Kamal Shah

Kamal Shah

Hello, I'm Kamal from Hyderabad, India. I have been on dialysis for the last 13 years, six of them on PD, the rest on hemo. I have been on daily nocturnal home hemodialysis for the last four and half years. I can do pretty much everything myself. I love to travel and do short weekend trips or longer trips to places which have dialysis centers. Goa in India is a personal favorite. It is a great holiday destination and has two very good dialysis centers.

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Sunday, 22 April 2012 06:36

Pump up your dialysis speed!

One of the most important factors in the quality of your dialysis is the dialysis pump speed. This is the speed at which the dialysis machine draws blood from your arterial line, puts it through the dialyzer or the artificial kidney and then returns it to your body through the venous line.

The higher the blood pump speed, the better your blood gets cleaned by the artificial kidney. This is mainly because with higher pump speeds, more blood gets drawn and put through the artificial kidney which allows the artificial kidney to remove more and more toxins from the blood.

This is a picture of the blood pump from a Fresenius 4008S machine and the number '195' in the picture is the pump speed.


So, as someone on dialysis, it is in our interest to have the highest blood pump speed that our body and vascular access can tolerate and is required. Note that this is true only for people on conventional in-center dialysis who come twice or thrice a week. For those on daily dialysis, the pump speed can be lower to give a more gentle dialysis.

Many people complain that they do not feel 'good enough' on dialysis. This could be because they are not getting enough clearance or not enough toxins are being removed by dialysis. Ideally of course, the frequency of dialysis or the duration of the session must be increased. But if that is not possible, the next best alternative is to increase the blood pump speed. This will result in increased clearance and the person feels better.

Technicians and nurses sometimes do not risk high blood pump speeds because it can lead to some complications. However, they should gun for the highest pump speeds that the patient can tolerate. The pump speed must be gradually increased and if the patient does not complain of any problems and good flows are obtained (no air bubbles appear in the arterial line), then the pump speed is all right.

A word of caution though: every change in pump speed must be signed off by your nephrologist as every individual is different and may have different conditions (especially cardiac related) which may necessitate a different line of action.

But this is something definitely worth considering and talking about with your nephrologist and your technician or nurse.

... http://www.kamaldshah.com/2012/04/pump-up-your-dialysis-speed.html

There is some very exciting and unexpected news for us dialysis patients! Dr. Victor Gura's Wearable Artificial Kidney (WAK) is soon going to be undergoing clinical trials. Under the United States FDA's new Innovation Pathway Program, this device among three devices in all have been selected for accelerated evaluation to bring them to the market.

To be very honest, I did not expect this to happen for a few years. But to mine and everyone else's surprise, this program was recently announced and the WAK was one among the devices chosen! More details on how the clinical trials are going to be held are given in Dr. Peter Laird's blog here. I quickly did the math on the slide on Dr. Laird's blog and found that in less than a year the clinical trials are going to be completed. That is of course, assuming that the different stages will happen immediately one after another. That may not be the case. Two years maybe, then? Still not bad!

Here is a picture of the WAK:


When I put the WAK on the Cover Page of the first edition of the Quarterly Newsletter of the Hyderabad Kidney Foundation, I was accused by many of giving false hope to dialysis patients since the device was believed to be decades away from use by people like you and me. So, now you see? The hope was not false! But seriously, at that point even I believed it was decades away myself and said as much in my write up in the newsletter.

Who knew that the FDA would bring up such a scheme and endeavor to bring these life changing devices to the people much sooner?

How soon would the device be now available for people like you and me? Well, I would think about two years in the US and ten years in India. Considering that the NxStage System One is still not available in India despite being available in the US for years now, I am still pessimistic about the availability in India. However, on the positive side, the device is small enough to be picked up from a shop! So, like the iPad which my brother picked up for me on a trip to the US, this device too might just be picked up on a similar trip. Prasan, are you listening? :-)

... http://www.kamaldshah.com/2012/04/hope-on-horizon-for-dialysis-patients.html

Tuesday, 10 April 2012 22:00

Dialysis pricing conundrum

Should dialysis prices be high or low? A simple question like this can confound nuts like me!

As a patient, I feel pricing should be as low as possible. It is, as it is, an expensive treatment. How can ordinary people afford the treatment if the prices are too high?

However, if prices are too low, can quality really be maintained? Can people who value quality and are interested in providing quality remain in business if the prices fall too low? Yes, this may seem like a lame argument from someone who earns his living from dialysis. But think about it without being biased. It is true.

There are dialysis providers at both ends of the spectrum and many in between. The problem comes when people start expecting quality from the low priced providers and low prices from the quality providers. The unfortunate truth is both quality and low price are simply not possible together.

We must remember a simple truth. Businesses are here to make money. Whether it is the restaurant business, the movies business or the healthcare business. Everyone is there in it for the money. Despite tall pretentions of doing good, the primary motive is money. Satisfying taste buds might be a by-product. Entertaining people might be a by-product. Providing quality healthcare might be a by-product. The primary motive is to make money. Neither the providers nor the customers should ever forget that.

When it comes to charity organizations, we must remember the primary motive is not quality. The primary motive is to benefit as many people as possible. The primary intention is to reach people who need the treatment. So, you cannot expect any frills. You should be happy to get the basic dialysis treatment. Which is also all right because at least people continue to get dialysis. People, who otherwise might have died from lack of dialysis are alive because of this.

When we accept these two aspects, the rest follows easily.

... http://www.kamaldshah.com/2012/04/dialysis-pricing-conundrum.html

The guy in the car at the traffic signal continued to honk. People continued to rush to work.

Not one thing changed because Chandrashekhar died.

The smiling 20-something year old on dialysis finally lost his battle with kidney disease. It struck me as weird that I was at a party that evening. It struck me as weird that people around me were all having a ball. The cake was cut. Snacks were served. There was laughter all around.

Not one thing changed even though Chandrashekhar died.

For Chandrashekhar, it was the end. That was it. There was no more. His entire life had ended. For the management at his dialysis center, his name got added to a report. A certain count got increased by one. And everyone moved on.

Not many of us realize how the world simply continues to function even after someone dies. After someone I have known dies, I find it very strange that birds continue to fly in the sky as if nothing has happened. People on the road go about their daily chores like nothing has changed.

For the individual however, it is all over.

As I keep hearing about one loss after another, all I feel is lead in my heart.

... http://www.kamaldshah.com/2012/04/winds-continued-to-blow-sun-continued.html

Tuesday, 03 April 2012 20:56

NephroPlus comes to Bangalore

NephroPlus launched its first center at Bangalore in Koshy's Hospital in Ramamurthy Nagar. The unit has come out really nice and we feel it is one of our best units so far. We're starting with ten machines.


This is a huge step for NephroPlus as it is our first unit outside the state of Andhra Pradesh. Managing units in one state is fine but the moment you start talking about two states, things are entirely different. Yes, even though we moved out of the city of Hyderabad a few months back by launching our Mahbubnagar unit, starting a unit in a different state is a different ball game altogether. You not only have to manage a different geography, you have to also be sensitive to a different culture.

The biggest challenge in my opinion would be imbibing NephroPlus values and the NephroPlus culture into the team at Bangalore. The technicians and nurses have typically been working at different units and have their own thoughts and processes. It is imperative that they learn our ways and get assimilated into our culture. The founders being physically away from the unit is not going to make this task easy!

As NephroPlus grows, I cannot help drawing comparisons to Effigent. The difficulties are similar. In Effigent too, we started off from Hyderabad and then opened an office in Bangalore. The difference in  cultures was stark. Assimilation did not quite happen.

In NephroPlus however, we have a specific plan to address this and hopefully we will. How we are able to do this will largely dictate our plans for other states we have lined up as well.

Our team is very excited to take on this new challenge and we strongly believe we will be successful!

... http://www.kamaldshah.com/2012/04/nephroplus-comes-to-bangalore.html

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