Baxter International Inc. · NYSE:BAX
Baxter International — Investor Presentation (August 2007)
99 slides from Baxter International's investor presentation, August 2007
Slide 1: Pre-Dialysis Education
Pre-Dialysis Education Understanding Your Treatment Options
Slide 2: Understanding Your Treatment Options: Introduction
Understanding Your Treatment Options Introduction
Slide 3: Rate of kidney failure in Australia and New Zealand
Rate of kidney failure in Australia and New Zealand Kidney failure increasing by 6% per annum 600,000 patients are expected to be affected by kidney disease by 2010 Dialysis is performed worldwide Anyone can have kidney failure
Slide 4: Where are the kidneys?
Where are the kidneys? Renal artery Kidney Renal vein Ureter Bladder Urethra
Slide 5: What do the kidneys do?
What do the kidneys do? Clean the blood and Filter out remove extra waste fluid products Keep your body Control blood chemicals in pressure and balance red blood cells
Slide 6: How do the kidneys work?
How do the kidneys work? Blood In Artery Vein Kidney Ureter Clean Blood Bladder to Body Urethra Wastes Out
Slide 7: What do the Nephrons do?
What do the Nephrons do? Nephrons are microscopic units inside the kidney that: Filter blood to remove wastes and excess fluid Balance the amount of fluid and chemicals your body needs Discard what your body does not need as urine
Slide 8: What is kidney failure?
What is kidney failure? When kidneys stop working or when the level of working is less than 15% The result is a build-up of fluids and chemical wastes in the body This condition is life-threatening unless treated by dialysis or kidney transplantation
Slide 9: What is uremia?
What is uremia? When waste products build up in the blood Possible symptoms: Loss of appetite Bruising/bleeding easily Nausea and vomiting Swelling (edema) Headache Shortness of breath Drowsiness or confusion High blood pressure Trouble concentrating Puffiness around the eyes
Slide 10: What is anemia?
What is anemia? A low red blood cell count Possible symptoms: Ongoing fatigue Shortness of breath Rapid, irregular heartbeat Trouble concentrating Impotence Feeling dizzy or lightheaded Constant feeling of being cold
Slide 11: What causes kidney failure?
What causes kidney failure? Diabetes Untreated high blood pressure Inflammation Heredity Chronic infection Obstruction Accidents
Slide 12: How do you treat patients with kidney failure?
How do you treat patients with kidney failure? Diet and fluid management Medications Kidney dialysis Haemodialysis Peritoneal Dialysis Kidney transplantation Non-treatment
Slide 13: Selecting a treatment
Selecting a treatment You need to take an active role in your own care! Learn the facts Consider your medical condition and lifestyle Talk over your options with your health care team and your family Treatments may change as your needs change
Slide 14: Understanding Your Treatment Options: Adjustment
Understanding Your Treatment Options Adjustment
Slide 15: How does kidney disease affect the family?
How does kidney disease affect the family? Roles Rules Style New roles Independence and dependence
Slide 16: Typical emotional reactions
Typical emotional reactions Feelings Denial Acceptance Depression Anger Fear Guilt Having feelings is normal and healthy
Slide 17: Typical behaviour changes
Typical behaviour changes Many of these changes are temporary Irritability Moodiness Confusion Depression Easily tired Edginess Memory loss Problems with sleep Anger Lowered energy level
Slide 18: How will renal failure affect sexuality?
How will renal failure affect sexuality? It is important to discuss the physical and emotional changes that occur with renal failure Often a chronic illness will change one’s desire for sexual intimacy These problems can often be treated and corrected
Slide 19: Children and/or the need for contraceptives
Children and/or the need for contraceptives Discuss the use of contraceptives with your physician Discuss the desire for children with your physician
Slide 20: Successful adjustment
Successful adjustment Signs of successful adjustment: Medical treatment becomes more routine Knowledge wins over anxiety Time passes Patient and family feel more settled A sense of calmness is experienced Secrets of successful adjustment: Education Professional help Communication A
Slide 21: Secrets of successful adjustment
Secrets of successful adjustment Secret 1 - Education Secret 2 - Professional help Knowledge conquers fear, so obtain as much education as possible about kidney disease and its treatment
Slide 22: Secrets of successful adjustment
Secrets of successful adjustment Secret 3 – Communication Keeping friendships and family relationships going is as important to your mental health as medical treatment is to your physical health
Slide 23: Secrets of successful adjustment
Secrets of successful adjustment Secret 4 - Attitude Secret 5 - Sense of humor Having a positive attitude and a sense of humor will help you gain the best results from your treatment
Slide 24: Secrets of successful adjustment
Secrets of successful adjustment Secret 6 - Activity Once you are feeling better, it will be important to return to as many of your past activities as possible
Slide 25: Selecting a treatment
Selecting a treatment Learn the facts about each treatment option Consider your medical condition and lifestyle Talk over your options with your health care team and your family Treatment may change as your needs change
Slide 26: Understanding Your Treatment Options: Diet
Understanding Your Treatment Options Diet
Slide 27: What do the kidneys do?
What do the kidneys do? Clean the blood and Filter out remove extra waste fluid products Keep your body Control blood chemicals in pressure and balance red blood cells
Slide 28: How do the kidneys work?
How do the kidneys work? Blood In Artery Vein Kidney Ureter Clean Blood Bladder to Body Urethra Wastes Out
Slide 29: Why is diet important?
Why is diet important? Managing your diet can slow your renal disease The need for dialysis can be delayed Your diet affects how you feel
Slide 30: Managing your diet
Managing your diet Each person’s diet is individualised by the physician and dietitian Learn all you can about your diet Take an active role in planning your diet
Slide 31: Controlling your diet
Controlling your diet The most important foods to control are those containing: Protein Potassium Sodium Phosphorous Fluid
Slide 32: Proteins
Proteins Proteins keep your body tissue healthy Proteins must be eaten each day High quality protein (animal protein) Dairy (milk, cheese) Meat (steak, pork) Poultry (chicken, turkey) Eggs Low quality protein (plant protein) Vegetables Breads Cereals
Slide 33: Potassium
Potassium Potassium is a mineral that helps muscles and nerves work the right way Damaged kidneys can cause a build-up of potassium in your body Major sources of potassium include: Milk Legumes Potatoes Nuts Bananas Salt substitute Oranges Chocolate Dried Fruit
Slide 34: Sodium
Sodium Sodium is a mineral that is important in controlling blood pressure Sodium is found in most processed foods, especially salt. Too much sodium can cause swelling, high blood pressure, weight gain and difficulty breathing Try using alternate food seasonings: lemon and limes, spices, sea
Slide 35: Fluids
Fluids Healthy kidneys remove fluids as urine As kidney function declines, you make less urine and fluids build up in your body Check for fluid and sodium retention You will need to restrict your fluid intake
Slide 36: Phosphorus
Phosphorus Phosphorus is a mineral which combines with calcium to keep bones and teeth strong Too little calcium and too much phosphorus You will need to control the phosphorus in your diet You may need to take a phosphate binder or a calcium supplement
Slide 37: Do I need to limit calories?
Do I need to limit calories? Calories are needed in your diet for energy and for maintaining your body weight It is important to eat enough calories every day
Slide 38: What about vitamins?
What about vitamins? Your physician will prescribe your vitamins, which may include: Folic acid Iron supplements Do not take OTC’s without consulting your doctor.
Slide 39: How will I know that my diet is working?
How will I know that my diet is working? The best indicators of how well you are following your diet are: Weight loss or gain Blood pressure Swelling of hands and feet Blood samples
Slide 40: Know your numbers
Know your numbers Blood/Urine Test Your Value Normal for You Serum Creatinine GFR (24 hour urine) Urea Potassium (K+) Phosphorus Calcium Albumin Haematocrit/Haemoglobin
Slide 41: Grocery shopping and cooking
Grocery shopping and cooking All of the foods in your diet are easy to find in your grocery store Read all food labels for “hidden ingredients” such as salt, sodium chloride, potassium chloride and MSG Recommended Cookbook: “Back On The Menu” by Kidney Health Australia Call 1800 682 531 for mo
Slide 42: Dining out
Dining out Once you understand your diet, you will be able to pick the correct foods to eat, whether you are at home or in a restaurant.
Slide 43: How is diet different for each treatment?
How is diet different for each treatment? Haemodialysis Diet and fluid restricted Peritoneal Dialysis May have fewer restrictions for proteins, fluids and potassium Transplantation May have fewer restrictions for proteins, fluids and potassium, but more restrictions on calorie intake
Slide 44: Summary
Summary Like learning a new skill, time and practice are needed to succeed in managing your renal diet Patience and good communication with your physician and dietitian are important Remember, each person’s diet is set up for him or her, because no two people are alike You have excellent sup
Slide 45: Understanding Your Treatment Options: My Treatment Options
Understanding Your Treatment Options My Treatment Options
Slide 46: Summary
Summary The main treatment options for End Stage Renal Disease (ESRD), or kidney failure include: Peritoneal Dialysis Haemodialysis Kidney Transplantation There are two options for Peritoneal Dialysis - performing the therapy manually (this method is called Continual Ambulatory Peritoneal
Slide 47: Understanding Your Treatment Options: Haemodialysis
Understanding Your Treatment Options Haemodialysis
Slide 48: What is Haemodialysis?
What is Haemodialysis? The word “haemo” refers to blood. Haemodialysis is a process which balances blood chemistry (electrolytes) and filters wastes and fluids from the blood The blood travels outside the body through tubing and passes through a filter on a dialysis machine The filter cleans t
Slide 49: What happens during Haemodialysis?
What happens during Haemodialysis? The dialysis machine pumps the blood through the filter - called a dialyser Two needles are inserted into your arm for each treatment One withdraws the blood One returns the filtered blood to your body
Slide 50: Is there a risk of getting a blood disease from other patients?
Is there a risk of getting a blood disease from other patients? Haemodialysis staff are carefully trained resulting in a lowered risk to patients Your blood never touches any surface where another person’s blood has been Each person has his/her own needles, tubing and filter which are attached
Slide 51: Your treatment schedule
Your treatment schedule 3 days a week 4-5 hours per treatment Your Renal Care Team will work with you to determine the right schedule, diet and type of dialysis for you
Slide 52: How is blood removed and replaced?
How is blood removed and replaced? Venous Arterial Line Line A “Fistula” is the surgical linking of an artery to a vein providing access to blood vessels Vein Artery A “Graft” is tubing Radial Artery Graft surgically placed under the skin, linking an artery to a vein Vein
Slide 53: Possible access problems
Possible access problems Clotting Some people have problems with blood clots that grow in the fistula or graft Infection Any redness, drainage, or signs of infections should be quickly reported
Slide 54: Caring for the access
Caring for the access Avoid anything that puts pressure on the access Avoid sleeping on the access area Do not wear tight jewelry or elastic clothing over the access Do not let anyone draw blood from the access or use your access for taking blood pressure
Slide 55: A dialyser acts as an artificial kidney
A dialyser acts as an artificial kidney The ‘Dialyser’ is sometimes called an ‘Artificial Kidney’ because it is a man-made replacement for the damaged filters in your own kidneys
Slide 56: What does the dialysis machine do?
What does the dialysis machine do? Prepares the dialysate Monitors the treatment
Slide 57: Potential problems during Haemodialysis
Potential problems during Haemodialysis Although problems are rare, it is important to understand what could happen Low blood pressure Nausea Cramping Headaches Whether you experience problems depends greatly on how well you follow diet and fluid guidelines between treatments, your age a
Slide 58: New developments in Haemodialysis
New developments in Haemodialysis Short daily dialysis Not all patients are candidates Not all dialysis centers offer this type of treatment Your physician will prescribe the appropriate therapy to meet your individual needs Nightly Home Haemodialysis Performed nightly while you sleep
Slide 59: Clinic Haemodialysis
Clinic Haemodialysis Patient takes an active role in clinic Haemodialysis treatment Dialysis staff are on hand to assist The patient is responsible for: Preparing the dialysis machine Placing the needles Adjusting machine settings Charting progress
Slide 60: Home Haemodialysis
Home Haemodialysis Patient and partners do the Haemodialysis treatments at home Usually takes as long as 1 to 2 months to learn Full nursing & clinic support
Slide 61: How will my lifestyle change? Diet, Travel
How will my lifestyle change? Diet Travel
Slide 62: How will my lifestyle change? Sports, Activities
How will my lifestyle change? Sports Activities
Slide 63: Clinic Haemodialysis: Advantages and Disadvantages
Clinic Haemodialysis Advantages Disadvantages Regular contact with other Travel to centre/ unit 3 times a Haemodialysis patients and week, on a fixed schedule staff Need a permanent access, 3 treatments per week usually in your arm (4 days off) Insertion of 2 needles for each No need for
Slide 64: Home Haemodialysis: Advantages and Disadvantages
Home Haemodialysis Advantages Disadvantages Help from family members Need for a permanent access, More control over when you usually through your arm dialyse Insertion of 2 needles for each No travel to a clinic for treatment treatment Restricted diet/ limited fluid Works during sleep,
Slide 65: Understanding Your Treatment Options: Peritoneal Dialysis
Understanding Your Treatment Options Peritoneal Dialysis
Slide 66: What is Peritoneal Dialysis
What is Peritoneal Dialysis Just like in Haemodialysis, Peritoneal Dialysis (PD) uses a filter to clean the blood and remove excess fluids With PD, the blood is cleansed inside the body using one of the body’s own membranes, the peritoneum, as the filter PD is performed primarily as a home the
Slide 67: How does Peritoneal Dialysis work?
How does Peritoneal Dialysis work? PD uses your peritoneal membrane - the lining of your abdomen - as the filter Solution is placed in the abdomen in contact with the peritoneal membrane for several hours Waste and fluids pass through the filter, then the solution and waste are drained from yo
Slide 68: The catheter
The catheter For PD, a tube called a catheter is surgically placed through the wall of your abdomen as a permanent access for PD The catheter is usually placed about an inch below and to the side of the navel About 5-6 cm of the catheter extends out of the body
Slide 69: What is CAPD?
What is CAPD? Continuous Ambulatory Peritoneal Dialysis CAPD is done manually and is a self- care therapy CAPD has been in use for over 28 years
Slide 70: What is APD?
What is APD? Automated Peritoneal Dialysis Dialysis exchanges are done at home, with the help of a “cycler” machine The cycler machine does exchanges while you sleep and can be used additionally during the day In the morning, you detach the tubing from the cycler
Slide 71: How do I perform a CAPD treatment?
How do I perform a CAPD treatment? Connect Drain
Slide 72: How do I perform a CAPD treatment? (cont.)
How do I perform a CAPD treatment? (cont.) Fill Disconnect/dwell
Slide 73: When and where can I perform a CAPD exchange?
When and where can I perform a CAPD exchange? Exchanges are performed when you wake up in the morning, at lunch, near dinner and before going to bed An exchange takes about 30 minutes Exchanges can be performed in any clean area at home, at work, at school or even on holidays
Slide 74: What happens during Peritoneal Dialysis?
What happens during Peritoneal Dialysis? Waste products (shown by trash cans) and excess water (shown as water drops) cross the membrane and are drawn into the dialysis solution by the process of osmosis and diffusion
Slide 75: How do I learn how to do Peritoneal Dialysis?
How do I learn how to do Peritoneal Dialysis? During training you will learn how to: Do an exchange Take your blood pressure Check your weight and evaluate fluid Care for your exit site and catheter Understand your diet and medication Evaluate signs and symptoms of infection
Slide 76: What about infection?
What about infection? Advances in PD have made infection less of a problem Early detection Antibiotics
Slide 77: What is involved in follow-up care?
What is involved in follow-up care? Regular clinic visits with your physician and PD team Usually monthly, to see how you are doing Home visit After initial training, to help you adjust to home care Phone calls To answer any questions
Slide 78: How does a patient get supplies?
How does a patient get supplies? Your physician writes your prescription You will learn how to order your supplies and arrange for delivery Supplies are delivered by a dialysis equipment and supply company Your HomeCare driver will carry and stack all of your supplies
Slide 79: Who would I call if I have a problem?
Who would I call if I have a problem? Your dialysis unit has rules for you to follow on what to do if you need help Often you can wait until the next morning if you need to go to the clinic Your PD team has someone “on call” to help and advise you
Slide 80: How will my lifestyle change? Diet, Travel
How will my lifestyle change? Diet Travel
Slide 81: How will my lifestyle change? Sports, Activities
How will my lifestyle change? Sports Activities
Slide 82: Peritoneal Dialysis: Advantages and Disadvantages
Peritoneal Dialysis Advantages Disadvantages Fit your treatment around your lifestyle Exchanges need to be made Independence – mostly you perform daily your therapy yourself Permanent catheter Few fluid diet restrictions Some risk of infection Fewer visits to the dialysis unit May sh
Slide 83: Understanding Your Treatment Options: Transplantation
Understanding Your Treatment Options Transplantation
Slide 84: What is kidney transplantation?
What is kidney transplantation? A kidney transplant is an operation in which a healthy kidney from another person is placed into your body This new kidney performs the functions of your own non-working kidneys Dialysis will probably be required while awaiting your transplant
Slide 85: Sources of transplanted kidneys
Sources of transplanted kidneys Living related donors Family members make the closest tissue matches Living unrelated donors Such as a spouse, good friend or others Cadaver Donors From people who decide to donate their organs when they die Today 80% of all transplanted kidneys are cada
Slide 86: What is kidney transplantation?
What is kidney transplantation? To determine a good, healthy match, the following steps are done: Blood tests Blood type Tissue type Healthy Kidney Cross-matching Match Medical criteria Age
Slide 87: Where is the new kidney located?
Where is the new kidney located? During the operation, a healthy kidney is placed deep under the muscle near the hip bone It can be placed on either the left or right side of the abdomen
Slide 88: How do you take care of a transplanted kidney?
How do you take care of a transplanted kidney? Take your medicine every day Visit regularly with your physician Follow your physician’s guidelines Control your diet Keep yourself active Watch for and report any problems
Slide 89: What lifestyle changes can the donor expect?
What lifestyle changes can the donor expect? 5-7 day hospital stay 1-2 weeks at home 1-2 months no heavy lifting/labor The donor may eat normally The donor should consider surgery risks The donor is left with one healthy functioning kidney
Slide 90: Cadaver donor kidney transplantation
Cadaver donor kidney transplantation Approximately 55-60% of all transplanted kidneys are cadaver donor kidneys Anyone can volunteer to donate a kidney or other organs, such as the heart, lungs, liver, pancreas
Slide 91: How are you evaluated for a kidney transplant?
How are you evaluated for a kidney transplant? The recipient is the person who receives the kidney transplant As a recipient, you will need to: Follow the treatment guidelines of your physician and treatment team Take an ongoing interest in your health Have a complete medical evaluation
Slide 92: Immunosuppressive medicines
Immunosuppressive medicines To suppress or stop the body’s normal immune response to reject the donor kidney Help you tolerate the new kidney Must be taken daily Major advances in immunosuppressive therapy Cyclosporine is the most common
Slide 93: Risks and possible side effects
Risks and possible side effects Lowered resistance to illness Immunosuppressive medications lower your resistance to infection To stay healthy, you must protect yourself from coming in contact with infections Take the correct dosage of medication and see your doctor regularly
Slide 94: Risks and possible side effects (cont.)
Risks and possible side effects (cont.) Major surgery There are also risks associated with major surgery These should be discussed thoroughly with your transplant coordinator and treatment team Side effects Use of immunosuppressive medications have been associated with many mild to severe side
Slide 95: Risks and possible side effects (cont.)
Risks and possible side effects (cont.) Some of the most common side effects include: Weight gain Increased sweating Elevated blood pressure Acne Muscle weakness Gum problems Upset stomach Hand tremors Mood swings Puffiness of the face and abdomen Increased susceptibility to in
Slide 96: What is rejection and how is it treated?
What is rejection and how is it treated? Rejection means your body is trying to get rid of something . that doesn’t belong Rejection is the major problem with kidney transplants: Immune system Rejection stops the transplanted kidney from working Rejection episodes are common in at least 1/
Slide 97: How will my lifestyle change? Diet, Travel
How will my lifestyle change? Diet Travel
Slide 98: How will my lifestyle change? Sports, Activities
How will my lifestyle change? Sports Activities
Slide 99: Transplantation: Advantages and Disadvantages
Transplantation Advantages Disadvantages feels closest to having your own the stress of waiting for a match kidneys risks associated with major no dialysis treatments required surgery lets you maintain a normal risk of rejection - your transplant schedule and visit a clinic less may not
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