER 2008 · 8

Carolyn G. Price ­ Winner of the Convention attendee Betty Josephine Rinaldi at the 70s themed Berman Award Welcoming Ceremonies. This award honors the first Treasurer of AAKP. It is given to a patient or family member who devotes much of his or her time to carrying out the mission of AAKP. Ms. Price is the newly elected Vice President of the AAKP Board of Directors, she chaired the 35th Annual Convention and works with kidney support groups in her community.

Treasurer of the AAKP Board of Directors and has given talks at many AAKP patient centered events.

Arceneaux is a former AAKP Board Member. He's helped raise thousands of dollars for kidney patients in South Florida, helped sponsor educational programs and is a supporter of AAKP.

FMQAI Network 7 ­ Winner of the Dominick Gentile Award Each year, AAKP presents the Dominick Gentile Memorial Award to an End Stage Renal Disease Network (ESRD) that has a history of providing patients with beneficial programs, important informational resources and an avenue to report grievances. This year, AAKP recognized the efforts of FMQAI Network 7.

Amy L. Friedman, MD, FACS ­ Winner of the Peter Lundin Award The award honors one of the great Presidents of AAKP, who was both a long-term dialysis patient and nephrologist. It recognizes a physician who makes contributions to the care and welfare, and well-being of kidney patients over the course of his or her career. Dr. Friedman comes from a family of kidney patient advocates. She's secretary of the AAKP Board of Directors, a member of the AAKP Medical Advisory Board and has contributed numerous articles to AAKP publications. Dr. Friedman was recently named Director of Transplantation and Professor of Surgery at SUNY Upstate Medical University in Syracuse, NY. Jess Arceneaux ­ Winner of the AAKP President's Award This award is given by the AAKP President to someone she believes embodies what AAKP stands for - patient advocacy, leadership, friend to the kidney community and strength. Mr.

Jennifer Weil, MD ­ Winner of the Maureen Lundin aakpRENALIFE Award This award recognizes a patient or healthcare professional who contributes to the official magazine of the Association, aakpRENALIFE. This award, named after one the magazine's first editors, places a special emphasis on those talents. Not only has Dr. Weil made several contributions to aakpRENALIFE and Kidney Beginnings: The Magazine, she's also encouraged several colleagues to contribute articles to AAKP publications. She has a passion for patient education and believes in AAKP's mission of improving the lives of all kidney patients and their family members.

Network 7 is a leader in the development and promotion of disaster preparedness education and policies that directly enhance the lives of kidney patients nationwide. The Network tries to make sure patients understand how disasters can impact their lives, and how they must prepare for emergency events. In Florida, Network 7 is a member of the Florida Kidney Disaster Coalition and administrative lead for the Kidney Community Emergency Response Coalition.

Feature Article, continued on next page aakpRENALIFE · NOVEMBER 2008 · 9

Feature Article, continued from previous page

David Jacobs ­ Patient Comeback of the Year Award This award is presented to a patient who has overcome major obstacles and has gone on to live a productive life. David Jacobs battled polycystic kidney disease and its many complications for years. After receiving a kidney transplant he vowed to do what he could to make a difference in the lives of other kidney patients. So without saying a word to anyone, he created medical software called Matchmaker, which is designed to optimize matches for paired donations between willing families. The California Pacific Medical Center is using the software. Elizabeth Jones, MS ­ Winner of the Caregiver of the Year Award AAKP created this award to recognize the very important role caregivers play in the treatment and healing process. Being a caregiver is a difficult job and takes a lot of patience. Elizabeth Jones has made a career of caring for others. She's worked as a social worker for nearly 20 years and takes an active role in her patients lives, helping to get prescriptions filled, coordinating rides to dialysis facilities, making doctor appointments and being a counselor. Kristine and Chelsea Berry ­ AAKP Volunteer of the Year Award AAKP honored two people with the AAKP Volunteer of the Year Award. The award is usually given to one person who has played a vital role throughout the year in AAKP activities. Kristine and Chelsea Berry are great examples. They attend every kidney support group meeting in their city promoting the activities and services of AAKP. They are even seen wearing their AAKP Convention t-shirts around town. No matter the obstacle, they support each other and spread the mission of AAKP.

aakpRENALIFE · NOVEMBER 2008 · 10

AAKP President Roberta Wager, RN, MSN, presents Carolyn G. Price with the Josephine Berman Award.

Renee Bova-Collis, MSW, LCSW ­ AAKP NOVA Award The NOVA Award is presented to an individual who has played an important role throughout the year in the everyday activities of AAKP. This award is chosen by the AAKP staff for their appreciation of an individual's commitment and responsiveness to the needs of the National Office. NOVA Award recipients are volunteers who have selflessly donated their generous services, support and time to the association. Renee Bova-Collis, MSW, LCSW, has gone beyond the call of duty on a number of occasions. Whether it's driving 200 miles to speak at an AAKP educational program, writing an article for one of AAKP's magazines or simply forwarding an email to colleagues, she never says no to the AAKP staff's requests and she does it with a smile. Bova-Collis is also an AAKP Board Member.

2009 AAKP Convention AAKP is excited to announce the 2009 AAKP Annual Convention will be held in the "Mile High City", Denver, Sept. 3-6. The official Convention brochure will be available late spring 2009. To be placed on the Convention mailing list, call (800) 749-AAKP or send an email to [email protected] To see pictures from the 2008 Annual Convention, visit www.aakp.org/ events/convention/2008.

aakp

STEP AWAY FROM THE BUFFET!

A Holiday Survival Guide for People on Kidney-Friendly Diets

By Barbara Zebrowski, MS, RD, CSR, LDN

Delicious!

Special Bonus!

Every year when November rolls around, my friends and I have the same conversation. "The holidays are here. What are you doing this year to survive?"

What are the first thoughts that come to your mind when you hear, "the holidays are here?" Do you immediately think of meals with family, friends and colleagues? Are you excited, or do you think, how am I going to enjoy or even get through this season with all the diet restrictions I have to follow? Most people with kidney disease need to modify their intake of particular nutrients including sodium, potassium, protein, phosphorus and fluid. People who are on dialysis should be meeting with a dietitian at their dialysis facility on a regular basis. You can ask your dietitian to spend some extra time with you to prepare for the holidays. No two people are the same, so it is important to work closely with your dietitian to learn the foods that are better choices for you and those that may cause harm to you. Ask for kidneyfriendly cookbooks and recipes, as well as shopping tips, to keep your meals pleasant and interesting. And talk to your dietitian about your favorite foods so you can learn ways to fit them in to your meal plans. Here are some tips for you to enjoy holiday parties ­ and the food that comes with them.

Holiday Eating Tips for People on KidneyFriendly Diets Before the party: · Make family and friends aware of your diet so they are able to serve foods that are healthy for you.

Barbara Zebrowski, MS, RD, CSR, LDN, is Corporate Dietitian for Fresenius Medical Care North America. Ms. Zebrowski is a Registered Dietitian and a Board Certified Specialist in Renal Nutrition. She has 22 years of experience working with patients who have kidney failure.

· Have a snack before the party so you are not starving when you arrive. At the party: · Limit temptation - move away from the buffet table. · Sauces and gravies are usually salty and full of fat. Limit the amount you have by putting them "on the side." · Take your phosphate binding medication as ordered by your doctor. · At a buffet or cocktail party, keep a plate with a napkin on it in one hand, and a cup in the other. This can dissuade others from urging you to eat and drink more once you have had enough. When planning your own party: · Leave out salty ingredients. · Add salt-free seasonings and herbs for more flavor. · Have a variety of foods available to meet your dietary needs, along with those of your guests. Spending time with family and friends is what makes the holidays important and memorable. Food choices are also important, but they don't have to make you miserable. Use the tips above to follow the meal plan you and your dietitian have made. Then, enjoy! !

11

He lives with CKD and is counting on us.

At Genzyme, patients are our first priority. So far, we've helped more than 750,000 people with kidney disease around the world. We continue to seek ways to do more. To find better treatments. To offer more assistance. To help in any way we can. Visit Genzyme.com to find out how we can help you.

2008 Genzyme Corporation. All rights reserved. HV001 v1 01/08

Recipe Roundup

Following a kidney-friendly diet during the holidays doesn't have to be boring. Check out these tasty dishes fit for any gathering!

Zesty Turkey Breast with Cranberry Sauce

Ingredients:

1 can cranberry sauce 1 pound turkey breast 1/2 cup of water 1 Tbsp flour 1 Tbsp orange zest 1 tsp grated ginger root 1/2 tsp black pepper 1 Tbsp canola oil

Serves 6, Serving Size: 2.6 ounces

Directions:

Place cranberry sauce in a one quart saucepan along with water, orange zest and grated ginger root. Bring to a simmer and stir over low heat for 3 minutes. (This can be made in advance and stored in the refrigerator). Place turkey pieces between two sheets of waxed paper and pound with a heavy object until flattened. Dredge turkey pieces in the flour. Heat canola oil in a large non-stick frying pan. Place floured turkey pieces in a large pan and brown lightly (3 minutes per side). Set aside and keep warm. Re-heat cranberry sauce if needed until heated through. Pour sauce over turkey and serve!

Nutrient Analysis: Calories: 224; Protein: 17 g; Carbohydrate: 33 g; Fat: 2.6 g; Cholesterol: 47 g; Sodium: 68 mg; Potassium: 190 mg; Phosphorus: 137 mg Renal and Renal Diabetic Exchanges: Two meats, one low potassium fruit, one high calorie Source: Adapted from Cooking for David: A Culinary Dialysis Cookbook. Visit www.CulinaryKidneyCooks.com for more information.

13

Savory Green Beans

Ingredients:

2 cups green beans 4 tsp canola oil 2 tsp mustard

Serves 4, Serving Size: 1/2 cup

1/2 tsp black pepper 1 tsp Worcestershire sauce (low sodium) 1 Tbsp bread crumbs

Directions:

Prepare green beans by microwaving on high for about 4-6 minutes or until cooked. Make a sauce mixing 2 tsp oil, mustard, pepper and low sodium Worcestershire sauce. Heat in microwave for 30 seconds. Toss sauce with hot cooked green beans. Mix remaining oil with bread crumbs. Sprinkle on top of green beans and broil in an (toaster) oven for 5-10 minutes or until brown.

Nutrient Analysis: Calories: 71; Protein: 1 g; Carbohydrate: 6 g; Fat: 5 g; Cholesterol: 0 g; Sodium: 92 mg; Potassium: 131 mg; Phosphorus: 23 mg Renal and Renal Diabetic Exchanges: One medium potassium vegetable, one fat Source: Adapted from Cooking for David: A Culinary Dialysis Cookbook. Visit www.CulinaryKidneyCooks.com for more information

!

Both recipes developed for ESRD patients.

dear dietitian

Q:

As a kidney patient, does organic or natural make a difference in my diet?

produced a list of foods ranked with the most pesticide and here's the top 12 from that list: 1. Peaches 2. Apples 3. Sweet Bell Peppers 4. Celery 5. Nectarines 6. Strawberries 7. Cherries 8. Lettuce 9. Grapes-Imported 10. Pears 11. Spinach 12. Potatoes As a consumer, you've probably seen or heard the word "organic" one too many times. And if you are a kidney disease patient, you are probably wondering how organic foods play a role in your already modified diet of controlled sodium, phosphorus and potassium.

What is "organic" food?

14

The term "organic" should not be confused with the word "natural." According to the U.S. Department of Agriculture (USDA) Web site, "organic food is produced using sustainable agricultural production practices. Not permitted are most conventional pesticides; fertilizers made with synthetic ingredients, or sewage sludge; bioengineering; or ionizing radiation. Organic meat, poultry eggs and dairy products come from animals that are given no antibiotics or growth hormones." Only foods bearing the USDA seal are certified organic. However, the term "natural foods" has no legal definition.

The last two produce in the list are high in potassium. It is best to check with your dietitian to plan a healthful diet that includes your favorite food items without increasing your potassium levels. One such practice is peeling your potatoes and soaking them in water. Then, draining and rinsing the potatoes in streaming water to help reduce the potassium content. Washing and scrubbing your produce in running water also helps reduce its pesticide content.

Although it has not been determined organic foods are more nutritious than conventional foods, organic farming may bring other benefits, especially to the environment. In addition to decreased chemical impact, crop rotation and natural fertilizers are beneficial in that they help to keep the soil nutrient-rich and reduce disease. Organic farming practices can be more expensive since it is also labor-intensive to raise organic crops. However, consumers who believe in its benefits are willing to pay the extra cost.

Get Fresh, Buy Local

Support your local farming community by buying local. Some organic foods may be shipped by gas-guzzling trucks or cargo ships. Some may even have traveled from across the globe. Buying your fresh produce from the

The Dirty Dozen

The Environmental Working Group, a nonprofit group based in Washington, D.C., has

local farmer's market or co-op not only ensures it is less harmful to the environment, it also supports your local farming community. Buying produce that are in season are tastier and the cost is comparable to their counterparts in grocery stores.

Check Labels

and many similar terms. Your healthcare team reviews your lab results every month and can make adjustments to your diet or medications (including your phosphate binders) as necessary. Always remember you are the most important part of the team. Get involved and ask questions. We're here to help! ! References:

1. Nutrition Concepts and Controversies 8th Edition: 16. 2. Consumer Corner. Is Organic the Answer? Nutrition Concepts and Controversies 8th Edition: 525.

As a kidney disease patient, it is important to develop a healthy habit of checking food labels. "Organic" foods are not always the healthiest choice. A food product can be certified organic with highly processed ingredients. Organic or not, you want to look for ingredients like sodium phosphate, tricalcalcium phosphate, monosodium glutamate

Resources: www.usda.gov www.ewg.org www.ultracare-dialysis.com Maria Sheila A. Opina, RD, works in four Fresenius Medical Care dialysis clinics in Ypsilanti, Mich. She practices yoga, Pilates and loves to travel.

15

Tips & Bits

Get Moving!

"I know I am supposed to exercise but how do I start?" The following pointers will help you on the road to fitness. · Get your physician's stamp of approval. Most likely, it will be happily given! · Pick an activity you enjoy. Walking? Dancing? Yoga? If you like it, you are more likely to actually do it! · Recruit a buddy to do it with you. Spouse? Friend? Dog? · Set small, realistic goals. Five or 10 minutes to start is fine. · Take advantage of your local community center, YMCA or gym. There are usually training classes for those new to exercise. Ask questions! · Listen to music or books on tape. The time will fly by.

Don't feel that exercise has to be a regimented formal program to be effective. Movement is the key. Dancing in your pajamas in the kitchen counts !

Exercise tip provided by Kathy Howard, RN, BSN, CCTC, CCTN, a registered nurse with 27 years of experience, most of those years in the transplant or dialysis field.

Washington Update

NEW MEDICARE LAW MAKES HISTORIC CHANGES IN THE ESRD PROGRAM

By John Schall, MMP

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) became law when both Houses of Congress overrode President Bush's veto of the bill in July. MIPPA makes far-reaching changes in the Medicare ESRD Program ­ including important improvements in the program that AAKP has long been calling on Congress to enact. This year our voices were heard! for dialysis rather than a catheter. Fistular access is clinically better, but you have to get it before you actually need dialysis.

Bundling Payments

The new law modernizes the Medicare reimbursement system for ESRD by moving to a bundled payment by 2011. Under a bundled payment system, the dialysis provider will receive one payment for both the dialysis and related drugs and lab services. This reform has been a longstanding recommendation of both the Medicare Payment Advisory Commission and the Government Accountability Office. AAKP advocated for bundling out of concerns for patient care. Research now shows when ESA is used to raise red blood cell levels too high, it can put dialysis patients at risk of death or cardiovascular disease. Because of this, the FDA put a black box warning on ESAs last year. Unfortunately, under the current system where ESAs are reimbursed separately, providers have a financial incentive to dose ESAs higher, with the ensuing health risks. A bundled system, however, will realign the system so dialysis centers have

Kidney Disease Education and Prevention

The law establishes new pilot projects to increase public and medical community awareness of chronic kidney disease (CKD) and to increase screening for CKD. The pilot projects will also test surveillance systems to improve how we assess the prevalence of kidney disease. The law also creates a new education benefit for pre-ESRD patients. This is the first time ever such activities will be covered by Medicare. The goal here is that hopefully patients can delay onset of the need for dialysis. And when they do need dialysis, they will be better informed about their options between home and in-center dialysis, as well as the importance of getting a fistula. A fistula creates a vascular access used

aakpRENALIFE · NOVEMBER 2008 · 16

an incentive to be more efficient providers of care ­ including more efficient and appropriate use of ESA. The financial incentive to raise dosing levels will be eliminated. Of course, under a bundled payment system, there must be strong protections in place to make sure every patient gets the care they need. Bundling cannot be "one size fits all." It must be able to respond to individual patient needs. To ensure proper care for Medicare beneficiaries with more complex needs, the law puts in place protections to ensure every patient will get the ESAs necessary to manage their anemia. First, the bill requires case mix adjustment, which adjusts payments upwards for more complex patients with higher costs of care. Second, the bill requires additional reimbursement to help providers cover the expense of high-cost outlier patients. Third, the legislation requires providers of ESRD services to meet a certain standard for quality of care, and cuts payments for providers who don't.

first time ever there will be quality incentive payments in the ESRD Program. The bad news is the initial anemia management quality measure in this bill is not strong enough. The quality measure tells providers they are providing acceptable anemia management care as long as they haven't gotten worse than their past track record. This is wrong. We should be encouraging providers to improve the care provided. There are serious health issues at stake, as we know from the FDA warning. But the measure in the law gives providers a pass as long as their anemia management care in the first year doesn't get worse than past performance. Clearly there is more work to do and AAKP will closely monitor it to make sure it is done right. Overall, this has been a great year for accomplishing important policy changes for the ESRD program. These are big steps forward in improving dialysis services to kidney patients across the country. We especially thank Congressman Pete Stark (D-CA), Chairman of the House Ways and Means Health Subcommittee, who was the major champion of these long-sought changes. AAKP testified before Congress last year asking for these needed changes for kidney patients and Congressman Stark pushed them through Congress. It would not have happened without him! John Schall, MMP, is a Vice President with Jefferson Government Relations. He has more than 20 years experience with the Executive and Legislative branches of government. He is a public policy and communications professional with noted expertise in a wide range of policy fields.

Quality Measures

It is critical bundling have a strong quality component to ensure patients are receiving appropriate care. The good news is that for the

Break out of the clinic into the light.

Have you ever dreamed of nding a dependable therapy to better meet your independent spirit? Look no further. Fresenius Medical Care introduces the Liberty® cycler, a cycler designed to deliver dialysis therapy in the comfort of your home. As one of the only machines that can be prescribed for dialysis during the night, you can dialyze while you sleep. Treatments are scheduled to accommodate your lifestyle. The slow and gentle nature of peritoneal dialysis can provide optimal therapy for many ESRD patients. Setup takes almost no time at all. So with Liberty, therapy time is now a time for rest. Sweet dreams! If you would like to learn more about the Liberty cycler or questions to ask your physician about the option to dialyze while you sleep, please contact 1-800-662-1237 x HOME (4663) or visit our website www.dreammachine.com.

See full package labeling for a complete description of hazards, contraindications, side effects and precautions. Fresenius Medical Care, the triangle logo, and Liberty, are trademarks of Fresenius Medical Care Holdings, Inc. and/or its af liated companies. All other trademarks are the property of their respective owners. ©2008 Fresenius Medical Care North America North America. All rights reserved.

aakpRENALIFE · NOVEMBER 2008 · 18

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aakpRENALIFE · NOVEMBER 2008 · 19

PATiENT PRoFiLE

Taking the Cruise Plunge

By Jerome A. Bailey means `self') - cause inflammation, pain and damage in various parts of the body. The lupus diagnosis was a surprise for Shakur. Fast forward to 2007. Shakur learned about AAKP and its Annual Convention as he was going through his transplant evaluation. Dr. Thomas Peters, a transplant surgeon and AAKP Board member, gave Shakur an AAKP brochure. After signing up to be an AAKP member, Shakur began receiving Kidney Beginnings: The Magazine. One of the articles in the publications featured a story about the AAKP National Convention. After reading the article, Shakur knew he had to attend.

Three days a week dialysis and a healthy fear of the open seas kept Shakur Bolden from taking that dream vacation. He had seen the brochures in his dialysis unit and on the tables in his doctor's office. "Exciting vacation opportunities...", "From Barcelona to Bermuda, there's a cruise that's going your way." And, "Dialysis patients needn't go without a vacation." Yes, those brochures made taking a vacation on the high seas sound very exciting. But Shakur knew better. When he was younger, he had gone deep sea fishing a few times and each time his stomach churned. He wasn't about to put himself through that again, on top of getting his dialysis treatment! Doctors diagnosed Shakur with end-stage renal disease (ESRD) in 2006. The cause of his kidney disease was not immediately known. During the operation to put his fistula in, doctors discovered Shakur had lupus. Lupus is an autoimmune disease that can affect different parts of the body, including the skin, heart, lungs and kidneys. Normally the body's immune system makes proteins called antibodies, to protect the body against viruses, bacteria and other foreign materials. These foreign materials are called antigens. In an autoimmune disorder like lupus, the immune system cannot tell the difference between foreign substances and its own cells and tissues. The immune system then makes antibodies directed against itself. These antibodies - called "auto-antibodies" (auto

aakpRENALIFE · NOVEMBER 2008 · 20

The AAKP Convention would allow him to speak with kidney healthcare professionals, but most importantly, it would allow him and his wife to interact with other patients.

"There was a wealth of information available, not only from physicians and patients, but also the vendors who attended," said Shakur. "I didn't realize the vast amount of products that are available to help people cope with the effects of kidney disease."

As Shakur and his wife walked the Exhibit Hall, they stopped and talked to representatives from Dialysis at Sea® Cruises. Dialysis at Sea provides dialysis services aboard cruise ships,

Shakur Bolden and his wife aboard a cruise ship.

allowing dialysis patients and their families the pleasure of taking a well deserved vacation. The company also provides a certified nephrologist and one or more dialysis nurses (depending on the number of dialysis patients on the cruise) on each cruise. Patients have access to the medical team 24 hours a day and if necessary, the stateside medical support team can be reached around the clock.

Dialysis patients must provide an extensive medical history to the medical department of the dialysis cruise company in the event of an emergency. The dialysis team on the cruise must be familiar with all the dialysis patients scheduled to cruise on the ship. Once on the ship, dialysis treatment is no different from dialysis on land. "Doing dialysis on the ship is just like doing dialysis on land," according to Shakur. "However, when I do dialysis on land, there's a TV or other activities. Out at sea, the only thing I could do is sleep. But the treatment went very well."

information outlining everything he needed to do before the trip. "For example, I had to send my lab results, chest x-rays and CT-scans. Getting those things was no trouble at all. And I already had my passport. For me, it was a very easy process."

Although he was hesitant, Shakur entered his name into a drawing to win a free cruise for two from Dialysis at Sea. "I wasn't expecting to win anything," said Shakur. "My wife will tell you, I don't like cruises. I get sea-sick." When it was time to announce the big winner, Shakur's name was plucked from the basket.

And the concerns Shakur had about sea sickness? "The first day on the cruise, I thought for-sure I would get sick. I had the seasickness patch ready, but I never had to use it. The ship was so big. It was smooth sailing. And the rooms were really nice and there was so much to do." Cruise ships have a variety of activities for all their passengers including children, people with special needs and older adults. Activities include a kids' zone, rock climbing wall, shopping, bingo and Broadway shows. "My wife and I really enjoyed the Broadway shows. The quality of the shows reminded me of something you would see in New York or Las Vegas," said Shakur. Shakur suspects he and his wife will cruise again. "Patients can still have a fun cruise experience and their dialysis and not miss a thing!" Jerome A. Bailey is the Communications Manager for AAKP and Editor of aakpRENALIFE.

aakpRENALIFE · NOVEMBER 2008 · 21

According to Shakur, he wasn't too excited about winning a free cruise. "My wife had to convince me that we needed to do this. I remember going out on deep sea fishing boats and getting seasick. It's the worst feeling in the world." But representatives from Dialysis at Sea explained to Shakur that cruise ships are much steadier than boats. And there will be plenty activities to keep him and his wife entertained. Dialysis at Sea sent Shakur a packet of

Dear Doctor

At some point, most dialysis patients will stop urinating, but the rate of decline in urination is different for each patient and is dependent upon the type of kidney disease as well as the type of dialysis modality employed. Generally, patients receiving hemodialysis (HD) lose their ability to urinate faster than patients receiving peritoneal dialysis (PD). This decline in urinary output has various implications on patient management and survival. Patients who continue to urinate while on dialysis (HD or PD) are said to have "residual renal function" (RRF), and this factor is an important consideration in their management. Dietary restrictions on sodium and fluid intake can be liberalized to some degree. Depending on the degree of RRF, less dialysis therapy may be indicated. Nevertheless, close monitoring is needed because kidney function tends to decline over time. Recognition and acceptance of this fact greatly facilitates individualization of dialysis therapy. Studies also suggest dialysis patients, who have RRF, have a greater likelihood of survival than patients who do not. In PD patients, RRF declines steadily by 1.2-2.8 percent per month, irrespective of the underlying kidney disorder that initially led

aakpRENALIFE · NOVEMBER 2008 · 22

Questions From Patients · Answers From Doctors

The Dear Doctor column provides readers with an opportunity to submit kidney-related health questions to healthcare professionals. The answers are not to be construed as a diagnosis and, therefore, alterations in current healthcare should not occur until the patient's physician is consulted.

Dear Doctor, Does every dialysis patient, at some point, stop urinating?

to dialysis2. This survival advantage falls in tandem with declining urinary output.

AAKP would liKe to invite reAders to submit Any medicAl Questions they mAy hAve for rePly in this column.

interested readers may mail their questions to: AAKP dear doctor 3505 e. frontage rd., suite 315 tampa, fl 33607 or e-mail: [email protected] or fax: (813) 636-8122

Similar survival benefits have been shown for HD patients. A Netherlands trial (NECOSAD-2) showed a 56 percent reduction in death in HD

patients who had RRF3,4. Similar results were shown in a study conducted at Brown University5. HD patients lose RRF at a faster rate than PD patients; about 5.8-7.0 percent per month, irrespective of the underlying kidney disorder2.

For those on dialysis, significant RRF permits patients' a degree of denial about the severity of their kidney disease. As long as a patient has some RRF, it permits the notion that kidney function may recover. As such, a patient may deny that dietary restrictions and dialysis prescriptions are fully applicable to their situation. The consequences of this denial can result potentially in significant morbidity. RRI_Concierge_HlfPgAd.qxd 5/15/08 2:21 PM Page 1 Conversely, the loss of RRF forces a patient to

Although PD patients lose RRF at a slower rate than HD patients, the likelihood of survival on either dialysis modality over a five-year period is comparable. Therefore, it would not be advantageous to change from HD to PD despite the differences in RRF.

Recommendations for stopping the decline in RRF are limited. It is not clear why RRF decreases once patients start dialysis, nor why there is a difference in RRF between HD and PD patients. However, it is safe to assume in most instances there is inexorable progression of the underlying disease process itself. Some general guidelines to slow the decline in RRF include: 1) Vigorous blood pressure control, 2) The use of angiotensin-converting enzyme inhibitors (ramipril, enalapril, lisinopril) and angiotensinreceptor blockers (losartan, valsartan, candesartan), and 3) Avoidance of kidney-toxic agents (non-steroidal anti-inflammatory agents, aminoglycoside antibiotics, iodinated contrast agents used for Cat Scans)2. Because each patient is different, it is important you speak with your physician regarding the applicability of

Dear Doctor, continued on page 26

fully confront the stark reality that he/she is dependent on dialysis and must be fully engaged in appropriate lifestyle and dietary modifications.

You can count on the Renal Research Institute to take the worry out of arranging your dialysis needs. We offer a Concierge Services team dedicated to the complete coordination of your dialysis treatment during your travels. With one call, all prescription information, special medical needs and arrangements for your treatment will be addressed by this team of dedicated professionals. And upon completion of your treatments, all medical information will be forwarded to your home dialysis facility. With eighteen clinics nationwide and in Canada, and access to a network of dialysis clinics throughout the country, the Renal Research Institute strongly encourages patients to travel. If you are interested in taking advantage of our Concierge Services team to coordinate your dialysis needs for your upcoming trip contact the Concierge Services Team directly at 866-303-3773.

California · Connecticut · aakpRENALIFE · Illinois · Michigan · New2008 · 23 · Canada NOVEMBER York · North Carolina

866-303-3773 www.renalresearch.com

Life Membership

"As Life Membership Chair, I want to encourage your participation in AAKP and ask that you consider becoming a Life Member. AAKP provides educational support for thousands of patients through its publications and works to provide valuable input on a variety of public programs addressing the needs of kidney disease patients. This only scratches the surface of what AAKP does. With your help, it can do even more. As a patient, family member or friend, you are part of a team that makes a difference in the quality of care you receive when you join the voice of AAKP. Being a Life Member gives you the opportunity to help sustain an organization dedicated to working with you to help better patients' lives. For more information on Life Membership, please call AAKP at (800) 749-2257."

Stephen Z. Fadem, MD, FACP AAKP Life Membership Chair * Indicates New Life Member AAKP Harbor-South Bay-Orange County Chapter Seal Beach, CA *Paul Abraham, MD Eagon, MN Leticia Adan, MD Miami Beach, FL Anders Althin Miami Lakes, FL Sanford P. Altman North Miami Beach, FL George Aronoff, MD Louisville, KY Bruce Arnold Lauderhill, FL Atlantic Dialysis Management Services Ridgewood, NY Joseph Aucella Waterbury, CT John and Gloria Avellanet Hoboken, NJ Leonard A. Baker Miami, FL Selgene Balaban Scottsdale, AZ Margaret Becker Sugarland, TX J. William Becton Durham, NC Richard Beevers Toms River, NJ Winifred & Lee Bell Palm Harbor, FL Robert L. Benz, MD Wynnewood, PA Anne Berman Flushing, NY Sy Berman Hollywood, FL Al Bernette Pompano Beach, FL Shirley Bier Brooklyn, NY Christopher Blagg, MD Seattle, WA Elaine Borden Los Angeles, CA John Bower, MD Brandon, MS Susan Bray, MD Philadelphia, PA Virginia M. Brown Corpus Christi, TX Craig L. Brooks Thousand Oaks, CA Hester P. Bryant Holly Ridge, NC Earl Buffington, Jr. Brown Deer, WI Jeffrey Burbank Tewksbury, MA Donald W. Burk Missoula, MT Robert Caiola Coral Gables, FL Edward M. Callahan Salem, NH Carrie Campbell Mountain Lakes, NJ Bruce D. Carlton Wilson, NC Jamie Carvlin Long Beach, CA Rebecca Caspi Jerusalem, Israel Greg R. Castillo San Francisco, CA Yi-Fa & Margaret Chang Waterloo, IA Beverly & Stan Chabinsky Tarrytown, NY Carolyn Chin West Orange, NJ Thomas Cleveland Long Valley, NJ Dr. Mark Colomb Jackson, MS John Brian Copley, MD Weston, FL Joseph Cooperstein Edison, NJ Liane Cordes Eugene, OR Charles Cotton West Palm Beach, FL Carmelo Cozzolino St. James, NY Cam Crouch Fayetteville, AR Edna Curry Brandon, MS Carol Holben Daniel Allentown, PA Jenifer Darley Carson, CA Larry M. Day Golden, CO Frank DeIeso Tuckahoe, NY Uma Deperalta, MD San Gabriel, CA John Dickmeyer, MD Orinda, CA Anna Didonato Freehold, NJ Wilfred & Nancy Dow Waterloo, WI Ryan Dowd Yorktown Heights, NY Donald Dowe Harmony, MN Gregory A. Dowe Cascade, IA In Memory of Keenan & Isabella Dowe Catherine Drake Ponte Vedra Beach, FL Grady Drake Ponte Vedra Beach, FL Gilbert D. Dugan Stone Mountain, GA Duke University Medical Center Div. of Nephrology Brenda Dyson Jackson, MS Cheryl Fant Memphis, TN Shirley Fester, RN Phoenix, AZ Jane & Robert Fink Boca Raton, FL June Bryant Fitzpatrick Covington, LA Amy L. Friedman, MD Woodbridge, CT Eli Friedman, MD Brooklyn, NY Jennifer Frohlinger-Castillo San Francisco, CA Robert Frost, Sr. Port Saint Lucie, FL Titilola George, MD Albany, GA Robert Geronemus, MD Lauderdale Lakes, FL Stephen C. Gilbert West Hills, CA Richard Goldman, MD Albuquerque, NM Thomas Golper, MD Nashville, TN Edward Gray Hollywood, FL Martin C. Gregory, MD Salt Lake City, UT Sara Jo Grethlein, MD Syracuse, NY George Grimbilas New York, NY Blaire Grube Freeport, PA Robert Gutman, MD Durham, NC Everett Hampton, Jr. Hagerstown, IN Isaac Hayes Memphis, TN August W. Heckman, JSC Secaucus, NJ

Mary Heisick Seal Beach, CA Mark Helge Rockford, IL Paul R. Herman South Bend, IN Jean L. Holley Charlottesville, VA Barbara Hostrup Chamblee, GA *Stephanie Huguelet Bolingbrook, IL Myra Hurley Babylon, NY Linda Ilizaliturri, MD Green Valley, AZ Lenore Indell Boca Raton, FL Constance Jackson Ft. Lauderdale, FL Fran Jeko Ft. Myers, FL Charlotte M. Jones Pembroke Pines, FL Shirley Jones Dana Point, CA Grace C. Joyce Boynton Beach, FL Johanna & Irwin Kamen Brooklyn, NY Celia Kanter Newport Beach, CA Lucille Kenny Stuart, FL Elizabeth Key Southaven, MS Lawrence Kinet Winnetka, IL Cynthia Kingston Wellington, FL * Phyllis Kinzbrunner Lauderhill, FL Frances Kissling Washington, D.C. Leonard Koehler North Hollywood, CA Magda Elaina Konig Pittsburg, PA Irvin Kotkin, MD Roslyn, NY Abraham Krosnoff Glen Clove, NY Maurice F. Krug Sarasota, FL Nancy Kutner, PhD Atlanta, GA Grover "Chip" Lazar Montague, NJ

Life Memorials

The following names are in memory of Life Members of AAKP. We remember them for their generosity and dedication to our mission.

William Blackton Mark Bowman James Call Prudence Cohen Keenan & Isabella Dowe Ellie Durrett

Mildred (Barry) Friedman Michael Gahr Muriel Glickman Jean B. Golper Marvin N. Golper, MD Amos Hanks

Michael Holben David Jones Lawrence Kahme Elie Katz, PhD, DSC Sydney Lewis Martin T. Lublin

Lone Star Chapter Harriet Leavitt New York, NY Maurice & Donna Lee Orange, CA Cheryll Leiby Plantation, FL Paul J. LiBassi, MD Clarence, NY Brian Ling Asheville, NC Ben Lipps Lexington, MA Edmund G. Lowrie, MD Concord, MA Esther Malach Riverdale, NY Angelina Maranzano Middle Village, NY Larry Marsh Great Falls, VA Michael Matson Seattle, WA Alice G. McCall, RN Oakton, VA Sandra McCray Boulder, CO H. Tim McCurdy, PhD Oklahoma City, OK Mr. and Mrs. Ramon McFarlane Thiensville, WI Paul McGinnis, MD Ridgeland, MS Glen R. McGraw Sun City, AZ Rita McGuire Anaheim, CA Keith McMurran Newport News, VA Morton "Buddy" Mevorach Lake Luzerne, NY Francis Migliore Edison, NJ William Miles, Jr. Scottsdale, AZ J. Davis Miller Dallas, TX Robert Miller, MD Alburquerque, NM Samuel Milligan Mishawaka, IN Virginia Monier Las Vegas, NV Alvin H. Moss, MD Morgantown, WV Alonzo Mourning Miami, FL Spero Moutsatsos Tampa, FL

Warren K. Moyle Mukwonago, WI John W. Nelson New Port Richey, FL John Newmann, PhD Reston, VA William Newmann, MD Olympia, WA Allen R. Nissenson, MD Los Angeles, CA Keith Norris, MD Marina Del Rey, CA North Louisiana Chapter Terry & Edith Oberley Madison, WI Olive Oh Glenview, IL Brian O'Moore Petaluma, CA Anacleto Ordinario, MD Lake Charles, LA Eileen O'Shea New York, NY R. Edward Ozier Glendale, AZ Palm Beach County Chapter Richard Parodi, DDS San Francisco, CA Mary Lou Pederson Seattle, WA Sam Pederson Seattle, WA Brian Pereira, MD Boston, MA Verlie W. Pete Leesburg, GA Thomas Peters, MD Jacksonville, FL Herbert Pincus Glenside, PA Sandy Popham Duluth, MN Carolyn Price Jackson, MS Tim Prince, MD Orlando, FL Catherine Register Malibu, CA David A. Reichert, MD Tempe, AZ Marc Reid Tampa, FL Al Remingio Mililani, HI Phillip Ricker, PE Aloha, OR Jimmy L. Roberts, MD, FACP Chico, CA Carl Robinett Las Vegas, NV

Kris Robinson Largo, FL Ronald Rosen Manalapan, NJ Alex Rosenblum Dallas, TX Knud-Eric Rosenkrantz Brooklyn, NY Herbert Ross Boca Raton, FL Benjamin Ruback Boston, MA Elizabeth Rudisill Atlanta, GA Jeff Salvail Benton, LA Stacy Sand Miami, FL John J. Scavo York, ME In honor of George E. Schreiner, MD Mel Senville Boca Raton, FL Erik S. Shank, MD Winchester, MA Brendan Sheedy Bellport, NY Dorothy Short San Rayburn, TX Michael Short The Woodlands, TX John Sipp Brooklyn, NY Jeanne Sisneros Anaheim, CA Jeff Soref New York, NY South Valley Regional Dialysis Center Paul J. Stahl, Sr. Hatboro, PA Joseph Stern Brooklyn, NY David O. Stapel Haltom City, TX Michael Stetzel Tucson, AZ Patty Stewart Lafayette, CA Barbara Swartz Brooklyn, NY Roy Takeda Encino, CA Ben Teitzman Stony Brook, NY Jeffrey R. Thompson, MD Dallas, TX M. Alice Thurston, Esq. Washington, DC

James Trabilsy, Esq. Watchung, NJ Jenny Underwood Mesa, AZ Barry R. Valentine Rahway, NJ Carol Victor Westfield, NJ Mark Vukelich White Bear Township, MN Robert & Roberta Wager San Antonio, TX Joseph Warren, MD Maitland, FL Lynn Wasserman New Orleans, LA *Joe Watlington, MD Whitwell, TN Carol M. Weinlander Dansville, NY Virginia Weinstein Union, NJ Judy Weintraub Los Angeles, CA Russell Weathersby Germantown, TN Anne M. Jacobi White Buffalo, NY Edward L. White Dayton, OH Joseph D. White Allendale, NJ Diane Wilkinson LaGrange, IL Robert Winston Pompano Beach, FL Jay Wish, MD Cleveland, OH Shirley Witkin Clearwater, FL Stephen Wojcechowskyj, Jr. Bradenton, FL Yalemzewd Woredekal, MD Brooklyn, NY Johnson N.S. Wong Rolling Hills, CA Ann Marie Wyrsch St. Charles, MO David Zinn, MD Anniston, AL

A. Peter Lundin, MD Maureen Lundin John R. Lyzott Nancy Rountree McMurdy Lawrence J. Moreau, Esq. Maxine Newmann

Nacianceno Rodela, Jr. Kirby Rodriquez Louis Sand Morton Sand John Sawvel, Jr. Frank J. Soldovere

Joyce Thwaits Bonny Wilburn Brenda Burnham-Uhler Viola Wong Mia Verona Louis Wyrsch Michael Waite Hy Yuda Jim Ward Lt. Col. (Dr.) & Mrs. Robert F. Houck aakpRENALIFE · NOVEMBER 2008 · 25 Max Weintraub

Dear Doctor, continued from page 23

these recommendations to your situation.

More research needs to be done to learn the importance of RRF in patient survival. Generally, patients who begin dialysis will notice a steady decline in urination (and RRF) at varying rates. Survival is improved if RRF is preserved for patients receiving PD or HD, but RRF alone does not make one form of dialysis better than the other. With additional research, we will know if it is important to direct our therapies toward preserving RRF at all. References:

1. Bargman JM and Golper TA. The Importance of residual renal function for patients on dialysis. Nephrology Dialysis Transplantation, 2005. Volume 20: pp. 671-673. 2. Jansen MAM, et.al. Predictors of the rate of decline of residual renal function in incident dialysis patients. Kidney International, 2002. Volume 62: pp. 1046-1053. 3. Termorshuizen F, et.al. Relative Contribution of Residual Renal Function and Different Measures of Adequacy to Survival in Hemodialysis Patients: An analysis of the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD)-2. Journal of the American Society of Nephrology, 2004. Volume 15: pp. 1061-1070.

4. Termorshuizen F, et. Al. The relative importance of residual renal function compared with peritoneal clearance for patient survival and quality of life: an analysis of the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD)-2. American Journal of Kidney Diseases, 2003. Volume 41: pp. 1293-1302. 5. Shemin D, et.al. Residual Renal Function and Mortality Risk in Hemodialysis Patients. American Journal of Kidney Diseases, 2001. Volume 38: pp. 85-90.

James Bailey, MD, is a professor of medicine in the division of nephrology at Emory University and head of the renal fellowship program. Tejas Desai, MD, is a Nephrology Fellow in the Emory University Division of Nephrology. His academic interests focus on Internetbased medical education for physicians in-training and dialysis patients.

aakpRENALIFE · NOVEMBER 2008 · 26

the only nAtionAl orgAn izAtio n dire cted by Kidney PA tients for Kidn ey PAtients. Benefits of Membership:

P is AAK

AAKP Members

hip

· A membership packet filled with some of our most popular publications and your very own member ID card. · Subscriptions to AAKP's magazines: aakpRENALIFE, Kidney Beginnings: The Magazine and aakpDelicious! · Opportunity to subscribe to AAKP's five FREE electronic newsletters. · Access to AAKP My HealthTM (an online resource for patients who want to be more proactive in managing their healthcare). · Advanced updates of upcoming programs and events. · Access to relevant and updated public policy information. · Affiliation with an organization that shares your commitment to making a difference. · Assurance that your voice is heard and your interests are represented in Washington, DC.

3 Easy Ways to Become a Member...

1. Web site: Visit the Membership section of our Web site, www.aakp.org, to join instantly. 2. Mail: Complete the membership application below and mail it to us at the address on the bottom of the application. 3. Phone: Give us a call at (800)749-AAKP. Please allow 4 to 6 weeks to receive your membership packet.

Membership Application

Member Information Name:___________________________________________ Address:_________________________________________ City:_____________________________ State:__________ ZIP: _______________Phone: ( )__________________ q I am already a member of AAKP but I would like to make a donation of $_________. Payment Method q Check (enclosed and payable to AAKP) q Visa q American Express q MasterCard q Discover Account number:_______________________________ Name on Card:_________________________________ 3 or 4-Digit Security Code:________________________ Expiration Date:________________________________ q I am not interested in membership at this time, but please send me a complimentary package of information.

Email:___________________________________________ Choose a Membership Category: q Patient/Family Member........$25/annually q Professional Member...........$45/annually q Physician Member..............$100/annually q Institutional Member.......... $200/annually q Life Member.................. $1,000* *or four payments of $250 every six months for two years

Mail completed form & payment to: American Association of Kidney Patients, 3505 E. Frontage Rd, Ste. 315, Tampa, FL 33607 KidneyBeginnings October/November 2006 27

www.aakp.org

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