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FAQ Kidney Transplant and Nephrology

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The number of exchanges per day and length of time per exchange varies by person to person. Usually, CAPD is performed four times a day. Each solution exchanges last about half an hour. Assistants help people with problems using their hands to do CAPD.

Automated Peritoneal Dialysis (APD)

The second type of peritoneal dialysis, automated peritoneal dialysis (APD) involves a machine. You attach the tubing and solution bags to the machine. Before going to sleep, you connect the tubing to the peritoneal catheter. During the night the machine performs the dialysis. For extra therapy, dialysis solution remains in the peritoneal cavity during the day. The peritoneal cavity of most adults can hold two to three liters of fluid.

 Kidney Transplant:

If you are nearing the need for dialysis and would like to explore getting a transplant, start the discussion with your nephrologist. Your doctor will discuss the transplant process with you, which generally starts with being referred to a transplant center for further evaluation. While transplant requirements vary between centers, you’ll most likely undergo comprehensive medical tests to determine if you are a viable candidate. If you are, then the search for a donor can begin.

Finding a match:

There are two types of organ donors: a living donor and a non-living, or cadaver, donor. Compatibility between a patient and the donor reduces the chances of organ rejection and can contribute to a more successful transplant. Additionally, because medication to help prevent organ rejection is so effective, donors don’t always have to be genetically similar to the recipient.

If you don’t have a potential living donor, you will be placed on the waiting list for a cadaver organ and will need to register for the national transplant waiting list at United Network of Organ Sharing (UNOS). The wait for a transplant can vary greatly depending on the type of donation you receive, your geographic location and current health.

Going in for surgery:

You will be scheduled for surgery as soon as an appropriate organ match has been identified. In most cases, your surgeon will leave your kidneys in place and simply place the new, healthy kidney in a different location in your abdomen. You will remain in the hospital for several days after the surgery and be monitored for any complications.

Common transplant concerns:

While your age and health conditions prior to the transplant surgery can affect the risk of complications, there are three common post-transplant concerns.

  • Rejection: Medication will be prescribed to help ensure your body accepts the new kidney.
  • Functionality: In some cases, the newly transplanted kidney begins working right away, while in others it may require dialysis for a few days before it starts functioning normally.
  • Organ lifespan: The average life span for a donated kidney is 10 to 15 years. When a transplant fails, a patient may opt for a second transplant or return to dialysis.

Taking care of your new kidney:

Maintaining healthy habits and following your doctors recommendations is vital to help your new kidney function properly so you can have a better quality of life for years to come.
 Hemodialysis:

Blood is pumped outside the body to an artificial kidney machine. The machine cleanses the blood and returns it to the body. Only a small amount of blood is out of the body at any time.

A “istula (the surgical linking of an artery to a vein) provides access to blood vessels. So does a graft (tubing surgically placed under the skin, linking an artery to a vein).

Two needles are placed into the fistula or graft. The needles are then attached by plastic tubing to a special filter. This filter is an artificial kidney called a dialyzer. One needle withdraws blood for cleansing. The other needle returns filtered blood to the body.

A pump pushes blood through the dialyzer. Blood passes on one side of the filter. Solution made by the dialysis machine passes on the other side. The solution draws excess fluid and waste out of the blood. A filter is used with pores large enough to allow waste to leave. Larger molecules like blood cells cannot pass through the filter. The average person receives three treatments per week. Each treatment lasts three to four hours.

 Peritoneal dialysis:

Continuous Ambulatory Peritoneal Dialysis (CAPD)Autonomic Peritoneal Dialysis (APD)Peritoneal dialysis occurs inside the body. It uses your peritoneal membrane (the lining of your abdomen) as the filter. For this treatment, a tube called a catheter is surgically placed through the wall of your abdomen. Special dialysis solution will flow into the peritoneum through the catheter. Waste products and excess fluids pass from the blood. They move through the peritoneal membrane, into the dialysis solution. Then, they are drained from the peritoneal cavity. Peritoneal dialysis can be performed by hand or by using a machine. Tubing and bags are worn only during the solution exchange.

Continuous Ambulatory Peritoneal Dialysis (CAPD):

CAPD allows gravity to draw dialysis solution in and out of the peritoneal cavity, using system of tubing and bags. With CAPD, you connect tubing and a bag of sterile dialysis solution to the peritoneal catheter. By raising the bag to shoulder level or higher, the solution flows into the peritoneum. When empty, simply remove and throw away the tubing and solution bag.

During daily activities, the peritoneal membrane acts as a filter for your blood. Waste products and excess water transfer to the dialysis solution. After a few hours, you attach new tubing and an empty bag to the catheter. Then, lower the bag to drain the waste-filled filled fluid from the peritoneum.

Connect the tubing set to the catheter. Drain out the used solution. Fill with the new solution. Disconnect the tubing set from the catheter. Throw away the used solution, disposable tubing and bags.

The Advantages and Disadvantages of Peritoneal Dialysis

Advantages:

  1. Patient very involved in self-care
  2. Control over schedule/freedom
  3. Less restricted diet
  4. Typically, once a month clinic visits
  5. No needles
  6. More steady physical condition
  7. Typically, no daytime exchange (APD)

Disadvantages:

  1. Four exchanges per day
  2. Nightly machine exchange (APD)
  3. Permanent external catheter.
  4. Some risk of infections
  5. Potential weights gain
  6. Store supplies at home
  7. Body image change

AV graft procedures with AVF

An AV graft is done when a patient does not have a suitable superficial vein for the creation of an AV fistula. It is similar to an AV fistula, except an artificial graft (a tube made out of Teflon) is used to connect an artery to a vein. The graft is tunneled underneath the skin, so nothing sticks out of the patient AV grafts are inserted much like AV fistulas are created. Instead of one small incision, usually two small incisions are made. It is still usually done under local anesthesia and patients usually go home the same day.

An AV graft can be used approximately three weeks after it inserted. As with an AV fistula, hemodialysis access is achieved by way of two inserted needles. One needle drains blood out of the patient and into the dialysis machine so the blood can be filtered. The second needle returns the filtered blood back to the patient.

Procedures:

  • Renal Biopsies
  • Central venous catheterizations
  • Hemodialysis catheter
  • PD Catheter insertios
  • Perm cath / Tunneled cuffed catheter insertions
  • AV Fistula and Graft placements
  • Cystoscopy and lithotripsy

Will have with you, they each have their areas of specific focus. Your HHD team will be made up of:

DR. PANKAJ WADHWA

Director & Unit Head Dr. Pankaj Wadhwa is a Urologist with expertise in Endo-Urological, Urological ...

Dr. Tanmay Pandya(Senior Consultant)

Dr. Tanmay Pandya is a popular Nephrologist in Chanakyapuri, Delhi. He has over 13 years of experien ...

Dr. Harbinder Singh

Dr. Harbinder Singh is an associate consultant in the department of urology at Primus. He has done h ...

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