UHS Medical Times January 2016

UHS Medical Times 1

e-newsletter | January 2016

DIALYSIS

UNIT AT UNIVERSITY HOSPITAL SHARJAH

e-newsletter from University Hospital Sharjah

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e-newsletter | January 2016

The physical aspect of kidney failure Healthy kidney The kidneys are bean-shaped organs, each about 10 centimeters (4 inches) long. They are positioned in the back of the body behind the lower ribs.

A healthy kidney is basically a filtering system. In fact, each kidney is made up of about a million filtering units called nephrons.

As blood passes through the kidneys, it is "cleaned" - the body's waste products and excess fluid are removed. These waste products, along with the excess fluid, are then sent through the ureters to the bladder. Then they are passed out of the body as urine.

Healthy kidneys also balance the chemicals in the blood, and produce hormones which control blood pressure and maintain healthy blood cells and bones.

What causes kidney failure?

There are a number of known causes of kidney failure but in quite a lot of people the cause is never found. The commonest causes are diabetes, high blood pressure and a painless inflammation of the kidneys called glomerulonephritis. There is a progressive loss of the filtering units (nephrons) in the kidney.

Other common causes are the inherited condition of cysts in the kidneys (polycystic kidney disease); repeated kidney infections or kidney infections (pyelonephritis) in childhood; and obstruction to the urine flow.

The most common causes of kidney failure: Diabetes High blood pressure Glomerulonephritis (acute inflammation of the kidney) Polycystic kidney disease Scarring from kidney infection in childhood Obstruction of the ureters mainly caused by stones

What happens when the kidneys fail?

If the kidneys are damaged, they may carry on producing urine but become less efficient at removing waste products from the blood.

Instead, the waste products continue to circulate and build up in the bloodstream.

At the same time, without the hormones that a healthy kidney would produce, the bone marrow becomes less efficient at producing red cells, so anaemia develops. For some patients, this may be a very gradual process. Over time, however, it can cause quite a wide range of symptoms. Not everyone will experience all the symptoms. Also, because it can be such a gradual process, some people don't even realise the effect the symptoms are having until - with treatment - they begin to feel better.

Once the kidney problem has been diagnosed, regular blood tests will be required. Treatment with a variety of drugs may be needed, for example, to control blood pressure. Remember, your treatment may be changed quite frequently based on the results of your blood tests. You may require dialysis at some time in the future.

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e-newsletter | January 2016

What are the symptoms of kidney failure?

Some of the symptoms are: Generally feeling ill Lacking interest in everyday activities; difficulty in concentrating or relaxing Tiredness and loss of energy Shortness of breath Altered taste sensation/appetite Increased night-time urine production Sickness and nausea Loss of libido/sex drive Itching Swelling of the legs

Treating kidney failure through dialysis If the kidneys fail, it is possible to replace their function using dialysis, an artificial way of getting rid of toxins.

How a patient is feeling and blood tests determine when it is necessary to begin dialysis. Some patients do not need to start until some time - occasionally years - after diagnosis. But even if this is the case, they need to know in advance about the different options available, because they should have a choice about which method of dialysis they use.

There are two different kinds of dialysis - haemodialysis, where the blood is cleaned outside the body via a machine, and Peritoneal dialysis, where the cleaning is done inside the body. Occasionally, there may be medical reasons to prefer one sort of dialysis to another - this is something to discuss with your doctor.

Haemodialysis

This form of dialysis removes waste products from the blood by passing it out of the body, through a filtering system (dialyser) and returning it, cleaned, to the body. While in the filtering system, the blood flows through tubes made of a membrane that allows the waste products (which are much smaller than blood cells) to pass out through it.

The waste products pass through the membrane into a dialysis solution (dialysate), then out of the machine. The "clean" blood is carried on through and returned safely to the body.

This happens over and over again throughout the dialysis session. Each time the "clean" blood is returned to the body, it picks up more waste products from the cells it circulates through, and brings these newly-collected toxins back to the dialyser to be removed. Fresh dialysate is passed through continuously, to make the rate of the cleaning process as fast as possible.

As well as cleaning the blood, the dialysis machine also removes excess water. This part of the process is called ultrafiltration which can be done separately without dialysis.

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e-newsletter | January 2016

The Dialysis Machine at UHS Nikkiso Dialysis System - DBB-07 is a flexible dialysis system to drive advanced treatment. The most important feature of this system is that it has the capacity to adapt itself to the varying needs of patients. It has a special feature whereby there is a Dialyser inlet blood pressure monitor to prevent blood clotting.

Water Purification Systems at UHS: Reverse Osmosis Units The quality of water used in haemodialysis systems is a key requirement of successful dialysis treatment and must be available at all times. UHS has specifically designed Reverse osmosis units (RO units) making it easy to have an uninterrupted supply of the cleanest possible water for dialysis.

e-newsletter from University Hospital Sharjah

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e-newsletter | January 2016

UNDERSTANDING YOUR HEMODIALYSIS OPTIONS Dialysis is a treatment to filter wastes and water from your blood, allowing people with kidney failure to feel better and continue doing the things they enjoy.

In hemodialysis, your blood goes through a filter outside your body and the clean blood is returned to the body.

HEMODIALYSIS is a medical procedure designed to remove wastes, toxins and fluids from the blood when the kidneys have failed. It is the most common treatment for end-stage renal disease (ESRD), more commonly known as kidney failure. Doctors may recommend hemodialysis if your kidneys have failed and can no longer perform the function of removing waste and extra water from the blood to form urine.

Before beginning dialysis, doctors create an “access.” The access serves as a site, usually in the arm, where blood can be safely removed and returned to the body. The access site is often referred to as the “lifeline.” There are four access options: a fistula, a graft, a subcutaneous device or a catheter.

A permanent access involves the creation of a connection between an artery and a vein under the skin. These are used for patients with renal failure who are expected to need long-term dialysis treatment. The other types of access, catheters and subcutaneous devices, involve direct placement of a tube into a large vein in the neck, chest or groin. These are used for those who need short-term dialysis or those who are on long-term dialysis and no longer have a place to insert a fistula or graft.

During each dialysis treatment, two needles are inserted into your access. Each needle is connected to a hollow plastic tube. The dialysis machine pumps blood from the body to the hemodialysis machine by way of a flexible, plastic tube. The blood is cleaned and returned to your body through a second tube and needle. (See picture).

Remember, your kidneys works 24 hours a day, seven days a week

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e-newsletter | January 2016

During the procedure, fluids and waste products are removed from the blood before being returned to the body. The blood is cleaned by a part of the hemodialysis machine known as an artificial kidney or dialyzer, which filters the blood after it has entered the machine. The dialyzer does not completely replace your original kidney’s function.

It might look like there is a lot of blood outside your body. Actually, there is only about one cup of blood in the tubing and dialyzer at any time during the treatment.

Just as people are not normally aware of blood moving through the body, you cannot feel blood being pumped out to the machine. Dialysis machines have many gauges and alarms. You may find this overwhelming at first. The machine makes sure your treatment is safe by monitoring your venous pressure, how quickly your blood moves through the tubing and how much water is removed during the treatment.

Conventional hemodialysis is usually performed three or four times a week.

When will I need to start treatment?

Treatment is needed when someone has stage 5 chronic kidney disease (CKD), or kidney failure. Your doctor can tell your stage of CKD by checking your glomerular filtration rate (GFR). Your GFR can be estimated from the results of a blood test for creatinine, a waste product from muscle activity. If your GFR falls below 15, you are said to have kidney failure (CKD stage 5), and you will need to have some form of treatment to replace the function of your kidneys. If your GFR is less than 30, your doctor should talk to you about the different treatments for kidney failure. Learn all you can to make the best treatment choices for yourself and your family.

How long will each hemodialysis treatment last?

Hemodialysis treatments are usually done three times a week. Each treatment lasts about four hours, but you may need more time to ensure that enough wastes and fluid are removed. The amount of dialysis you need depends on:

How much your own kidneys are working

How much fluid weight you gain between treatments

How much you weigh

How much waste you have in your blood

The type of artificial kidney used by your dialysis center

Your doctor will give you a dialysis prescription that tells how much treatment you need. Studies have shown that getting the right amount of dialysis improves your overall health, makes you feel better, keeps you out of the hospital and enables you to live longer.

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e-newsletter | January 2016

MEET OUR DOCTORS

EXPERIENCE Dr. Adnane has 28 years’ experience in the diagnosis and treatment of acute and chronic kidney diseases, follow-up and care of dialysis patients as well as preparation, evaluation and follow-up of kidney transplant patients. His expertise includes also acute dialysis (CRRT) in intensive care unit, vascular access catheter insertions, and renal biopsy.

He has special interest and expertise in all Apheresis techniques (plasmapheresis, cascade filtration, LDL – Apheresis, Red cell apheresis, platelet apheresis, leukapheresis and photopheresis). He performed the first LDL-Apheresis (1998) in the Arab World, using Cobe ultracentrifugation machine in two patients with familial hypercholesterolemia and the first red cell apheresis (2004) in a patient with sickle cell crisis.

Prior to joining UHS, Dr. Adnane was Consultant Nephrologist and Head of the Nephrology division of King Fahd Military Medical Complex, Dhahran, Saudi Arabia, where he was also involved in renal transplantation from living and cadaveric donors.

Dr. Adnan got his initial training in France and was associated with various hospitals in France including Amiens University Hospital, Lille University Hospital and Roubaix General Hospital.He has authored several scientific papers in peer reviewed journals in the field of nephrology and transplantation and is widely published in medical journals. He is also reviewer for the American Journal of Kidney Diseases. He received an award from the International Society of Nephrology in Sydney for young first author of a poster.

SPECIAL INTEREST

Dr Adnane Guella MD, French Board in Nephrology

Management of Acute Renal Failure.

Management of Chronic Renal Failure.

Management of Electrolyte Disorders.

Management of Hemodialysis Patients.

Evaluation and follow up of Kidney Transplant Patients.

Evaluation and Management of Kidney Diseases.

Hypertension, Diabetic Kidney Disease, Auto-Immune Diseases.

Senior Consultant Nephrologist

LANGUAGE KNOWN English, Arabic, French.

QUALIFICATIONS Dr. Guella gained his MD degree at the Faculty of Medicine, University of Oran, Algeria and completed his French Board in Nephrology (C.E.S; Certificat d’ Etudes Speciales de Nephrologie) from the Faculty of Medicine of Lille, France.

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e-newsletter | January 2016

EXPERIENCE Dr. Amit is an American Board Certified Surgeon from Cleveland Clinic, USA with immense experience in the treatment of vascular disease, performing more than 1100 vascular & endovascular procedures over the last 5 years in the Middle East. These include, the first successful atherectomy in the Middle East as well the first use of a drug eluting peripheral stent. He has also established a successful diabetic foot program.

His clinical interests include mainly endovascular and open treatments of diabetic ischemic feet, carotid disease for stroke prevention, aortic pathology specifically in dissections and aneurysms involving the thoracic and abdominal aorta.

He was the Principal Investigator of the first vascular study in the Middle East, The ABC in PVD study, a multi-institutional study across the Emirates.

Previously he has received a grant for Robotic Surgery, which he pursued at East Carolina University, North Carolina, USA. His research interests involve design and innovation. He designed the “Deep Driver,” for use in deep abdominal surgery.

In his efforts to promote vascular awareness he has given more than 70 talks both locally as well as at international conferences on the topic of vascular disease in the Middle East. In addition he has organized several vascular conferences.

His most recent publication “Handbook of Endovascular Interventions” has recently been published in the US. For his efforts as an educator he received the Resident’s Teaching Award while at the University of Rochester.

He is also associated as the Assistant Professor of Surgery at Columbia University, New York, NY, USA.

SPECIAL INTEREST

Dr. Amit Kumar

Diabetic Foot & Amputation Prevention.

Varicose Veins.

Lymphedema - Leg Pain, Leg Swelling.

Aortic Aneurysms – Open & Endovascular Treatment.

Carotid Artery Stenosis.

DVT (Deep Vein Thrombosis).

Wound Care.

Dialysis Access Surgery.

General Surgery Consultant Vascular Surgeon

QUALIFICATIONS Dr. Amit completed his General Surgery residency at the University of Rochester, Rochester, New York and his Vascular Surgery fellowship at the Cleveland Clinic, Cleveland, Ohio. He is American Board of Surgery certified in addition to being a Fellow of the American College of Surgeons as well as a member of the Society for Vascular Surgery.

e-newsletter from University Hospital Sharjah

LANGUAGE KNOWN English, Hindi

For appointment call +971 6 505 8555 or visit www.uhs.ae

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e-newsletter | January 2016

SCOPE OF SERVICES AT UHS MEDICAL SERVICES

SURGICAL SERVICES

CARDIOLOGY

NEUROPHYSIOLOGY

Anesthesiology

Bariatric Surgery

24-Hour BP Monitoring

Electroencephalogram (EEG)

Aviation Medicine

Ears, Nose and Throat Surgery

24-Hour Holter Monitoring

Electromyography (EMG)

Cardiology

General Surgery

2D/3D Echo

Evoked Potential Test

Critical Care

Neurological Surgery

3D Transesophageal Echo

Brain Auditory Evoked Potential

Dermatology

Obstetrics and Gynecologic Surgery

CT coronary Angiography

(BAEP)

Emergency Medicine

Ophthalmic Surgery

Dobutamine Stress Echo for

Somato Sensory Evoked Potential

Endocrinology

Orthopedic Surgery

Ischemia and Viability Studies

(SSEP)

Family Medicine

Pediatric Surgery

Interventional Cardiology

Visual Evoked Potential ( VEP)

Gastroenterology

Plastic and Reconstructive Surgery

Stress Test

Internal Medicine

Urology Surgery

Treadmill Stress Test

Medical Oncology

Vascular Surgery

Neonatology Nephrology

MEDICAL DIAGNOSTICS IMAGING (MDI)

PATHOLOGY & LABORATORY MEDICINE

Nerve Conduction Studies (NCS)

AUDIOLOGY

Neurology Pediatrics

128 Channel CT Scan with

Biochemistry

Acoustic Reflex Threshold

Psychiatry

Coronary and Cardiac Facility

Blood Transfusion Medicine

Auditory Brainstem Response

Pulmonology

Bone Densitometry

Cytology

Auditory Steady State Response

Rheumatology

Digital X-Ray and Fluoroscopy

Hematology

Cochlear Implant Mapping

Mammography and Guided

Histology

Electrocochleography

Breast Intervention

Immunology

Free Field Audiometry

MRI 1.5 TESLA

Microbiology

Hearing Aid Fitting and Programming

Ultrasound

Phlebotomy

Newborn Hearing Screening

Vascular Interventional Lab

Otoacoustic Emission Pure Tone Audiometry (PTA) Speech Audiometry Tinnitus Evaluation Tympanometry

HEMODIALYSIS

PHARMACY

PHYSIOTHERAPY

AMBULANCE SERVICE

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e-newsletter from University Hospital Sharjah

For appointment call +971 6 505 8555 or visit www.uhs.ae