Director:
Vascular and Endovascular Sciences

Vice President:
Vascular Access Society of India

Editorial Board:
Annals of Vascular Surgery

Councilor:
Asian Society of Vascular Surgery

Address:
Medanta Hospital, Gurugram, Haryana 122001

Diseases

Dr. Tarun Grover
Dr. Tarun Grover
Director
Peripheral Vascular & Endovascular Sciences

Chronic Kidney Disease Medicines

Kidney failure

The loss of kidney function is called acute kidney injury, also known as acute renal failure IARFI. This can occur following a traumatic injury with blood loss, the sudden reduction of blood flow to the kidneys, damage to the kidneys hem shock during a severe infection called sepsis, obstruction of urine flow, or damage from certain drugs or toxins.

Kidney failure management

For people with total, failed kidney, it is not easy of we can say it is not possible to recover the kidney function according to present medical treatment. However, for these who is diagnosed with kidney failure in early stage. There are treatment options.

Dialysis

Dialysis is the most commonly used medical treatment for kidney failure patients. Dialysis helps patients clean blood and shows quick treatment effects. The most common form of dialysis is called hemodialysis. Hemodialysis is a process that uses a man-made membrane (dialyzed to:

Eliminate extra fluid from the body. For hemodialysis. Yon are connected to a filter (dialyzed by tubes attached to your blood vessels. Your blood is slcm4y pumped from your body into the dialyzer where waste products and extra fluid are removed. The filtered blood is then pumped back into your body.

Vascular Access

For hemodialysis (HD) patients, a well functioning dialysis access is necessary to provide. the best dialysis treatment possible. Learning about the different types of dialysis access is important so you can be involved in the decision of which one is best for you.

What are my choices for an access?

If you have chosen HD for your therapy, there are three main types of vascular access. These am an AV fistula, an AV graft, and a catheter

AV Fistula

An arteriovenous IAA fistula is an access that is made by connecting a vein and an artery together. After this connection is made. the stronger flow of blood from the artery takes a .detour. through the vein, which then makes the vein larger. It typically takes time 13 - 4 months! and exercise for a fistula a to become developed enough to use for dialysis treatments. Since a fistula uses your own vein and artery. it is less likely to clot or become infected. AV fistulas last much longer than other access types. For most people. an AV fistula is the best type of access.

AV Graft

A graft is an access that is created by inserting a small flexible tube under the skin in your arm. One end of the graft is sewn into an artery and the other end is sewn into a vein. It takes two to six weeks before a graft can be used. Grafts are synthetic and they are more likely to become infected or clotted when compared to fistulas. With good care, a graft may last for several years, but usually a graft does not last as long as a fistula.

Catheter/Permacath

Catheter access for HD is created by putting a small tube into a large vein in the neck, chest, or groin. The bottom part of the catheter stays in the vein under the skin, while the upper part extends outside the skin. The catheter has two channels that allow blood to leave the body through one channel and then return through the second channel. This access can be used immediately and is often used when dialysis must be start before a permanent access has been created or while the permanent access is developing. Catheters have an increased number of problems with clotting and infection. In addition, the amount of blood flow is usually limited, so the dialysis treatments are not as effective as with a permanent access. Although there may be exceptions, a catheter is not the best long-term access choice for hemodialysis.

Tests & diagnosis

You will most likely need some special tests to help the doctors decide the best type of vascular access and the best place to secure the access. The most common test is Doppler ultrasound.

Before surgery, you may have an electrocardiogram (ECG/EKG!, blood tests. urine tests Si a chest x-ray to give your surgeon the latest information about your health. You may be given something to help you relax a mild tranquilizer before you are taken into the operating room.

The surgeon will then create the A-V fistula or the kV graft in one of your arms.

What are the benefits from the treatment?

Treatment for chronic kidney disease increases the life expectancy and improves the quality of life. Treatment enables the patient to walk and move on his/her own and be independent.

What is the expected outcome of the surgery?

You will be discharged the same day, generally the procedure is taken as day care procedure or else requires a day admission. You may resume to your regular activities the next day itself and be back to normal routine.

Post operative care (after AV fistula)

Follow up

You will be required to follow up with your surgeon regularly every month to ensure that your fistula / graft is functioning well & also evaluate with a duplex exam every month.

You are also requested to report to your surgeon if the flow rate in the dialysis machine are not appropriate or are decreasing. Your doctors in the dialysis room will be able to inform you regarding decreasing flows. The first duplex examination of the fistula is done on his visit to AV Fistula Support Clinic.