an independent supplement by mediaplanet to usa today aaron mcCargo shad ireland bold fl avors for defying the restricted diets odds on dialysis KiDnEY hEaLth april 2011 3 tiPS

SPREADING THE WORD Denise Richards inspires and educates others about kidney cancer after losing her mother to this deadly disease photo: startraksphoto.coM photo:

No one is immune to the risk of venous needle dislodgement. It can happen at any facility, to any nurse or patient. (J. Hurst, RN, CLNC) (J. Hurst, RN, CLNC)

Redsense Medical Inc. Redsense is an FDA cleared device to monitor for blood loss from the hemodialysis Chicago, IL 60601, US access site. To be used as directed by a physician. www.redsensemedical.com 2 · april 2011 an independent supplement by mediaplanet to usa today ChaLLEngEs tiP Understanding the kidneys’ major role in overall health, knowing risk factors for these conditions and taking the time to get screened 1 can make a di erence in the lives and health of thousands. Get SCReeNeD ReGUlaRly

kidney health, 3rd edition, april 2011 managing Director: Jon silverman protect your [email protected] editorial manager: Jackie mcdermott [email protected] responsible for this issue: Publisher: megan brunhofer [email protected] Business Developer: luciana Colapinto kidneys: it’s vital [email protected] Designer: mariel Fitzgerald mariel.fi [email protected] olores Bisagni suf- lates blood pressure. Dr. lynda radiation and chemotherapy. Contributors: michelle dalton, fered from high Chronic kidney disease (CKD) Szczech It is serious, but the earlier it is Fresenius medical Care north america, president, Kidney Cancer association, medical blood pressure occurs when the kidneys are national Kidney found, the greater the chance that education institute, national Kidney Foundation, national Kidney registry, dr. for years. Until damaged and high levels of waste Foundation it can be cured. A number of new allen nissenson, dori schatell, dr. lynda her kidneys failed begin to accumulate in the blood. drugs are now available that show szczech, uKidney, dr. Jordan Weinstein and she began Today, 26 million Americans have promise in managing advanced Distributed within: dialysis, she never chronic kidney disease, yet with kidney cancer. usa today, april 2011 realized there was a connection— early detection and control of The medical community is this section was created by mediaplanet D and did not involve usa today or its that the high blood pressure was risk factors such as high blood “the medical turning kidney disease and kidney editorial departments. damaging her kidneys. She didn’t pressure and diabetes, more than cancer into treatable and in some community Special thanks: consider checking her kidney two-thirds of new cases of kidney cases, preventable conditions. function and her doctor never failure are preventable. Screen- is turning The National Kidney Foundation suggested it. ing for those at risk is essential to off ers free screenings to those at Dolores isn’t alone in ignor- fi nding, managing and treating kidney disease risk through its Kidney Early Eval- ing her kidneys. Unless they’re the disease. and kidney uation Program (KEEP). For those not working, most people don’t Kidney cancer is a related condi- with symptoms of kidney cancer, focus on how integral the kid- tion that is also often found in the cancer into doctors can detect it through tests neys are to the functioning of the later stages. Symptoms include treatable and performed in their offi ce. The call rest of the body and what to do blood in the urine or a lump in to action is clear. Understanding folloW us on faceBook & tWitter! to protect them. Although they the back. Smoking, obesity, kidney in some cases, the kidneys’ major role in overall facebook.com/mediaplanetUSa are fi st-sized, the kidneys multi- failure and contact with harmful preventable health, knowing risk factors for twitter.com/mediaplanetUSa task 24/7 as they fi lter toxins from chemicals are all risk factors that these conditions and taking the mediaplanet’s business is to create new the blood, activate Vitamin D can be avoided or controlled. Kid- conditions.” time to get screened can make a customers for our advertisers by providing to maintain healthy bones and ney cancer is treated by surgically diff erence in the lives and health readers with high-quality editorial content that motivates them to act. release the hormone that regu- removing all or part of the kidney, of thousands.

Information for people with kidney disease

Kidney School is supported by an exclusive, unrestricted www.KidneySchool.org educational grant from Fresenius Medical Care North America

4 · april 2011 an independent supplement by mediaplanet to usa today inspiration

a Day iN tHe PaRK Denise Richards spends time with her daughters Sam and lola. Photo: startraksPhoto.com tiP Question: What is the biggest lesson actress Denise Richards took from her mother’s struggle with kidney cancer? answer: Be your own advocate. 2

KNOW yOUR OWN BODy putting the spotlight on kidney cancer leader to leader how little was known about the disease “It’s hard to raise awareness of this journey.” and its potential treatments. At the disease because it is so rare,” she says. The biggest lesson Richards took Kidney cancer (or renal cell time her mother, Joni, was diagnosed, “When you’re in the public eye, the big- from her mother’s struggle? Be your carcinoma) is rare but will still there was no treatment available. By gest gift is to be a voice to raise aware- own advocate. affect more than 50,000 people the time the disease came out of remis- ness.” She wants to help raise enough “Know your own body. When some- this year alone. sion 18 months later, “She was able to funds to help fi nd ways to eliminate thing’s not right, don’t take ‘no’ for an try a couple of drugs that had just been “if you’re the cancer altogether. answer,” she says. “If you’re diagnosed “Of everyone who has cancer, only approved, and we were waiting for diagnosed Richards says while her mother was with kidney cancer, fi ght. Don’t give up, three percent of those cases are kidney another one to gain approval when she with kidney sick, she never once complained or don’t lose hope.” cancer,” says Denise Richards, whose passed away in 2007 at age 54.” cancer, asked, ‘why me?’ mother succumbed to the disease. “Of In addition to fi lming public service fi ght. don’t “She really showed me that life is a those, 90 percent are men. So when my awareness ads, Richards is actively gift. Her will to live was her grandkids. mom told me that was her diagnosis, I involved in fundraising for the Kidney give up, I never had to say, ‘C’mon mom.’ She was shocked.” Cancer Association. She encourages don’t lose really inspired us. Anyone that’s gone michelle dalton Even more shocking, she says, was everyone to become more involved. hope.” through cancer personally, it’s such a [email protected] An independent supplement by Mediaplanet to USA Today april 2011 · 5 inspiration

family time Denise spends quality time with her father Irv and her daughters. Photo: startraksphoto.com 6 · april 2011 An independent supplement by Mediaplanet to USA Today insight

tips for paired exchange Who are the best Surviving kidney cancer candidates for paired exchange? Last year, more than 1.3 mil- used to treat kidney cancer, and inside, fearing for you and them- to delay the cancer’s return, or to ■■Patients with incompatible lion new cancers were diag- will have a very positive impact selves. When cancer strikes, it hits treat metastatic disease. or poorly compatible donors. nosed in the United States. for many patients. Continued the whole family. Your friends and The choice of treatment, where research efforts will improve our family are rooting for you. treatment is administered, the What donor characteris- According to the American Cancer understanding of the disease even Sometimes kidney cancer is frequency of check-ups, and many tics matter the most? Society, more than 50,000 of these more and increase the options called by its medical name, renal other aspects of the management ■■Age of donor (under 50 pref- individuals were diagnosed with available to fight kidney cancer. cell carcinoma. Kidney cancer of your disease are determined erable) kidney cancer. But there is hope: includes various forms, including with input from you. The more ■■Donor blood type. “O” donors More than 200,000 kidney cancer Time to start healing clear cell, papillary, sarcomatoid, you know, the better your deci- are 10 times more powerful survivors are living in the United Each person diagnosed with kid- transitional cell, and others. sions, and the more you can feel in than other types. States right now. Recent advances in ney cancer goes through the shock Some patients are diagnosed control of your illness. Knowledge diagnosis, surgical procedures, and of being told they have the disease. before the cancer has metasta- about your disease will help you Choice of transplant center treatment options will allow even It is a difficult experience. Feelings sized (spread) to other parts of better communicate with your Many transplant centers pro- more patients to live with the dis- of shock, loneliness, alienation, the body, while others have meta- doctor and nurse, and increase vide paired exchange services ease, continuing to maintain their fear, frustration, anger, and hurt are static disease when their cancer is your confidence in the treatment but the differences in perfor- normal schedules and lifestyles. natural parts of any life-threaten- initially diagnosed. Surgery may that you receive. Getting smarter mance and outcomes vary. A This marks the beginning of ing illness. It is okay to have these be the first course of treatment, about kidney cancer is an impor- good transplant center is deter- an important new era for kidney feelings, to cry, and to be upset. or systemic treatment—that is, a tant step in effectively fighting mined by: cancer patients, with the recent After the shock of diagnosis, treatment that is injected into the your disease. ■■How many active incompat- approval by the Food and Drug it’s time to start healing. Don’t let bloodstream or swallowed—may contributed by ible pairs are in their pool Administration (FDA) of new drugs your emotions and your cancer be recommended prior to surgery kidney cancer association ■■How many exchange trans- to treat their advanced disease. destroy your home life or relations (though this tends to be rare). If For more information, visit plants the center completed in These drugs target cancer cells in with the important people in your surgery is done first, additional www.kidneycancer.org the last 12 months different ways than current drugs life. They may also be hurting treatment may be recommended [email protected] ■■What percentage of the cen- ter’s incompatible pool have been transplanted since the program started. Kidney transplants: The gift of life As a point of reference: There are almost 53,000 Dr. Titte Srinivas. Blood type com- “Living donors are heroes in ■■NKR’s average transplant people waiting for a “Living donors patibility, previous pregnancies or transplantation,” he says. Paired wait time is between three and kidney transplant, but blood transfusions all affect wait donation matches one incompat- 10 months. The national aver- only 16,500 are performed are heroes in list times. Socioeconomic factors ible living donor/recipient pair to age wait time is approximately each year, according to the transplantation.” also play a role—older, poorer another pair in the same situation. five years. United Network for Organ minorities and those without Other advances include noc- Sharing. Once donated, healthcare wait the longest. tural dialysis at sleep clinics, home For further information kidneys can function for “More than half the people dialysis, and expanded criteria for ! and a free booklet on about 16 years. over age 60 will not live to see a kidney donation acceptance. “Finding a Kidney” go to: transplant,” Dr. Srinivas says. He www.kidneyregistry.org Wait times could improve more, advises getting on a wait list as michelle dalton according to the Cleveland Clinic’s soon as you’re diagnosed. [email protected]

Average Wait Time In Paired Exchange

National Kidney Registry 11 months

Industry Average over 4 years www.kidneyregistry.org

0 10 20 30 40 50 60 * Average wait time = pool size / transplant run rate x 12 (months). Pool size is the current active unmatched recipients in the system. Transplant run rate is the number of transplants facilitated over the past 3 months X 4 (annualized) Aveo-KidneyHealthReport-Ad-v4.indd 1 4/18/11 2:52 PM 8 · april 2011 An independent supplement by Mediaplanet to USA Today insight Don’t “a-salt” the kidneys When it comes to dietary ■■Fresh fruits and vegetables are without any added salt. sodium, less is certainly low in sodium. Canned and frozen ■■Try to spread your sodium best, yet Americans today fruits and veggies are typically intake out throughout the day; consume 50 percent more low-salt as well. But watch out it’s easier on your kidneys than than the recommended for frozen vegetables that contain eating lots of salt all at once. daily quantities of sodium. added seasoning or sauces, which ■■You can learn to adjust to eat- may contain lots of extra salt. ing less salt. It typically takes According to the National Kidney ■■Make reading food labels a about six to eight weeks on a Foundation, diets high in sodium habit. Sodium content is always low-sodium diet to get used to it. increase blood pressure levels. listed on food labels. After that, you’ll actually find it High blood pressure damages the ■■Sodium content can vary from harder to eat very salty foods, like kidneys over time, and is a leading brand to brand, so compare and potato chips. cause of kidney failure. choose the lowest sodium product. “As high blood pressure rates ■■Avoid spices and seasonings have increased, kidney disease that contain added sodium, for For more information: has spiraled to the point where it example garlic salt. Pick garlic ! The National Kidney Foun- now affects 26 million Americans. powder instead. dation is offering a free screen- Reducing salt intake can lower Photo: istockphoto.com ■■Many restaurants list the ings for those at risk around the blood pressure and that may be sodium content of their products country through its Kidney Ear- beneficial in easing the burden National Kidney Foundation. to help reduce salt intake: on their Web sites, so do your ly Evaluation Program (KEEP). To of chronic kidney disease in this ■■Stick to fresh meats, rather homework before dining out. find a screening near you or for country,” says Dr. Joseph Vassa- The National Kidney Foun- than packaged products, which ■■When dining out, you can also more information on salt reduc- lotti, Chief Medical Officer of the dation offers the best tips are high in sodium. request that your food be prepared tion, visit www.kidney.org.

a future role for nutraceuticals in chronic kidney disease?

Nearly one in eight people available to the public without in the United States the same oversight require- suffer from chronic ments or FDA approval. They can kidney disease (CKD). be made readily available upon If untreated, CKD can development, but consumers slowly progress and as must be cautious to be sure that it advances, leads to the the claims made for safety and need for dialysis or kidney Dr. Allen Nissenson efficacy can be substantiated Emeritus Professor of Medicine, David transplantation. Geffen School of Medicine at UCLA; with solid evidence. Chief Medical Officer,D aVita Inc. A number of nutraceuticals CKD patients experience have now been identified to have increasing symptoms as the strokes, and lower limb ampu- anti-inflammatory properties disease progresses, with fatigue, tations. Research has greatly and this has raised the excit- weakness, inability to concen- increased the understanding of ing possibility that treatment of trate, loss of libido prominent. the mechanisms involved in the the inflammatory component Most patients develop CKD inflammatory process. Unfortu- of CKD may be possible. A num- because of diabetes, hyperten- nately, therapeutic approaches ber of nutraceutical companies sion, or a combination of these to preventing or treating the are now undertaking rigorous factors. CKD patients represent inflammation have lagged clinical research to test the value only one percent of all Medicare behind, although considerable of these substances scientifi- patients but consume over 10 research effort is ongoing in cally. If this research shows that percent of all Medicare dollars. this area. nutraceuticals can provide safe It is now known that CKD Nutraceuticals are foods and effective anti-inflammatory patients have an increase in or food products that provide therapy, longer lives and higher inflammation throughout the health benefits. Unlike medica- quality of life may be possible for body resulting in an increased tions, either over the counter or CKD where inflammation is a key propensity to heart attacks, prescription, nutraceuticals are contributor to poor outcomes. an independent supplement by mediaplanet to usa today april 2011 · 9 rECipE

loW-sodiuM crunchy leMon herBed chicken

ingredients: 3. Beat egg yolk with 1 tablespoon RENAL RECIPE ■■6 (2-ounce) chicken tenders water. Fresenius Medical Care North America, the ■■4 tablespoons unsalted butter 4. Place chicken tenders between nation’s leading network of dialysis facilities, (half chilled) two pieces of plastic wrap and has partnered with Aaron McCargo Jr., star of Food ■■½ cup Japanese bread crumbs pound with small groove side of Network’s “Big Daddy’s House,” to create fl avorful, (Panko) mallet until thin, but not ripped. satisfying meals for people with kidney failure. ■■¼ cup of lemon juice, plus zest 5. Dip chicken in egg wash mix- of one lemon ture then in herbed breadcrumb ■■1 egg yolk mixture until coated. ■■1 tablespoon fresh chopped 6. Place breaded chicken in sauté oregano pan with melted butter only after ■■1 tablespoon fresh chopped increasing heat to medium. basil 7. Cook chicken, approximately ■■1 tablespoon fresh chopped 2-3 minutes each side. thyme 8. Remove chicken and place on ■■3 tablespoons water (1 table- sheet tray to rest. spoon for the egg wash, 2 table- 9. In same pan add remaining spoons for the fi nishing of the herbs, salt, and lemon juice, then sauce) heat until simmering. 10. Turn off heat; cube remaining Preparation: 2 tablespoons of chilled butter and 1. Pre-heat 2 tablespoons of butter add to sauce (stir vigorously). ZeSty aND HealtHy lemON 11. HeRBeD CHiCKeN is the on medium low heat. Slice the chicken on the bias. perfect meal for dialysis 2. Add zest of one lemon and half 12. Placed sliced chicken on a patients—and the entire the herbs to bread crumbs, save plate, pour the sauce over the top, family. Photos: JUaN carLos moraLEs the rest for lemon sauce. and add garnishes.

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Learn how a DialySiS PatieNt SiNCe and why to tHe aGe Of 10, Shad ireland has grabbed life by the handlebars, refusing to allow do dialysis his disease to limit his abilities. at home Photo: coUrtEsY oF BEN irELaND overcoming A program of Medical Education Institute, Inc., with support from multiple sponsors. the obstacles ■■Question: What is shad “Inspiration comes in all dif- by Hema Assistance Products, Inc. ireland’s recipe for success? “it’s been a ferent shapes, sizes, and forms,” ■■answer: deal, accept, live. he says. “One of the things I say to dream of mine patients across the country is that change since i was a kid you have to believe in the possibil- ity of it all.” Deal, accept, live. Those three little to be an athlete. Ireland’s current goal is to “not words continually provide moti- only inspire, but to provide the vation for two-time kidney recipi- and now, here tools and resources to give other ent and Ironman competitor Shad i am, living that patients a format to follow.” His Ireland belief that kidney disease “does Typical descriptions of pro- dream. i’m living not limit your ability” comes fessional athletes usually don’t through in each of his clinic visits. include diagnoses of childhood successfully He knows that initial diagnosis ® HemaStrap , the most effective product that enhances kidney disease or double kidney with kidney may seem overwhelming, but that comfort and safety for dialysis patients. transplants; but Shad Ireland is it’s possible to live a normal and Now you or your patients can wear the same strap that anything but typical. Once given disease.” even active lifestlye on dialysis. many dialysis patients wear to enhances their safety — only six months to live and having By focusing on what patients can ® The HemaStrap by Hema Assistance Products, Inc. wasted away to a mere 75 pounds, do instead of what they can’t is a HemaStrap®, to enhance your safety while on hemo dialysis. Ireland found inspiration when 2004, he became the fi rst dialysis message Ireland will continue to Rest easy without the fear of catching your dialysis tubing, watching the Ironman competi- patient to fi nish an Ironman com- spread. leading to infiltration or needle dislodgement. HemaStrap® for tion on TV. He saw athletes “doing petition (running, swimming, and “It’s been a dream of mine since your comfort and safety, by Hema Assistance Products, Inc. the impossible, and I wanted what biking for a combined 140.6 miles). I was a kid to be an athlete. And they had,” he says. Ignoring the As a national spokesperson for now, here I am, living that dream. physicians who told him he’d Fresenius Medical Care and home I’m living successfully with kid- never compete, within 24 months dialysis, Ireland spent 2009 biking ney disease,” he says. Ireland had bounced back and was 4,639 miles across the country to www.hemausa.com living healthily on dialysis. raise awareness about kidney dis- michelle dalton But that was not enough: In ease and its lack of limitations. [email protected] an independent supplement by mediaplanet to usa today april 2011 · 11 nEWs tiP END-STAGE RENAL DISEASE: 3 CHOOSe tReatmeNt EXPLORING THE OPTIONS tHat fitS yOUR lifeStyle end-stage renal failure Peritoneal dialysis (PD) is (eSRD) is a devastating home-based therapy that off ers associated with even better health condition affecting clinical outcomes similar to con- outcomes. Over the last decade, 500,000 americans. ventional hemodialysis but with new strategies have emerged some definite lifestyle advan- to expand the supply, including Because the kidneys perform tages. In PD, the abdomen is fi lled paired exchange, which allows many life-sustaining functions, with dialysate, which draws extra donor pairs who are not compat- patients reaching this threshold of fl uid and waste products out of the ible with one another to essen- chronic kidney disease must even- blood. The vast majority of care for tially ‘swap’ kidneys with other tually choose from a growing array PD patients takes place outside pairs whom they have never met. options for kidney replacement. the clinical setting and allows for Paired exchange has evolved to Hemodialysis (HD) is the most Photo: NatioNaL kiDNEY FoUNDatioN considerable portability. allow long donor-recipient chains common form of renal replace- The ideal option is renal trans- throughout the country. ment, which relies on a highly has allowed patients with ESRD (namely, venal needle dislodge- plantation, which is associated sophisticated machine to fi lter to enhance their treatment eff ec- ment, which has been recognized with better life expectancy and dr. Jordan Weinstein, md the blood. This form of dialysis has tiveness and has restored many by the Renal Physicians Associa- quality of life. As a result, demand division of nephrology, st. michael’s seen a fairly recent proliferation patients’ quality of life. While con- tion as one of the top areas need- for this procedure has led to a Hospital; assistant professor of medicine, in options, both in terms of inten- siderable obstacles remain in this ing safety improvement), there is defi cit of organs available from university of toronto; Founder and sity and in venue (at home vs. in treatment area, including funding tremendous optimism regarding deceased donors. Live donation director, uKidney.com hospital). Home hemodialysis issues and various safety concerns this burgeoning therapy. is a superior alternative that is [email protected] Finding freedom with at-home dialysis it is possible to have a work-friendly, and with treat- ■■You can do home hemodi- you live the life you want to have. fulfilling life if you require ment each day—or at night while alysis on your own schedule, and To learn more about home dialysis dialysis. you sleep—you will feel the posi- you don’t have to purchase the options, visit Home Dialysis Cen- tive eff ects. machine. The dialysis clinic will tral at www.homedialysis.org. How? Learn all you can, stay posi- ■■Hemodialysis is most often provide it and train you on proper *Medicare routinely pays for three tive, take an active role in your done in a clinic. But did you know usage. Some people do short daily treatments/week. care, and choose a dialysis treat- that some clinics off er nocturnal hemodialysis fi ve to six days a ment that fi ts your preferred life- hemodialysis three times a week week*, others opt for nocturnal style. You have options! ReClaim yOUR life (for eight hours) while you sleep? treatments. Survival with these dori schatell ■■Peritoneal dialysis (PD) is a With new portable dialysis equipment, The long treatments are easy on options is about the same as executive director, you can receive treatment in the needle-free, easy to learn, portable comfort of your own home. your heart. And, they don’t disrupt deceased donor transplant. medical education institute, inc. home treatment. PD is gentle, Photo: NXstaGE mEDicaL, iNc. your day! Your choice of dialysis can help [email protected]

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I’ll see my kids grow. The NxStage System One™ is a prescription device. Daily home hemodialysis with the “ - Duane, 2 year NxStage Patient System One involves risks and responsibilities which are detailed in the free information kit. ©2011 NxStage Medical, Inc. NxStage is a registered trademark of NxStage Medical, Inc. System One is a trademark of Talk to your doctor to see if daily home hemodialysis with NxStage is right for you. NxStage Medical, Inc. CAUTION: Federal law restricts this device to sale by or on the order” of a physician. APM523 Rev. A Dialysis patients need to make lots of choices.

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