Dialysis Management, AV Fistula Care & Critical Care CRRT Protocols

1. Modern Renal Replacement Therapies

Dialysis is a life-sustaining medical modality that replicates the essential excretory, fluid balance, and electrolyte regulatory functions of failing kidneys. With state-of-the-art dialysis infrastructure at Fortis Escorts Hospital Amritsar, Dr. Fayaz Ahmad Wani oversees outpatient maintenance hemodialysis, home peritoneal dialysis training, and acute hemodialysis in intensive care settings.

2. Modalities Offered & Supervised

• Maintenance Hemodialysis (HD): High-flux biocompatible synthetic dialyzers, ultra-pure reverse osmosis (RO) water treatment compliant with international standards, automated volumetric ultrafiltration, and individualized anticoagulation protocols (heparin / heparin-free).
• Peritoneal Dialysis (CAPD / APD): Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis utilizing the patient's peritoneal membrane. Ideal for patients seeking independence from hospital visits or with difficult vascular access.
• Continuous Renal Replacement Therapy (CRRT): Continuous Veno-Venous Hemofiltration / Hemodiafiltration (CVVH/CVVHDF) administered in the Intensive Care Unit for hemodynamically unstable patients suffering from septic shock, severe acidosis, or multiorgan dysfunction syndrome (MODS).
• Sustained Low-Efficiency Daily Dialysis (SLED): Extended gentle hybrid dialysis modality bridging the gap between standard hemodialysis and CRRT in critically ill patients.

3. Vascular Access Creation & Lifeline Preservation

A dependable vascular access is universally regarded as the "lifeline" of a hemodialysis patient. Our clinical practice emphasizes:

• Native Arteriovenous (AV) Fistula First: Timely surgical creation (Radiocephalic or Brachiocephalic) performed months prior to anticipated dialysis initiation in CKD Stage 4/5.
• Fistula Maturation Monitoring: Clinical and Doppler ultrasound surveillance ensuring adequate flow (>600 mL/min) and vessel caliber before initial cannulation.
• Tunneled Cuffed Catheters (Permcath): Fluoroscopy or ultrasound-guided internal jugular placement for intermediate-term access with low infection rates.
• Temporary Dual-Lumen Catheters: Urgent emergency vascular access for acute kidney injury or emergent uremic indications.
• Access Surveillance: Routine palpation of thrill, auscultation of bruit, and early detection of venous stenosis or thrombosis to prevent vascular access failure.

4. Quality Indicators & Patient Well-Being

Every dialysis session is calibrated to achieve adequate urea clearance (Kt/V ≥ 1.2, URR ≥ 65%), maintain optimal dry weight without post-dialysis hypotension, normalize electrolyte parameters, and maintain high standards of patient safety in dedicated hepatitis-negative and isolation suites.

Medical Notice: The information presented on this page is for clinical education and patient guidance. Kidney disease, hypertension, and transplant regimens require individualized diagnostic evaluation, serum laboratory monitoring, and physician consultation. In acute emergencies, call 112 or visit the nearest tertiary emergency department.