Dr S. Sahariah

Dr S. Sahariah

Jubilee Hills Jubilee Hills , Hyderabad, Telangana
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Dialysis Treatment

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Dialysis is the major treatment for kidney failure. It is the medical word for filtering waste products and removing fluid from the body that kidneys are no longer able to remove.

    Haemo dialysis: (Figure 3)
    Peritoneal dialysis: (Figure 4)

Haemo Dialysis:

Haemodialysis is the process of removing waste product and excess fluid from the blood. This is done by circulating blood through a filter, called a dialyzer, or artificial kidney. The dialyzer is used with a dialysis machine. There are different types and brands of dialysis machines, but they all work to produce the same results. Ideally a patient with chronic kidney failure should have hemodialysis three times a week each session lasting from three and half to four hours. Frequent dialysis as mentioned above keep the patient more stable, fit and free from untoward complications like fluid overload, lack of general wellbeing etc. He or she can also take a diet with minimal restrictions.
Haemo Dialysis
What is Peritoneal Dialysis (PD)?

In essence peritoneal dialysis involves the transport of solutes and water across a "membrane" that separates two fluid containing compartments.

These two compartments are:

a. The blood in the peritoneal capillaries which in renal failure contains an excess of urea, creatinine, potassium, and so forth.

(b) The dialysis solution in the peritoneal cavity, which contains sodium, chloride and lactate and is rendered hyperosmolar by the inclusion of a high concentration, of glucose. The peritoneal membrane that acts as a "dialyzer" is actually a heteroporous, heterogeneous, semi permeable membrane with a relatively complex anatomy and physiology. Peritoneal dialysis is divided into CAPD (Continuous Ambulatory Peritoneal Dialysis) and APD (Automated Peritoneal Dialysis). CAPD has to be done daily (3-4 cycles a day at eight hourly interval) either by patient himself or any family member or helpers who can be trained to do such dialysis. This can also be done by a machine (Cyclar) where the peritoneal dialysis catheters are connected to the machine for continuous dialysis overnight and disconnected in the morning
Peritoneal Dialysis

 
Why do kidney failure patients need to have Dialysis?

They need to have dialysis because the kidneys are not working well. The kidneys, when they are healthy, filter out waste products and fluids from the body to keep a balance of chemicals and fluids steady. The dialysis machine acts in place of kidneys to:

    Remove waste products
    Remove excess fluid
    Help with the chemical balance in your body
    Help control blood pressure

What Dialysis machine cannot do?

The human kidney also produces hormones needed for producing red blood cells (Erythropoietin) and vitamin D, without which our body cannot absorb calcium from foods, which causes weakness of bones.

Other hormones, regulated by the kidneys are rennin angiotensin for control of blood pressure and salt (electrolyte) balance in the body. In kidney failure patients all the above mentioned hormones need supplementation in the food or drug schedule to maintain satisfactory health.
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Kidney Transplantation Service

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Kidney Transplantation has become the most accepted mode of treatment for patients with terminal Chronic Kidney Disease (CKD) throughout the world as the quality of life and longevity is much better as compared to long term dialysis. Since the first successful human kidney transplantation between two identical twin donor recipient pair in USA in 1958 thousands of patients underwent this procedure with an excellent outcome. The programme was started at few centers across India in '70s and presently more than 4000 such operations are carried out every year in the country. Though more than 100,000 terminal kidney failure patient need kidney transplantation every year in India the number of transplant performed are very few. Besides the cost of such treatment lack of human organ for transplantation is the biggest hurdle to provide this treatment to every needy patient. Shortage of human organ for transplantation is a global problem and even in most developed countries where 80 percent of the organ transplanted are from cadaver donors, the average waiting period for a cadaver transplantation is about five years. In India more than 95 percent of the transplanted kidneys are from living donor and remaining from cadaver donors as awareness about organ donation after death is very low in general population. The government is also making effort to create awareness about organ donation and thus increase the number of cadaver donors in the country and in coming years we may start seeing the results.

In kidney transplantation, one kidney from another human being (whether living person or cadaver) is implanted into the patient's body by a sophisticated surgical technique. The new kidney works like patient's own kidney and most of the time they start producing urine immediately after transplantation. Within a reasonable period of time (normally less than a week) the Urea, Creatinine level return to normal and the patient experience a tremendous feeling of well being and start eating normal diet with virtually no food restriction. All patients are immediately put on immunosuppressive drugs to prevent rejection of the transplanted kidney. During first 48 - 72 hrs patient are kept under close observation and they are regularly monitored for blood pressure, temperature, pulse, urine output etc. and blood and other investigations are done at frequent intervals to monitor the progress. Normally the donor is discharged after 5-6 days of surgery and the recipient 10-12 days after surgery and they are monitored regularly on outpatient basis. During the operation some tubes are left in the operated area and they will be removed by the surgical team at an appropriate time. An urinary catheter is kept in the bladder for about a week to closely monitor the urine output.

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Deceased Donor Kidney Transplant

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Shortage of organ for transplantation is the biggest challenge faced by the transplantologist all over the world to-day. There is more number of patients awaiting organ transplantation than the people who has successfully undergone transplantation. The best source of organ is the brain dead patient in hospital following severe head injury. Though number of such brain dead persons is very high but unfortunately the numbers of people willing to donate their organ after death are very few.

More than 100,000 persons develop end stage renal failure in India every year, who can be benefited by transplantation. But only about 4000 live donor operations are done annually mostly due to non-availability of human kidneys. Only 1-2 percent of of kidney transplants in our country is done using organs from cadaver donor. On the other hand about 100,000 persons with severe head injury due to road traffic accidents die every year in various hospitals in the country (which is the highest in the world) whose organ like kidneys, liver, heart, lungs, pancreas, corneas etc. can be used for the purpose of transplantation. These types of organ donors are known as CADAVER DONORS or DECEASED DONORS. Mostly due to lack of public awareness about usefulness of organ donation after death the cadaver organ transplantation programme has not been very successful in most countries including India. By donating organs after death we can save many lives. Think about it, discuss with your family and friends, discuss in your local community meetings or any other forum and make people aware about value of organ donations after deaths. This is the greatest gift one can give to a fellow human being.


At Krishna Institute of Medical Sciences, Hyderabad we could perform more than 80 deceased donor kidney transplantation during last four years with satisfactory results and presently more than 200 patients are waiting for their turn to receive a kidney from deceased donor. In our deceased donor list we have a 18 month old boy (youngest deceased donor in the country) who died following head injury due to fall as well as a 79 years old man (oldest deceased donor in the country) who died following a massive brain hemorrhage .

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Dr S. Sahariah House No. 256, Road No. 18, Jubilee Hills, Jubilee Hills Jubilee Hills ,
Hyderabad-500034, Telangana, India

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