WINSTON-SALEM, N.C. – Wake Forest University Baptist Medical Center is one of only two academic medical centers in the country offering outpatient procedures to maintain easy access to the bloodstream for patients undergoing kidney dialysis. More than 1,000 procedures were performed during the Dialysis Access Center’s first year.
“Offering these procedures in an outpatient setting is relatively new, but is increasing in popularity because of the large number of people on hemodialysis,” said Tushar Vachharajani, M.D., center director and an associate professor of nephrology.
In addition, some of these procedures to maintain dialysis access are also performed at the Medical Center by vascular surgeons and interventional radiologists.
Easy access to the bloodstream is vital for hemodialysis – or cleansing of the blood by an artificial kidney. In most cases, the access is a fistula, which is formed when an artery and vein in the arm are surgically connected. This operation causes the vein to become larger and stronger so that it can withstand two needles to be inserted for the three-times-a-week dialysis treatments.
In some patients, access is through a catheter inserted in a major vein. Patients often begin dialysis with a catheter because it can take two months or longer for a fistula to develop after the surgery.
Problems that can develop with dialysis access include blood clots, narrowed vessels and infections at the catheter site. Procedures performed at the center include angioplasty, or insertion of a balloon inside the access, to open the narrowed vessel. In addition, physicians can place stents in the access, place or remove catheters and “de-clot” fistulas.
Vachharajani, who moved to Winston-Salem to establish the service, works closely with Dr. Shahriar Moossavi, the other interventional nephrologist at the Dialysis Access Center. These physicians typically perform several access procedures each day at the Center. Interventional nephrology is a relatively new specialty that is practiced at less than a dozen academic centers in the country, only two of which are outpatient.
“Most patients need to have these procedures several times a year and appreciate the convenience of the outpatient center,” said Vachharajani. “In most cases we’re able to schedule procedures on a day that doesn’t disrupt the patient’s regular dialysis schedule.”
There are about 1,300 patients undergoing dialysis at 13 centers operated by Wake Forest University Health Sciences. The dialysis centers and the Dialysis Access Center (www.dagwfu.com) are managed by Health Systems Management Inc.
To help ensure that problems with access are treated early, the centers use a computer-assisted test during the dialysis treatment to monitor changes in access and blood flow.
“If an access stops working, it can lead to a bigger procedure,” said Vachharajani. “By using surveillance measures to detect a problem early, we can solve it before complications develop. There are only four preferred sites to create fistulas, so it’s important to keep them healthy and functional.”
Because of Wake Forest’s role as a research center, patients at the Dialysis Access Center have the opportunity to participate in the latest studies, if they so choose. For example, the center is one of seven in the country testing a new type of catheter designed to be easier to use and to ensure that the blood is fully cleansed.
The field of interventional nephrology started in the mid-1990s and the American Society of Diagnostic and Interventional Nephrology was formed in 2000. Vachharajani completed a fellowship in interventional nephrology at Louisiana State University Health Sciences Center and has been elected as a councilor to the society.
In the United States, approximately 400,000 people have end-stage renal disease and are dependent on artificial dialysis to stay alive. According to the National Kidney Foundation, one out of every nine adults has chronic kidney disease, which can progress to kidney failure and the need for dialysis. The most common causes of kidney disease are diabetes and high blood pressure.
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Wake Forest University Baptist Medical Center is an academic health system comprised of North Carolina Baptist Hospital, Brenner Children’s Hospital and Wake Forest University Health Sciences, which operates the university’s School of Medicine and Piedmont Triad Research Park. The system comprises 1,154 acute care, rehabilitation and long-term care beds and has been ranked as one of “America’s Best Hospitals” by U.S. News & World Report since 1993. Wake Forest Baptist is ranked 32nd in the nation by America’s Top Doctors for the number of its doctors considered best by their peers. The institution ranks in the top third in funding by the National Institutes of Health and 4th in the Southeastern United States in revenues from its licensed intellectual property.
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