For an appointment with one of our physicians, please call the physician's clinic

Dr. Ram Chary works with Dr. Shirish Joglekar, Dr. R. Mulay, Dr. Susan Alex and Dr. Murty Narapareddy at West Tennessee Kidney Specialists, 221 Sterling Farms Drive in north Jackson. All are board-certified nephrologists, specializing in diseases of the kidneys.

Working with them at the Access Center are members of Jackson Radiology Associates: Dr. John Crocker,
Dr. Matthew Graham, Dr. Louis Lucas,
Dr. Abdul Quadeer,
Dr. Greg Bruno and Dr. Steven Thomas.

For an appointment at the clinic, call 731.668.4337.

To reach the Access Center, call 731.668.9995.

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Proactive care benefits dialysis patients

 Dr. Steven Thomas, an interventional radiologist, does a procedure on a dialysis patient at the Access Center, operated by West Tennessee Kidney Specialists.

The physicians at West Tennessee Kidney Specialists and the Access Center know that when it comes to kidney failure, it pays to be proactive.

Patients receive better care, end up in the hospital less often and incur lower medical expenses, explained Dr. Ram Chary, a board-certified nephrologist.

That's why the physicians opened the Access Center next door. It provides a cost-effective way of treating dialysis patients who require vascular access procedures.

They've gone beyond that, though. They've become a role model for the national Fistula First Breakthrough Initiative, which was created by the Centers for Medicare and Medicaid Services (CMS).

According to its website (fistulafirst.org), "the mission of Fistula First is to improve the survival and quality of life of hemodialysis patients by optimizing vascular access selection — which for most patients will be an AV fistula — to lower infection, hospitalization and mortality rates while preserving vital Medicare resources."

Fistulas provide access to vein for dialysis
To receive dialysis, the patient must have an access to his veins. The initiative supports the use of AV fistulas to create that access instead of central venous catheters, which can get infected and lead to hospital stays. The CMS found that the hospital stays required by the infections in the catheters were too costly.

Dr. Chary explained that a fistula is created by a surgeon in the hospital outpatient center to connect an artery to a vein so a patient can receive dialysis. The patient's veins are "mapped" with special equipment at the Access Center so the surgeon can select a good vein.

The vein is accessed at two spots: to pull blood from the body and to return the blood after it has been filtered in the dialysis machine. (Dialysis takes on the job of diseased kidneys to clean the blood of impurities.)

"It's a simple procedure," said Dr. Chary, "but it's a lifeline for the patient." The long-term preservation of the fistula is fundamental to the success of the fistula to avoid repeated surgeries, he said.

Patients monitored to detect problems
"We have a surveillance procedure in place that is monitored at all of the DaVita Clinics, which provide the dialysis for our patients."

As soon as a problem is recognized, the patient is immediately sent to the Access Center where trained staff examines the patient and checks the doppler-related flows to verify the problem. The patient is immediately scheduled for an intervention procedure.

"The result is a substantial increase in the preservation of the access," said Dr. Chary. "The patients get better dialysis and have a better quality of life."

West Tennessee Kidney Specialists also works with patients (who eventually will need dialysis) to create the fistula before total kidney failure occurs and dialysis is needed, said Dr. Chary. This gives the fistula time to develop.

The biggest barrier to quality dialysis care is often the patient, said Dr. Chary. "The patient is reluctant to get the fistula; he or she may be in denial or simply misinformed. We're aggressively educating the patient. The result is that our patients are becoming more proactive, too. That's a huge accomplishment."

Angiograms look for leg problems
In an effort to help its patients further, West Tennessee Kidney Specialists also has expanded its services to provide lower extremity angiograms. "We have a significant number of patients who are diabetics with poor circulation of the legs," said Dr. Chary. "With limb checks and the angiograms we can preserve the legs and help prevent amputations."

The clinic also is offering the management of varicose veins, which is open to the general public.
"We are very fortunate to have a highly trained physician staff, as well as a nursing and technical staff."

With the Fistula First initiative, he said, "we're not only preventing hospital stays, we're also preventing infections. We're saving the government money and giving our patients a much better quality of life. This is a timely intervention for our patients."