You Can Live: 

Your Guide for Living 

with Kidney Failure 

This booklet gives tips on: 

• Treating kidney failure 

• Making treatments better 

• Living a healthier lifestyle 
Dear Reader, 

The Centers for Medicare & Medicaid Services (formerly the Health Care Financing 

Administration) is pleased to provide you with this booklet. As a health care payer, 

Medicare wants to make sure that you get good care and the information you need 

to make informed choices about the treatment of kidney failure. The information in 

this booklet was reviewed by doctors, nurses, and patients and is meant to assist new 

kidney failure patients as they began dialysis or prepared for transplantation. 

If you are a kidney patient, it is important for you to learn as much as you can 

about your illness. If you are a family member or caregiver, learning about kidney 

disease and its treatment will help both you and the person with kidney failure. If 

you have questions, don’t be afraid to ask your health care team for help. 

Your local End Stage Renal Disease (ESRD) Network Organization can help you if 

you have a problem. Their phone number is on page 39. ESRD Networks help 

patients needing information and with resolving complaints. ESRD Network 

Organizations also work on improving the quality of care in dialysis facilities and 

keep your facility aware of important dialysis and transplant issues. 

We hope this booklet will be helpful to you as you start dialysis or prepare for 

a transplant. 

Best Regards, 

Centers for Medicare & Medicaid Services 

questions. 

your Medicare 

to get help with 

(1800-633-4227) 

1-800-MEDICARE 

on the W

www

Look at 

eb or call 

.medicare.gov 
Table of Contents 

2 Living with Kidney Failure: 31 Tips for Living with 

You Are Not Alone Kidney Failure 

3 What You May Be Feeling 31 Following Your Diet and 

Fluid Intake Plan 

4 Paying for Treatment 33 Make an Exercise Plan 

or Transplant 34 Going Back to Work 

35 Plan Ahead for Travel 

5 Treating Kidney Failure 36 How to File a Complaint 5 When Kidneys Fail 

6 Your Treatment Options 36 Your ESRD Network 

6 Hemodialysis 36 Your State Survey Agency 

10 Hemodialysis Checklist 37 Your Rights 

11 Questions to Ask Your 38 Your Responsibilities 

Hemodialysis Center Staff 

12 Peritoneal Dialysis 39 Kidney Failure Resources 

15 Transplant 39 ESRD Networks 

17 The Choice to Stop Treatment 38 State Survey Agencies 

17 Advance Directives 44 Additional Kidney Failure 

Resources 

18 You and Your Health Care Team 

21 Tips for Making Treatment Better 

21 Changes in Mental Health


22 Physical Changes


22 Changes in Sexual Desire


23 Talk with Your Doctors


23 Take Your Medicine As Prescribed


24 Beware of Over-the-Counter


Medicine and Other Remedies 

25 Alternative Treatments 

26 Vaccinations 

26 Track Your Dialysis Treatment 

Progress 
Living with Kidney Failure: 

You Are Not Alone 

“Understanding 

kidney failure 

may lessen some 

of your fears and 

help you deal 

with the changes 

in your life.” 

When your kidneys stop working, your life changes. At first, you 

may ask yourself: “Why me?” You may have fears about dying 

or treatment. Because kidney failure is a serious condition that 

must be treated for the rest of your life, it can be hard to accept. 

Understanding more about kidney failure may lessen some of 

your fears and help you deal with the changes in your life. 

Learning about your treatment and how to take care of yourself 

puts you in charge. You can control things like following your 

treatment plan and diet and keeping a good outlook on life. Your 

health care team will help you manage your treatment. You can 

also look to your family and friends for support. Remember that 

you are not alone. Nearly 300,000 people live with kidney 

failure. There is hope and there are ways to rebuild your life. 

2

What You May Be Feeling 

Kidney failure means some changes in your life, but you can 

still do many of the things in life that you enjoy. Try to stay 

positive, and talk to someone who understands what you are 

going through, such as another person with kidney failure or 

a counselor. You can also set goals to: 

• Stay active 

• Do the things you did and enjoyed before kidney failure 

• Return to work, school, or volunteering 

• Pursue new interests 

• Live as best you can 

Learning to live with kidney failure can take time, so do not be 

discouraged. Talk with your loved ones about how you feel. 

Listen to what they have to say too. Some days you may feel like 

giving up or may be angry that your life is not the same as it 

was before. See your doctor or social worker right away if these 

feelings of sadness or anger do not go away, if you are using 

drugs or alcohol to cope, or if you have thoughts of taking your 

life. You do not have to deal with your feelings alone. Your loved 

ones, others with kidney failure, and your health care team can 

help. Dealing with your feelings will help you live a full life. 

“Kidney failure 

means some 

changes in your 

life, but you can 

still do many of 

the things in life 

that you enjoy.” 

3

Paying for Your Treatment 

or Transplant 

“Your social 

worker can help 

you understand 

how to pay for 

dialysis treatment 

or transplant.” 

4 

Your social worker can help you understand how to pay for 

dialysis treatment or transplant. Ask about private, state, or local 

programs that help pay for prescriptions or medications. Your 

social worker can also explain your health insurance coverage. In 

addition to Medicare, you may have coverage through: 

• Private Health Insurance 

• Veterans Benefits 

• State Medical Assistance (Medicaid) 

• State Kidney Programs 

• CHAMPUS (for active or retired from the military service) 

• Railroad Retirement Board 

For more information on Medicare, visit the Internet site, 

www.medicare.gov. You may also call 1-800-MEDICARE 

(1-800-633-4227) or TTY/TDD access at 1-877-486-2048. 

On the Internet or over the phone, you can get a copy of the 

booklet, “Medicare Coverage of Kidney Dialysis and Kidney 

Transplant Services.” 

You can also contact Medicare to find your local office for the 

State Health Insurance Assistance Program (SHIP), where you 

can get one-on-one counseling on Medicare, Medicaid, and 

Medigap health insurance coverage. SHIP counselors can explain 

your Medicare bills and your Medicare rights. They can tell you 

how to deal with payment denials or appeals, how to choose a 

Medicare health plan, or how to buy Medigap, a supplemental 

insurance policy. 
Treating Kidney Failure


“Kidney failure 

is also called 

End Stage 

Renal Disease 

or ESRD.” 

When Kidneys Fail 

Your kidneys are just below your rib cage in the middle of your 

back. They are twin organs shaped like kidney beans. Healthy 

kidneys work all day, everyday, to clean your blood and make 

urine that flows into your bladder. Kidneys make hormones that 

help control your blood pressure and help make red blood cells, 

which carry oxygen. They also help balance the level of many 

minerals and chemicals in your body. 

Kidney failure occurs when kidneys cannot clean your blood or rid 

your body of extra fluid. When this happens, you feel sick. When 

your kidneys slowly stop working over time or slow down so that 

wastes are not filtered out, it is called Chronic Renal Failure (CRF). 

Many diseases can cause CRF. Some of the most common causes 

are diabetes and hypertension. 

When kidneys stop working completely or when they cannot work 

well enough to keep you healthy without dialysis or a transplant, 

it is called End Stage Renal Disease (ESRD). When ESRD occurs, 

it must be treated for the rest of your life. You must have either 

dialysis or a kidney transplant to live. 

5

Your Treatment Options 

To treat kidney failure, you may go on dialysis or have a kidney 

transplant. Dialysis is a medical term that means to clean the 

blood by artificial means, like using an artificial kidney. There are 

two kinds of dialysis: hemodialysis and peritoneal dialysis. Each 

kind works well and can be done at your home or at a treatment 

center. A transplant is another treatment option that you should 

talk to your doctor about. With a transplant, you no longer need 

dialysis. A transplant is when you get a kidney from someone 

else, and the kidney is put into your body with surgery. 

You may need to change the kind of treatment you receive for 

medical or other reasons, such as a change in where you work or 

live. To determine what type of treatment is best for you, your 

health care team needs to consider: 

• Your type of kidney disease 

• How far you live from a treatment center 

• Your physical abilities 

• Your support system 

• Your lifestyle and emotional health 

Hemodialysis 

Hemodialysis uses a machine to clean your 

blood. The dialysis machine has a filter 

called a hemodialyzer or dialyzer. The 

dialyzer works like an artificial 

“Hemodialysis 

usually occurs 

three times a 

week for about 

four hours 

each time.” 

In-Center Hemodialysis 

kidney and removes the 

wastes and the extra 

fluid that builds up 

when your kidneys are 

not working. 

6

Hemodialysis cannot do all the work your 

kidneys did. Healthy kidneys work all day, 

everyday. Hemodialysis usually occurs three 

times a week for about four hours each time. 

Your kidney doctor orders the length of your 

treatment like a prescription to meet your 

body’s needs. 

During a hemodialysis treatment, your blood 

is carried through plastic tubes to the dialyzer 

to be cleaned. Once your blood is cleaned, it 

is returned from the dialyzer to your body 

through another plastic tube. Only about one 

cup of blood travels through the dialysis 

machine at a time. 

Hemodialysis 

Home 

Hemodialysis can be done at an outpatient treatment center or 

in your home. For home hemodialysis, you and a family member 

or caregiver will need to be trained on how to safely do each step 

of the treatment. Equipment and supplies are sent to you if you 

dialyze at home. Not all centers offer home hemodialysis. Ask 

your kidney doctor if this is an option for you. 

In a center, nurses and technicians with special training carry 

out the steps of your treatment. At the center, your dialyzer may 

or may not be re-used. Re-use is when the dialyzer is specially 

cleaned and tested after your treatment and kept for you to use 

at your next treatment. 

For hemodialysis, you need a way for blood to be safely removed 

and returned to your body. Vessels are not strong enough or big 

enough to carry blood to and from the dialysis machine. To do 

this you need surgery to create a pathway called an access. An 

access can be in your arm, leg, chest or neck. 

“For home 

hemodialysis, 

you and a family 

member or 

caregiver will 

need to be 

trained on how 

to safely do each 

step of the 

treatment.” 

7

There are three kinds of access, Fistula, Graft and Catheter. 

•Surgically connecting an artery and a vein to each other 

makes a fistula or arteriovenous fistula 

• Surgically connecting an artery and vein with special tubing 

makes a graft or arteriovenous graft 

• Inserting a soft, flexible tube called a catheter into a vein in 

the neck, chest, or groin to make a temporary access 

You can get adequate hemodialysis with any kind of access. 

Although medical studies show that a fistula gives the best results 

for hemodialysis, it may not be the right access for everyone. 

Fistula Access Cross-Section 

For each hemodialysis treatment, two needles are put into your 

access. Each needle is connected to a plastic tube. One line takes 

the blood with wastes out of your body. The other tube carries 

the clean blood back into your body. 

The dialysis machine measures how quickly your blood moves 

through the tubing and how much water is being removed. Some 

machines measure your blood pressure too. In a center, the nurse 

and technician monitor your vital signs, the amount of fluid 

removed and machine settings during your treatment. 

8

Care of your Hemodialysis Access 

An access that works well will help keep you healthy. Members 

of your hemodialysis team will teach you how to take care of 

your access. When you wake every morning, check for a strong 

pulse and a buzzing or rushing feeling in your access. This is 

called a thrill and is a sign of good blood flow. Also check your 

access for early signs of infection. Signs can be redness, swelling, 

or feeling warm to the touch. If you see signs of infection, 

cannot feel your thrill, or have other problems with your access, 

call your kidney doctor and treatment center right away. 

You can help keep your access working well. Keep your access 

clean and dry between treatments. Do not let anyone take your 

blood pressure, draw your blood, or put an IV into the arm or 

leg that has your access. Do not wear jewelry or tight clothes on, 

over, or above your access. If your access is in your arm, do not 

carry a bag or purse on that arm. Also avoid sleeping on the arm 

or leg where your access is. Try not to bump your access, and 

never cut it. Remember that your access is your lifeline. 

“Every morning, 

check for a strong 

pulse and a 

buzzing feeling 

in your access.” 

9

Hemodialysis Checklist 

Before every hemodialysis treatment, you should: 

■ Wash your hands before going to your chair. 

■	 If you have fistula or graft access, clean your access before going to your chair. 

If you have a catheter, keep the dressing clean and dry. Be sure a member of 

your health care team cleans and changes the dressing at each treatment. 

■ Tell the nurse or doctor if you have concerns about how you are feeling. 

■ Report any nausea, pain, vomiting, diarrhea, or constipation you have to 

your nurse. 

■ Check that your dialyzer has your name on it if your center re-uses dialyzers. 

For every hemodialysis treatment, your nurse or technician should: 

■ Wash his or her hands and put on new gloves before putting in your needles. 

■ Ask how you have been feeling and eating. 

■ Check your access for good blood flow and early signs of infection. 

■ Program your machine to your kidney doctor’s hemodialysis orders. 

■ Check for any cleaning fluid in the dialyzer. 

■	 Take your weight, temperature, heart rate, and blood pressure. They should write 

them down on your treatment sheet or put them into a computer. 

■	 Check your machine’s alarms, which includes the temperature and conductivity. 

They should write the numbers down on your treatment sheet or put them into 

a computer. 

■	 Check that the right size needles and correct heparin dose are set up for your 

treatment. (Heparin is a drug that keeps blood from clotting.) 

■ Check for the correct potassium concentration. 

■ Listen to the front and back of your chest with a stethoscope. 

■ Check your legs and feet for swelling. 

■ Write your treatment results on your treatment sheet or put them into a computer. 

10

Questions to Ask your Hemodialysis Center Staff 

■ Does my treatment time affect when I should take my prescribed medicines? 

■ How should I plan what I eat around my treatment time? 

■ Do I have to get my treatment at the center that my doctor recommends? 

■ Does the center set times for treatment, or is it first come, first serve? 

■ Can I ask for a treatment time that works best for me? 

■ Are there staff who speak the same language as I do? 

■ Who reviews my monthly lab work with me? 

■ If the center re-uses dialyzers, how will I know the dialyzer is mine? 

■ How often does the doctor see people during treatment? 

■ What kind of patient education does the center offer? 

■ Does the center teach home dialysis? 

■ What are the times that the social worker or dietitian can see patients? 

■ Does the center have an exercise program or a place and equipment for exercise? 

■ What are the center’s hours during a holiday? 

■	 What things will I be billed for that are not covered by Medicare or 

my insurance? 

■ What are my transportation options for getting to and from the dialysis center? 

■ Can I have visitors during treatment? 

■ Will I have my own TV? Are there headphones to keep out noise? 

■	 If I go on a trip or have to go to the hospital, will the center hold my treatment 

time for me? For how long? 

■	 When was the last health and safety inspection or survey of the center? 

Were there any problems, and have they been fixed? 

11

“Your kidney 

doctor will 

tell you how 

many exchanges 

you should do 

each day.” 

Peritoneal Dialysis 

Peritoneal dialysis (PD) uses the space in your belly called the 

peritoneal cavity to clean your blood. PD does not use a dialyzer. 

This space is lined with a membrane called the peritoneum. It 

surrounds and protects your intestines, bowel, and other organs. 

The membrane has many tiny holes that can be used to filter 

waste out of your blood while keeping blood cells and proteins. 

PD usually works all day, everyday. To have PD, you must have 

an access, which is a soft, flexible tube called a catheter surgically 

placed in your belly. The bottom part of the tube is put into the 

peritoneal cavity. The middle part of the tube runs under your 

skin. The top part stays outside of your body and can be taped 

against your skin. 

A liquid called dialysate travels through the catheter and fills the 

empty space in your belly. This liquid stays in the space while 

waste products and extra fluid move from your blood through 

the membrane into the dialysate. The dialysate with the waste 

products and extra fluid is then drained out of your body. Next 

the space in your belly is refilled with the clean dialysate, and the 

cleaning process begins again. The process is called an exchange. 

Your kidney doctor will tell you how many exchanges you should 

do each day and how long the dialysate should stay in your belly 

for it to work. 

There are two kinds of PD: Continuous Ambulatory Peritoneal 

Dialysis (CAPD) or Continuous Cycling Peritoneal Dialysis 

(CCPD), sometimes called Automated Peritoneal Dialysis 

(APD). You and your kidney doctor can talk about what kind of 

PD can work for you. 

12

To determine what type of PD treatment is best for you, your 

“Do not skip 

exchanges or 

shorten your 

treatment.” 

Continuous Cycling 

Peritoneal Dialysis (CCPD) 

kidney doctor needs to consider: 

• Your body size 

• Your lifestyle 

• Your lab test results 

• Your ability to do the steps in dialysis 

CCPD is done at home with a machine called a cycler. The 

cycler connects to your access and works at night while you 

sleep. For eight to ten hours each night the machine fills your 

belly with clean dialysate and then it drains the used dialysate 

from your belly. In the morning, clean dialysate is put in your 

belly after you are unhooked from the cycler. You may do one or 

two more exchanges by hand during the day. 

CAPD should be done in a place that is clean and well lit. Try to 

pick a place that is free from drafts or pets and where you can close 

the door. Before you start an exchange, be sure to wash your 

hands. A CAPD exchange lasts about 30 minutes and is done 

about every four to six hours during the day. Most people begin 

their exchanges in the morning and end their day with one before 

bedtime. Some people who do CAPD can also do an exchange 

during the night. 

These are the steps in an exchange: 

1)	 A closed bag of dialysate is 

attached to your access with 

plastic tubing. 

2)	 The closed bag is hung 

above your head on a 

hook or pole. 

3) 	A second bag sits on 

the floor. 

13

4) The used dialysate from inside your belly flows into the bag 

on the floor. 

When the bag on the floor is full, the tubing to this bag is 

clamped closed. 

The tubing to the bag above your head is then opened. 

The clean dialysate flows from the bag above your head 

into your belly. 

8) When your belly is filled, you disconnect the bag 

tubing from your access tube and empty the used 

dialysate from the bag on the floor into the toilet. 

9) The clean fluid stays in your belly for about four 

to six hours. During this time, you can go about 

your normal routine. 

How you feel is not a good way to tell if you are 

getting enough dialysis to stay healthy. Do not skip 

CAPD exchanges or shorten your CCPD treatment. 

Doing so could be harmful to your health. 

Care of your Access with Peritoneal Dialysis 

Keeping your access (the PD catheter) clean is the key to 

preventing infection and staying healthy. If germs get into your 

belly, they can cause an infection called peritonitis. Peritonitis 

will make you sick with stomach pain, a fever, or cloudy fluid 

from your exchange. You will need to take antibiotics to treat 

the infection. 

Any time you have peritonitis; your peritoneal membrane can 

become scarred. Scars can make it hard for the membrane to 

filter waste products from your blood. If your membrane has too 

many scars to work well, you may have to change to another kind 

of treatment. 

14 

“Keeping your 

access clean is the 

key to preventing 

infection and 

staying healthy.” 

Continuous Ambulatory 

Peritoneal Dialysis (CAPD) 
To help stay healthy, keep your access clean and dry and keep 

the tube taped to your body. To help with this, taking a shower 

is better than taking a bath. A bath exposes your access to germs 

that have washed off your body. Also, you should not swim in 

lakes, rivers, ponds, pools, or spas because of the chance of 

getting an infection. If you want to swim, ask your kidney 

doctor about ways to swim in the ocean or in clean, chlorinated 

swimming pools. 

Transplant 

A transplant is when you get a kidney from another person. The


person who gives you the kidney is called a donor. The donor’s


blood type and tissue must match yours. The new kidney is put


into your body through surgery and is usually placed in the


lower part of your belly (see diagram


below). Your old kidney may or may not


be taken out during surgery. The new 

Transplanted Kidney


Cross-Section 

kidney does the work that your old 

kidneys did. 

With a transplant, you will always need to 

take special medicines. Some of these 

medicines are called anti-rejection 

medicines. They help your body accept the 

kidney. Early signs that your body may be 

rejecting the new kidney can be fever, 

tenderness at the new kidney site, and 

making less urine. 

To have a kidney transplant, you must be 

diagnosed with End Stage Renal Disease 

(ESRD), and you may or may not have 

started dialysis. 

“With a 

transplant, you 

will always need 

to take special 

medicines.” 

Diseased 

Kidney 

Diseased 

Kidney 

Artery 

Bladder 

Vein 

Transplanted 

Kidney 

15

“Because you 

are related to 

someone does 

not mean that 

your blood and 

tissue type 

will match.” 

If you want to be considered for a transplant: 

• Your health care team will check your health to find out if 

your body is ready for a transplant. 

• Your doctor can refer you to a transplant center, or you can 

refer yourself. 

• A health care team at a transplant center will check your 

health to see if a new kidney would work for you. You may 

have medical conditions or health problems that keep you 

from having a transplant. 

• Your health care team will look at how well you keep to 

your dialysis schedule and if you take your medicine when 

you should. 

• Your health care team will try to help you find a program 

that can help you pay for the anti-rejection medicines you 

will need to take after surgery. 

Types of Transplants 

There are three kinds of transplants: 

• Living-related 

• Living non-related 

• Cadaver 

A living-related donor is a family member who is related to you 

by blood and who agrees to give you one of his or her kidneys. 

This kind of donor could be a parent, brother, sister, or other 

blood relative. Blood and tissue type are always tested to see if 

there is a good match. Just because you are related to someone 

does not mean that your blood and tissue type will match. 

A living non-related donor is a person who is not related to 

you, but whose blood and tissue type matches your own. A 

friend, spouse, or co-worker can be a donor and agree to give 

you a kidney. 

16

Cadaver donors are people who have just died and whose 

families have given their organs for others to use. For this kind of 

transplant, you need to put your name on an official list with 

others who also need a kidney. Talk to your doctor, social worker, 

or nurse about what must be done to get your name on the list. 

When a kidney becomes available, you can always choose not 

have to have the transplant, but you will not have this choice 

unless your name is on the list. When a kidney that matches 

your blood and tissue type becomes available you and your 

doctor will be called and surgery will be done right away. 

Finding a kidney that is a good match may take a short time or 

several years. 

The Choice to Stop Treatment


Just because there are treatment options does not mean you have 

to be treated. Some people choose to have no treatment or to 

stop treatment. This is a choice you can make, but understand 

that treatment is keeping you alive. When you withdraw from 

treatment, you put your life at risk. If you stop treatment 

completely, you will die. Your kidney doctor can give you more 

information about what happens when you stop treatment. This 

is a personal choice that may be hard to make. Talk with your 

family and your health care team if you want to stop treatment. 

Advance Directives 

If you were to have a life-threatening medical emergency, you 

may not be able to say what kind of treatment you would want. 

You have the right to choose ahead of time what you want done 

in case of such an emergency. An advance directive, sometimes 

called a “living will,” is a legal paper that says what you want 

done at that time. Your social worker can tell you about advance 

directives. Tell your kidney doctor and center if you have an 

advance directive. Make sure your doctor writes in your orders 

that you have one and that an original copy of it is in your files. 

“You have the 

right to choose 

ahead of time 

what you want 

done in case of 

such an 

emergency.” 

17 
You and Your Health Care Team


You and the people who care for you make up your health care 

team. Your family or caregiver, doctors, nurses, social workers, 

dietitians and technicians are all part of the team. Your health 

care team guides you in choosing and managing your treatment, 

understanding your insurance options, and planning your diet. 

Each person on the team plays a role in your care, especially you. 

Your Role 

You are the number one person on your health care team. It 

is your job to take care of your health and to tell the team 

what you need and how you are feeling. The team can 

teach you about your health and treatment, but only you 

can do what is needed to stay healthy. 

At least twice a year, your health care team meets to 

talk about your current care and plan for your future 

treatment. Your health care team needs to listen to 

how you feel. You should always go to these 

meetings so you understand your treatment and 

how you can make it better. 

Always feel free to ask questions. There are no 

dumb questions. If you do not understand 

an answer, let someone know. You can write 

down questions you have for your health 

care team in a notebook. When you go for 

treatment, take the notebook with you, and 

write down the answers. 

18

Your Family or Caregiver 

When kidney failure affects you, it affects your whole family. 

At first, your family or caregiver may feel helpless because they 

cannot change the fact that you have kidney failure. They may 

be angry because this has happened or fear that you may die. 

It helps for you and your family to talk about these feelings. 

Treatment needs to become part of the family’s daily routine. 

Your family or caregiver may do some things for you to help you 

follow your treatment plan, but they cannot do everything for 

you. Just as you need their support, they need yours. Understand 

your family’s needs as well as your own. 

Your family should also get checked for signs of kidney disease, 

especially if they have high blood pressure or diabetes. Kidney 

failure can run in families. If found early, there are ways to slow 

or prevent it. Your family members can check to see how well 

their kidneys are working with the following tests: 

• Blood pressure check 

• Blood tests for urea and creatinine 

• Urine dipstick test for hematuria, microalbumin, and pyuria 

• Calculated creatinine clearance 

Your Kidney Doctor 

Your kidney doctor has special training in treating people with 

kidney disease and is called a nephrologist (nef-RAHL-oh-jist). 

Your kidney doctor works with your family doctor to monitor 

your health. You can also ask your kidney doctor how to put 

your name on a transplant list. 

Your Family Doctor 

Your primary care or family doctor will still see you for check ups 

and for health problems. If any doctor other than your kidney 

doctor treats you for any health problem or gives you any new 

medicines, tell your kidney doctor right away. 

“Treatment needs 

to become part of 

the family’s daily 

routine.” 

19

“To protect your 

health, tell your 

kidney doctor 

before you make an 

appointment with 

your dentist.” 

20 

Your Dentist 

Your dentist cares for your teeth. To protect your health, tell your 

kidney doctor before you make an appointment with your dentist. 

Your Nurse 

Nurses coordinate your care. They answer questions about your 

health, your treatment, and on how to manage your medicines. 

They can help teach you and your family how to stay healthy. 

You need to talk with your nurse often about how you are feeling. 

Nurses can also give dialysis treatments and oversee other staff 

who helps with dialysis treatments. Some nurses also train 

patients and family members to do home dialysis. 

Your Social Worker 

Your social worker can give one-on-one, family, or group 

counseling to help you cope with your kidney failure, life’s 

stressors, and other issues. Social workers can help answer 

questions about your insurance, paying for care or medications, 

and getting to and from your treatments. They can also make 

referrals to community programs that can help with such things 

as getting proper foods. Your social worker can also help you find 

resources for job training or placement. 

Your Dietitian 

Your dietitian’s role is to help you understand what kind of foods 

to eat and how much fluid to drink. This is important because 

when your kidneys stop working, what you eat or drink can help 

or hurt how you feel. Your dietitian can teach you how to pick 

foods that will help keep you healthy, even when you eat out. 

Your dietitian may also help you understand how your blood test 

results are affected by your diet. 

Your Technician 

Most treatment centers have technicians who help care for 

you. When supervised by nurses, technicians can start and stop 

your dialysis treatment. They also watch your vital signs 

during treatment. 
Tips for Making Treatment Better


Dialysis or a transplant can affect your whole body and how 

you feel. This section talks about the things you can do to help 

yourself feel better and to keep your body healthy. To keep your 

life on track, you need to take charge of your health. 

Changes in Mental Health 

Life can be stressful, whether or not you have kidney failure.


Kidney failure brings a lot of changes in your life. Sometimes


these changes can be managed and become part of daily life, and


sometimes you may need help dealing with these changes. You


can talk with your social worker about ways to help you and


your family adjust. Your social worker can also tell you where to


get counseling if you need it.


Everyone adjusts to having kidney failure in different ways. If


you notice that you often feel uneasy, fearful, tired, irritable, or


nervous, it could be due to anxiety. Other signs of anxiety are 


a fast heartbeat, heavy sweating, or an upset


stomach. If you are sick, you may have these


same symptoms. It is important that you talk to


your doctor as soon as you can if you are feeling


this way, so that you can get the help you need.


Mood changes are common in people with


kidney failure for a few reasons. Stress can affect


a person’s mood. Some medicines can cause


mood swings. Also uremia (the build up of


waste products in the blood) can irritate the


body’s nervous system and cause mood changes.


“Dialysis or 

transplant can 

affect your whole 

body and how 

you feel.” 

21

“You can talk 

with your 

social worker 

about ways to 

help you adjust.” 

Tell your doctor right away if you cannot, or do not, want to 

eat, have trouble sleeping, have repeated angry outbursts, or lose 

interest in daily living or in sex. These may be signs of depression. 

Other signs are feeling sad or angry all the time, using drugs 

or alcohol to cope, or having thoughts of taking your life. 

Remember, do not wait to tell your doctor if this is how you 

are feeling. 

Physical Changes 

With kidney failure you may see changes in your body. Sometimes 

your skin may become darker, paler or a little yellow looking. 

Skin may become dry and flaky. Darker skin may look ashy. It 

helps to wash and moisturize your skin daily. 

The taste in your mouth and smell of your breath may change. 

This is from the build up of waste products in the body that 

used to be removed by your kidneys. Following your treatment 

plan helps remove the waste products that cause this condition. 

It can also help to gently brush your teeth, gums, and tongue a 

few times a day. 

Changes in Sexual Desire 

For both men and women, it is very common that desire for sex 

may change, as they adjust both physically and emotionally to 

kidney failure. Men may be unable to have or maintain an 

erection. Women may be unable to have sexual arousal. This may 

be due to certain medicines, anemia, or built up wastes in the 

blood. If you have concerns about these problems, talk to your 

doctor, nurse, or social worker. You may feel uncomfortable 

talking about your sex life, but your health care team cannot 

help you if they do not know something is wrong. 

22

Talk with Your Doctors 

Before you see your doctor, write down any questions you have. 

Bring these questions with you to your visit so you can ask your 

doctor and get answers that you understand. 

•	 On a regular basis, talk with your kidney doctor on how 

your treatment is going and if changes to your treatment 

plan are needed. 

•	 Every six months, discuss your treatment plans with your 

kidney doctor and health care team. 

• See your family doctor for routine check ups. 

•	 Tell your kidney doctor before you make an appointment 

with your dentist. 

•	 Take a copy of your health records to any doctor you see. 

Keep all of your doctors informed about your treatment 

and changes in your health. 

Take Your Medicine as Prescribed


Medicine is an important part of your treatment. You need to 

take the medications that all your doctors prescribe. But first, tell 

your kidney doctor before taking any medicine another doctor 

prescribes for you. You may need to take medication to: 

• Help your body make red blood cells 

• Control your blood pressure 

• Replace vitamins and minerals lost during dialysis or from 

diet restrictions 

• Keep your bones strong 

• Get rid of phosphorus that builds up when your kidneys 

are not working 

• Replace hormones that your kidneys used to make 

• Treat an infection or other illness you may have 

“Tell your 

kidney doctor 

before taking any 

medicine another 

doctor prescribes 

for you.” 

23

“Write down 

all your 

medications 

and keep this list 

with you 

at all times.” 

24


Ask your kidney doctor when, how often, and how best to take 

your medications. Some medicine should be taken with a meal 

and some should be taken when your stomach is empty. Also, 

ask your kidney doctor if you are not sure how much water you 

should drink when you take your medicines. If you do not want 

to take a certain medicine, tell your kidney doctor. 

Ask your doctor about any side effects and what you should do if 

you have them. You can also ask your pharmacist these questions. 

If you can, try to fill your prescriptions at the same place each 

time. This way your pharmacist can get to know you and the 

medications you take. 

Know the names of your medications, why you are taking them, 

the dosage, and when and how to take them. Write down all 

your medications, and keep this list with you at all times. If a 

prescription has passed its expiration date, throw it away. Also, 

never give your medicine to anyone else. 

Beware of Over-the-Counter 

Medicines and Other Remedies 

Some people with kidney failure hope to feel better by taking 

over-the-counter medicines or using home remedies. Some of 

these medicines or remedies can make you very sick or even kill 

you. Tell your health care team about all medicines and remedies 

that you are taking, even vitamins or other supplements. Ask 

your kidney doctor before taking any medicine or herbal remedy 

that he or she did not give you. 
Medicines to Avoid: 

• Baking soda or remedies for heartburn or acid indigestion 

that bubble. They are high in sodium. 

• Antacids with aluminum or magnesium. Aluminum and 

magnesium can build up in your body and cause problems 

in your brain. 

• Aspirin, unless your kidney doctor tells you to take it. 

Aspirin can keep your blood from clotting and may 

cause bleeding. 

• Enemas and laxatives because you can become dehydrated 

or lose needed minerals. 

• Vitamins (unless prescribed), food supplements, or salt 

substitutes. These may be high in potassium or magnesium. 

• Any “cure all” remedies, herbs, or over-the-counter medicines 

that your kidney doctor has not told you are okay. 

Talk to your Kidney Doctor Before 

Starting “Alternative” Treatments 

Alternative medicine is a treatment that is used with, or instead 

of, traditional care. Common treatments are acupuncture, herbal 

remedies, chiropractic therapy, and mind-body techniques, 

among others. Mind-body techniques can be visualization or 

breathing exercises. 

While some people may be helped by alternative treatments, 

there may be harmful side effects for people with kidney failure. 

Ask your kidney doctor before starting any alternative treatments. 

Tell your health care team about any of these kinds of treatments 

you may be using now. 

“Ask your kidney 

doctor before 

starting any 

alternative 

treatments.” 

25

“You can get a 

free pneumonia 

shot as well as a 

flu shot once a 

year if you go 

to a doctor 

that accepts 

Medicare.” 

26 

Get Vaccinations to Help 

Stay Healthy 

If you are on dialysis or have a transplant, your body may have 

trouble fighting off infections and diseases. You need extra 

protection from the flu, pneumonia, and Hepatitis B. Getting 

vaccinated can help you avoid getting sick or going to the 

hospital. Vaccinations may even save your life. 

You can get a free pneumonia shot, as well as yearly flu shots if 

you go to a doctor that accepts Medicare. For a Hepatitis B shot, 

Medicare pays 80 percent of reasonable cost, and you or your 

other insurance company pays the other 20 percent. Often 

vaccinations are given at the treatment center. 

Track Your Dialysis Treatment 

Progress 

As part of your dialysis treatment, you may have lab tests once a 

month or more often to track your progress. If you know what 

these tests measure and what your treatment goals are, you will 

be able to take better care of yourself. Your dietitian can give you 

tips on how to meet some of your goals by having a proper diet. 

Recommended lab tests measure: serum creatinine, blood urea 

nitrogen (BUN), URR, albumin, hematocrit, hemoglobin, TSAT 

and serum ferritin, parathyroid hormone (PTH), calcium, 

phosphorus, and potassium. Your Kt/V, blood pressure and 

weight are also recorded to track your treatment progress. 

Blood Urea Nitrogen (BUN) 

Urea nitrogen is a waste product in your blood that comes from 

the breakdown of proteins from the food you eat and from your 

body’s stored protein. Healthy kidneys remove BUN from blood. 

With kidney failure, your dialysis treatments remove the BUN 

from your blood. Your BUN level can go up if you do not get 

enough dialysis or eat too much protein. 
URR 

URR stands for “Urea Reduction Ratio.” This test measures how 

much urea was removed from your blood during hemodialysis. 

Urea is a waste product that builds up in your body when your 

kidneys stop working. Your blood is tested before and after 

treatment to see how much cleaner the blood is. URR is shown 

as a percent. A URR of at least 65 percent shows that your 

dialysis was okay or adequate. 

Kt/V 

Kt/V (pronounced “kay tee over vee”) is another measure of how 

well your dialysis treatment is working. Kt/V applies to people 

on both hemodialysis and peritoneal dialysis. Kt/V of at least 1.2 

is the minimum number you can have for your hemodialysis to 

be okay or adequate. Adequate dialysis for peritoneal dialysis is a 

Kt/V of at least 2.1. 

To help reach your target Kt/V or URR, do not miss any 

treatments. Be on time for your treatment and stay on the 

dialysis machine for the full time that your kidney doctor sets 

for you. If you reach your target, do not shorten your dialysis 

time. Only your kidney doctor can change the amount of time 

you have dialysis. 

Serum Creatinine 

Creatinine is a waste product in your blood that comes from 

the normal function of your muscles. Healthy kidneys remove 

creatinine from blood. With kidney failure, your dialysis 

treatments remove the creatinine from your blood. Your 

creatinine level can go up if you do not get enough dialysis. 

Albumin 

Albumin is a type of body protein made from the foods you eat. 

Your albumin level may be low if you do not eat enough protein 

and calories. This may lead to health problems like your body 

having trouble fighting infections. 

“Your dietitian 

can give you tips 

on how to meet 

some of your 

goals by having 

a proper diet.” 

27

“To keep the 

right amount of 

calcium in your 

bones, your 

kidney doctor 

may recommend 

taking calcium 

supplements.” 

Hematocrit 

Your hematocrit measures the red blood cells that your body 

makes. A low hematocrit (or low number of red blood cells) may 

mean you have anemia. Anemia will make you feel tired. To treat 

anemia, you may need to take extra iron and a hormone called 

EPO. You will feel less tired and have more energy when your 

hematocrit reaches about 33 to 36 percent. 

Hemoglobin 

Hemoglobin lets red blood cells carry oxygen to all the cells in 

your body. Your hemoglobin level is another way to tell if you 

have anemia. Your hemoglobin level should be at least 11 to 12. 

TSAT and Serum Ferritin 

TSAT means transferrin saturation. Both TSAT (active iron) and 

serum ferritin (stored iron) are tests that measure the iron in your 

body. Iron is needed to make red blood cells. Your TSAT should 

be at least 20 percent and not more than 50 percent. Your serum 

ferritin should be at least 100 and not more than 800. You may 

need extra iron to reach your target range. 

Parathyroid Hormone (PTH) 

A poor balance of calcium and phosphorus in your body can lead 

to high levels of parathyroid hormone (PTH). This can cause 

bone disease. Ask your doctor and dietitian how your calcium 

and phosphorus levels can be kept in balance so your PTH level 

does not get too high. 

Calcium 

Calcium helps make strong bones and teeth. Low blood calcium 

can cause muscle spasms. Calcium is also needed for blood 

clotting. To keep the right amount of calcium in your bones, your 

kidney doctor may recommend taking calcium supplements. 

28

Phosphorus 

Phosphorus is found in most foods. A high phosphorus level 

can lead to weak bones and can make your skin itch. Taking a 

phosphate binder helps control the amount of phosphorus in 

your blood between dialysis treatments. It acts like a sponge to 

soak up, or bind, phosphorus while it is in the stomach. When 

it is bound, phosphorus does not get into the blood and is 

passed out of the body in the stool. Follow your diet and take 

your phosphate binders with all meals and snacks. 

Potassium 

Too high or too low a level of potassium in your blood can lead 

to heart problems and even a heart attack. Follow your diet as 

to how much food with potassium you should eat. Ask your 

dietitian about which foods are high or low in potassium. 

Blood Pressure 

Ask your doctor what your blood pressure should be. List your 

average pre- and post-dialysis blood pressure each month. If your 

blood pressure is high, it helps to take the blood pressure medicine 

that your kidney doctor has told you to take. Following your fluid 

intake plan and cutting down on salt in your diet will help too. If 

your doctor tells you that you are overweight, losing weight with 

exercise will also help lower your blood pressure. 

Target Weight or Dry Weight 

Your target weight is what your kidney doctor thinks your weight 

would be if you did not have kidney failure. Your target weight is 

when your body has the right amount of water – not too much 

and not too little. Because your kidneys have stopped working 

most of the fluids you drink will stay in your body. When your 

body holds fluid, you gain weight. If you are losing weight 

without even trying, talk to your dietitian to make sure you are 

eating right to stay healthy. With hemodialysis, you are weighed 

before and after each treatment to see how close you are to your 

target weight. If you are on PD, you need to weigh yourself 

each day. 

“If your doctor 

tells you that you 

are overweight, 

losing weight 

with exercise will 

also help lower 

your blood 

pressure.” 

29 
“Do not 

drink more fluid 

or eat more salt 

than you can have 

in your diet.” 

30 

Average Daily Weight Gain 

Too much fluid weight gain between treatments can cause 

swelling, a weakened heart muscle, shortness of breath, or 

high blood pressure. It can also make your dialysis treatment 

uncomfortable. Follow your fluid and salt intake closely. Do 

not drink more fluid or eat more salt than you can have in your 

diet. Otherwise, you may gain too much fluid weight between 

dialysis treatments. 
Tips for Living with 

Kidney Failure 

“Planning meals 

around your 

treatment times 

helps make 

the treatments 

work better.” 

Follow your Diet and Fluid 

Intake Plan 

When you eat or drink anything, your body uses what it needs 

for fuel. But the body cannot use all that you eat or drink. When 

your kidneys were working, they cleaned the body of many waste 

products. Now that your kidneys do not work, waste products 

stay and build up in your body. Treatment helps rid your body of 

these wastes, but it cannot clean your body of all of them. That 

is why following your diet and fluid intake plan as close as 

possible is so important. 

Your dietitian can teach you how to plan your diet 

and pick healthy foods, even when you are eating 

out. You can also ask your dietitian if he or she can 

help you change your favorite recipes to fit your diet 

needs. Eating and drinking what your dietitian 

suggests, not only helps you feel better, it makes 

your treatments more comfortable. Planning meals 

around your treatment times helps make the 

treatments work better. If you need help getting the 

proper foods, ask your social worker about programs 

in your community. 

31

“Avoid foods with 

lots of water like 

gelatin and soup 

or frozen foods, 

such as ice cream, 

sherbet, or even 

ice cubes.” 

Avoid Salt 

Sodium from salt or salty foods can make your body swell up. 

Salty foods can also make you thirsty, which makes it hard to 

keep from drinking too much fluid. 

There are a few easy things you can do to limit the salt in your 

diet. Try to use unsalted seasonings, herbs or spices when you 

prepare food. Buy meat that is fresh, not meat that is smoked or 

cured as it has more salt. 

Stay away from fast foods, pickled foods, canned meats, canned 

soups, condiments, chips, and crackers. These kinds of foods 

have a lot of salt. If you eat out, ask that your food be made 

without salt. 

Limit Fluids 

To avoid fluid weight gain, many people are told to limit how 

much water or fluid they drink. Even though you are careful, 

you may still have trouble with weight gain. Also, some foods are 

mostly water and add to weight gain. Avoid foods with lots of 

water like gelatin, watermelon, soup, gravy, or frozen foods, such 

as popsicles, ice cream, sherbet, or even ice cubes. Talk to your 

dietitian about what to eat or drink to help you meet your needs. 

Your dietitian can tell you what your fluid intake should be. 

Below are some examples of fluid measurements. 

32

Make an Exercise Plan 

Exercise is one of the best things you can do for yourself. It can 

help make you feel better and can: 

• Give you more energy 

• Make your muscles stronger 

• Make your joints more flexible 

• Help control your blood pressure 

• Lower your chance of a heart attack 

• Help you fight depression 

• Make it easier to do the things you do every day 

Talk to your health care team before you start any exercise 

program. Your health care team will know you are ready when: 

• You are getting enough dialysis 

• You have stable blood pressure 

• You are free from infections or other illnesses that need care 

• You are following your diet closely 

• You are taking the medications prescribed by your doctor 

• You have stable glucose control, if you have diabetes 

Your health care team can help you make an exercise plan. You 

will be more likely to stick to your plan if you set realistic goals, 

keep track of how often you exercise, and reward yourself when 

you do well. Being on dialysis may make you feel tired and not 

up to exercising. Even so, try to stay active. Try to find 

something that you like to do. 

“Exercise is one of 

the best things 

you can do for 

yourself. It can 

help make you 

feel better.” 

33

“You may need to 

talk about how to 

balance work 

with your dialysis 

or transplant 

center schedule.” 

Doing any exercise comes with some risks, so exercise safely. Do 

not try to do more than your body will let you. Avoid exercise if 

you have a fever, missed a dialysis treatment, or have a new illness 

that has not been treated. 

Stop exercising and call your health care team if you feel tired 

or have: 

• Shortness of breath 

• Chest pains or pressure 

• Irregular heartbeats 

• Nausea 

• Leg cramps 

• Dizziness or feel lightheaded 

• Pain or pressure in your neck or jaw 

• Blurry vision 

Going Back to Work 

If you go back to work, Medicare still pays for dialysis or 

transplant services. In time, many people with kidney failure 

return to school or work or even start new jobs. Talk to your 

social worker about work options or about how to get training in 

new skills. 

Whether you keep the same job or find a new one, you may 

need to talk to your boss about changing the amount of hours or 

days you work based on how well you feel. You may also need to 

talk about how to balance work with your dialysis or transplant 

center schedule. 

According to the Family and Medical Leave Act (FMLA), if you 

cannot do your job for a period of time because of kidney failure, 

you can take up to 12 weeks of unpaid leave. This law also says if 

a family member (husband, wife, parent, or child) needs to take 

care of a person who has a serious health condition, such as 

kidney failure, he or she may also be able to take unpaid leave. 

34

Plan Ahead for Travel 

Kidney failure does not mean you have to give up traveling. You 

can still get the care and treatment you need while you are away, 

but you need to plan at least one month in advance, if not 

longer. If you are going to a popular place for a vacation, you 

may want to plan as far as three months ahead. Your transient 

coordinator (social worker) can help you arrange your travel 

plans with a center near your destination. Your social worker will 

send your health and treatment information to the new center. 

Before you travel, find out from your transient coordinator: 

• If the center is Medicare-approved and has the space and 

time to treat you 

• How much treatment costs, if there are any other fees, 

when payment is due, and what payment options does the 

center accepts 

• Where the center is located 

If you are on PD, call your supplier to arrange for your supplies 

to be sent ahead of time to your destination. By doing so you 

will not have to carry extra suitcases with your supplies. Just in 

case, you may want to take with you one or two extra dialysate 

bags and needed supplies. People who use a cycler for CCPD can 

also have the machine delivered to where they are going. 

Remember to bring enough or extra medicine on your trip. Drug 

stores where you travel may not have all the medicines you need. 

Also, if you are on a transplant list, let your health care team 

know where they can reach you at all times, so they can contact 

you if a kidney becomes available. 

Medicare only pays for hospital or medical care you get in the 

U.S. and U.S. territories. Medicare does not pay for treatment in 

other countries or for treatment on board cruise ships. This does 

not mean you cannot travel outside the U.S., but you will need 

the money to pay for treatment. If you have other insurance, 

find out what it covers. 

“For more 

information on 

facilities located 

where you will be 

traveling, visit the 

Internet site, 

www.medicare.gov 

and click on 

Dialysis Facility 

Compare.” 

35

How to File a Complaint


Filing Options: 

1. Talk to a 

member of your 

health care team 

or 

2. Call your ESRD 

network 

or 

3. Call your State 

Survey Agency 

36 

As you learn to live with kidney failure, you may have to deal 

with some problems along the way. In dealing with any problems 

that may come up, it is best if you and your health care team can 

talk in a calm way about what is happening and not let feelings 

build up. 

If you have a problem with your dialysis treatments or transplant 

services that has not been resolved, you can file a complaint or 

grievance. There are two ways to do this. You can ask for a copy 

of the dialysis center’s rules on how to file a complaint with 

them. Or you can file a complaint about the center through your 

ESRD Network or State survey agency. 

Your ESRD Network 

The ESRD Networks monitor quality of care for people on 

Medicare with kidney failure. The Networks can help you file a 

complaint if you have problems with your care. A list of ESRD 

Networks can be found on page 39. 

Your State Survey Agency 

The State survey agencies carry out dialysis center inspections for 

the Medicare program. These inspections make sure that your 

treatment center is clean and safe and that your center meets 

Medicare standards. A State survey agency investigates 

complaints and makes sure that the treatment center fixes 

problems. You have the right to contact your State survey agency 

if you wish to file a complaint about your treatment center. You 

do not have to give your name when you make a complaint. A 

list of State survey agencies can be found on pages 40-43. 
Your Rights


As a person with kidney failure, you have certain rights and responsibilities. When you go 

to a treatment center, ask for a copy of your rights and responsibilities. This will help you 

know what to expect from your health care team and what they can expect from you. Your 

center may have a list like the following: 

• I have the right to be told about my rights and responsibilities. 

• I have the right to be treated with respect. 

• I have the right to privacy. My medical records cannot be shared with anyone, unless I 

say so. 

• I have the right to meet with my whole health care team to plan my treatment. 

• I have the right to see the dietitian for help with food planning and the social worker 

for counseling. 

• I have the right to be told about my health in a way that I understand. 

• I have the right to be told about the treatment options open to me and to help choose 

my treatment method. 

• I have the right to be told about any tests ordered for me and the test results. 

• I have the right to be told about the services offered at the center. 

• I have the right to be told about the process of dialysis and dialyzer re-use. 

• I have the right to be told about any expenses that will be charged to me if they are 

not covered by insurance or Medicare. 

• I have the right to be told about any financial help available to me. 

• I have the right to accept or refuse any treatment or medicine my doctor orders for me. 

• I have the right to be told about the rules at the treatment center (for example, rules 

for visitors, eating, personal conduct, etc.). 

• I have the right to choose if I want to be part of any research studies. 

37

Your Responsibilities


• I need to treat other patients and staff as I would like to be treated, with respect. 

• I need to pay my bills on time. If this is hard for me, I can ask about making a 

payment plan. 

• I need to tell my health care team if I refuse any treatment or medicine that my 

doctor has ordered for me. 

• I need to tell my health care team if I do not understand my medical condition or 

treatment plan. 

• I need to be on time for my treatments or when I see my doctor. 

• I need to tell the staff at the center if I know that I am going to be late or miss a 

treatment or visit with my doctor. 

• I need to tell my health care team if I have medical problems, am going to the 

dentist, am being treated by another doctor, or have recently been to the hospital. 

• I need to follow the rules of the center. 

• I need to get to and from the center for my treatments. I can talk with my social 

worker if I need help doing this. Medicare does not pay for transportation. 

Summary 

The people at Medicare wrote this guide to help you deal with 

the changes you face with kidney failure and to help you take 

care of yourself. Kidney failure may be part of your life, but it is 

not the only thing in your life. Many people with kidney failure 

enjoy full and happy lives. Remember, you can live! 

38

Pages 39-47 of this booklet were intentionally left blank. 

They contain phone number information. For the most 

recent phone numbers, please visit the Helpful Contacts 

section of our website. 
U.S. DEPARTMENT OF 

HEALTH AND HUMAN SERVICES 

Centers for Medicare & Medicaid Services 

7500 Security Boulevard 

Baltimore, Maryland 21244-1850 

Official Business 

Penalty for Private Use, $300 

Publication No. CMS-02119 

January, 2002