The better informed kidneyKidneyTwo kidneys are located at the rear of the abdominal cavity, one each on the right and left side of the spinal column. These vital organs are approximately 12 cm long and weigh only around 160 grams each. The kidneys ensure a regulated acid-base balance by filtering excreta and producing urine. Approximately 1,500 liters of blood normally pass through the kidneys every 24 hours. patients are about their illness and how they themselves can make a difference, the better the treatment results are likely to be. This is why Fresenius Medical Care places great value on providing dialysis patients with intensive medical advice and education. In the reporting year, we enhanced our educational services. One example is the “Thrive! with UltraCare” series, which we extended with a new range of videos and audio plays in 2010. In these, dialysis patients at Fresenius Medical Care clinics discuss subjects which many patients find difficult, but which can have a significant influence on the success of the treatment: Why it is crucial to attend all treatment sessions, for example, the importance of healthy nutrition, regular exercise, and limited fluid intake, and how to deal with depression. This is an issue rather often for patients due to the restrictions imposed by kidney disease. Our patients in the U.S. can watch and listen to the Thrive! materials either at the clinic or at home with their families. The program also comprises training modules to help our clinic employees empathize more strongly with patients. In this way, they can respond even more effectively to patients’ needs, and motivate them to adhere to their treatment plan in a more disciplined manner.

Our Treatment Options Program (TOPs) is directed towards patients in the pre-stages of chronic kidney failure. In the U.S., we have been offering this free of charge in both English and Spanish since 2006 to educate patients and their families about the various treatment options for chronic kidney failure, from hemodialysis treatment at the clinic and peritoneal dialysisPeritoneal Dialysis (PD)Dialysis treatment method using the patient’s peritoneum, i.e. the tissue that covers the inner surface of the abdominal cavity and the abdominal organs, as the dialyzing membrane for blood purification. A sterile dialysis solution is introduced and removed through a catheter that has been surgically implanted into the patient’s abdominal cavity. The solution absorbs toxins and excess water. Most treatments are supported by a machine, the cycler, and are administered by the patients in their home or workplace several times a day or during the night.
therapy at home to kidney transplants. We also explain to patients how important it is for the quality of their treatment to have an adequate vascular access prepared as soon as possible before starting dialysis as this minimizes the risk of infection and ensures good bloodBloodFluid circulating in the body composed of plasma and cells (red blood cells, white blood cells, platelets, etc.). The main function of blood is to transport oxygen, nutrients and hormones to the cells and to remove waste products (such as carbon dioxide and urea). Blood also regulates the water and electrolyte balance and helps fight off contaminants as part of the immune system. flow during treatment. It has been proven that access in the form of an arteriovenous fistulaArteriovenous (AV) fistula (Shunt, vascular access)A direct surgically created connection between an artery and a vein in a patient’s forearm. This connection forms a large blood vessel with an increased blood flow, providing access for hemodialysis. Adequate vascular access is a prerequisite for hemodialysis. significantly reduces the risk of complications and additional days spent in hospital compared with a hemodialysisHemodialysis (HD)Treatment method for chronic kidney failure where the patient’s blood flows outside the body through disposable bloodlines into a special filter, the dialyzer. The dialysis solution carries away waste products and excess water, and the cleaned blood is returned to the patient. The process is controlled by a hemodialysis machine that pumps blood, adds anticoagulants, regulates the purification process, and controls the mixing of the dialysis solution and its flow rate through the system. A patient typically receives three treatments per week, lasting from three to six hours each.
catheter. From September 2006 to October 2010, we already trained more than 146,500 patients using TOPs; approximately 90% of patients surveyed stated that they found the program useful in helping them make their choices. In the International segment, we use the Kidney Options program in much the same way as TOPs to give patients initial information about the course of chronic kidney failure, and the possible therapy options. This education series is now available in 28 languages and used in more than 40 countries.

Once patients finally begin dialysis, they often have difficulties coping with it at first as it changes their daily routine to a great extent: They need to schedule several hours for treatment a few times a week, and the range of food they are allowed to eat is restricted. Every day, patients are required to take numerous drugs, while greatly reducing their fluid intake at the same time. Many patients find it difficult to muster the necessary discipline for this treatment plan, especially when they know little about their illness. To provide these patients with even more intensive care outside of their clinic visits during this difficult initial phase, Fresenius Medical Care introduced the RightStart program in North America in 2010. We will gradually roll this out to all of our clinics in the U.S. During the first months of treatment, each new dialysis patient will receive a weekly visit or phone call from a dialysis case management specialist. This case managerCase ManagerThe job of a Case Manager is to plan, coordinate and evaluate a patient’s treatment on the patient’s behalf. The Case Manager communicates with both the patient and with the relevant service providers; in-patient and out-patient care are combined. The objective is to ensure high-quality and cost-efficient treatment that takes patients’ needs into account as far as possible. The Case Manager’s post is usually filled with care personnel. provides patients with comprehensive information on the course of the illness and treatment, the importance of high-quality vascular access, a healthy diet, and specific treatment needs if the patient also suffers from diabetes (additional examinations and glucose testing). He or she answers patients’ questions, and works closely with the dialysis clinic team so that treatment can be tailored as closely as possible to the needs of the patient. RightStart helps the clinic teams improve the quality of patients’ life during the critical initial phase of therapy, while boosting their confidence. This is crucial, as patients can contribute greatly to the success of their treatment if they take initiative, use sound information and make the right decisions.

In the complex and comparatively new medical discipline of dialysis, the ongoing training of doctors and nursing staff is just as important as providing advice to patients. The Advanced Renal Education Program (AREP) is our U.S. internet-based training program that deals with the treatment and care of dialysis patients. In it, we offer full and half-day seminars for nephrologists, as well as e-learning courses for doctors and nursing staff, for example. To an increasing extent, we also provide training on dialysis quality issues for physicians in Asia, Africa and the Middle East. In these regions, treatment standards are in many cases still being developed and demand for professional advice is accordingly high. Fresenius Medical Care also organizes conferences, lectures, and workshops around the world, working with international nephrology experts.

Moreover, we provide advice to health authorities and organizations. For example, Fresenius Medical Care supports a number of initiatives in Russia that are committed to developing new quality standards for dialysis. This is made possible, among others, by a German-Russian non-governmental organization that coordinates joint projects between the two countries to improve medical care. In Russia, German healthcare companies are regarded as reliable and qualified partners, thanks to their expertise.

In addition to education and training programs, we offer a number of other services. One example is the national mail-order pharmacy Fresenius Rx in the U.S. Dialysis patients are typically required to take many different drugs each day. Since people with chronic kidney failureChronic kidney failure (end-stage renal disease, ESRD)Permanent failure of the kidney (terminal kidney failure) resulting from slow and progressive loss of the kidney function over several years. Since the renal function cannot be recovered, the patient has to be treated with renal replacement therapy, i.e. kidney transplantation or dialysis. Chronic kidney failure is accompanied by long-term complications such as renal anemia, hypertension and other cardiovascular problems, as well as bone disease, loss of appetite and malnutrition. also frequently suffer from concomitant illnesses such as diabetes or cardiovascular diseases, they often receive prescriptions from different doctors. Fresenius Rx specializes in the needs of kidney patients, and assists them as well as doctors and clinics.

• A team of pharmacists checks all of a patient’s prescriptions for any possible interactions, and combines them into a single list that is regularly sent to the patient’s dialysis clinic and attending physician. This helps to ensure a transparent process and safe treatment.
• We ship the drugs to patients free of charge; they are notified when a new batch is sent. If a particular prescription needs to be renewed soon, we inform the doctor. This allows us to identify any irregularities in the patient’s medication intake and to make their treatment more successful.
• A team of specialists is available 24/7 to answer any queries from patients or doctors.

In the event of extreme weather conditions or natural disasters, such as severe storms or floods, professional emergency response teams from Fresenius Medical Care are called into action in North America. To enable patients to continue receiving their life-sustaining dialysis treatment during emergencies such as hurricanes, the teams coordinate emergency shelters, organize generators, distribute food and fuel, and allocate additional staff. Fresenius Medical Care North America’s incident command center is in constant contact with the U.S.-wide Kidney Community Emergency Response Coalition (KCER). This is a network of different organizations and institutions, such as patient and professional nephrology associations, dialysis providers, hospitals, and authorities such as the Food and Drug Administration (FDA) and the Centers for MedicareMedicare / MedicaidA program developed by the federal U.S. Social Security Administration that reimburses health insurance companies and providers of medical services for medical care to individuals over 65, people with chronic kidney failure (end-stage renal disease, ESRD) or the disabled. and MedicaidMedicare / MedicaidA program developed by the federal U.S. Social Security Administration that reimburses health insurance companies and providers of medical services for medical care to individuals over 65, people with chronic kidney failure (end-stage renal disease, ESRD) or the disabled. Services (CMS). By working with KCER, we can closely coordinate our crisis management as needed with the activities of government emergency organizations, such as the Federal Emergency Management Agency (FEMA), a U.S. national coordination office for disaster relief, and the United States Department of Homeland Security, which FEMA reports to.

In 2010, the emergency response teams were mainly kept busy as a result of heavy snowstorms. Thanks to our emergency planning, we were also able to take care of patients of other dialysis providers. Another important area where we were able to help in the reporting year was Haiti, where we supplied dialysis equipment to the organization Doctors without Borders within 72 hours; more information on this can be found in the “Responsibility” chapter as well as in the magazine. In 2010, Fresenius Medical Care North America received an award from the U.S. branch of the International Association of Emergency Managers (IAEM) for its crisis management system and excellent cooperation with external crisis institutions. IAEM is an international non-profit association that is committed to professional crisis and disaster management worldwide with publications, seminars, and conferences, among other things.

In the EMEALA region, we have also established a crisis management organization in recent years. The aim of this is to protect patients and employees in emergency situations, such as natural disasters or pandemics, and to provide the best possible care even under the most difficult conditions. Our 2009 activities concentrated on pandemics, in particular the H1N1 virus (“swine flu”). The effects of this virus on our business were very low thanks to our comprehensive emergency planning. We intend to further develop our crisis management in the coming years for other emergency scenarios. In the reporting year, our teams were in demand in Chile, following the severe earthquake in late February. We were able to put all but one of our clinics in this country back into service within 48 hours and organize care for patients of the single clinic that was not operational. Additionally, we sent water treatment specialists to the region, who also assisted public clinics and dialysis centers belonging to other private providers and worked closely with Chile’s Ministry of Health to summon up the capacity to treat up to 400 additional patients from areas affected by the earthquake.