Renal Transplant & Vascular Access

What is Renal Failure & Dialysis Access?

Renal failure is a serious condition when the kidneys - organs that filter toxins from the body - are unable to remove waste products from the blood stream. The toxins and waste products then accumulate in the blood stream, causing uraemia.

The process of renal failure is slow going, so initially, the kidneys may continue to do some filtering work and are able to compensate for a mild degree of failure. Eventually though, the kidneys are unable to keep the pace and will degrade into chronic renal failure.

Dialysis is the method in which the blood is filtered. It is like having an artificial kidney. There are two methods of dialysis - peritoneal and haemodialysis. Haemodialysis is a filtering of the blood using a dialysis machine. For this, access to the blood via the veins and arteries is required. Dialysis Access is the term for methods used to access the veins and arteries to get a complete flow of blood through the dialysis machine. A highly successful way to access the veins and arteries for dialysis is through the creation of an arteriovenous fistula.

What causes Renal Failure?

Some of the causes of renal failure include:

• Diabetes - even if it is well managed, diabetes can cause kidney damage.
• High blood pressure
• Glomerulonephritis - swelling or inflammation of the tiny filtering units (nephrons) in the kidney
• Polycystic kidney disease - an inherited condition
• Urinary reflux - urine flows backwards into the kidneys, causing sclerosis.
• Medications - some drugs such as lithium and cyclosporin can cause kidney failure.

There are factors that may increase your risk of chronic kidney disease that may lead to renal failure, such as:

• Having diabetes
• Having high blood pressure
• Being obese
• Over 60 years of age
• Having a family history of end-stage kidney disease or hereditary kidney disease in a first or second degree relative
• Having established heart problems (heart failure or a past heart attack) or have had a stroke
• Smoking
• Having a history of acute kidney injury
• Being of Maori or Pacific origin
• Being of Aboriginal or Torres Strait Islander origin

What are the signs/symptoms of Renal Failure?

The early stages of kidney disease are usually asymptomatic. Worryingly, advanced stages of kidney disease can still be asymptomatic, even when up to 90% of kidney function is gone. This is why it is important to detect any renal degeneration early, to prevent kidney failure.

Once symptomatic, kidney disease symptoms can include:

• Tiredness
• Loss of appetite
• Difficulty sleeping
• Headaches
• Lack of concentration
• Shortness of breath
• Nausea and vomiting
• Changes in the amount and number of times urine is passed
• Changes in the appearance of urine or blood in the urine
• Puffiness in the legs and ankles
• Pain in the kidney area

These symptoms can be caused by other conditions, but if you are in a high-risk group for kidney disease, you should speak with your doctor.

How will Renal failure, and Dialysis, affect my health?

Renal failure is a serious condition. Patients with chronic renal failure need lifelong dialysis or a kidney transplant to stay alive.

There is an important distinction between kidney disease and kidney failure. If you have kidney disease, it does not mean that you will develop kidney failure. As mentioned earlier, your kidneys can continue to work at less than 100% for a long time, and if you have kidney disease, you will likely not experience any symptoms until the kidneys are very damaged.

What are the stages of Renal Failure and Dialysis Access?

Renal failure can be acute (happening very quickly and a medical emergency) or chronic (happening over many months, or years).

Chronic kidney disease is when you have lost over 30% of your kidney function. It is a gradual process that happens over the course of many years.

Chronic kidney failure is end stage chronic kidney disease. The kidney no longer functions and dialysis, or a kidney transplant, is required.

Because this process takes a long time, you will likely visit a vascular surgeon and other specialists, who together would have developed a treatment plan in consultation with you.

I think I have Renal Failure – What should I do?

Prevention is key to avoiding renal failure. It is much easier to monitor kidney function throughout your life, than to suddenly find yourself in need of a new kidney! It is almost impossible to know if you have kidney disease or failure without monitoring, until it is very advanced.

If you find a reduction in kidney function during the course of monitoring tests, it is ideal to visit a GP and seek a referral to a Vascular Surgeon.

The SVS Vascular Surgeons can review your medical history, assess your lifestyle and present treatment plans that work best, including information about the most appropriate dialysis access method.

What if I don’t have my Renal Failure treated?

This is unfortunately very simple to answer. Without treatment, either with dialysis or a kidney transplant, you will not survive.

What treatment options does SVS offer for Renal Failure and Dialysis Access?

Sydney Vascular Surgery offers two treatment options for renal failure:

• Renal Transplant
• Arteriovenous Fistula creation & surveillance

Both treatments are surgical, life-extending and do require monitoring for the remainder of your life.

Renal transplant

A renal transplant is a kidney transplant, either from a living or deceased (cadaveric) donor. It is considered a treatment, not a cure, providing a potentially longer and more active life free of dialysis.
At Sydney Vascular Surgery, Dr Vikram Puttaswamy has spent many years working closely with the Royal North Shore Hospital Renal Department and Renal Transplant team and has experience in performing living, cadaveric and Paired Kidney Exchange (PKE) transplants.

You can have a transplant if you are medically suitable. If the transplant is from a living donor, the operation can be done before you need dialysis. The average wait for a kidney from a deceased donor is about four years.

Preparing for organ donation surgery is a complex and time consuming process. It is important and it is life-changing. By the time you see a vascular surgeon in the presence of chronic kidney disease or kidney failure, you are already accustomed to seeing many specialists and you will already have an excellent idea of what type of transplant you are to be treated with.

If you are visiting this site today and you are not a registered organ donor, we strongly encourage you to reconsider. If you would like more information please visit Donate Life.

Arteriovenous fistula creation and management

An arteriovenous fistula is a direct connection between an artery and a vein that is created in a surgical operation. The connection is made so that the vein enlarges over a period of weeks, with the aim to make the vein larger, and the vein wall tougher, to be able to withstand future dialysis needle punctures.

The vein increases in size because arterial blood at a higher pressure is now flowing through the vein. The vein wall toughens (matures) over a few weeks or months.

When dialysis is required needles are inserted into the vein and connected to a dialysis machine. The blood leaves the body through one needle, is filtered through the dialysis machine, and returns to the body through the other needle.

An arteriovenous fistula can be created using native veins (called ‘autogenous fistulae’) or with the use of a synthetic material such as gortex or PTFE (called a ‘PTFE forearm loop’). Autogenous fistulae are referred as they are likely to work for longer and require less maintenance.

Arteriovenous fistulas are most commonly created in the arm or leg. Arm fistulas are much more common than in the leg. It is preferable to locate the fistulae as low on the arm as possible, closest to the hand, and on the non-dominant arm.