Early Creation of A-V Fistula Would Help Those With Renal Failure

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Press AV picsKidney diseases have become a major public health problem which is a leading cause of morbidity and mortality in India and other low- and middle-income countries. Many people who have kidney disease don't know it because the early signs can be very subtle. It can take many years to go from chronic kidney disease (CKD) to kidney failure. Most people with this disease live out their lives without ever reaching kidney failure. Depending on the underlying cause, some types of kidney disease can be treated. Often, though, chronic kidney disease has no cure. In general, treatment consists of measures to help control signs and symptoms, reduce complications, and slow progression of the disease.

If your kidneys can't keep up with waste and fluid clearance on their own and you develop complete or near-complete kidney failure, you have end-stage kidney disease. At that point, dialysis or a kidney transplant is needed. Hemodialysis is the most common way to treat advanced kidney failure.

“Hemodialysis is a treatment that removes wastes and extra fluid from your blood when your own kidneys have failed. Before hemodialysis can be done, a connection must be made to the blood inside your blood vessels. Your hemodialysis access, or vascular access, is a way to reach your blood for hemodialysis. The access allows your blood to travel through soft tubes to the dialysis machine where it is cleaned as it passes through a special filter, called a dialyzer. An AV (artery-vein) fistula is the best choice for hemodialysis. It is preferred because it usually lasts longer and has fewer problems like clotting and infections. A fistula should be placed several months before you need to start dialysis. This allows the fistula enough time to be ready for when you need treatment. A fistula (also called an arteriovenous fistula or A-V fistula) is made by joining an artery and a vein under the skin in your arm. When the artery and vein are joined, the pressure inside the vein increases, making the walls of the vein stronger. The stronger vein can then receive the needles used for hemodialysis. . Your wrist or elbow is the preferred location for your fistula. A fistula will usually last for many years. A fistula usually takes one to four months to “mature” or enlarge before it can be used.” says Dr. Rakesh Mahajan, Head Vascular Surgery, Apollo Hospitals, Delhi.

There are two different types of access that can be placed for hemodialysis apart from AV Fistula. They are called, A-V graft, and a Catheter.

Minor surgery is needed to create the fistula. Connecting a vein to a nearby artery, usually in your arm, makes it. This creates a large blood vessel that has a fast flow of blood. Your wrist or elbow is the preferred location for your fistula. It’s done under local anesthesia on daycare basis. Infectious complications of the AV fistulas are redness, swelling, soreness, feeling of warmth around your access site; fever, chills, and achy feeling.

Commentary from Dr. J. Gnanaraj, mdCurrent-India Author

It is a good idea to prepare for hemodialysis before the need arises because this could be carried out is a elective setting instead of as an emergency procedure. It also gives sufficient time for the fistula to mature. Small Kidneys, low hemoglobin, Glomerular filtration rate of 15 to 29 ml/min/1.73 meter square, etc would indicate the need for the procedure.

NOTE FOR RURAL PATIENTS WITH END STAGE RENAL DISEASE

During our student days we started a study about the quality of life among patients who had renal transplant at CMC Vellore. Before we could finish it we were asked to stop the study and no one was willing to publish the incomplete study. This was because at the end most of the relatives felt that it might have been better if the patient had died after a brief illness rather than dying after draining the emotional, financial and social reserves of the family. Hence unless someone is sponsoring even transplant might not be an ideal option. However our experience in the rural areas was that doing CAPD or Continuous ambulatory peritoneal dialysis was an appropriate option for the rural patients. They could continue it at home. They get sufficient time to settle the affairs at home and often they come to the hospital after few months and prepared to remove the tubes and ready for the eventuality [1]. We were able to produce a low cost silicon tube and also devise minimally invasive technique using laparoscopy [1].

References (click to show/hide)

  1. Gnanaraj J. Lalhlimpuii Varte . CAPD in rural area is it a worthwhile option? Rural Surgery Vol. 3 No. 1 p 5- 6, Jan 2007

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