Glossary

Glossary

A

Albumin

A protein that has two important functions. On the one hand, it contributes through its relatively large amount to the fact that the liquid contained in the blood remains in the bloodstream and does not penetrate the arterial walls in the surrounding tissue. On the other hand, it is an important transport protein for various substances. Among others, many drugs, but also free fatty acids and hormones are bound to albumin and are transported in the blood throughout the body. The level of this protein provides information on the general nutritional condition of a patient.

Anemia

Reduced oxygen transport capacity of the blood, measured as decreased hemoglobin content in the blood.

Anticoagulant

An agent (e.C.heparin) that prevents blood coagulation.

Arteriovenous (AV) fistula (Shunt)

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-supported version of peritoneal dialysis treatment usually performed at night.

B

BCM – Body Composition Monitor

This device can be used to precisely measure the composition of the human body and its fluid status 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 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.

Bloodline system

System of tubes connecting a patient‘ s blood circulation with a dialyzer during extracorporeal dialysis treatment.

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.

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. In hemodialysis, a catheter can be used as a vascular access for dialysis treatment. In this case, the catheter is usually inserted into the superior vena cava, or occasionally the femoral vein.

Composite rate

Medicare / Medicaid basic reimbursement rate for dialysis treatment.Medicare/ Medicaid basic reimbursement rate for dialysis treatment.

Continuous ambulatory peritoneal dialysis (CAPD)

A treatment method where the dialysis solution is exchanged manually, generally four times a day.

D

Diabetes

A condition characterized by raised blood glucose (sugar) resulting from the body‘s inability to use glucose efficiently. As the main regulatory hormone in sugar metabolism, insulin is normally used to control this condition.

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 dialysis solution.

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 dialysis solution.

E

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 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

U.S. Food and Drug Administration.

G

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.

Stages of chronic kidney disease according to the U. S. National Kidney Foundation

  • Stage 1 – Kidney damage with normal or increased GFR
    ≥ 90 GFR (ml/min/1.73m)
  • Stage 2 – Slightly decreased GFR
    60 – 89 GFR (ml/min/1.73m)
  • Stage 3 – Moderately decreased GFR
    30 – 59 GFR (ml/min/1.73m)
  • Stage 4 – Severely decreased GFR
    15 – 29 GFR (ml/min/1.73m)
  • Stage 5 – Kidney failure
    < 15 (or dialysis) GFR (ml/min/1.73m)

H

Hemodiafiltration (HDF)

Hemodiafiltration is a process that combines hemodialysis and hemofiltration. The theoretical starting point for combining these two processes is the fact that low-molecular substances such as urea and creatinine are predominantly removed through diffusive transportation such as hemodialysis, whereas the larger molecules are to be predominantly removed through convective transportation as in hemofiltration. In hemodiafiltration (HDF), the total amount of removed toxins is greater than in the individual processes, as convection and diffusion do not complement each other, but run in parallel and affect each other. The more permeable synthetic membranes (“high-flux dialyzers”) with superior ultrafiltration performance are used for hemodiafiltration. As in hemofiltration, the ultrafiltrate is replaced by a sterile solution (substitution solution) in hemodiafiltration.

Hemodialysis (HD)

Treatment method for dialysis patients 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 dialysis solution. The solutes are removed using convective forces to filter plasma water through a semipermeable membrane. Substitution solution 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 hemodialysis.

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

Kidneys

The 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 failure, acute

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.

Kidney failure, chronic (end-stage renal disease, ESRD)

Permanent failure of the kidney (terminal kidney failure) resulting from slow and progressive loss of 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.

Kidney failure, terminal

Terminal renal failure occurs when the kidneys no longer detoxify the body, have lost this function finally and thus kidney substitute therapies become necessary.

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 solution. It is equipped with a state-of-the-art pumping mechanism, is easy to set-up and also has 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

ONLINEplus 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, user-friendly, resource-saving and cost-efficient alternative to ready-made infusion solutions in bags.

Osmosis

Passage of water from the blood through a semipermeable filter 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 excess phosphate that is consumed with food within the intestines. Excess phosphate 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. PhosLo and OsvaRen are examples of phosphate binders for patients with chronic kidney disease.

PIN technology

Unique automatic inline-closing system that eliminates the risk of contamination during disconnection from peritoneal dialysis (PD) systems.

Polysulfone

A polymer (plastic) 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 within a defined period.

S

Sorbent systems / SORB technology

Technology used to treat tap water for dialysis so that the dialysis solution can be reused. As a result of its water- and space-saving properties, the technology is very suitable for home hemodialysis, and is thus an important step towards a portable artificial 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

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.

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