5 reasons renal patients should consult a radiologist before going dialysis-dependent

More and more people are being diagnosed with end-stage renal disease (ESRD)—a condition that, without dialysis, can lead to death within weeks—and those patients need radiologists more than ever, Sandra O’Rear, BSN, RN, and colleagues wrote in the Journal of Radiology Nursing.

In JRN, O’Rear and her co-authors discussed the value radiologists can add to the nephrology-dominated setting of ESRD, especially when they collaborate with surgeons and nephrologists themselves. This is why they think dialysis patients should pay attention to the imagers on the sidelines.

1. Radiologists are there from the beginning.

It’s a specialization with a reputation of little patient interaction, but radiology plays a huge part in determining a patient’s vascular access placement—one of the first steps in treating ESRD. Whether a patient opts for arteriovenous fistula, arteriovenous graft or tunneled dialysis permacath, nephrology staff need to work closely with radiologists during the planning, creation, monitoring and maintenance stages of vascular access.

2. Think their job is over once your vascular access is in place? Think again.

Nephrology teams work with radiologists to continuously assess and monitor the maturity of arteriovenous (AV) access, O’Rear and co-authors wrote. Early cannulation of an immature AV access could mean infiltration, hematoma, pain or shortened AV access usage, and an access’s lifetime is already tenuous. When something as simple as wearing tight clothes or lifting heavy objects can shorten that AV access’s lifespan, it’s important to have multiple specialties monitoring its progression.

“It requires a great amount of teamwork between the nephrology and radiology teams to help ESRD patients to maintain their vascular access and reach their optimal condition,” the authors wrote.

3. Nephrologists can’t know everything.

Quality of care is an important factor in patient satisfaction and practice rankings, especially in today’s medical climate. For the most advanced care regimens, dialysis patients will be referred to not only nephrologists, but radiologists, dialysis nurses and vascular surgeons. And having a diverse team of experts who can collaborate to problem-solve means renal disease patients are better equipped to confront complications and emergencies.

4. Radiologists are one of your first lines of defense in any hemodialysis emergency.

When it comes to compromised dialysis access, clinicians have three options: percutaneous transluminal angioplasty, surgical treatment and fistula declot, or thrombectomy. In the case of angioplasty, O’Rear et al. wrote, the thrombosed autogenous and graft fistula need to be treated by either interventional radiology or surgery. Some surgical approaches might require less imaging expertise, they said, but in the case of recurrent stenosis a patient should be referred to radiologists, who can treat with or without stent placement under imaging guidance.

5. They could be with you for awhile. 

When it comes down to it, the authors added, more than 660,000 Americans are being treated for ESRD in 2018, and nearly half a million are undergoing hemodialysis. With that number expected to grow with the rise of obesity and diabetes, radiologists will need to ensure patient safety for years to come.

“Quality of life for the long-term hemodialysis patient can be greatly enhanced by reliable vascular access,” O’Rear and colleagues wrote. “Close collaboration between nephrologists and radiologists is required for optimal and timely management of the long-term hemodialysis patient.”