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Overview

Dialysis - Treatment, Procedure And Side Effects

What is the treatment?

A healthy kidney has the function of filtering around 1500 liters of blood every day. If the kidneys fail to work properly, waste can accumulate in the blood. This can lead to serious health issues, resulting in coma and even death.

When the kidneys cannot function properly, a person needs to undergo dialysis to keep his/her body in balance. Dialysis performs the of your kidneys until they are functional. The process of dialysis removes waste, salt as well as the extra water, thus preventing them from accumulating in your body. It also ensures to keep certain chemicals in the blood like sodium, bicarbonate, and potassium within optimal levels. Lastly, dialysis also helps in controlling the blood pressure.

Dialysis is mainly of two types; hemodialysis and peritoneal dialysis. In hemodialysis, a hemodialyzer (artificial kidney) is used for removing the waste and extra chemicals from the blood. The peritoneal dialysis involves a surgery where a catheter is implanted in the stomach area, and a fluid named dialysate flows into the abdomen. This fluid draws out the waste from your abdomen after which it is drained out.

A dialysis can be done in the dialysis unit of the hospital or at your home. The doctor decides on the location based on your preferences and the status of your condition.

How is the treatment done?

There are mainly two types of dialysis treatment that a patient can undergo:

  • Hemodialysis – This is the most common form of dialysis. The doctor creates an incision so that the blood can flow to the artificial kidney or the hemodialyzer. The entrance point is made by creating a small incision in the arm or the leg. It can also be done by joining one of the arteries to a vein under the skin in order to make a bigger blood vessel known as a fistula. This surgical entrance point allows a large amount of blood to flow from your body during the treatment. As a result, more blood is purified and filtered. This treatment usually lasts for three to five hours. A patient is generally required to undergo a hemodialysis thrice every week. This option generally works for people who require long-term treatment.
  • Peritoneal Dialysis – This treatment involves implantation of a catheter in the area around the belly through which the fluid is administered to your body. The dialysate fluid draws out the waste from the blood, and then the waste is drained from your abdomen. Peritoneal dialysis can be further classified into two types. One is the Continuous Ambulatory Peritoneal Dialysis, where the abdomen is filled and drained multiple times in a day. The other is the Continuous Cycler-Assisted Peritoneal Dialysis, where a machine is used for cycling the fluid in and out of the abdomen. It is generally done at night when the patient is sleeping.

Who is eligible for the treatment? (When is the treatment done?)

You may need to undergo dialysis in the following conditions:

  • If you are suffering from a chronic kidney disease, you may require dialysis treatment until the time you decide to go for a kidney transplant.
  • Some people opt for dialysis if they come across symptoms of kidney failure like swelling, fatigue, nausea or vomiting.
  • When the results of your lab tests show high levels of waste in your blood. The rise in the blood urea nitrogen level and the creatinine level are indicators of poor performance of the kidneys.

Who is not eligible for the treatment?

Dialysis is usually not recommended for the following people:

  • Those who have some major illness apart from a damaged kidney like a heart or a lung disease
  • Peripheral artery disease of the legs, where your arteries become narrower and decrease the blood flow to your legs

Are there any side effects?

Dialysis can have the following side effects:

  • Weakening of the abdominal muscles
  • Gaining weight
  • Muscle cramping
  • Difficulty in getting sleep
  • Itching
  • High blood sugar due to the presence of dextrose (sugar) in the fluid (dialysate)
  • Depression
  • Low blood pressure
  • Increase in the blood potassium levels
  • Pericarditis, a condition where the membrane around the heart gets inflamed
  • Amyloidosis, if you are undergoing a long-term dialysis treatment. In this condition, the amyloid proteins that are produced in the bone marrow builds up in the liver and the kidneys. It can cause swelling, joint pain, and stiffness.

What are the post-treatment guidelines?

Listed below are some of the post treatment guidelines of a dialysis patient:

  • You must be careful about what you are eating and drinking. Take the advice of your doctor regarding the amount of protein, salt, and fluid that you are supposed to consume.
  • Avoid smoking, drugs or the consumption of alcohol that can affect the condition of your kidneys
  • Check for redness, swelling or pus at the incision site that has been made. If you see any of these signs, consult the doctor.
  • Ensure that the bandage covering the catheter is dry and clean
  • The person who helps with your treatment must always wash their hands properly before helping

How long does it take to recover?

The recovery time after undergoing a dialysis varies from person to person. For some it can be 2 hours, for some it is 4 to 6 hours and for few, it takes almost 12 hours to recover completely after the treatment.

What is the price of the treatment in India?

The cost of getting a hemodialysis can vary from Rs. 12,000 to Rs. 15,000 per month. A peritoneal dialysis can cost between Rs. 18,000 to Rs. 20,000 per month.

Are the results of the treatment permanent?

Dialysis can improve the condition of your kidneys and the quality of your life if the damage is in the initial stages. After a few sessions, you can stop the treatment. In the case of a chronic disorder, there is a possibility that you may need to undergo dialysis for the rest of your life.

What are the alternatives to the treatment?

There are no alternatives to the treatment of dialysis.

Safety: Medium Effectiveness: High Timeliness: Medium Relative Risk: Medium Side Effects: High Recovery Time: Medium Price Range: Rs. 12,000 - Rs. 20,000

Popular Health Tips

Undergoing Dialysis - What Should Be Your Diet?

MBBS, MD - General Medicine, DM - Nephrology, DNB (Nephrology)
Nephrologist, Delhi
Undergoing Dialysis - What Should Be Your Diet?

Every organ is important for the human body to perform its functions normally. Kidneys too are vital and are responsible for removing the excess fluid and toxins from the body. If the kidney is not functioning properly, then the patient is advised to undergo dialysis treatment. In some cases, the patient is advised to undergo a transplant. However, in any case, the patient has to follow a healthy diet, for the treatment and the medicines to work positively.

Suitable diet during dialysis
Most of the patients are not aware of the diet prescribed for dialysis. Though it is always advised to consult a dietician before following any diet for the condition, it is also advisable to gain some knowledge about what the dietician might suggest, so that one is not clueless about the treatment. In a majority of the cases, food containing potassium, phosphorus, low-fat cholesterol, and sodium is included in the diet of these patients. However, these are prescribed in a limited amount and vary from patient to patient.

  1. Sodium: The sodium level of the dialysis patients needs to be controlled; and this can be done by eating food items that have a low sodium content, not more than 2,000 mg. Hence, the quantity of snacks, pudding, and chips are to be reduced in the diet chart.
  2. Potassium: The level of potassium also needs to be kept in check to avoid further deterioration of the kidney. Bread, certain vegetables, and grains contain a high amount of potassium. Moreover, various salt substitutes contain potassium chloride instead of sodium chloride. Large intake of these foods may affect the kidney permanently. Hence, these are majorly excluded from the diet. The patients are advised to include tomatoes and bananas in their diet, though not on a daily basis.
  3. Phosphorus: The patient is advised to avoid foods with high phosphorus. This includes milk and dairy products and grains. However, while on dialysis, meat is important as it gives enough protein despite being high on phosphorus. But, an abundance of meat in the diet may affect adversely. Hence, this is advised, but kept in control.
  4. Cholesterol: To keep cholesterol amount in check during dialysis, the patient needs to cut down on fruits and vegetables and specific fat diets, while eating a sufficient amount of fish.
  5. Protein: High protein food is necessary for a patient with a kidney disease. Meat is an excellent source of protein. Along with that, poultry, fish, and eggs are important, as well. Hence, all this is included in the diet.
  6. Fluids: Dialysis helps in removing the excessive waste fluids from the kidney. But, to keep the body hydrated, the patient is allowed liquid intake, but only up to a certain limit.

It is necessary to maintain a proper diet during dialysis, as it quickens the treatment as well as helps the patient recover quickly.

2 people found this helpful

AV Fistula - Why It Is Used In Dialysis Process?

MBBS, MS - General Surgery, Fellowship in Vascular Surgery, Ted Rogers Fellowship
Vascular Surgeon, Delhi
AV Fistula - Why It Is Used In Dialysis Process?

The human circulatory system is a highly complex and well-orchestrated system designed with two sets of channels. The arteries are a chain of vessels which carry oxygenated blood to all parts of the body from the heart. The venous system, on the other hand, carries impure or deoxygenated blood from each of the end organs to the heart. These start from minute branches in the distant parts of the body and gradually grow in size until they reach the heart.

These two channels do not interact unless either created artificially or in disease conditions. Naturally, these could be due to developmental anomalies or as a result of an aneurysm and would require a surgical correction. The AV fistula is, however, commonly created naturally in people who have to undergo hemodialysis.

Why an AV fistula: Generally, an artery in the forearm is sewn into a vein in the forearm. This AV fistula may take about 4 months to heal or mature, and a needle is then inserted into the vein during dialysis. When an AV fistula is created, there is a decrease in the peripheral resistance as the blood does not have to exert as much pressure as before, and there is an easy movement of blood into the veins.

How to care for it:

  1. There could be initial limitations on the amount of weight that can be lifted
  2. Keep the dressing in place for 1 to 2 days
  3. Do not sleep on the fistula arm
  4. Do not wear jewelry on the arm
  5. Always wash hands before touching the access
  6. Avoid lifting heavy objects using the hand
  7. Avoiding damage to the arm like cuts or bruises
  8. Regular checking for the pulse or thrill in the arm
  9. Monitoring for signs of infection (redness, blood clots, swelling, pus formation, etc.)

Advantages:

  1. Uses the body’s own blood vessels, no artificial material (as in catheter for instance)
  2. Reduced chances of clotting
  3. It provides good blood flow for dialysis
  4. Is more effective than other types of access (graft or catheter)
  5. Lesser complications compared to other access types
  6. Is done on an outpatient basis and are less expensive
  7. Usually last longer than other access methods

Disadvantages:

  1. Longer maturity time (sometimes up to 4 months), so are not available for ready use
  2. Stenosis or narrowing of the vessels is common, sometimes leading to blood clots.
  3. If they fail to mature, a fresh fistula may need to be created
  4. Usually created on the forearm, so are quite visible

In case you have a concern or query you can always consult an expert & get answers to your questions!

3126 people found this helpful

Dialysis - What To Eat & What To Avoid?

FISN, FISPD, MD - General Medicine, MBBS, DM
Nephrologist, Delhi
Dialysis - What To Eat & What To Avoid?

A dialysis diet is a special diet that is customized for patients who are or will be starting dialysis within a short period of time. Such a diet is prepared to reduce the waste and fluid levels that keep on accumulating between the dialysis sessions so that the patient remains healthy for the process to be carried out seamlessly.

What can you eat?
Eat foods which are rich in high-quality proteins (poultry, fish, lean meat and egg whites).

What can’t you eat?
Eat less of foods which are rich in sodium and phosphorus.

Foods high in Sodium
1. Use minimum salt in preparing the dishes; this helps control BP and probable weight gain that might happen between the dialysis sessions.
2. Make use of spices, herbs and other salt-flavored enhancers.

Meat
1. Patients on dialysis need to include more of high-quality protein foods in their diet. This will help regulate blood protein levels. Eat about 10 ounces of foods rich in high-quality protein every day.
2. 1 egg, ¼ cup of ricotta cheese, ¼ cup of tuna.

Salads/Vegetables

  1. The potassium content of vegetables can be alarming for a patient on dialysis. Eat 3 servings of vegetables that are low in potassium every day. These include broccoli, cauliflower, cabbage, carrots, garlic, cucumber, eggplant, celery, radishes, etc.
  2. Avoid vegetables such as beets, potatoes (in any form- wafers or wedges), winter squash, cooked spinach, pumpkin, asparagus and avocado.

Note:

  1. Although seeds, nuts, peanut butter, lentils, dried beans and peas are rich in protein, they are generally struck off from the diet plan because of their high phosphorus and potassium content.
  2. You can have moderate amounts of grains, bread and cereals.
  3. Try and not have brown bread and other whole grains as they are loaded with phosphorus.
  4. Usually, 5-10 servings of these are considered sufficient for patients on dialysis.
  5. Also, limit intake of milk and other dairy products.
  6. ½ cup yoghurt or ½ a cup of milk is considered safe. Also, remember that all varieties of milk- skim, whole and low fat, have the same amount of phosphorus.
  7. All fruits contain some amount of potassium. However, some of them contain more potassium than the others. Limit your intake of fruit juices.
  8. Avoid or limit fruits like: 
  9. Orange juice and oranges
    • Kiwis
    • Prune juice and prunes
    • Dried fruit and raisins
    • Melons
    • Bananas

In case you have a concern or query you can always consult an expert & get answers to your questions!

2581 people found this helpful

Undergoing Dialysis - What To Expect From It?

MBBS, MD - Internal Medicine, DM - Nephrology
Nephrologist, Bangalore
Undergoing Dialysis - What To Expect From It?

The kidneys are the purifiers of the body; they help in removing the waste from the body through the urine. In those suffering from kidney diseases, the function of the kidney is affected, and so their ability to clear out waste from the body is reduced and completely lost gradually. However, waste continues to form, and therefore, such patients have to undergo dialysis, where the blood is purified through an external device.

The frequency and duration of the dialysis would depend on how effectively the kidneys are still functioning and how much waste has been formed from the time of the previous dialysis session. The person’s overall body mass index (BMI) and the water weight gained are also considered.

Once it is decided that a person’s kidneys are damaged and dialysis is required, the person has to prepare for a long-term process. The following outlines what to expect before, during, and after the dialysis sessions.

Before the session:

Since most people prefer to get it done at a dialysis centre, it is preferable to plan for it, three treatments a week on an average, with each session lasting about 4 to 4 hours.

During the session:

  1. The blood flows through the dialysis device, which acts as an artificial kidney. The sequence of events are as follows:
  2. The Weight is checked
  3. Vital signs, including heart rate, blood pressure, breathing and pulse are checked.
  4. The access areas are washed, and needles are used to connect these areas to the dialysis machine. Anesthesia may be used in the beginning to reduce the pain in this area.
  5. The same access areas are used for each session, and over a period of time, buttonholes are formed which is like a small tunnel.
  6. Though the session would last about 3 to 4 days, normal activities can be done, including reading, working on a laptop, watching television, or even sleeping.
  7. Once the dialysis session is complete, the tube will be removed and a dressing is placed over the site.

After the session

The same site is used each time for the dialysis, so for the first couple of sessions, there could be discomfort. There could also be nausea, diarrhoea, cramping, and headaches.
The treatment needs to be adjusted based on symptoms, so please let the doctor know if you experience any symptoms.

Call the doctor if you are facing the following:

  1. Bleeding from the access site
  2. Inflammatory signs around the site
  3. Persistent fever of over 104 degrees
  4. Numbness or weakness in the arms
  5. Confusion, drowsiness, or cognition problems

Though initially uncomfortable, once you get into the dialysis schedule, you will notice the difference of how cleansed you will feel after each session.

In case you have a concern or query you can always consult an expert & get answers to your questions!

3584 people found this helpful

Chronic Kidney Disease - Understanding The Stages!

DM - Nephrology, MD-Medicine, MBBS
Nephrologist, Delhi
Chronic Kidney Disease - Understanding The Stages!

Chronic kidney disease is categorized under various stages and your doctor will periodically assess the severity of kidney damage. Thankfully, the good news is that kidney disease progresses slowly and early detection will help to deter further complications.

How stages of Chronic Kidney Disease are Determined?
The stages are determined by glomerular filtration rate or GFR that measures kidney function. The glomerular filtration rate is a calculation that estimates how well the blood is filtered by the kidneys. It is usually calculated using a formula that takes into account the individual’s age, gender, race and serum creatinine levels. The lower the GFR, the worse the kidney function and more the damage. 

Five Stages of Chronic Kidney Disease
The National Kidney Foundation has created a guideline for nephrologists to help identify the severity of kidney damage and provide the right care accordingly. Each stage calls for different tests and treatments:

Stage  Description GFR What Can Be Done
Stage 1 Early kidney damage 90 or above The exact cause of the kidney disease will be determined by your doctor. Your blood pressure and sugar levels are to be constantly watched out for. Opt for a kidney-friendly diet.
Stage 2 Mild kidney damage 60 to 89 Continuously monitor your condition and check how quickly the disease is progressing. Manage high blood pressure and diabetes.
Stage 3 Moderate kidney damage 30 to 59 Any complications like anemia, bone disease will be checked and treatment will be administered by your doctor
Stage 4 Greater kidney damage 15 to 29 Continue treatment and monitoring. If you are progressing towards kidney failure, consult the best treatment options you have based on your condition
Stage 5 Kidney failure Below 15 Start dialysis, consider kidney transplant and choose the right treatment

How is Chronic Kidney Disease Treated?
The first step is to determine the cause of the disease and then take the right measures to alleviate it. In most cases diabetes and high blood pressure are the prime reasons. So, simple lifestyle changes can help to prevent the progression of the disease and reduce your symptoms. Here’s what you can do:

  1. Follow a diet that is easy on your kidneys: Watch your protein and sodium intake. Drink the right amount of fluids and incorporate super foods that will not deter your kidney function
  2. Weight ManagementMake exercise a routine part and find the right exercise program that works for you. The more active you are, the lesser health problems you will have
  3. Avoid tobacco, smoking and alcohol

The first four stages of chronic disease focus on preserving the kidney function for as long as possible. The stages will help you analyze where you stand and what can be done to prevent kidney failure.

In case you have a concern or query you can always consult an expert & get answers to your questions!

2017 people found this helpful

Popular Questions & Answers

Hi Sir, I am in confusion Sir my dad is kidney patient having dialysis weekly because of diabetes he had lost one leg now he's normal we consulted doctor for artificial leg he had suggested for cardiologist appointment. For fitness test We also done Echo and ECG. Already his blood pumping bit low. In result echo there's bit block there's no problem now. Doctor said if you do angiogram test we can clarify but his creatine level is not normal. Help us sir we don't know what to do.

MBBS, CCEBDM, Diploma in Diabetology, Diploma in Clinical Nutrition & Dietetics, Cetificate Course In Thyroid Disorders Management (CCMTD)
Endocrinologist, Hubli-Dharwad
Mr. lybrate-user, Thanks for the query. I have seen the details given. The case seems fairly complex, in such a situation only the concerned doctors can advise what has to be done and what is appropriate. Please follow the cardiologist's advise. Thanks.
1 person found this helpful

Sir! Currently my father is on dialysis thrice in a week since 2 months ago. He had done checkup 2 days ago and the reports was s.creatine 5.9 & blood urea 90 Mg/Dl. Initially he has 7.9 creatine level & 149 mg/Dl. Any possibility to get normal and avoid kidney dialysis?

MBBS, MS - General Surgery, Diplomate of National board in Surgical Oncology
General Surgeon, Kolkata
Hi lybrate-user its unfortunate thay yur dad is undergoing the rigots of treatment the reports imply end stage renal disease Unfortunately dialysis is the only option wel discuss the option of a renal transplant with yur nephrologist as he might require it in near future. Dialysis is life saving and there are no slternate options to it thsnks.
1 person found this helpful

Hi, My grandmother who is 75 years old is on dialysis for the past 1 year. She has had history of knee problems (like pain, swelling etc) for the past 20 years but the general massage and medications were followed. Recently for the past 1 week, one of the knee is hurting very badly even when she is sitting (we suspect it might be due to wrong massage). There is swelling on that knee too. We got her examined in one of the hospitals in gurgaon and they suggest knee replacement to be done as the pain killers are not subsiding the pain. She is old, has 2 dialysis every week and so we are not sure if it would be the right decision or not. Also, in order to proceed with the surgery, the doctors here have conducted two dialysis within 24 hours so that her parameters are stable. Could you please suggest what should we do?

DM - Nephrology, MBBS Bachelor of Medicine & Bachelor of Surgery, MD - Medicine
Nephrologist, Gurgaon
Dear Lybrate user, from what I can understand your grandmother is already a patient of ESRD and on dialysis. Such patients are quite high risk for any surgery and especially a major surgery like knee replacement. So for once conservative measures should be tried. Also during dialysis we do give injection heparin which is a form of blood thinner and as you are saying some massage or manipulation was done hence there is also a chance of bleeding into the joint or hemarthrosis which can cause increased pain swelling and pain. There are also conditions which are related to severe renal failure and might not improve with replacement. Hence a proper evaluation should be done before going ahead with a major surgery.

I want suggestions regarding if kidney is in last stage as suggested by doctors then whether I have to put patient on dialysis or not.

MBBS, MD - General Medicine, DM - Nephrology
Nephrologist, Delhi
Hello, end stage renal disease is defined when the kidneys are functioning <15% of its capacity. whether you need dialysis at present depends upon a number of factors. if you are eating well, there is no breathlessness and your potassium and acid level are within acceptable range, you can wait. however, you should be ready for need of dialysis in future, if it arises. you should be prepared and have a av fistula made at earliest and get vaccinated
1 person found this helpful

Hello My father age 62 suffering by sugar, lever apcess and 80% kidney damage is there any treatment which can stop Dialysis stage. Is stem cell therapy is helpful.

FISN, FISPD, MD - General Medicine, MBBS, DM
Nephrologist, Delhi
Controlling blood sugars, proper treatment of liver abscess should help in recovering kidney damage and may delay dialysis. Stem cell therapy is still under trial and in experimental basis. It is not indicated for treatment today. You must remain in touch with a nephrologist on regular basis.

Table of Content

What is the treatment?
How is the treatment done?
Who is eligible for the treatment? (When is the treatment done?)
Who is not eligible for the treatment?
Are there any side effects?
What are the post-treatment guidelines?
How long does it take to recover?
What is the price of the treatment in India?
Are the results of the treatment permanent?
What are the alternatives to the treatment?
Play video
Renal Dialysis
Hi, my name is Dr Hmanshu Verma. I am a Vascular and endovascular surgeon.

Dialysis aaj kal bohot he common hai. Renal Failure aaj kal bohot he common hogya hai. Aur ek point pe kidneys certain damage ke beyond hojati hai to uske baad patient ko permanent dialysis ki zarurat hoti hai. Dialysis ke liye normally gale me line daal kar usse blood ko dialysis machine tak lejaya jata hai. Aur clean blood ko wapas body me daalte hai. Lekin unfortunately in lines ko bohot zada der tak body me nahi rehne dia ja sakta hai. Kyuki isse infection ka khatra rehta hai aur sath he yeh lines ander ki nerves ko block karne lagti hai. Iske liye AV Fistula surgery ki zarurat hoti hai. Ideally hume ek aisi khoon ki nass ki zarurat hoti hai jisse khoon ko body se nikal kar dialysis machine tak lejaya ja sake aur wahan se clena blood ko wapas body me daale.

Aisi koi khoon ki nass actual me exist nahi karti hai jiske lie 2 khoon ki artery or vein ko surgery karke aapas me jod dete hai. ise AV Fistula surgery kehte hai. Ek baar AV Fistula surgery karne ke baad 5-6 hafte me vein badi hojati hai size em aur usme khoon ka flow badh jata hai, tab yeh fistula taiyar hoti hai.

AV Fistula surgery baaki surgeries se isliye alag hoti hai kyuki yahan pe koi cheez bana ke dete hai apko jisk baar baar needle daal ke istemaal hota hai. Kisi bhi jagah hum bar bar needle daalte hai to wo 6 months ya saal bhar me damage hojati hai. Isliye we talk in terms of ki AV Fistula ki ek life hoti hai. Isliye agar AV Fistula agar fail hojati hai to doosri AV Fistula ki zarurat padti hai. Agar failed AV Fistula aap sahi samay pe pehchan jaae to fir usko bachaya bhi ja sakta hai. Ek chalti hui AV FSIstula me bhi kahi baar complications ho sakte hai.

AV Fistula ki wajah se kuch patients ko haath me swelling aane lag jati hai. Adhiktar humne dekha hai ki in patients ki jo chaati k ander ki jo nerves hoti hai, unme narrowing hoti hai. Un narrow nerves ki wajah se haath me swelling ane lag jati hai. Aise mareezo ke liye typically Angioplasty ki zarurat padti hai. Angioplasty ke results bohot he acche hote hai aur within 6-8 hours hath ekdam normal hojata hai.

Apne dekha hoga ki bohot baar patients ko yeh boldia jata hai ki apka Fistula nahi kia ja sakta. Hum is tarah ki expertise rakhte hai jin patients ko bata dia jata hai ki koi naya Fistula nahi kia ja sakta hai.

So, har wo patients jinhe AV Fistula ke options mana kardia jata hai, unme bhi kuch na kuch AV Fistula ke options bache hue hote hai, ye thode un common hote hai, normal fistula se thodi badi surgery hoti hai. But since AV Fistula ek Dialysis patient ki lifeline hot hai, un patients ke liye in options ko explore karna bohot he important hota hai.

Baisilic vein transposition and AV Graft, ye bohot he common procedure hai jinko in patients me kiya ja sakta hai. Agar aap in patients me se hai jisnke liye AV Fistula ke raste band ho chuke hai, aap hume contact kar sakte hai Lybrate ke through ya fir aap humare centre pe personal appointment ke liye bhi aa sakte hai.
Having issues? Consult a doctor for medical advice