When the kidneys stop working, renal failure occurs. If this renal failure continues (chronically), end-stage renal disease results, with accumulation of toxic waste products in the body. In this case, either dialysis or transplantation is required.
Common Causes of End-Stage Renal Disease
- Diabetes mellitus
- High blood pressure
- Polycystic Kidney Disease
- Severe anatomical problems of the urinary tract
For the kidney transplant process, the required body part is to be taken from two different sources:
- A living donor
- A deceased donor
Apollo Hospital for Nephrology & Kidney Transplant
- Treatment Offered
- Renal Replacement Therapy
- Kidney Transplant
The Department of Nephrology and Kidney Transplant is equipped with the most advanced dialysis machines and offers round the clock service with facility for Continuous Renal Replacement Therapy (CRRT) for hemo-dynamically unstable patients and Continuous Ambulatory Peritoneal Dialysis.
The Department Kidney Transplant is equipped with the latest diagnostic and therapeutic facilities like Ultrasound, Doppler, IVP. The Department has rocedures ensuring quality treatment as well as complete privacy and comfortable surroundings.
The Apollo for Renal Sciences and Kidney Transplant is well supported by world standard laboratories and by excellent interdepartmental cooperation from the Departments of Anaesthesia, Cardiology, Pathology, Immunology, Radiology and Interventional Radiology.
Renal Replacement therapy
This encompasses all life saving treatment options for advanced renal failure which are hemodialysis, peritoneal dialysis, hemofiltration, hemodiafiltration and renal transplantation.
Once it is determined that renal replacement therapy will be required, the patient (along with his physician) should consider the advantages and disadvantages of three types of therapy.
- 1. Hemodialysis (in the hospital or at Home)
- 2. Peritoneal dialysis at home. (CAPD) and
- 3. Renal Transplantation (Living donor or deceased organ donor, also called cadaveric donor)
Renal replacement therapies are treatments for severe kidney failure (also called stage V chronic kidney disease or end stage renal disease). When the kidneys are no longer working effectively, waste products and fluid build up in the blood. Dialysis takes over the function of the failing kidneys to remove the fluid and waste products.
It is typically needed when about 90% or more of kidney function is lost.
It replicates a normal kidney’s functions. This is used for the treatment of chronic kidney disease because kidney is incapable of performing all kinds of functions.
The choice between hemo or peritoneal dialysis is influenced by a number of considerations such as availability, convenience, underlying medical problems home situation and age. This choice is best made by discussing the risks and benefits of each type of dialysis with your concerned doctor and his support staff.
When to Start Dialysis?
It is recommended that dialysis begin well before kidneys disease has advanced to the point where life threatening complications affecting the brain, heart and lungs occur. If one starts dialysis very late, than the quality of life is not significantly improved even after receiving regular dialysis.
Emergency dialysis is usually given when
Blood tests reveal very high BUN/Serum Creatinine
- Patient has severe shortness of breath due to
- Fluid overload
- Severe metabolic acidosis
- Life threatening hyperkalemia (high potassium levels in blood)
- Bleeding diathesis due to uremia
- Pericarditis, i.e. fluid collection around the heart
- Patient is in altered mental state or has motor weakness due to involvement of nerves
However a patient is advised to go for early dialysis electively and not to wait for an emergency, as the emergency dialysis has much higher mortality and morbidity risks.
Preparation for Hemodialysis
Mental preparation for hemodialysis should be made well in advance before its need arises.
Primary AV fistula is the preferred type of vascular access.
It requires a surgical procedure that creates a direct connection between an artery and a vein. During dialysis, two needles are inserted into the fistula vein. Blood flows out through one needle, circulates through the dialysis machine, purified and flown back through the other needle.One should get a fistula created usually two to four months before the expected start of life saving hemodialysis. This will save the patient from temporary catheters, which are more prone to cause infections, injuries and clotting.
CAPD (Chronic Ambulatory Peritoneal Dialysis)
More common is the home CAPD in India.
A small plastic catheter is inserted in the patient's abdomen by a simple surgery. The patient with his attendants are taught how to instill dialysis fluid in his abdomen through this catheter and then drain the used fluid out four hours later. This process has to be done thrice a day with all due precautions.
The Advantage of this Therapy
- It can be done in the home environment: so time, money and energy spent in traveling to hospital thrice a week, for hemodiaysis, is avoided.
- There are fewer requirements for blood transfusion
- Generally less restriction is placed on food and fluid intake
- It is a safer modality for patients with advanced cardiac, neurological disease
Patient can pursue a normal lifestyle. All the types of Dialysis (Hemodialysis, SLEDD, CRRT) are done at this centre. Besides this Nocturnal Hemodialysis,Home dialysis, Bed-side Renal Replacement therapies in ICU and other critical care areas are also provided Follow up after kidney Transplant
Follow Up After Kidney Transplant
There are two main types of kidney transplants
- Living Donor Transplants
- Deceased Donor Transplants
Kidney transplant operations are guided by the and Human Organ Transplantation (Amndment ) Act 2011 of the Parliament of India. There are certains provisions which have to be fulfilled before a patient is considered for Renal Transplantation. These are the links on these provisions and the necessary affidavits for renal transplantation which are needed in each case.
Technology : Apollo Hospital, Centre for Kidney Transplant
Team of Specialists : Centre for Kidney Transplantation & Renal Diseases
- Apollo Hospital, Centre for Kidney Transplant
- Anesthesia Team
- Nephrology Team
- Kidney Transplant Team