NephroCare · NephroCare for me Summer 2014 NephroNumber St. Wendel, with a population of just under 30,000, is a quaint town in Saarland’s north-east corner. A former stocking

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Summer 2014

Worth knowing in renal

Different countries – different habits

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In the know about peritoneal dialysis

My four kidneys and I Four decades of innovation in St. Wendel

NephroCare

NephroCare for me Summer 2014

News from around the world 4Brand new dialysis centre opens in Salerno 4

NephroNumber 6Four decades of innovation in St. Wendel 6

Worth knowing in renal 10In the know about peritoneal dialysis 10Kidney transplantation – is it the right choice for me? 14Diabetes: the sweet truth 18

Different countries – different habits 22The best of Germany 22 From career man to hobby farmer 26A life-changing new treatment 28My four kidneys and I 30

NephroCare people 34Passionate about his patients 34

Back to the roots 38The origins and rise of peritoneal dialysis 38

Here’s to your health 42Monitoring your liquids and salts 42Tastes of summertime 44

Worth living 48Finding your green thumb 48

Inspiring 52Brain calisthenics 52Announcements 54Questionnaire 55

Dear Readers,

Most of us would agree: summer is a delightful time of year. Longer days, warmer nights. Seemingly endless moments to spend outside enjoying the simple things in life, like reading a book in the garden or having a barbecue with friends or the family.

In the spirit of summer, we’re excited to share a range of enjoyable, informative topics in this issue of NephroCare for me. Ones that’ll help you make the most of the year’s nicest months – and at the same time help to stay active.

Variety is the spice of life and, as you’ll see, this sentiment certainly applies here and now. Those of you who always wanted to try gardening will be inspired in our section “Worth living.” Or without leaving your home, take a trip to the heart of Europe: Germany.

Of course, you’ll also find encouraging stories from fellow patients – from different countries and various places. Meet 14-year old Eda who by switching to home dialysis can now balance her all-important treatments and pursuing her dreams. Also hear a humorous account from Hungarian celebrity András Both about his four kidneys.

Though you’ve probably heard of peritoneal dialysis (PD), you might not know about it in detail. The first instalment of a multi-part series on PD will introduce the basics. And finally, transplantation will always be a key topic for some of our patients with chronic kidney disease. Join us as we explore this complex subject. We wish you a wonderful summer and happy reading!

Your NephroCare Team

Welcome!

“Summer afternoon – summer afternoon; to me those

have always been the two most beautiful words

in the English language.”Henry James

Content

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News from around the world


Located on the Gulf of Salerno, the town is a popular tourist destination, both around Christmas when visitors flock to see Salerno’s famous Christmas Lights, and in the summer because of its proximity to the beautiful Amalfi Coast.

The new dialysis centre, NephroCare Salerno, replaces two smaller facilities and has the ca-pacity to treat up to 128 patients. Specially designed to provide high quality, state-of-the-art dialysis care the centre is easy to reach and has a convenient private entrance and its own car park. Operating two dialysis shifts a day, six days a week the facility currently serves 83 patients assisted by 28 medical, nursing and auxiliary staff.

Quality of patient care is top priority and all patients receive Online HDF treatment with

Fresenius Medical Care’s 5008 CorDiax dialysis machines. The adequacy of every single treatment is measured with the Online Clearance Monitor, and thanks to the Body Composition Monitor physicians can manage the balance of the patient’s body fluids and their nutritional status.

Another key factor in designing the building was eco-sustainability, and a new generation water treatment system, a system for the central delivery of concentrates, and a cutting edge waste water treatment system all contribute to safeguarding the environment.

Every effort has been made to ensure the time patients spend in the centre is as com-fortable as possible. The centre is very quiet and has a bright and spacious treatment room with 32 dialysis stations. A cheerful waiting area provides patients and their rela-tives with a place to sit and chat while they wait for their treatment.

Perhaps the greatest challenge of the new centre was the logistics of moving from the two old centres to the new one. To guarantee the continuity of the dialysis treatments everything had to be moved from the old

centres and installed in the new centre in the space of just 24 hours. Not an easy task! However thanks to a great team of specialist removers, supported and coordinated by NephroCare staff, everything was planned perfectly and the teams worked late into the night to ensure that everything was ready for dialysis sessions to start normally the next day.

For the clinical data, on the other hand, the move was straightforward: thanks to the EuCliD clinical database, which is used throughout the NephroCare network to collect the data of patient treatment sessions, the clinical data was transferred easily to the new facility. The centre opened for patients on December 1st and on December 17th the official opening ceremony was held. This aus-picious event was attended by local dignitaries

including Dr. Antonio Iannone, President of Salerno Province, Dr. Antonio Squillante, Di-rector of Salerno Health Authority and Prof. Marcello Feola from the Faculty of Political Science at the University of Salerno, repre-sentatives from Fresenius Medical Care, as well as staff and patients of the new centre.

Moving to the new centre meant a lot of changes for everyone involved, but of course changes can also be for the better! For the staff of both centres it was important to reas-sure their patients and keep them up-to-date with activities in the run-up to and during the move. They were with them every step of the way making sure they really felt that the care they receive goes far beyond the dialysis treatment itself. Just a few weeks after moving to the new centre, Medical Director Dr. Domenico Bonanno reported that all patients have settled in well and are very happy to be receiving their dialysis care in these pleasant new surroundings.

If you are planning a holiday in Italy, the new NephroCare centre in Salerno welcomes holiday patients as do all NephroCare centres in Italy.

Brand new dialysis centre opens in Salerno

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In December 2013 a new dialysis centre opened its doors to patients in Salerno, Italy. Salerno is a lively coastal city with a wonderful Medieval Old Town and a beautiful seafront promenade.


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St. Wendel, with a population of just under 30,000, is a quaint town in Saarland’s north-east corner. A former stocking factory in the town’s industrial zone is home to a Fresenius Medical Care production plant. However, it does more than just bring numerous jobs to the region: the factory manufactures various products, used in dialysis centres where they play essential roles in providing best-possible treatment to people with chronic kidney dis-ease. Specific products developed and man-ufactured in St. Wendel that you may be fa-miliar with include dialysers, bloodlines, and systems for peritoneal dialysis.

Research and development focusSince opening its doors in 1974 numerous dialysis milestones have been reached in

St. Wendel. Each of them has greatly improved treatment options for patients. For instance, the high-tech facility is renowned for its highly automated production of dialysers, the filters used in haemodialysis treatment that mimic the function of a healthy kidney. In fact, the site develops and manufactures more dialysers than any other factory in the world.

To continuously offer patients a higher level of care, the committed team of engineers and scientists in St. Wendel’s research and devel-opment department spend their time researching and testing new products. When they’re sure one is a success, it goes into global production before being dispatched to dialysis centres all over the world where it improves the treatment patients receive.

Strong from the startJust four years after the factory’s opening,St. Wendel began producing the first-ever dialysers featuring a membrane made of a cellulose-based material. During its devel-opment, the engineers in St. Wendel imple-mented new techniques leading to dialysers that purified patients’ blood better than in the past.

Four decades of innovation in St. Wendel

In the early ‘80s, engineers in St. Wendel began developing a new kind of membrane that became known as the ‘F60’. A number of unique traits made it remarkably similar to the natural kidney and it was exceptionally good at eliminating waste in dialysis patients. What’s more, patients tolerated the mem-brane extremely well.

Steam sterilisation premieresAt the St. Wendel factory in the early ‘90s, Fresenius Medical Care became the first company in the world to introduce steam

sterilisation of dialysers in a process named INLINE steam sterilisation. Though it’s not something patients may regularly think about, sterilising dialysers is a must in dialysis to ensure they are clean and free of residue. This invention from St. Wendel was so ground-breaking because patients were having allergic reactions to the previously-used disinfectant.

Today, INLINE steam sterilisation continues to be the preferred method of sterilisation for most dialysers used in NephroCare centres.

Saarland may be one of Germany’s smallest federal states in terms of size and population. But the area in westernmost Germany that borders France, Luxembourg, and the German federal state of Rheinland-Pfalz is huge in developing innovations for dialysis patients worldwide.

Steam sterilisation of filters

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Earth- and patient-friendly: BiofineTo further better patient care and respond to a growing demand for PVC-free medical products, the team in St. Wendel began to explore more environmentally- and patient-friendly dialysis options. The result: Biofine dialysis products. All products carrying the Biofine name are 100% free of PVC and are safe, transparent, tear-resistant and can be steam-sterilised, which makes them suitable for medical use. What’s more, Biofine has a smaller carbon footprint and is easy to recycle.

Leaps forward since 2000Another innovative product with origins in St. Wendel is the FX class dialyser Helixone. This dialyser is more user-friendly, and significantly smaller and lighter than the previous F-Series dialysers. Plus, it requires fewer resources for production and is more environmentally friendly when disposed of. Since its launch, Fresenius Medical Care has produced more than 210 million dialysers with the FX design at St. Wendel and at two other production sites.

In 2013, a big breakthrough happened at St. Wendel that helped protect patients from exposure to potentially harmful bacteria during dialysis: the development of a new ultrafilter called DIASAFE®plus. The production of these helpful filters is exceptional as well. Processes are fully automated and St. Wen-del employees monitor every step via a video camera system. This ensures the filters used in patient treatment are free of any flaws – for top- quality care.

Today and in the future St. Wendel will remain focused on developing new innovations that will go on to enhance the care patients with chronic kidney disease receive.

In St. Wendel, just like at all our production sites and treatment centres, we at Fresenius Medical Care are fully committed to offering you the best possible treatment. Our passion is doing everything we can to make your life better!

NephroNumbers in St. Wendel

• Top regional employer: Today, 1,800 staff at the St. Wendel plant help produce

life-saving dialysis products.

• Non-stop filtering: Currently 3.5 million DIASAFE®plus ultrafilters are produced

annually in St. Wendel, keeping a growing number of patients safe from unwanted

contact with bacteria. The great news: the factory can increase production as

patients require additional filters.

• High performer: As of 2013, the St. Wendel factory has been producing

130,000 dialysers every day, which reach patients all over the globe.

• Fully-automated helpers: Since the 2013 remodelling and expansion of the

factory’s warehouse, 14 driverless forklifts use laser navigation to bring the right

pallets to the production area. 24-hours a day, 7 days a week.

High-tech control centre of membrane production

Checking of the stay•safe® system

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In the know about peritoneal dialysisYou may have heard the term peritoneal dialysis before but were unsure exactly what it is. Here we present the first article in our new series all about peritoneal dialysis, where we will explore this treatment method, look at the different types available and find out who are suitable candidates.

Two types of dialysis treatments exist to clean the blood of persons whose kidneys no long-er work properly. While haemodialysis cleans the blood via an external machine and a dia-lyser, peritoneal dialysis uses the inside lining of the patient’s abdomen as a natural filter. Each therapy has its own advantages and disadvantages and the best choice for you is something you should discuss in detail with your nephrologist.

In order for peritoneal dialysis to work ade-quately it is important that your kidneys still have a significant degree of residual renal function. For this reason many patients with a long history of haemodialysis are not suited to

PD. Other medical issues (e.g. hernias, previ-ous abdominal surgery, etc.) may also mean that PD is not the best option for you. If you are interested in PD as a possible treatment option, please discuss your individual situa-tion with your nephrologist.

How it worksPeritoneal dialysis uses the lining of your ab-domen, the peritoneum, to help perform the dialysis process. Waste products and excess water are filtered from the blood into a fluid called dialysate through the peritoneal mem-brane, a very thin layer of skin that covers the intestines and the liver.

Before starting peritoneal dialysis, a soft sili-cone tube called a catheter is placed in your belly by a surgeon or nephrologist during an ambulatory operation. The catheter stays there as long as you are undergoing perito-neal dialysis as part of your treatment. With the catheter in place, a sterile cleansing fluid, the dialysate, can now flow into your abdo-men and the filtering process, known as the equilibration, can begin. When filtering is completed, the fluid, containing the waste products and excess water, exits your body via the same catheter.

Successful peritoneal dialysis requires you to complete the process of putting sterile clean-ing fluid into your abdomen via the catheter and draining it out. Together this process is known as an exchange, and has to be re-peated at regular intervals.

Types of peritoneal dialysisThere are two ways in which peritoneal dialy-sis can be performed: manually, known as Continuous Ambulatory Peritoneal Dialysis (CAPD) or automated, known as Automated Peritoneal Dialysis (APD). The general idea behind both is the same, though they differ in the number of treatments in a 24-hour period and when and how they are carried out.

CAPD – manual daytime exchanges If you are using CAPD, most exchanges will take place during the day. Expect to have around four per day, each of which lasts

around 30 minutes in total excluding the dwell period, which we will address next. However, the precise number of exchanges required for your treatment is something you will decide with your nephrologist. There is some flexibil-ity in when you can fit in exchanges to ac-commodate work or attend school. Ask your healthcare team to help you set up a sched-ule that works with your daily routine.

CAPD consists of three steps: inflow, dwell, and drain or outflow. During inflow, the pre-warmed sterile cleansing fluid uses gravity to flow through the catheter into your empty peritoneal cavity. This step usually takes around 10 minutes.

Then comes dwell, where the actual dialysis process takes place. During dwell time, waste products and excess body water are removed from your blood and move to the dialysis fluid by passing through the peritoneal membrane, which acts as a filter. The fluid remains in your peritoneal cavity until it is time for your next exchange. You now have the freedom to con-tinue with your normal daily activities, and can walk around freely. The length of dwell time varies from patient to patient, so it’s important to follow your doctor’s advice.

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The third step, drain or outflow, occurs at the end of each dwell time. This is when the fluid, now called effluent, leaves your abdomen through the catheter and flows into a drain-age bag. Usually this step is done in around 20 minutes.

APD – automatic night time exchangesIn APD, exchanges usually take place at night with the assistance of a device called a cycler. If you and your nephrologist decide that APD is the best option for you, you will be con-nected to the cycler for approximately 8 - 10 hours per night. While you sleep, the sterile cleansing fluid is delivered via a special tube that links you to the cycler. The cycler then drains and refills your belly automatically while you sleep.

In the morning you simply disconnect yourself from the cycler and you are free to go about your daily routine and activities.

Advantages of peritoneal dialysisIf you have chronic kidney disease, one of the biggest advantages of peritoneal dialysis is greater freedom and flexibility. In fact, thanks to continuous or night-time dialysis your life-style does not differ much from people with healthy kidneys. Also, PD patients may be able to eat more freely and reduce certain medications. Of course, any changes to diet or medication should only be made under the supervision of your nephrologist.

Who is PD right for?There are situations where peritoneal dialysis may be the better treatment option. In many

cases, it’s a medically-driven choice, for example, if you have certain heart or vascular diseases.

Because of restricted vascular access, peritoneal dialysis is usually the treatment of choice for young children. Opting for a form of dialysis performed at home also allows children to continue their schooling.

When haemodialysis is bestWhile peritoneal dialysis does provide excellent, more flexible treatment for many persons with chronic kidney disease, sometimes it’s not the right choice. For example, if you have loss of peritoneal function, mechanical problems with your abdomen or lack good hand-eye coordi-nation, your nephrologist will most likely pre-scribe haemodialysis as the best-fit treatment.

Other conditions that could lead your nephro-logist to prefer haemodialysis over peritoneal dialysis include a recently implanted abdominal prosthesis, peritoneal leaks, extreme body sizes (large or small), and inflammatory bowel disease. Also, there is a risk that abdominal or skin infections could contaminate the catheter and lead to infection, so it’s important to inform your care provider if this applies to you.

Frequent episodes of the digestive disease diverticulitis also pose a special risk because they can cause inflammation of the abdominal membrane. Whether peritoneal dialysis is an option to explore is something you need to take up with your nephrologist. Remember to inform your care provider of any changes to your health or new diagnoses you receive from other doctors: they could influence which kind of dialysis is best for you.

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Kidney transplantation – is it the right choice for me? Transplantation is an important topic for thousands of people worldwide with chronic kidney disease. For those who do receive a donor kidney, it offers hope for a chance to live more freely and with fewer dietary restrictions. It’s a complex subject that re-quires ample information, time and thought before you can make the best decision for yourself. Read on to learn more about kidney transplantation.

What is kidney transplantation?The process of implanting a healthy kidney from another person, either a live or deceased donor, into a person with chronic kidney disease is known as kidney transplantation. Receiving a new kidney is not a cure for kidney disease, but a treatment.

Many patients with chronic kidney disease are suitable candidates for transplantation, but not everyone is. So if you would like to explore transplantation as a treatment option,

the first step is to discuss your personal situ-ation with your nephrologist. He or she will evaluate a number of aspects of your overall health and kidney condition before making a recommendation for you.

If your nephrologist concludes you are a good candidate, you will need to complete the necessary examinations and tests. Then your doctor can place you on the national trans-plant list to receive a kidney from a deceased individual, or find a compatible live donor.

Compatibility is keyKidney transplantation enjoys an overall high success rate – especially in the first year after the operation. However, for successful trans-plantation, the recipient and the donor must be compatible with each other. This means that both parties have a compatible blood type and matching tissue, which lowers the risk of the recipient’s body rejecting the donor kidney. Prior to the operation, a range of lab-oratory tests will be done to verify compati-bility.

Receiving a kidneyAs previously mentioned, there are two ways to get a donor kidney: from a living person or a deceased donor. Living donors tend to be someone in your family – one of your parents or a sibling – or someone close to you like a friend or spouse. The main advantage of receiving a kidney from a living person is the time saved. As soon as you find someone who is compatible with you and willing to donate, the transplantation process can begin.

Deciding to donate a kidney requires careful thought and consideration. The donor should be aware of the risks associated with the operation to remove the healthy kidney and

know that monitoring is required post- operation to ensure that the remaining kidney is ade-quately filtering out the body’s wastes.

In contrast, receiving a deceased donor kidney, which usually originates from some-one who died in an accident, requires patience. After placing your name on the national transplant waiting list, there is no rule about how much time will pass before a matching donor kidney will become available. Occasionally the wait is short. But realistically


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you may wait for a few years – though the average waiting times differ from country to country.

In the operating theatreAfter you have a donor kidney, the next step is surgery. Because organs are very sensitive, surgery must happen as soon as possible after a kidney becomes available. If you are on the waiting list, you will have a kidney-alert when a suitable kidney arrives, so be sure you are easily reachable under your contact num-ber at all times. After a final check to ensure the kidney is OK, the operation can begin.

As long as your own kidneys are not causing an infection, your surgeon will typically opt to leave them in. Your new healthy kidney is simply placed next to them in your abdomen and joined to your artery and vein. This allows blood to start passing through and your body can begin producing urine.

Possible complicationsPart of making an informed decision about transplantation is knowing about the potential risks. Receiving a donor kidney is associated with three primary concerns: rejection, func-tionality, and organ lifespan.

After the transplant, you will need to take certain medications, including immunosup-pressants that reduce the risk of rejection. It’s essential for you to take all medications your nephrologist prescribes you to reduce this risk to an absolute minimum. However, be-cause these drugs suppress your immune system, it’s essential for you to really take care of yourself after the operation.

In terms of functionality, some donor kidneys begin working immediately while others take a few days. If you fall into the latter group, you may require dialysis until your new kidney functions normally. This is common and is not an immediate reason to worry about the transplant’s success.

Finally, on average a donor kidney lasts for 10-15 years. This is because the kidney function slowly decreases over time. There-after, you always have the option of going back on dialysis or trying to find a second donor kidney either via live donation or the national transplantation list.

While complications can happen, try not to worry about them beforehand. Your nephro-logist will give you the best possible treatment

before, during and after transplantation, and you should address any specific questions or concerns you have with him.

Making the right choiceTransplantation is a highly personal topic – one that you should give both time and thought to. Perhaps begin by speaking to your nephrologist about your own situation. If you both agree that transplantation is an option, you can always place yourself on the list if you don’t have a living donor, and give the decision more thought while you wait. Speaking to others about the pros and cons of transplantation could help you reach a decision.

On pages 30-33 you can also read the inspir-ing story of a Hungarian patient who had transplantation and shares his experiences with us.

In the meantime, know that you have the full support of the NephroCare team. No matter what, we will always be there to provide the best quality dialysis care – if, when and where you need us. We also offer our patients assistance and advice related to trans-plantation.

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Diabetes: the sweet truthThis is the first in a series of articles which will talk about diabetes. Diabetes is the lead-ing cause of kidney failure, in fact almost a fifth of all dialysis patients need dialysis as a result of diabetes-related kidney disease. As we explore this topic together, we hope to answer some of your questions, increase your knowledge and help you manage your condition for a better quality of life.

The history of diabetesDiabetes, or diabetes mellitus to give it its medical name, has a very long history. The earliest known record was found in an ancient Egyptian manuscript dating back to 1500 BC, where the physician Hesy-Ra described the ailment as “too great emptying of the urine” (what we today refer to as polyuria, or exces-sive urination). Indian physicians identified the disease at around the same time referring to it as “honey urine” as they noticed that the urine of affected patients attracted ants!

The term diabetes means “to pass through or siphon” and was first used in 230 BC by the Ancient Greek Appollonius of Memphis. The word mellitus (sweet like honey) was added a few centuries ago when English physicians noticed what their ancient Greek, Egyptian and Indian colleagues had discovered centu-ries before – that the urine of a diabetic has a sweet taste!

Basics, different typesMany people think that diabetes is caused by eating too much sugar, but of course it’s not as simple as that! Diabetes refers to a group of metabolic diseases where a person has high blood sugar – or glucose. This happens

when the pancreas doesn’t produce enough insulin, or when the cells of the body no long-er respond as they should to the insulin pro-duced.

Insulin is a hormone produced by thebody and responsible for regulating blood sugar levels. In diabetes the body is not able to regulate these levels and so glucose builds up in the bloodstream.

As insulin is a protein it would be bro-ken down during digestion if taken in pill form, therefore diabetic patients take it as a subcutaneous injection.

There are three main types of diabetes: Type 1, Type 2 and gestational.Although Type 1 diabetes can affect both adults and children, it is most common in children which is why it is often referred to as “juvenile diabetes”. This form of diabetes can start suddenly if the pancreas is no longer able to produce insulin, either for genetic reasons or because of infection.

In Type 2 diabetes your body no longer produces enough insulin or doesn’t use it properly, or a combination of both. This form of the disease is more common and usually affects adults over the age of 40. It is caused by lifestyle factors such as obesity, lack of physical activity, poor diet and stress.

The third main type is gestational diabetes and affects 2-5% of pregnant women. It can be treated but requires careful medical super-vision during the pregnancy to safeguard the health of both mother and baby. After giving birth the diabetes may improve or disappear completely.

Development of the disease / Risk factors As you can see insulin plays a key role in diabetes. It is needed to convert sugar, starch

and other food into the energy our cells need to work. When this no longer happens the cells don’t get the energy they need and sugar accumulates in the blood, which is damaging to our health. Although this damage

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is not immediate, there is the risk of long-term complications that tend to develop after around 10-20 years.

The long term damage caused by having high blood sugar for long periods of time can affect the eyes (causing visual impairment and blind-ness), the nerves (numbness in feet, legs and arms), the heart (atherosclerosis and related diseases), and the kidneys.

In the kidneys, high blood sugar levels can cause tissue scarring and the kidneys may eventually stop working. Diabetes is actually the most common cause of kidney failure and around one in five people on dialysis have diabetic kidney disease, (also called diabetic nephropathy).

Signs and symptomsThe symptoms of Type 2 diabetes are not always clear and as they appear gradually at first, a patient may not even be aware he has the disease. Other patients however do experience symptoms which may indicate they have diabetes. The most common signs are passing large amounts of urine, feeling thirsty, increased hunger, weight loss and tiredness. Other signs can be irritability, tin-gling hands or feet, blurred vision, frequent infections, slow-healing wounds, vomiting or stomach pain.

In Type 1 diabetes the symptoms develop rapidly over a period of weeks or months, whereas in Type 2 diabetes symptoms develop more slowly, or may not appear at all.

Treatment possibilitiesDiabetes is a chronic disease and there is no known cure to date, however it can be treated. Treatment consists in managing blood sugar levels to keep them as close to normal as possible without letting them get too low, caus-ing hypoglycaemia. This can be done by means of medication, appropriate diet and exercise.

If you have diabetes your doctor will advise you:

• to stop smoking• to keep your cholesterol levels and blood pressure under control• to lose weight if you are overweight or obese• to do some regular physical exercise

If you have Type 1 diabetes your doctor will prescribe you insulin, whereas for Type 2 diabetes you may need oral medications and possibly also insulin.

Being diabetic does not stop you from pur suing your ambitions, and there are many success-ful sports personalities, singers, actors, writ-ers and politicians who are living proof that being diabetic doesn’t have to hold you back

- you can continue to pursue your dreams!

Famous diabetics:

Tom HanksActor

Halle BerryActress

Larry KingCNN news anchor

Mikhail GorbachevEx-Russian President

Elvis Presley Singer

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The best of Germany


Famous Berlin – worth a tripWith countless sights to see, the federal cap-ital is always worth visiting. Stroll along Kur-fürstendamm, visit world-famous museums, or explore the city by boat on the Spree. A few Berlin highlights that shouldn’t be missed are the Brandenburg Gate and the Alexander-platz. The latter, located on the thoroughfare between the city’s eastern and western sides, is one of the city’s most colourful districts and a major transportation hub. When the city was divided into West Berlin and East Berlin, Alexanderplatz was the most important city square in the German Democratic Republic.

Insider tip: The legendary Alexander-platz is just a 20-minute tram ride away from the Berlin Weißensee Dialysis Centre.

Want a 360° view of Berlin? Then a visit to the iconic TV tower, Germany’s highest building is an absolute must. From the so-called pano-rama level, you’ll enjoy the best view the city has to offer. The restaurant inside turns full circle twice an hour, giving its patrons a stun-ning look at the old and new capital and its magnificent sights.

Munich says ‘Grüß Gott’Munich unites big city life with stunning natural surroundings and Bavarian lifestyle. The city’s most famous landmark is without question the Frauenkirche (Cathedral of Our Dear Lady), though it is just one of many attractions the busy urban centre has to offer. Also worth seeing are the impressive neo-gothic Neues Rathaus (New City Hall) on the centrally-locat-ed Marienplatz, the lively, vibrant outdoor market known as Viktualienmarkt, gorgeous Nymphenburg Castle and its gardens, the Alli-anz stadium in the city’s northern corner, and the countless high- calibre museums.

Come summer, the Olympic Centre, the Eng-lish Garden and many natural lakes in the area invite residents and visitors alike to take time out to relax. The beer gardens scattered throughout Munich and its vicinity are the

perfect places to enjoy a touch of Bavarian tradition in a relaxing outdoor atmosphere.

Oktoberfest - tradition of MunichIf you’re travelling to Munich, don’t miss out on an essential part of Munich culture: The Oktoberfest. On 20 September 2014, the 181st Oktoberfest kicks off on the Theresien-wiese. The boisterous and colourful festival offers something for all ages. Children enjoy the various rides, while pretzels and beer are perhaps the most famous culinary attractions. These days, traditional dress has made a comeback and you’ll see many women donning a dirndl and men wearing lederhosen.Munich keeps you well connected. From the NephroCare dialysis centre, you’ll reach the

city centre in next to no time with the S-Bahn, the city’s network of suburban trains. Travel-ling to the airport is also easy via S-Bahn. Visit Munich and experience a cosmopolitan city with a prominent cosy side.

Discover the heart of Europe – with the support of NephroCare.The Federal Republic of Germany is an open-minded country that is split between tradition and modernity. With 82 million inhabitants, Germany is the most highly popu-lated country in the European Union. It offers a wide range of leisure and recreational activities, and is home to countless culinary delights. Join us on a tour of Germany’s highlights and whet your appetite for this fascinating country. Let’s go!

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Hamburg - tradition meets modernWhether you want to explore the traditional port, visit an inspirational museum, or simply enjoy authentic culture, Hamburg is the place to be. One must-see is Hamburg’s fish market. Every Sunday morning from 5.00h - 9.30h the traditional market bustles at full speed – and has done since it opened in 1703.

The Speicherstadt, or the warehouse district, is an icon of Hamburg and one of the city’s biggest attractions. The warehouses are built on oak timber piles and the area is intersected by canals that ships navigate during high tide.

Time for a strollThe Jungfernstieg station is the ideal place to go for a stroll and enjoy the water of Inner Alster Lake. Shopping enthusiasts will feel at home on the nearby high streets while those who love nightlife and novelties should head over to Hamburg’s Reeperbahn. The St. Pauli district is teeming with bars, pubs and drag queen shows, but you really ought to see for yourself what the neighbourhood has to offer.The NephroCare dialysis centre in Hamburg-Barmbek is centrally located near the idyllic Hamburg city park. The centre is easy to get to and just a short ride away from the airport, which, by the way, connects directly to Ham-burg’s Central Station by S-Bahn.

On holiday in Germany – it’s possible with NephroCare.In Germany there are 39 NephroCare medical care centres at 19 locations that provide out-patient care to more than 10,000 patients. All centres focus on nephrology and dialysis. Planning a stay in Germany? Then take advantage of our network of centres. We’re there for you when and where you need us! To reserve a dialysis spot for your holiday, simply ring up a centre, contact us by email or ask your healthcare team for help. Our highly qualified staff would be delighted to offer their care and expertise during your stay in the area.

Leave daily life behind and spend time discov-ering exciting new surroundings. Enjoy your holiday with the support and care of NephroCare. We look forward to meeting you! For contact details of all NephroCare dialysis centres in Germany,

please visit www.nephrocare.com

BerlinContact: Mrs. Angela Hilse Tel:+ 49 30 9238617Email: [email protected]

MunichContact: Mr. Helmut KleinwächterTel:+ 49 89 530701-32 or -35Email: [email protected]

Lahr & EttenheimContact: Mrs. Claudia KilgusTel:+ 49 7821 9166-219Email: [email protected]

Ludwigshafen & Böhl-Iggelheim & SpeyerContact: Mr. Detlev HennekenTel:+ 49 621 529700-0Email: [email protected]

Hamburg-BarmbekContact: Mr. Grazia ReutemannTel:+ 49 40 61860-10Email:pflegedienstleitung@dialyse-hamburg-barmbek.dewww.nephrocare-hamburg-barmbek.de


Bremen

Berlin

Schleswig-Holstein

Sachsen-Anhalt

Brandenburg

Sachsen

Mecklenburg-Vorpommern

Nordrhein-Westfalen

Thüringen

Bayern

Baden-Würtemberg

Rheinland-Pfalz

Hessen

Saarland

Niedersachsen

Hamburg

Hamburg

Berlin

Gelsenkirchen

Hagen

Grevenbroich Betzdorf

WetzlarDaun

Ludwigshafen

Mannheim

Bensheim

Pirmasens

Lahr

Kaufering

München

Ingolstadt

Berchtesgaden

NephroCare dialysis centres in Germany

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From career man to hobby farmer


Legal professional, husband, father, farmer, writer: Romanian Neculai Grigoraș has assumed many roles over his 61 years. The highly-motivated man did not let the diagnosis of chronic kidney disease at age 40 stop him from pursuing what he wanted in life. Now retired, Grigoraș splits his time between his childhood home in the peaceful Romanian countryside in Bacău County and his urban apartment in the nearby city of Oneşti. Though he performs his dialysis exchanges at home, he receives regular care from the NephroCare centre in Bacau.

Family and careerAlready at a young age, Grigoraș learned to overcome hardships: he lost his mother when he was just seven. Thereafter, his father stepped in and cared for his upbringing. After secondary school, Grigoraș decided to pursue a career as an electrician and upon gradua-tion he began working in the synthetic rubber plant in Onești, a small city with just under 40,000 inhabitants in north-central Romania.

Realising his initial career choice did not give him the fulfilment he sought, Grigoraș went back to school part-time to study law. All together he remained a loyal employee of the

synthetic rubber plant for 35 years from 1971 to 2006. Always interested in trying new things, Grigoraș also had a brief stint as man-ager of a private company in 2006 and served as a trade union leader and on the city council.

Accepting his diagnosisDiagnosed with chronic kidney disease in 1993, Grigoraș began dialysis in 2007. Initially learning he had to start dialysis came as a shock. But he quickly adjusted to his new routine. Support from family and friends and his overall positive attitude have played vital roles in accepting dialysis as just another part of his life.

Choosing PDGrigoraș chose to follow peritoneal dialysis (PD) as his form of treatment. Primarily be-cause it offers him greater freedom to move about, and his nephrologist emphasised that the advantages for the cardio vascular system could benefit him. There is no question that his life has changed since starting PD and the treatment gave him the nudge he needed to rethink his lifestyle. Five exchanges per day led him to choose retirement, a decision that allowed him to finally return to the countryside home of his youth.

Since returning to the country, Grigoraș has realised that a well-established exchange schedule is vital to taking care of his health and to managing his full schedule of daily activities. He also emphasises how much he values the care he receives from the team of NephroCare, which regularly runs tests for him and rings him up for a monthly check-up.

A life worth savouringToday, Grigoraș devotes the bulk of his time to gardening, farming and winemaking. With its vegetable garden, orchard and vineyard, his countryside home offers the perfect setting for him to pursue his favourite pastimes.

Regularly meeting friends for a game of chess or going to parties give him the social inter-action he needs to thrive and enjoy life’s simple pleasures. An avid writer, he’s also working on a memoir of his experiences.Grigoraș admits that he struggles with not

being able to enjoy unlimited amounts of the fruits and vegetables he grows in his own soil and picks with his own hands. But he’s also come to terms with his situation and has learned to find joy in other activities. Espe-cially his 15-month-old grandson is a source of constant energy and hope.

How one Romanian man restarted his life after beginning peritoneal dialysis.

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A life-changing new treatment


Eda Saraç first suffered from nephritis when she was just one year old. The condition, which can result from infection, toxins or, most commonly, autoimmune disease, causes inflammation of the kidneys and can lead to decreased kidney function. Despite aggres-sive treatment, Eda began dialysis when she was only seven. Unfortunately, a donor kidney from her parents was not an option: her kind of nephritis would likely reoccur with a rela-tive’s kidney. After two years of haemodialysis, Eda was lucky to receive a kidney from a de-ceased donor. But the same disease attacked her new kidney and she had to go back on dialysis. This came as a shock for her, but

thanks to home dialysis she has regained control of her life and the new therapy gives her the drive to pursue her education.

Before switching to home dialysis Eda was frustrated about missing school two days a week to get treatment. Moreover, she was experiencing symptoms that made it hard for her to concentrate in school. She often couldn’t quickly recall the answers to her teacher’s questions, although she knew them. For most teenagers, having an active social life is a big part of growing, developing and becoming an adult, and Eda was no excep-tion. However, regular dialysis limited the time she could spend with her friends.

Last year, Filiz Çalışır, head nurse at Eda’s dialysis centre, told Eda and her parents about a new treatment method: gradual but longer dialysis, which could also be performed at home. It could help eliminate some of her symptoms so she could attend school and be more successful. Her mother was hesitant at first but Eda insisted on trying. At 13 her big-gest wish was to feel better and be academi-cally successful so she could become an emergency medical technician who helps patients.

So Eda and her mother began practicing per-forming dialysis at the centre. Everybody was surprised about how skilfully Eda inserted the needles into her vein. After a while, Eda and her mother realised it wasn’t as hard as they’d thought, which also set a good example for other patients.

In addition to learning how to perform the actual dialysis, in-home treatment required the installation of a comprehensive dialysis machine and water system in Eda’s family home. In many respects, Eda is lucky to live in Turkey: her country supports patients who want to try home dialysis but this is not the case in all countries.

After a little practice, Eda got the hang of per-forming dialysis at home, and so was able to go to school every day. At the end of the school day, she now goes home for 7-8 hours of dialysis with her mother’s assistance. As Nurse Filiz explained, by cleaning her blood slowly over a long period the new treatment helps eliminate some of the side effects Eda had been experiencing. A diligent student, Eda takes advantage of the time on dialysis and uses it to study. And thanks to home di-alysis, Eda finally has her social life back and she is happy to see her friends regularly. Now she can spend more time with her parents, too.

One and a half years have passed since Eda first started performing haemodialysis at home. When asked how her life has changed she explained ‘During the first nine months, I put on weight: I was so thin before, now I feel physically and emotionally better’.

When asked about other changes, Eda added, ‘Now, I can follow what my teacher is saying and participate in class. I’m no different to the other children in the classroom. My grade in maths was really bad, but now I’ve improved a lot and am sure I’ll get even better grades soon.’

How transitioning to home dialysis gave 14-year-old Eda Saraç from Bolu, Turkey renewed energy for school and friends.

2928


My four kidneys and I


Farewell to my kidneysSince 1993 or 1994, I have known that one day I would have trouble with my kidneys. Back then my kidney disease arose from a very simple infection.

I first noticed something wasn’t right at work. During a rehearsal I wasn’t able to stay on my feet. My colleague took me home and we thought I just needed some rest. But that didn’t keep my wife from worrying. She insisted on seeking out a doctor who per-formed an ultrasound before diagnosing poly-cystic kidney disease. I didn’t even know what it was! My doctor referred me to a nephrolo-gist where I learned it’s a chromosome disor-der. The protocol: Yearly check-ups to moni-tor the disease’s progression, which later turned into check-ups every six months.

At first my nephrologist reassured me I prob-ably wouldn’t need treatment until I was 50 or 60. But life is unpredictable and in fact I needed care earlier. Constant fatigue was bringing me down. In hindsight I know it was due to my kidneys’ inability to filter my blood properly.

In 2003, I was put on the waiting list to get a donor kidney and was told that in the mean-time I needed dialysis. I also learned that the average waiting time for a donor with my blood type, 0, was longer than others. I wasn’t worried about the operation. I knew what to expect because my nephrologist had discussed the details with me, and I decided to not stress about something beyond my control. I also reminded myself that an alert that a kidney is available does not guarantee a transplant will take place. Multiple elements must align for the nephrologist to go through with the operation.

The first alert and surgery Nevertheless, my wife prepared a hospital bag for me that I kept in my wardrobe. That way I was ready to go if I received an alert. And it actually happened, before I even start-ed dialysis. ‘Good morning, András Both’, the

coordinator said on the phone, ‘you have an alert now.’ Again life was unpredictable! I had one hour to get to the clinic. That’s when I started to panic. Suddenly, my mind was working at lightning speed. Who should I talk to? What did I need to organise? I had to get there fast, but I didn’t know if I’d get the kidney! When there is an alert several patients are called in and a series of tests are required. At the hospital they took blood samples to find the most suitable recipient and after around one hour, I learned that the kidney was mine.

I don’t really remember the operation. I just know it hurt all over after I woke up. Back then it was an older surgical technique and a different kind of anaesthesia. Together with the doctors and nurses, we checked if the kidney had started working: it had! Now I had to wait for another three or fours days to make sure my body accepted my new kidney. When the moment arrived, I packed my bags and went home. After the operationThree months later, things took a turn for the worse. My nephrologist performed an array of

tests and I received a stent, a tubular metal mesh to widen a narrow artery, in a blood vessel near the kidney. Eventually my donor kidney failed, but I still have the kidney in my body!

Everyone in Hungary knows András Both or at least his voice. He is the “voice” of the largest private TV channel in Hungary and a great actor. But many people may not realise he’s also the ambassador of the Hungarian National Kidney Programme. After first undergoing dialysis and later two transplantations, András Both took the time to share his experiences with us.

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Connected to the machine My first visit to the dialysis centre wasn’t for treatment. I was there for a check-up and had a look around out of curiosity. I wanted to get out of there as quickly as possible. ‘Me, here?’, I thought, ‘They can’t be serious!’ But I knew that dialysis awaited me – and that it would keep me alive. While on dialysis, I tried to focus on living my life and doing the things I enjoyed. At the weekend, I had more free-dom, though I had to take my medication, eat smartly and monitor my liquids.

In for surgery againThe call for my second donor kidney also came unexpectedly. But this time I knew what to expect. I realised how important it was to

have a good relationship with my doctor. He understood what I wanted and I followed his orders to get it, which made his job easier. Of course, a little luck played a role. For surgery, you have to be healthy – free of a cold, flu or other viruses. I was lucky not to be ill when I received the second alert.

The surgery was easier the second time, part-ly because of advances in drugs and surgical techniques, and I found the intervention to be much smoother. Knowing what to expect made the psychological aspect easier, too. It’s been almost three years since the surgery and I go in for a check-up every six months. Family life – honesty rulesMany people have asked how my family dealt with my personal journey. I am a big advocate of honesty, so I spoke openly with everyone – including my kids – from the beginning. Occasionally they visited me during dialysis, which gave them a glimpse into this part of my life. When I learned my donor kidney was not working, we didn’t let the situation ruin our lives. We still went on trips and travelled even if doing so required better planning.

Does a person who is transplanted live healthier?Since the transplant, I’ve become more health-conscious. My immune system is weaker because of the anti-rejection drugs so I have to take care of myself.

I take my prescriptions and talk to my doctor about everything. When I travel, I double-check I have the right quantities of all my medica-tions as well. Other than this aspect, I live the same life as everyone else. Just with a little more care and a little more consciousness.


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NephroCare people

Saransk


A day in the life of …Dr. Michael Kokinov, nephrologist, anaesthesiologist and intensive care doctor at the NephroCare Saransk Dialysis Centre.

The Republic of Mordovia, a small Russian state, is located at the heart of the vast coun-try’s European half. In the capital city of Saransk is the NephroCare Saransk Dialysis Centre that first opened its doors in Novem-ber 2009. This is where Dr. Michael Kokinov and his colleagues currently provide top qual-ity care for 140 patients with chronic kidney disease.

A natural career path Some might say becoming a doctor was in his genes. Dr. Kokinov always knew he want-ed to follow in the footsteps of his grandpar-ents, who he respected greatly, by studying medicine. They inspired him to care for and help people in critical situations. ‘After finish-ing school I had no doubt about my career choice’, Kokinov said. He first studied to become an intensive care physician and anaesthesiologist because it allowed him to fulfil his wish to specialise in something requiring both excellent knowledge and prac-tical skills. Later, however, Kokinov went back to school at the University in St. Petersburg to pursue his true passion: nephrology. There from the start When it first opened its doors in 2009, the team at Saransk Dialysis Centre, located approximately 630 kilometres east of Mos-cow, treated just 50 patients with chronic kidney disease. Since then the centre has grown nearly threefold and today treats 140 patients. Both the patients and the centre benefit from a strong team that loves their work. Kokinov is ‘seriously proud of’ how the employees at the centre have grown together to form a cohesive team.

Four doctors, 15 nurses, 11 ward maids, a clinical nurse manager, a secretary, an engi-neer and a technician keep the NephroCare Saransk Dialysis Centre up and running on a day-to-day basis.

Early to rise As the saying goes, the early bird catches the worm. And Dr. Kokinov has long lived by this mantra. On a typical day the 42-year old wakes up before the sun at 5 a.m. to swim laps at the local swimming pool before going

to work. ‘This loads me up with energy and helps me stay awake the whole day,’ Kokinov says. After arriving at the centre, he discuss-es current issues with other doctors and the technical staff. This helps ensure patients always receive the best-possible level of care.

Then Kokinov starts his favourite part of the day: making rounds to see his patients. The nephrologist is not shy to admit that their wellbeing and care are his top priority. Only after checking his patients Dr. Kokinov finds

Passionate about his patients

3534


time for his other duties, which range from controlling prescriptions and checking cor-respondence to meeting heads of regional public health services. Quality care is key ‘The quality standards adopted in our com-pany are very high,’ Kokinov said. ‘Only by following these standards can we provide our patients with comprehensive treatment.’ He and his team know that successful treatment requires detailed coordination between doc-tors and nurses. So the staff participates in frequent training sessions, theory and

practical l essons, corporate online extension courses. According to Kokinov, speaking with patients in person, learning about their interests and worries, creating a favourable emotional climate, and providing psycholog-ical support also play essential roles in pro-viding quality care for the numerous patients at their centre. Their approach appears to be a success!

Empowering his patients Caring properly for the 140 patients at Saransk Dialysis Centre is only one part of successful treatment, emphasises Kokinov.

NephroCare people

Patient education about how to live – and enjoy life – with chronic kidney disease is the other essential part. ‘Patients coming for treatment have different levels of medical knowledge. Often they know nothing at all,’ he said. Many are confused when they enter the dialysis centre for the first time and it’s his role to act as a missionary.

Kokinov believes in a hands-on approach to learning. He shows patients the right way to do things, provides the necessary knowledge on the choice of treatment, explains how to follow therapy, gives recommendations on diet and hygiene, and shares travel opportu-nities and ways to stay active. ‘With this knowledge the patients are no longer help-less. They become partners with the doctor and nurses in caring for their own health, a task requiring continuity,’ Kokinov says.

Part of the centre’s programme to educate and empower patients includes inviting them to regular seminars covering various dialysis-related topics. Dialysis patients in Mordovia are especially lucky. They have founded a regional support group to promote their inter-ests and recently organised a meeting with the Ministry of Health at the centre. ‘Our

patients had an opportunity to inform the minister and his assistants in person about their problems and get answers to their ques-tions,’ said Kokinov. The meeting was a huge success: all decisions including those con-cerning preferential provision medicines were immediately taken on-site. ‘I think this experi-ence could be used by other regions.’

Finding time to relax Recently, friends of Dr. Kokinov opened a rock café on the outskirts of Saransk. He has become a regular on Friday nights when they play blues and rock music. It’s a moment during his busy week when he can let go. A long-time FC Mordovia fan, he and his son, Yura, enjoy going to the stadium to support their team whenever there are home match-es. ‘Everyone should come to Saransk for the FIFA World Cup 2018! Our city is very beautiful.’ When he finds time, the nephrolo-gist also enjoys fishing. ‘But I only fish in the summer with a fishing rod’. For him, though, fishing is about the process, not the results. ‘It doesn’t matter whether I bring a fish home or not. The energy the day has given me is what counts,’ he said. Words of a wise man with a big caring heart.

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Back to the roots


redesigned the system to prevent inflamma-tion. Most excitingly, the technique was suc-cessfully used by more than 75 patients.

Maxwell’s work resulted in a number of advances in PD. The most well known are the introduction of commercially available PD solutions, eliminating the need to prepare large amounts of cleansing fluid, and a new kind of catheter with fewer complications due to infection.

First automatic PD machineAfter Maxwell’s radical findings, the medical field began considering PD an alternative treatment for people with chronic kidney disease. However, further development was

necessary before PD could be widely used. One noteworthy example comes from a team at the University of Washington, USA who developed the first-ever automatic peritoneal dialysis machine. While the machine reduced contamination and decreased the time a nurse needed to be present, the process still had room for improvement.

The Tenckhoff catheter debuts1968 introduced an exciting breakthrough in peritoneal dialysis: Henry Tenckhoff devel-oped the Tenckhoff catheter. The catheter’s design and carefully-selected materials helped significantly reduce the risk of perito-nitis, which is inflammation of the inner abdominal wall. In search of human subjects,

Looking back on nearly a century of research and progress.

The origins and rise of peritoneal dialysis

In this issue of NephroCare for me, our Big Inventor series looks at milestones in perito-neal dialysis, commonly known as PD. In con-trast to haemodialysis, which relies on an ex-ternal dialyser to clean a person’s blood, PD uses the lining of the abdomen, the perito-neum, to filter waste. Though in the early years PD was slow to advance, the treatment eventually proved itself as an alternative to haemodialysis. From the beginning, many patients found appeal in PD’s independence from the dialysis machine.

Early research in unexplored territoryIn the early 20th century haemodialysis was developing but continued to be a compli-cated process. A German physician was looking for alternative treatments for patients with chronic kidney disease. He began ex-perimenting with peritoneal dialysis. At the same time at Johns Hopkins Hospital in the United States, it was discovered that the peritoneum could be used as a filter.

But despite these small initiatives, interest and research in peritoneal dialysis was mini-mal in the following two decades. One major reason for this: The materials and solutions used to perform peritoneal dialysis were still

in the early stages. Complications, especial-ly with the required catheter, were common-place. Small scale research continued in the decades to come, but advances in peritoneal dialysis were modest at best and for the patients it was not a common treatment option.

Surprising facts about PD

• The first ever lavage using the peritoneum was performed with a solution of Bristol water and red wine.

• The peritoneal cavity will receive 3,000 litres of fluids during a year to ultrafiltrate 300 litres of toxins.

• The Tenckhoff catheter is still exten- sively used today in an adapted version.

Maxwell offers a turning pointOver 25 years after PD’s first findings, a man named Morton Maxwell published his land-mark work on peritoneal dialysis. In it, he

Tenckhoff Catheter

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Back to the roots

Tenckhoff experimented with the catheter on himself to see if it helped prevent the spread of bacteria in humans. His conclusion: it did.But in spite of this development, in the late ‘60s and early ‘70s, less than 3% of dialysis patients used PD. The big turning point was yet to come.

A wearable revolution with CAPD PD finally got a boost in 1975 that changed it from a potential treatment for chronic kidney disease to an actual treatment. A patient in Texas, USA who lacked access to haemodi-alysis and refused to travel to another city for PD made it necessary for doctors to think dif-ferently about the treatment. Doing so led two physicians at the University of Texas to de-velop a technique featuring a portable and wearable peritoneal dialysis system. They later named it continuous ambulatory perito-neal dialysis (CAPD).

Breakthroughs in reducing infectionThough trials with patients were successful, CAPD continued to carry a risk of infection. Reducing this risk became a primary goal in the years to follow. A Canadian physician de-veloped a modified CAPD technique using plastic bags that could be disconnected at

the end of the dwell. This development proved to reduce the chances of infection and re-sulted in the first-ever connected PD system.

A few years later in 1980, two additional in-novations in CAPD helped further reduce the risk of infection: a bacteria filter and the new ‘Y-set’ connecting system. It was particularly appealing to patients because they no longer had to wear bags during CAPD.

Peritoneal dialysis todayToday patients who undergo PD treatment can choose from two methods: CAPD and APD, which stands for Automated Peritoneal Dialysis. The main difference from CAPD is that APD uses an automated cycler to per-form peritoneal dialysis at night. The ease and convenience of APD won the attention of

patients and physicians alike and was quickly adopted. You can learn more about modern-day peritoneal dialysis on pages 10-13.

References: 100 years of Fresenius, Dialysis History, Development and Promise – Todd S. Ing, Mohamed A. Rahman, Carl M. Kjellstrand

Peritocomb Fresenius PD machine

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Monitoring your liquids and salts

Here’s to your health


Because a dialysis patient’s body retains flu-ids, it’s important for you to keep a close eye on your liquid intake. Drinking too much or consuming large amounts of liquid-based foods can cause health problems ranging from hypertension and heart problems to dif-ficulty breathing.

Liquids: how much is good for you?First and foremost, discuss with your doctor how much liquid per day is right for you. The general rule of thumb is 0.5 litres plus the amount of urine you produce in a 24-hour period. Bear in mind that this includes both drinks – water, coffee, tea – and liquid-based foods such as drinking yoghurt, ice cream or soup. Liquids from other food still have to be added on top.

Reducing your liquids, lowering your thirstThere’s no question that drinking very low quantities can be a daily challenge. How -ever, there is a range of easy ways you can proactively limit your liquid intake and lower your thirst. Try keeping your daily liquid allowance in a water bottle. This way you always know how much you’ve consumed. You can also trick your mind by drinking from a smaller glass. If your mouth feels dry, rinse

your mouth or gargle with lukewarm water – or refresh your mouth by sucking on a half-slice of lemon up to four times a day. Chewing sugar-free gum can also stimulate saliva production, leaving your mouth feeling moister. A great trick for sweltering hot days is to make ice cubes with drops of lemon or other sour fruit, and suck on them.

Now take a moment to think about what your biggest challenges are. Do you easily loose track of how much liquid you’ve consumed each day? Try the trick with the water bot-tle. Often longing for a refreshing feeling in your mouth? Suck on half a slice of lemon.

As a dialysis patient, following special nutritional routines will help you feel good. This is especially true when it comes to your liquid and salt intake. Here are some tips on how to keep your thirst at bay and enjoy flavourful meals with less salt. For a healthier you!

Say no to saltFor people on dialysis, salt is not your friend. It can accumulate in your body and binds to water. So salt will make you thirsty and can lead to high blood pressure. And don’t let salt substitutes fool you: they are usually high in potassium which can also be harmful to your health.

Saltless ways to savourIt’s a myth that food needs salt to taste good. In fact, some parts of the world pro-duce delicious cuisine barely using salt at all. So how is it possible to cook tasty meals without salt? The secret is to generously use herbs and spices. Instead of reaching for the salt cellar, add basil, parsley or chives as well

as other foods that boost your dish’s flavour profile, like celery or a dash of vinegar. Also avoid processed foods: they typically contain more salt than you should consume.

Remember, your body will really thank you for it both in the short and the long run.

Did you know…?

The difficulty with salt is twofold: It makes you thirsty and causes water to accumulate in your body.

Herbs and spices are great alterna-tives: Instead of relying on salt for flavour, try fresh herbs like basil, mint, dill, or chives or milder spices such as cinnamon or sweet paprika.

Avoid salt substitutes: Salt substi-tutes often contain high levels of potas-sium, which is not good for your body.

Beware of processed foods: They usually contain higher levels of salt than what you should consume.

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Meals in the summer are a true delight. The bounty of fresh seasonal produce and pleasant temperatures make it easy to eat well and live well. Whether you choose to kick up the grill, enjoy a picnic in a park or simply eat al fresco, here are some best-habit recipes to enrich summertime dining.

Tastes of summertime



Colourful iceberg salad with cress dressing(serves 4)

1 small iceberg lettuce100 g carrots100 g corn kernels (canned)2 spring onions100 g cocktail tomatoes2 tbsp lemon juice1 tbsp balsamic vinegar, white2 tbsp pumpkin seed oil2 tbsp rapeseed oil1 tbsp mustarda little saltpepper2 tsp sugar1 bunch of cress

PreparationWash the lettuce, cut into quarters, remove the hard stalk and cut the quarters into strips. Wash carrots, peel and cut or slice into fine strips and soak them for at least two hours. Drain corn kernels. Wash spring onions, cut the white and the bright green parts into fine rings. Wash and halve cocktail tomatoes. Place everything into a salad bowl.

Froth up the lemon juice, balsamic vinegar, the oils and the mustard well with each other. Add seasoning. Cut the cress and mix 2/3 with the dressing. Spread the dressing over the salad and sprinkle the rest of the cress on top.

Sesame flax rolls with wild garlic butter

Sesame flax rolls (makes about 20 pieces) 21 g fresh yeast (½ cube)½ tbsp honey400 g water2 tbsp rapeseed oil, cold pressed500 g spelt flourbread seasoningsea salt30 ml single cream1 tbsp each of sesame and flax seeds

Crush fresh yeast with honey, stir in lukewarm water, rapeseed oil, spelt flour, bread season-ing and sea salt and knead for 10 minutes. The dough should have a slightly sticky consistency. Let the dough rise to twice its volume. Then knead one more time, form small rolls, brush with cream and sprinkle with sesame and flax seeds. Allow the rolls to rise once more and then bake for 25-30 min, at 200° C top and bottom heat.

Wild garlic butter

100 g butter20 g wild garlic (alternative: garlic or freshly chopped herbs)1 tbsp lemon juicesalt, pepper

Stir butter until very fluffy. Remove thicker stems from the wild garlic and chop very finely. Mix the butter, lemon juice and the season-ing with a hand mixer or a fork. Add the wild garlic whilst stirring. Now either fill the wild garlic butter into a small plastic container or form into a roll and wrap in tinfoil. Covered, the spread can be kept refrigerated for several days.

Tip: Not only does wild garlic butter taste great with bread, but it also goes well with grilled meat or as a sauce with potatoes or pasta.

Nutritional value per unit:Energy ProteinFatCarbohydratePotassiumPhosphorLiquid

234 kcal24 g17 g17 g

151 mg98 mg30 ml


147 kcal2 g

11 g11 g

339 mg50 mg140 ml

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Grilled pineapple with coconut cream (serves 4)

Ingredients: ½ fresh pineapple 100 ml coconut milk 50 g sugar 1 cup of cream1 tbsp sugar 1 small tsp. lavender blossoms 1 tbsp grated coconut

Peel the pineapple and cut into rings. Remove the central core. Dip each slice in coconut milk and then into sugar. Whip the cream, add the sugar, lavender blossoms and grated coconut to the cream and gently stir. Chill the cream. Line the grill with foil and brush with a little soft butter. Place the pineapple slices onto the grill and grill until golden brown. Dish the pineapple rings onto plates with the coconut cream.

Fish parcels with vegetables and herb dip (serves 4)

Ingredients: 4 cod fillets (400 g)a little salt1 red pepper (150 g)1 courgette (150 g)1 cm grated ginger1 pinch of grated orange zest1 pinch garam masala (Indian seasoning mix; alternative: curry)a little oil for brushing

Wash the cod fillets, leave to drip dry and lightly salt. Wash and clean pepper and courgettes. Cut the pepper into cubes and the courgettes into slices. Mix the vegetables with the seasoning. Brush four squares of tinfoil with oil and divide the vegetables onto the foil. Lay the fish fillets onto the vegetables and close the parcels. Place on the grill and cook for approx. 20 minutes.

Herb dip:½ cup sour cream 125 g curd 75 ml cream2 tbsp. mixed herbs (finely chopped)1 clove of garlic (finely chopped) a little salt 1 knife tip of tomato or paprika paste

Place the sour cream, curd and cream into a bowl and mix until smooth. Add the chopped herbs and garlic into the curd mixture. Season with a little salt and tomato or paprika paste.


258 kcal29 g13 g

6 g714 mg344 mg225 ml


270 kcal2 g

19 g24 g

282 mg52 mg114 ml

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Worth living


Finding your green thumb

For the sensesTouch, smell, taste, and see: gardening stim-ulates nearly all of the senses. It’s a chance to literally get hands on and in touch with the earth, for example while preparing and plant-ing beds. In spring and summer, the smell of blossoms and herbs fills the air, tantalising re-ceptors in our noses. Some scents, such as lavender, even have soothing effects.

For those who grow edibles – fruits, vegeta-bles and herbs – gardening also pleases your taste buds. From elegant pink roses, to cheer-

ful sunflowers, to lush green grasses: the visual pleasure of a garden in full bloom is second to none. Choose your plants wisely and you can enjoy a beautiful garden through-out the sunnier months.

Floral delightPeonies, daisies, hydrangeas, hollyhocks – nature’s beauty truly shines through in its flower palette. Beginner gardeners are best paired with easy-to-grow flowers, ones that you essentially just plant, water, and occa-sionally fertilise. Avoid a common beginner’s mistake by respecting the amount of sunlight each flower requires when scouting out a suitable home.

Because of climate differences, there is no one-size-fits-all recommendation for which

flowers to plant in your garden. Your best bet: solicit the advice of the experts at your local nursery or garden centre. They should be able to advise you about which ones will flourish in your geographical location.

Savouring the harvestMany fruit-bearing plants are suitable for a home vegetable garden. Selecting ones that fit your special nutritional needs means you can enjoy the labour and its fruits. If you are a first-time gardener, courgettes are an excel-lent pick. They tend to grow easily – some-times abundantly – and are low in potassium.

Just make sure to harvest them before they get too large when they can become bitter and watery. Cucumbers and onions are other low potassium options that even gardening novices can master.

Honourable herbsHerbs are also a great low-maintenance addition to a bountiful garden. And what is more satisfying than chopping home-grown herbs to add flavour to your favourite summer-time dish? Try planting a medley of herbs, such as flat-leafed parsley, basil, rosemary, chives, dill and thyme, for a salt-free taste-boost all summer long. Harvesting them is easy: using your hand, simply break off the leaves or branches you need for the dish. Don’t pick more than you will consume immediately because herbs are most aromat-ic when freshly picked. The best part: bold tasting fresh herbs add full flavour without adding salt. L iberally seasoning with basil, parsley and co. can help you keep your liquids balanced.

Insider Tip – HerbsWant to enjoy your herbs all summer long? Don’t let them flower! By always removing the flowering tops when they first start to appear, you will encourage the plants to continue producing tasty leaves, and prevent them from tasting bitter.

A relaxing activity for the mind, body and soul, gardening is a great way to break from your normal routine. And it brings with it many rewards, even if you just keep potted plants on a small balcony or inside on your windowsill.

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Worth living

Natural savingsA bounty in your garden means less money spent at the market and the florist. Next time you get together with friends or relatives, pick a few flowers from your garden and assemble them into a simple yet elegant bouquet.

Growing your own fruit, vegetables and herbs can also be very wallet friendly. Especially if you regularly purchase cut fresh herbs from

the store, you can save a bundle by having your own home-grown supply. Getting startedFirst and foremost, you need a designated place for plants to grow. If you are lucky enough to have a plot of land to plant, great! Otherwise, you will need to purchase flower pots or boxes for your balcony or patio. The size and shape are up to you but when

selecting them bear in mind what will work best in your outdoor space.

Seeds or starter plants?Starter plants offer many advantages including flexibility: most seeds need to be planted by a certain time to blossom or bear fruit. Seeds and the seedlings that grow from them require time, patience and care over many weeks and months. With starter plants, you can enjoy their beauty and lushness straightaway. Re-member that ultimately the choice of seeds or starter plants is yours and there is no right or wrong answer.

Bond with other gardenersTaking up gardening is more than just a pastime to pursue at home. If you become passionate about gardening and would love to exchange hints and tips with others, join a garden club! Look online or in the newspaper

to find a local branch. Or ask your local garden centre if they know of any organised garden clubs in your area. Happy gardening!

Common gardening mistakes and how to avoid them

• Overwatering. Contrary to popular belief, most plants don’t require daily watering. Research how much water the plants in your garden need and follow the instructions.• Non-native species: You’ll have greater gardening success if you select plants indigenous to your area or climate zone. • Fertiliser fanatic: More is not always better when it comes to fertiliser. In fact, using too much can result in lush green leaves, but no flowers or fruit.• Bye-bye bugs: Not all little pests are, well, pests. Actually, many small critters help your garden grow and flourish by eating the small population of harmful bugs, and by assisting in pollination.

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MATCHSTICKSMove just one matchstick to make the equation right.

NUMBER QUIZCan you figure out what the mystery number is ?

Brain calisthenics

You can find the solutions on page 54.

Below are two nearly identical pictures. But wait. There are 8 differences between the pictures. Can you spot them?

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8 differences 1

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8 x 4 = 32Number Quiz

32 - 5 = 2727


Announcements

XXth birthday celebrations!On May 16th, Luise Murphy will celebrate a very special birthday indeed. It will be her 100th! We would like to take this opportunity to send her our congratulations for her birthday and to wish her all the best as a newly crowned centenarian!

Every day is a new day to be celebrated in many ways!On this note, here are some special announcements for the birthdays and anniversaries of friends and loved ones. If you have a special announcement you would like to make, please get in touch with us.

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News from around the wordBrand new dialysis centre opens in Salerno

NephroNumberFour decades of innovations in St. Wendel

Worth knowing in renalIn the know about peritoneal dialysis Kidney transplantation – is it the right choice for me? Diabetes: the sweet truth

Different countries – different habitsThe best of Germany A life-changing new treatment From career man to hobby farmer My four kidneys and I

NephroCare peoplePassionate about his patients

Back to the rootsThe origins and rise of peritoneal dialysis

Here’s to your healthMonitoring your liquids and salts Tastes of summertime

Worth livingFinding your green thumb

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Fresenius Medical Care Deutschland GmbH · 61346 Bad Homburg · Germany · Phone: +49 (0) 6172-609-0 · Fax: +49 (0) 6172-609-2191Head office: Else-Kröner-Straße 1 · 61352 Bad Homburg v. d. H.

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NephroCare · NephroCare for me Summer 2014 NephroNumber St. Wendel, with a population of just under 30,000, is a quaint town in Saarland’s north-east corner. A former stocking