Dr. Nayak is a pioneer in the field of Peritoneal Dialysis (PD) internationally and Cadaver Kidney Transplantation and well known in the areas of Acute Kidney Injury (AKI), Chronic Kidney Disease Management, Critical Care Nephrology including CRRT, Liver Dialysis (MARS & FPSA; Prometheus: Largest series in India). He was responsible for the Country’s first Simultaneous Heart and Kidney Transplantation (SHK). He is also an internationally acknowledged expert in Telemedicine in Dialysis, Reverse ‘Medical’ Innovation & Medical Tourism.

As a member of various Task Forces & Committees, He has developed Best Practice Guidelines for CKD and Anaemia management. He is the Chief Co-ordinator of the Asia Pacific Chapter for ISPD and also a Past Councillor of ISPD. He successfully organized the prestigious 2nd Asian Chapter Meeting of the ISPD, Hyderabad in January 2005 and was also the Co-Director of the 3rd Hemodialysis UniversityTM of ISHD at Hyderabad, March 2014.

He has contributed extensively to International Journals such as KI, AJKD, JASN, NDT, Transplantation Proceedings, PDI, Nephrology, American Journal of Gastroenterology, Contributions to Nephrology, Harvard Business Review, etc. He has authored several invited editorials and book chapters and has delivered invited lectures all over the world, including the ‘Ronco’ meetings in Vicenza, Italy, International Society of Peritoneal Dialysis (ISPD), World Congress of Nephrology, Annual Dialysis Conference USA, International Society of Hemodialysis (ISHD),the prestigious Salzburg Global Seminar to name a few. The Harvard Business Review Magazine cited and applauded his work at Deccan Hospital and mentioned that it had world class outcomes

ABSTRACT

Emergent Start PD in the unplanned ESKD patient: The Way Forward

DR NAYAK

Though there is a heightened interest in urgent start PD(USPD), most studies have addressed only those patients being initiated on PD in the first 14 days after catheter insertion. This can be circumvented if we plan emergent start PD(ESPD) either manual or cycler assisted, immediately on presentation to the ICU.

Non-emergent urgent-start patients will still have to go through the CVC route and undergo HD in the unplanned start patients with attendant infections and other complications. The full benefit of totally avoiding CVC and HD in the unplanned start patients can be had only when we initiate PD immediately on their presentation with an urgent insertion of the Tenckhoff PD catheter by the nephrology team.

The success of an ESPD program is dependent on a multidisciplinary approach to ensure smooth initiation, proper monitoring of the therapy, and seamless transition to long-term PD therapy. This requires team-work with PD nurses coordinating with the ICU staff, renal nutritionists, and the ancilliary hospital resource staff including pharmacy. The assessment of the patient and family support for long-term PD needs are to be assessed on an urgent basis.

Training of the patient and designated “care giver” begins concurrently, before the end of the first week on PD, and depends on whether the choice is of manual PD or APD as the long-term RRT.

However, central to the success of an ESPD program is the passionate nephrologist team, which believes in the utility of such an approach to the treatment of the unplanned RRT initiation in the uremic patient. The advantages of ESPD are manifold and in addition, have seen a quantum leap of long-term PD uptake at our center subsequent to starting the ESPD program.