Kidney disease often arrives bundled with heart and brain disorders.
“To confront this, we must cultivate a deeper understanding and adopt a holistic strategy that blends the strengths of modern medicine with the wisdom of naturopathy.”
When one envisions kidney dialysis, a usual mental image may involve a room occupied by patients resting on rows of beds. However, a different layout awaits at the Hemodialysis Center within MedPark Hospital. Here, we have dedicated private rooms for hemodialysis. These private spaces serve a purpose far more significant than mere convenience.
In this special edition of MedPark Stories, we are honored to host Asst.Prof.Dr Napisvadee Wongchavanich - An esteemed internist specializing in nephrology and the director of our Hemodialysis Center. We invite you to join us for a tour of the center and a thoughtful conversation on navigating the growing challenges posed by the increasing prevalence of kidney disease.
The role of a nephrologist demands a continuous commitment to learning and growth.
Dr Napisvadee shared the story of her inspiration to pursue a career as a nephrologist. Upon graduation from the Faculty of Medicine at Siriraj Hospital, Mahidol University, she had the privilege of encountering a distinguished nephrologist faculty member during her internship.
Recalling this transformative experience, she said, “The visiting professor, who graced us with his presence just once a year for an intensive 5-day teaching session, delved into the intricate realm of renal physiology. Despite its inherent complexity, he had the remarkable ability to render it understandable and captivating. This encounter ignited my passionate desire to embark on a residency program, which led me to the University of Texas Southwestern Medical Center in the United States. There, I had the invaluable opportunity to learn from brilliant teaching faculties.”
Her time in the United States was notable for her significant accomplishments. She earned certification from the American Board of Nephrology and assumed an Assistant Professor of Medicine position at the University of Arizona Health Sciences Center. Her experiences in patient care and education underscore the importance of a nephrologist possessing a well-rounded knowledge base extending beyond the boundary of nephrology.
In her words, “Kidney disease does not manifest in isolation; it frequently coexists with heart and brain disorders. Therefore, we must broaden our understanding to include nutrition, medications, and herbal treatments. Furthermore, adopting an integrative medicine mindset, which embraces a holistic approach uniting the strengths of modern medicine with the wisdom of naturopathy, is essential in providing comprehensive patient care.”
“In the practice of nephrology, many patients bear the weight of chronic conditions that, regrettably, defy a cure. This burden often engenders stress, worry, or even depression. Thus, it is our solemn duty to attend not only to the physical well-being of our patients but also to the delicate state of their minds and spirits. In this endeavor, I embarked on a journey into the realm of psychotherapy upon my return to Thailand. The mind and body are intricately linked, and if it is indeed a matter of mind over body, then the health of the mind profoundly influences the health of the body.”
Moreover, as a proponent of thinking beyond the confines of conventional guidelines, I believe that a nephrologist should question the validity of scientific data, remain vigilant in keeping abreast of scientific advances, and meticulously weigh the implications of treatments on our patients.
Annual checkups can significantly mitigate the risk of dialysis.
Dr. Napisvadee sheds light on the prevailing state of kidney disease, revealing that among every 25 diabetic individuals, one will be on the path to hemodialysis. Alarmingly, a considerable number of diabetes cases go unnoticed, or patients opt to disregard medication and dietary control.
“This predicament bears not only a heavy health burden but also substantial economic implications for Thailand. The government shoulders subsidizing dialysis services, and in 2021, the registered count of dialysis patients stood at approximately 70,000, with an annual addition of ten to fifteen thousand new dialysis patients. Drastically reducing the influx of new cases could translate into substantial cost savings for the government.”
The insidious nature of chronic kidney failure in its initial stages, ranging from stage 1 to 3, is such that it often progresses without any discernible symptoms. Hence, patients typically seek medical attention when the condition has advanced to stage 4 or 5, accompanied by distressing symptoms like fatigue, anemia, and swelling. Unfortunately, by this stage, intervention often comes too late. Dr. Napisvadee strongly emphasizes that even individuals without an existing kidney disease should take preventive measures proactively.
She advises, “Our kidneys naturally deteriorate as we age, and if you are over 50, complacency should not be your course of action. If feasible, annual checkups are strongly advisable. In one poignant case, a patient who skipped checkups for a year and a half found themselves in dire straits, needing dialysis at their next doctor visit. Individuals with comorbid conditions such as diabetes, hypertension, chronic stress, and hyperlipidemia must undergo regular kidney assessments. Once the disease has progressed to stage 4 or 5, the feasibility of slowing its progression diminishes significantly. At these stages, we cannot reverse the failing kidney; it remains compromised.”
Water purity is of paramount importance.
Drawing from her substantial experience as the director of the hemodialysis unit at the Southern Arizona VA Health between 2000 and 2003, Dr Napisvadee played a pivotal role in shaping the Hemodialysis Center at MedPark Hospital upon accepting her position as its director. Her responsibilities extended to the center layout design and the formulation of meticulous management guidelines, adhering to the standards set forth by the Nephrology Society of Thailand and other regulatory bodies. A particular focal point of her efforts lay in the prevention of infection.
She underscored the importance of this focus, explaining, “Patients in need of hemodialysis have severely compromised immune systems, rendering them highly susceptible to infections stemming from subpar water purification systems. Hemodialysis patients who exhibit darkened skin complexion, fragility, and the persistence of intractable illnesses can often trace their troubles back to water impurity during treatment. Such impurity leads to the accumulation of waste products, sparking chronic inflammation and a state of ongoing illness. This stark reality emphasizes the indisputable significance of water purity within a Hemodialysis Center.”
The utilization of pure water in hemodialysis stands as a cornerstone of patient safety and well-being. Within the Hemodialysis Center at MedPark Hospital, we employ a high-intensity dialysis technique known as online hemodiafiltration (OL-HDF), which relies on an ultra-pure water system. Furthermore, the hospital installed two dedicated ultra-pure water systems: one in the Hemodialysis Center and another at the Critical Care Center. Stringent quality checks are performed monthly on these systems to ensure their quality and reliability.
Dr Napisvadee elaborated on the critical distinction, “For ICU patients requiring hemodialysis, many hospitals typically resort to portable reverse osmosis systems to purify tap water. However, the reality often demands that a patient stay in the hospital for an extended period, often 3 to 4 months. Prolonged reliance on water of substandard purity can detrimentally impact patient well-being. At MedPark Hospital, we installed an ultra-pure water system in the ICU, eliminating the need to move critical care patients to the Hemodialysis Center. Such proactive measures are rare in Thai hospitals, underscoring our commitment to patient well-being and safety.”
At the Hemodialysis Center, a commitment to patient well-being extends to single-use dialyzers, specifically the superior-grade super-high-flux and high-flux dialyzers. These advanced filters excel at waste product removal, surpassing the capabilities of conventional alternatives. The single-use dialyzer practice eliminates concerns related to contamination and the inadvertent interchange of dialyzers between patients. While it is inevitable that the equipment and supplies come at a higher cost, the hospital intends to keep hemodialysis fees reasonable and within reach, striving to make high-quality hemodialysis accessible and affordable for the benefit of the Thai community.
Additionally, the Hemodialysis Center extends its services beyond kidney failure treatment, offering a range of extracorporeal treatments. These include the removal of toxins, autoantibodies, and the removal of high blood levels of certain drugs. Notably, these services are available to hemodialysis and non-hemodialysis patients, further underscoring the commitment to comprehensive patient care.
Dedication to infection prevention
Ensuring safety from infection is of paramount importance. In addition to offering private hemodialysis rooms, the Hemodialysis Center is located strategically adjoining the same floor (3rd floor) car park, ensuring that dialysis patients are less likely to mingle with other patients. This spatial arrangement significantly diminishes the risk of infections.
Dr Napisvadee underlined the exacting design of the hospital, stating, “We meticulously crafted the hospital for not only the elegance in mind but also the well-being of our patients. It is purpose-built to safeguard you from infection. For patients facing acute respiratory infections, we erected the EIDARIC Clinic, which substantially reduces the risk of airborne transmission, exemplifying our deep-seated commitment to the welfare of patients, physicians, and every dedicated staff member.”
“In terms of treatment safety, one crucial request I would like to extend to patients and their loved ones is to abstain from eating or drinking during hemodialysis. Removing face masks and engaging in conversation while eating not only elevate the risk of airborne infections but also raises the potential for choking, which could exacerbate their health conditions.”
The treatment process necessitates a collaborative team effort.
Another aspect of undergoing hemodialysis at MedPark Hospital that Dr Napisvadee takes great pride in is the exceptional readiness of the medical team.
She remarked, “If a kidney disease patient faces a sudden health crisis such as chest pain, a heart attack, neurological issues, or infections, our team of specialists is readily available to take immediate action, eliminating the need for time-consuming transfers. Every time patients arrive for hemodialysis, they can consult with their doctors. We maintain a close and vigilant watch over the condition of our patients during each dialysis session, and we regularly review their prescribed medications every month, recognizing that these medications may impact their treatment outcomes.”
As evident, the care of hemodialysis patients extends beyond the scope of nephrology and encompasses a multidisciplinary team of specialists. Dr Napisvadee shared an illustrative case involving a patient with stage 4 kidney failure who also had a severe infection.
She recounted, “I diagnosed this patient with an inflamed gallbladder and a weakened heart. A skilled teaching staff surgeon performed a life-saving operation in this critical case. Since the patient was nearly a centenarian, the procedure carried significant risks. After the surgery, I provided continuous supportive care, and remarkably, the patient did not require hemodialysis, which would have otherwise necessitated three hospital visits each week. Considering the patient has dementia with uncooperative behavior, we offered diligent care until the patient died peacefully at age 101." This case exemplifies the comprehensive care extended to hemodialysis patients, involving various medical specialists and tailored solutions.”
Dr Napisvadee shared another notable case, describing an 85-year-old hemodialysis patient grappling with multiple comorbidities. “On one fateful day, this patient experienced a choking episode that led to a cardiac arrest. Fortunately, the incident occurred at the Hemodialysis Center, and the timely intervention of the medical team saved his life. Dr. Napisvadee emphasized the criticality of the situation, stating, "Had the patient not been in the hospital at that moment, the chances of survival would have been exceedingly slim. Remarkably, the patient returned home without needing a tracheotomy or a ventilator.”
Being a practicing physician at the center and its director is undeniably demanding, yet Dr Napisvadee continues to exude vitality and enthusiasm. Her passion for her work is matched only by her unwavering commitment to learning and staying abreast of the latest developments, which she seamlessly integrates into her patient care and treatments.
In leisure hours, her quest for knowledge extends into diverse realms. She delves into the fascinating domain of anti-aging medicine, seeks spiritual enrichment through raja yoga, and explores the intricate discipline of medical astrology, relying on planetary positions to predict potential diseases and raise awareness of possible future illnesses. Additionally, she embraces Bach flower remedies, a watered-down wildflower extract, as a complementary treatment to address emotional concerns. Each of these pursuits arises from her insightful intention to integrate holistic therapy into her approach to patient care.
