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    Living Day to Day with Kidney Dialysis

    Dialysis Under Scrutiny continued...

    FDA has produced numerous training videos and documents to inform dialysis clinicians about the importance of making sure their equipment is used properly and meets FDA requirements. In addition, the agency has met with many manufacturers of dialysis equipment to help them meet requirements for marketing their devices in the United States. FDA also maintains MedWatch, an adverse events reporting hot line that helps the agency track medical device problems.

    "We're hoping to enhance communications with dialysis providers and consumers," says Marie Reid, a nephrology nurse in FDA's Office of Surveillance and Biometrics. "Whenever there's an adverse event, we look at it to identify the problem and learn how we can help prevent it from happening again."

    The National Kidney Foundation, as well as others in the renal (kidney) care community, has been trying to improve quality in dialysis clinics nationwide. The foundation led an extensive project for the last two years to develop quality guidelines for dialysis treatment nationwide. If dialysis providers adopt the voluntary guidelines, experts say patients will benefit because the latest information on quality treatment will be available in even the smallest dialysis clinics.

    How Dialysis Works

    Dialysis acts as an artificial kidney. There are two types of treatment: hemodialysis and peritoneal dialysis. About 90 percent of dialysis patients receive hemodialysis, in which the blood is circulated outside the body and cleaned inside a machine before returning to the patient.

    Before hemodialysis can be done, a doctor must make an entrance, called an access, into the patient's blood vessels. This is done by minor surgery in the leg, arm or sometimes neck. The best access for most patients is called a fistula. Minor surgery is performed to join an artery to a vein under the skin to make a larger vessel.

    If no vessels are suitable for a fistula, the doctor might use a soft plastic tube called a vascular graft to join an artery and vein under the skin. For temporary dialysis in the hospital, a patient might need a catheter implanted into a large vein in the neck. Once the access is made and healed, two needles are inserted in the fistula or graft, one on the artery side and one on the vein side.

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