**16. Glossary of dialysis-related terms**

**Blood Urea Nitrogen** (BUN) is the blood test used to measure nitrogen in the form of Urea, which is the by product from protein metabolism produced in liver and removed by kidney

**Dialysate**-the fluid used in dialysis, typically with a lower solute concentration than the blood, into which metabolic waste and excess electrolytes diffuse.

**Hemodialysis**(HD)-a process of removal of fluid and solutes through a semi-permeable membrane into dialysate by passing the blood through an artificial kidney. Hemodialysis is most commonly delivered to patients three times a week for three to four hours (Conventional Hemodialysis-CHD), but may also be given more slowly across the day or night (Nocturnal Hemodialysis-NHD).

**Nocturnal Hemodialysis** (NHD). Nocturnal hemodialysis or nightly hemodialysis is a form of hemodialysis which is done at home by the patient or a family member when the patient is sleeping at night. Most patients dialyze five to seven nights a week, anywhere from six to12 hours, on average for eight hours.

**Peritoneal Dialysis** (PD)-the process of removal of fluid and wastes from the body using the semi-permeable membrane of the peritoneum for the diffusion and osmosis,

**Continuous Ambulatory Peritoneal Dialysis** (CAPD)-continuous dialysis process that involves infusion of fluid into peritoneum, a prolonged dwell period for dialysis and drainage. The procedure typically involves four exchanges of fluid daily.

**Kt/V** is a way of measuring dialysis adequacy. Kt/V is defined as the dialyzer clearance of urea (**K**, obtained from the manufacturer in mL/min, and periodically measured and verified by the dialysis team) multiplied by the duration of the dialysis treatment (**t**, in minutes) divided by the volume of distribution of urea in the body (**V**, in mL), which is approximately equal to the total body water.

### **17. References**


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**24**

*USA* 

**The Allo-Immunological Injury**

*Tulane University School of Medicine, New Orleans, LA,* 

**in Chronic Allograft Nephropathy** 

I. Enver Khan, Rubin Zhang, Eric E. Simon and L. Lee Hamm

Progressive loss of renal allograft function after the first year of kidney transplant is often referred to as chronic rejection, transplant nephropathy, transplant glomerulopathy or chronic allograft nephropathy (CAN) and the use of these terms is often interchangeable. Clinically, it is usually diagnosed by a slowly rising serum creatinine level, increasing proteinuria and worsening hypertension (Zhang et al., 2004). CAN is the second most common cause of graft loss after the leading cause, death with a functioning graft (DWFG) (Zhang et al., 2004). According to estimates, 25-30% of patients currently awaiting kidney

With the widespread usage of induction agents and the advancements in immunosuppressive medications, the first year outcomes after kidney transplant have shown steady improvement. In the United States, the incidence of acute rejection (AR) in the first year is below 10% (United States Renal Data System [USRDS]) while the unadjusted graft survival is 96%, 92% and 85% for living, deceased and extended criteria deceased donors respectively (Organ Procurement and Transplant Network/Scientific Registry of

In the long term though, the survival of grafts has shown very little improvement over the past decade. The 5 year graft survival is reported at 81%, 71% and 55% for living, deceased and extended criteria deceased donors in the time interval of year 2000-2005. This, in comparison, is hardly different from the 79%, 68% and 51% reported in the interval of 1994-1999 (OPTN/SRTR, 2008). The median graft survival years for all kidney transplants, according to a report published in 2004 has changed little when comparing transplants performed in the

An overall shortage of organs and the high cost of providing any form of renal replacement therapy inclusive of a kidney transplant, calls for attention into making efforts for kidney transplants to last longer. This would entail looking into the pathological processes that result in the eventual failure of grafts, delineating as far as possible one process from the other, and examining immunological and non-immunological determinants that may be targeted with the eventual goal of adopting strategies that may help in prolonging the survival of renal allografts (Zhang et al, 2004). The non-immunological factors may include

years 1988 through 1995, ranging between 7.5 to 8.0 years. (Meier-Kriesche et al, 2004)

**1. Introduction** 

transplant have received a transplant before.

Transplant Recipients [OPTN/SRTR], 2008).

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