VASCULAR ACCESS BEFORE DIALYSIS
Early diagnosis and evaluation is key for patients with kidney disease who are candidates for hemodialysis. “Our goal is to evaluate patients well before they need dialysis so we can provide them the proper access and determine if they are candidates for transplant,” says Michael Morris, MD, who heads the Vascular Access Clinic at Nebraska Medicine. Dr. Morris and his team specialize in vascular access surgery, laparoscopic procedures and kidney transplantation.
“One of the leading reasons for rehospitalization for these patients is complications related to their vascular access,” he says. Common complications include strictures, infections, aneurysms, clotting and poor blood flow. “Our team has been doing this for many years. We have the experience and expertise to ensure our patients are receiving the correct type of access, the procedure is performed properly and they are cared for and managed appropriately.” Dr. Morris and his team work very closely with nephrologists in the dialysis unit to determine the best solution for each patient and to minimize complications.
“This is a long-term relationship,” says Dr. Morris. “We are committed to the long-term care and health of our patients. “We understand that the loss of vascular access can mean the difference between life and death for our patients.”
Dr. Morris specializes in placing fistulas, which is the most difficult procedure to perform but it is also the most successful with the fewest problems over the long term, he says. Patients require four to six weeks of healing time after surgery before they can begin dialysis. He also performs catheter access procedures, which are intended for short-term use and should be avoided whenever possible as they tend to injure the veins.
Because the clinic is associated with the Transplant Program at Nebraska Medicine, patients have the benefit of being evaluated for kidney transplant at the same time they are evaluated for vascular access. “In some cases, we can delay dialysis, and at the very least, get the transplant process started while the patient is on dialysis instead of waiting until the patient is in a dire situation,” says Dr. Morris. This is important because unless the patient has a living donor, the transplant waiting time can be up to several years. Many patients qualify as transplant candidates.
The ultimate goal, notes Dr. Morris, is to avoid dialysis whenever possible and to get a patient on the transplant list. But for this to happen, “we need to see patients well before they need dialysis,” he says. “The risks associated with dialysis tend to be far greater than the risks associated with transplant and transplant patients have longer survival rates.”
Early symptoms of kidney disease include protein in the urine, uncontrollable high blood pressure and serum creatinine.
Dr. Morris is also co-director of the Kidney/Transplant program at Nebraska Medicine and associate professor of Surgery at the University of Nebraska Medical Center.