Patients managed by Dr. Venkatesh Rajkumar, one of the best nephrologist in Apollo Hospital Chennai
The best equipment has been used in the dialysis center
Regularly mentioned in the list of top dialysis centers in Chennai/India
Peritoneal dialysis ("home dialysis") facility is also available
Prevention of kidney failure
There are basically two kinds of kidney failure. "Acute" kidney failure typically develops over a period of days to weeks. On the other hand "Chronic" kidney failure develops over months or years.
Pre Dialysis Preparation
Creating an AV fistula: For hemodialysis we need blood to be drawn out of the body at speeds of around 300mls per minute and at periodic intervels( three times per week). An AV fistula is one which typically serves this purpose.
High quality dialysis
In simple terms, Dialysis is the artificial replacement for lost Kidney function. Dialysis is a process that helps eliminate waste and unwanted water from the blood artificially. There are two types of dialysis Haemodialysis and Peritoneal dialysis.
Acute kidney failure might be reversible if the underlying cause like infection,drugs, obstruction in the urinary tract etc are diagnosed and treated promptly.
Chronic" kidney failure is often without symptoms till it is very advanced. If it is to be detected in early stages then periodic blood and urine tests need to be performed especially in people with diabetes and high blood pressure.
Our kidneys are organs that perform a lot of functions most important of them being eliminating waste and excess water.
Fistulography is a simple test which is done to detect problems associated with AV fistula and grafts. It is done by injecting dye in to the fistula and visualizing it under X ray imaging.
Percutaneous balloon angioplasty
It is the procedure done wherein a small high pressure inflatable balloon is used to treat access related problems like stenosis, thrombosis etc.
It is a procedure much similar to the stenting done for heart attack whereby a self expanding meshwork of stainless steel/nitinol is used to treat narrowing of blood vessels of the chest seen in dialysis patients.
Thrombectomies of AV fistula/ graft
A well functioning AV fistula /graft is the most important requirement of a hemodialysis patient. Patients can themselves look for the functioning of a fistula by placing their hand over their fistula and listening for the “thrill”. It is a simple yet very useful test which can be done by the patients themselves with a little teaching from the physician/Nephrologist. Blockade of a fistula is a patient’s as well as a Nephrologist’s nightmare and the scientific term is thrombosis. It is often detected in bedside by the sudden disappearance of the thrill. An astute patient often detects it early and reports to his doctor. If detected early it can be treated by a procedure called declotting wherein we remove the blood clots in the fistula/graft by aspiration, lysis with drugs, balloon angioplasty or a combination of them. A timely treatment can save a fistula and prevents the need for dialysis catheters and new fistula creation.
AV FISTULA and GRAFTS
AVF and AVG related problems are very common and they can affect the quality of dialysis. It is important to detect them at the earliest so that adequate treatment can be done to salvage them. Some common problems include poor blood flows, high pressures during dialysis, swelling of the fistula arm, swelling of the face, prolonged bleeding after the needle is removed post dialysis etc.
A well functioning vascular access is the single most important requirement of a hemodialysis patient. Traditionally it is either one of AV fistula, AV graft or a dialysis catheter. Though an AV fistula is considered to be the best available vascular access, sometimes it is necessary to have an AV graft or a dialysis catheter for accesses in patients in whom an AV fistula can’t be created.
There are two types of dialysis catheters. Temperory catheters and tunnelled permanent catheters. Worldwide it has become the rule to prefer tunnelled catheters for dialysis in patients in whom an AVF can’t be created. Temperory catheters can be associated with a lot of problems like infections, poor blood flow rates and narrowing of blood vessels in the chest with disastrous consequences.
Tunneled permanent dialysis catheters
Though we say an AV fistula is the best available vascular access for hemodialysis today and strive to have a functioning fistula in all patients before they start hemodialysis, what we ultimately face is a patient who needs dialysis immediately but don’t have a fistula. In such circumstances we can’t help but to opt for a dialysis catheter. There are two options here a temperory catheter or a tunnelled permanent catheter.
Why a tunneled catheter?
Worldwide it is a common practice to prefer tunnelled catheters to temperory catheters. Tunnelled catheters have a lot of advantages over temperory catheters the important ones being good blood flow, low rate of infections, low chance of chest vein blockade and hand swelling, better cosmetic appeal to mention a few. Tunnelled dialysis catheter placements need adequate knowledge and training in placements as well as availability of certain infrastructure.
Tunnelled catheter placements Certain patients in whom an AV fistula or a graft can’t be created successfully may have to be on dialysis catheters for a long time. Tunnelled dialysis catheter is an excellent option for such patients as a properly placed and maintained tunnelled catheter can stay for a few years with much less risk of complications.