Dialysis Access Repair Close to Home

By Jennifer Hulon

After two years of managing dialysis access patients in small workspaces, McLeod Health Loris is now home to the region’s largest comprehensive center focused on dialysis access care. 

Dialysis is required for patients in advanced stages of chronic kidney disease. This disease disables the kidney’s ability to remove waste products and excess bodily fluids. Disruption of a patient’s regularly scheduled dialysis treatment could be life-threatening. Anyone who undergoes dialysis treatments understands the importance of being under the care of a trusted physician. Receiving quality care close to home offers both comfort and convenience for these patients and their families. 

In 2018, McLeod Health Vascular Surgeon Dr. David Bjerken recognized the need for accessible quality and timely care for dialysis patients. He envisioned and developed a program specializing in creating new dialysis access and performing urgent maintenance to preserve existing access. Partnering with area nephrologists, every dialysis patient is offered the most convenient and efficient surgical access care.  

Dr. Bjerken performed 675 fistula, graft, and catheter procedures during the first year. Since that time, almost 9,000 surgical access procedures have been completed.

“Changes in health care continue to occur, and at McLeod Health, we respond to these needs while emphasizing quality and service,” said Dr. Bjerken. “The McLeod Health Dialysis Access Center answers the call of dialysis access needs for these patients. Dialysis patients have scheduled treatments, usually three times a week, so keeping patient dialysis access open for treatment is critical. A patient's prognosis is unfavorable without an easily accessible facility and a provider capable of repairing the access points. “Now, we have a service line devoted to these patients and the urgency of their needs.” 

Referring Nephrologist Dr. Siva Balachandran with Coastal Kidney Center entrusts his patients to Dr. Bjerken and team. “Dr. Bjerken and the McLeod Loris Dialysis Access Center have tremendously impacted dialysis patients in this region. We can now offer our kidney patients convenient and effective dialysis access surgery.”  

Dialysis Access patients need either an arteriovenous (AV) fistula (joining a vein to an artery in the arm), an AV graft (piece of soft tubing that connects a vein and artery in arm), or a central venous catheter (CVC), placed in neck, chest, or groin. 

All forms of dialysis access require an initial surgery to create an access point followed by twice-yearly maintenance, on average, to treat and prevent blockages. 

Patients with grafts, catheters or fistulas often require immediate attention to salvage use when they become obstructed or clotted. 

Upon visiting Dr. Balachandran and his team, a patient with advanced kidney disease is scheduled with the Dialysis Access team to have an access created, usually an AV fistula. 

The reasoning for this is that the AV fistula is considered the “gold standard” for hemodialysis access because it demonstrates the best overall performance and is associated with fewer infections and hospitalizations. A CVC is generally only placed when urgent dialysis is needed. It offers temporary access, but has a high complication rate, namely infection and obstruction of the central veins.  

“The number of patients with kidney failure is increasing rapidly, up 600 percent in the past 35 years. This specialty has a lot of innovation; we stay connected and current with new techniques and devices. It is an exciting time to have McLeod involved at the forefront of this area of patient care,” said Dr. Bjerken. 

Since 2018, the Dialysis Access Center has received patient referrals from 25 dialysis locations in North Carolina and South Carolina. As this service continued to grow, so did the need to expand. 

In 2023, McLeod Health Loris constructed an additional operating room to accommodate more patient procedures. This growth has quickly necessitated an additional surgeon, Dr. Michael Mitchell, who joined in September, bringing decades of experience. 

"McLeod Health Loris is strategically positioned as a central location to support the care of McLeod Health patients from the Midlands to the Coast as well as patients from referring dialysis locations,” said Scott Montgomery, CEO of McLeod Health Loris and McLeod Health Carolina Forest. "With the strength of an experienced and specialized medical team, led by Dr. Bjerken, McLeod Health is transforming dialysis care for thousands of patients. We look forward to the continued growth of this program in the years to come."