Glossary
Unless otherwise indicated, all trademarks mentioned in the Annual Report 2010 of Fresenius Medical Care have been registered in the respective countries and are subject to the trademark rights of Fresenius Medical Care. They are either owned or used under license by Fresenius Medical Care and its affiliates.
A
Acute kidney failure
Acute loss of renal function. Depending on the severity of renal function loss, intermittent dialysis treatment may be necessary. In contrast to chronic kidney failure, dialysis can help completely restore kidney function in many patients.
Albumin
A protein that can be used to monitor a patient’s nutritional condition.
Anemia
Reduced oxygen transport capacity of the blood, measured as reduced hemoglobin content in the blood.
Anticoagulant
An agent (e.g. heparin) that prevents the clotting of blood blood coagulation.
Arteriovenous (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.
Artery
A blood vessel that carries blood from the heart to the body.
Automated peritoneal dialysis (APD)
Machine (cycler) supported version of peritoneal dialysis treatment usually performed at night.
B
BCM – Body Composition Monitor
This device can be used to determine the exact makeup of the human body and its fluids (body water, fat, and fat-free body mass) and to quantify the level of overhydration in dialysis patients.
BIBAG
Dry bicarbonate concentrate for ONLINE production of liquid bicarbonate concentrate used in bicarbonate hemodialysis with our hemodialysis machines of the 4008 and 5008 series ONLINEplus System.
Biofine
Environmentally friendly biocompatible material for producing foils, tubing and other components for peritoneal and acute dialysis. Biofine is recyclable and PVC-free
Blood
Fluid 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.
Blood cells, red (erythrocytes)
Cells responsible for transporting oxygen. They are created with the help of erythropoietin, a hormone produced in the kidneys.
Blood cells, white (leukocytes)
Cells that defend the human body against infection. They are involved in allergic reactions and destroy damaged, old and dead cells in the body.
Blood coagulation
A complex process during which blood forms solid clots. It is an important part of hemostasis whereby a damaged blood vessel wall is covered by a fibrin clot that stops hemorrhaging and helps repair the damaged vessel. Disorders in coagulation can lead to increased hemorrhaging and / or thrombosis and embolism. During dialysis treatment, blood coagulation is inhibited with anticoagulants such as heparin.
Bloodlines
System of tubes connecting a patient’s blood circulation with a dialyzer during extracorporeal dialysis treatment.
Blood pressure
Pressure exerted by the blood on the walls of the blood vessels. Unless indicated otherwise, blood pressure is understood to mean arterial blood pressure, i.e. the pressure in the large arteries, such as the brachial artery (in the arm). The arterial pressure is higher than the pressure of the blood in other vessels.
Buffer
Substance that reduces pH changes that occur in a system during the introduction of an acid or a base.
C
Calcimimetics
An expansion of the therapy options to more effectively influence the bone and mineral change in patients with chronic kidney disease. Calcimimetics are administered when the thyroid gland is hyperactive, as is often the case with dialysis patients. Calcimimetics also have a positive effect on the calcium level in the bones.
Case Manager
The 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.
Catheter
A flexible tube inserted by surgery through the skin into a blood vessel or cavity to draw out body fluid or infuse fluid. In peritoneal dialysis a catheter is used to infuse dialysis solution into the abdominal cavity and drain it out again.
Chronic 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.
Composite rate
Medicare / Medicaid reimbursement rate for dialysis treatment.
Continuous ambulatory peritoneal dialysis (CAPD)
A type of peritoneal dialysis treatment where the dialysis solution is exchanged manually, generally four times a day.
D
Diabetes
A condition characterized by high blood glucose (sugar) resulting from the body’s inability to use glucose efficiently. Insulin helps the body’s cells use glucose.
Dialysate (dialyis solution, dialysis fluid)
Fluid used in the process of dialysis in order to remove the filtered out substances and excess water from the blood.
Dialysis
Form of renal replacement therapy where a semipermeable membrane – in peritoneal dialysis the peritoneum of the patient, in hemodialysis the membrane of the dialyzer – is used to clean a patient’s blood.
Dialyzer
Special filter used in hemodialysis for removing toxic substances, waste products of metabolic processes and excess water from the blood. The dialyzer is sometimes referred to as the “artificial kidney”.
Dialyzer membrane
Semipermeable barrier in the dialyzer to separate the blood from the dialysate.
Diffusion
An exchange in the chemical concentration of two fluids that are divided by a semipermeable membrane. The molecules move from one fluid to the other, with metabolic toxins being transferred through the membrane into the dialysate.
Disease management
Integrated concept of patient care that takes into account all medical aspects of an illness.
E
End-stage renal disease (ESRD)
Chronic kidney failure.
Erythropoesis-stimulating agents (ESA)
Recombinant human EPO that is commonly prescribed to patients on dialysis who suffer from anemia.
Erythropoietin (EPO)
Hormone that stimulates red blood cell production.
EuCliD
European Clinical Database. Clinical database for ensuring the quality of dialysis treatment. The database records the treatment data of dialysis patients and allows an efficient comparison of treatment quality among individual dialysis clinics.
F
FDA
The U.S. Food and Drug Administration.
G
Glomerular filtrationrate (GFR)
The U.S. National Kidney Foundation categorizes kidney disease into five stages based on the glomerular filtrationrate (GFR). The GFR indicates the volume of liquid that the kidneys filter from the blood per minute (primary urine). This ranges from more than 90 ml/min in healthy kidneys (stage 1) to less than 15 ml/min (stage 5) when dialysis or a kidney transplant is needed. Persons with stage 4 chronic kidney disease (CKD) have advanced kidney damage (GFR of 15 to 29 ml/min); it is highly likely that these patients will need dialysis or a kidney transplant in the near future.
Description |
GFR (mL/min/1.73m2) |
|---|---|
| GFR: glomerular filtration rate ▲ increased ▼ decreased 1Treatment: 1-5 T if kidney transplant recipient 2Treatment: 5 D if dialysis (HD oder PD) | |
| 1. Kidney damage with normal or ▲ GFR | > 90 |
| 2. Kidney damage with mild ▼ GFR | 60 – 89 |
| 3. Moderate1 ▼ GFR | 30 – 59 |
| 4. Severe ▼ GFR | 15 – 29 |
| 5. Kidney failure2 | < 15 (or dialysis) |
H
Hemodiafiltration (HDF)
Special type of treatment for chronic kidney failure combining the advantages of hemodialysis and hemofiltration. High elimination rates are achieved for substances with small and large weight molecules via diffusive and convective mechanisms respectively.
Hemodialysis (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.
Hemofiltration (HF)
A type of treatment for chronic kidney failure that does not use dialysate. The solutes are removed using convective forces to filter plasma water through a semipermeable membrane. Substitution fluid is used to replace the volume removed by filtration.
Hemoglobin
Substance in red blood cells that carries oxygen around the body.
Heparin
Universal anticoagulant substance that is administered during hemodialysis to inhibit blood coagulation during dialysis treatment.
I
Iron Compound
Iron product used to treat anemia in dialysis patients resulting from iron deficiency. An example is the product Venofer.
ISO
International Organization for Standardization.
K
Kidney
Two 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.
Kidney transplantation
A surgical procedure to implant a kidney from a donor.
KT / V
Indicator to evaluate treatment quality. It is calculated by dividing the product of urea clearance (K) and the length of treatment (dialysis time, t) by the filtration rate of certain toxins (the urea distribution volume in the patient, v).
L
Lean Six Sigma
Quality management system used to describe, measure, analyze, improve and monitor processes with the goal of quality improvement.
Liberty cycler
Innovative device with PIN technology for automated peritoneal dialysis marketed exclusively in the U.S. The Liberty Cycler automatically regulates the exchange of used and fresh dialysis fluid. It is equipped with a state-of-the-art pumping mechanism, is easy to setup and also has an integrated patient data management software.
M
Medicare / Medicaid
A 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.
O
ONLINE plus system
A system for our 4008 and 5008 series hemodialysis machines to perform ONLINE hemodiafiltration and ONLINE hemofiltration. ONLINE means that the dialysis machine automatically produces the infusion solution for treatment. The ONLINE method is a safe, userfriendly, resource-saving and cost-efficient alternative to ready-made infusion solutions in bags.
Osmosis
Passage of water from the blood through a semipermeable membrane. In osmosis, as opposed to diffusion, molecules move only in one direction.
P
Peritoneal 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.
Phosphate binder
Phosphate binders bind phosphate within the intestines. Excess phosphate consumed with food is normally discharged by healthy kidneys. This filtering process can only partially be replaced through dialysis for patients with chronic kidney failure. Too much phosphate in the blood can have a number of adverse effects, such as bone disease, thyroid problems and vascular calcification.
PIN technology
Unique automatic inline-closing system that eliminates the risk of contamination during disconnection from peritoneal dialysis (PD) systems.
Polysulfone
A polymer used to produce dialyzer membranes. It is characterized by extreme thermal stability, chemical resistance and blood compatibility.
Prevalence
Number of all patients who suffer from a specific disease.
S
Shunt
Arterio-venous (AV) fistula.
Sorbent systems (SORB technology)
Purifies tap water to dialysate quality and allows dialysate to be regenerated; a water- and space-saving technology very suitable for home-hemodialysis and thus an important step towards a wearable kidney. The technology centers on sorbents, specific substances that bind toxins in liquids so that they can be removed.
Supply chain management
Management of all tasks along the supply chain, ranging from supplier selection, procurement and warehousing to the transport of goods to customers with the goal of improving efficiency in the value chain.
T
Terminal kidney failure
Terminal renal failure occurs when kidneys no longer detoxify the body, have lost this function finally and thus kidney substitute therapies become necessary.
Transplantation
Taking an organ or tissue from the body and grafting it into another area of the same body or into another individual.
V
Vein
A blood vessel that carries blood to the heart.
The financial glossary is included in the financial report here