The surgical transfer of a healthy kidney from one person into the body of a person who has little or no kidney function is termed as Kidney Transplant. The kidney serves to filter and remove excess waste, minerals and fluid from the blood by producing urine and keeping the body free of liquid waste. When the kidneys lose their filtering ability, harmful levels of fluid and waste accumulate in the body, which raise the blood pressure and result in kidney failure (end-stage renal disease). End-stage renal disease occurs when the kidneys have lost about 90% of their ability to function normally.
While it is possible to partly replicate the functions of the kidney through dialysis, this can be inconvenient and time-consuming, so a kidney transplant is the treatment of choice for kidney failure whenever possible.
At Aditya Birla Memorial Hospital we aim to find better treatments, and ultimately a cure for kidney diseases. Towards this our in-house research team has been silently and dedicatedly working to achieve this goal. In order to keep up with the increasing demand for treatment of kidney diseases, we have moved our dialysis department to a new wing, occupying an entire floor dedicated to dialysis services.
What sets up apart are the stringent protocols we follow for infection control, immunosuppressive protocols, the continuous monitoring for complications and their prompt management makes us the hospital of choice for hundreds of patients. Additionally, our modern dialysis unit fitted with 37 hemodialysis machines and manned by specially trained staff, ensure patient safety and comfort throughout the procedure.
Our team of expert nephrologist have performed 191 transplants, which include both, live and cadaveric, till December, 2016.
Dialysis - Hemodialysis and Peritoneal Dialysis
Dialysis is the artificial process of eliminating waste (diffusion) and unwanted water (ultrafiltration) from the blood. Our kidneys do this naturally. Some people, however, may have failed or damaged kidneys which cannot carry out the function properly - they may need dialysis.In short, dialysis is the artificial replacement for lost kidney function (renal replacement therapy).
Dialysis may be used for patients who have become ill and have acute kidney failure (temporary loss of kidney function), or for fairly stable patients who have permanently lost kidney function (stage 5 chronic kidney disease).
When we are healthy our kidneys regulate our body levels of water and minerals, and remove waste. The kidneys also produce erythropoietin and 1,25-dihydroxycholecalciferol (calcitriol) as part of the endocrine system. Dialysis does not correct the endocrine functions of failed kidneys - it only replaces some kidney functions, such as waste removal and fluid removal.
At ABMH we have facilities to provide different forms of Renal Replacement therapies based on patient's needs. The dialysis unit can provide-
• In-center Haemodialysis, where the blood circulates outside the body of the patient - it goes through a machine that has special filters. The blood comes out of the patient through a catheter (a flexible tube) or 'arterio-venous fistula' that is inserted into the vein. The filters do what the kidney's do; they filter out the waste products from the blood. The filtered blood then returns to the patient via another catheter. The patient is, in effect, connected to a kind of artificial kidney.This can be done both as an out-patient or in-patient.
• Peritoneal Dialysis where a sterile (dialysate) solution rich in minerals and glucose is run through a tube into the peritoneal cavity, the abdominal body cavity around the intestine, where the peritoneal membrane acts as a semi-permeable membrane. Peritoneal dialysis uses the natural filtering ability of the peritoneum - the internal lining of the abdomen. In other words, peritoneal dialysis uses the lining of the abdomen as a filter of waste products from the blood.
The dialysate is left there for some time so that it can absorb waste products. Then it is drained out through a tube and discarded. This exchange, or cycle, is generally repeated several times during the day - with an automated system it is often done overnight. The elimination of unwanted water (ultrafiltration) occurs through osmosis - as the dialysis solution has a high concentration of glucose, it results in osmotic pressure which causes the fluid to move from the blood into the dialysate. Consequently, a larger quantity of fluid is drained than introduced.
Peritoneal dialysis can be done at home by the patient. It gives the patient a greater amount of freedom and independence because they do not have to come in to the clinic at multiple times each week.
There are two principal types of peritoneal dialysis:
• Continuous ambulatory peritoneal dialysis (CAPD) - this requires no machinery and can be done by the patient or a caregiver. The dialysate is left in the abdomen for up to eight hours. It is then replaced with a fresh solution straight away. This happens every day.
• Continuous cyclic peritoneal dialysis (CCPD) - a machine does the dialysis fluid exchanges. It is generally done during the night while the patient sleeps. This needs to be done every night. Each session lasts from ten to twelve hours. After spending the night attached to the machine, the majority of people keep fluid inside their abdomen during the day. A study found that a significant number of patients prefer "dialysis while you sleep" treatment. Nocturnal dialysis improves heart disease in patients with end-stage kidney failure.
• Continuous Renal Replacement Technique (CRRT)-is to diagnose patients in a more physiologic way, slowly, over 24 hours, just like the kidney. Intensive care patients are particularly suited to these techniques as they are, by definition, hemodynamically compromised, and, when acutely sick, intolerant of the fluid swings associated with IHD.
The benefits of CRRT are-
• Supports the renal system through continuous, gentle removal of excess metabolic waste products, while returning normal electrolyte and acid/base balance.
• Restores and maintains net neutral fluid balance (prevents accumulation that leads to fluid overload).
• Delivers continuous nutritional support without concern for fluid restrictions.
• Provides for optimized drug dosing.
• May improve patient survival rates.A 55% survival rate was realized in the largest randomized control trial to date.
• May increase renal recovery, defined as freedom from dialysis dependence. A 94% recovery rate was achieved in the same large randomized control trial noted above.
• May result in a higher rate of renal recovery when compared to conventional hemodialysis after AKI, as indicated by multiple large clinical studies.
CRRT is typically done in the ICU's.