Coronary Heart Disease with Chronic Kidney Disease

Sample Opinion // coronary heart disease with chronic kidney disease // Diabetes // treatment with Coronary Artery Bypass Grafting (CABG) and Kidney Transplant

As per the shared medical reports, the patient has been diagnosed with 2 major issues Coronary Heart Disease and Chronic Kidney Disease stage.

Now because patient has been a longstanding case of Uncontrolled Diabetes, such situation in which Cardiac and Kidney Diseases happen together are common. 
 
Explanation of Coronary Heart Disease (CHD) and Chronic Kidney Disease

Coronary Heart Disease (CHD), or coronary artery disease, develops when the coronary arteries become too narrow. The coronary arteries are the blood vessels that supply oxygen and blood to the heart. CHD tends to develop when cholesterol builds up on the artery walls, creating plaques.
 
Chronic Kidney Disease, means lasting damage to the kidneys that can get worse over time. If the damage is very bad, your kidneys may stop working. This is called kidney failure, or end-stage renal disease (ESRD). Stage 3 kidney disease means the kidneys are moderately damaged and are not working as well as they should.
 
Patient will need evaluations for both problem. As follow-

Evaluations for Heart Disease– Patient will need to undergo detail clinical & physical examinations including –ECG, CAG, Blood investigations and other related investigations to confirm the diagnosis and treatment plan. 

Evaluations for Kidney Disease– CBC, KFT, LFT: Complete Blood Count, Kidney Function Test and Liver Function Test, HbsAg, HVC HIV I &II: These are all antibody tests, USG Whole Abdomen: Ultrasound – Abdomen

The evaluations will help us to conclude on what procedure is required.

Treatment Plan: 

Final treatment plan will be decided after investigations only. 

As of now, it is safe to conclude that patent will need to 2 procedures –

1. The patient may require Coronary Artery Bypass Grafting (CABG) for Coronary Heart Disease 

2.  The patient may require Kidney Transplant for Chronic kidney disease
 
Coronary Artery Bypass Grafting (CABG) is the most commonly performed procedure for treatment of patients with coronary heart diseases. Arteries or veins from elsewhere in the patient’s body are grafted to the coronary arteries to bypass atherosclerotic narrowing and improve the blood supply to the myocardium (heart muscle).
 
KIDNEY TRANSPLANT Treatment Process in India:

Upon arrival, the patient & donor will consult the doctor & investigations will be started. During the first week we will finish all the required diagnostics for patient / donor and prepare the Renal Transplant file to be presented to Renal Transplant Approval Committee. A Renal Transplant file consists of Medical Documents declaring the patient a candidate to receive the transplant, Medical Documents declaring donor the right candidate for donation with matching HLA etc. the proofs of relationship and ID proofs, affidavit as suggest below in my mail. This file is then endorsed by the High Commission of the patient’s native country here and presented to the Organ Transplant Approval Committee. This whole process takes 5-7 days after the patient arrival.

Evaluations for Kidney Disease–

The Patient & Donor would require detailed clinical Evaluations. Kindly find below the details-

Recipient:

1. CBC, KFT, LFT: Complete Blood Count, Kidney Function Test and Liver Function Test
2. HbsAg, HVC HIV I &II: These are all antibody tests
3. USG Whole Abdomen: Ultrasound – Abdomen
4. Blood Group

Donor:

1. CBC, KFT, LFT: Complete Blood Count, Kidney Function Test and Liver Function Test
2. HbsAg, HVC HIV I &II: Antibody Tests
3.  USG Whole Abdomen: Ultrasound – Abdomen
4. Blood Group
5. Urine routine 24Hrs: Urine Test
6. DTPA Scan / Kidney Scan: DTPA is diethylenetriaminepentaacitic acid scan used in scanning kidneys
7. Blood Sugar – Fasting and Post Prandial (After Eating)

Note 1- The Renal (Kidney) Transplant to be done on the basis of the transplant protocol to be followed and completed as laid by Ethic Committee.

Note 2- Hospital cannot arrange for the donor. The patient has to arrange for suitable donor from the family. According to Transplantation of Human Organs Act (THOA), it is illegal to arrange donor for patient in India for kidney transplant. To know more, legal document is attached. We are sharing cost of Kidney transplant for your reference but the final line of treatment will be decided post the physical and clinical evaluations of the patient on arrival only.
 
Note 3- The advised plan is solely based on the reports shared with us. The final line of treatment will be decided post the physical and clinical evaluations of the patient on arrival only.

We’d recommend the Best Hospitals and Cardiac Surgeons And Kidney Transplant Specialist doctors:

1. Jaypee Hospital // For Heart disease– Dr. Krishnanu Dutta Choudhury // For Kidney Disease– Dr. Amit Devra 
 
2. BLK Super Specialty // For Heart disease– Dr. Sushant Srivastava // For Kidney Disease– Dr. Sunil Prakash

 
3. Indraprastha Apollo Hospital // For Heart disease– Dr. Bhaba Nanda Das // For Kidney Disease– Dr. Sandeep Guleria 

Estimated cost:

 
Estimated cost of initial evaluations will be approx. USD 500-800 on OPD basis.
 
Estimated cost of Coronary Angiography (CAG) will be approx. USD 500-800 with 1day hospitalization in Twin sharing room.
 
Estimated cost of Excision of Coronary Artery Bypass Grafting (CABG) will be approx:
 

Package for Kidney Transplant (including surgery for recipient & donor with hospital stay) – Details of inclusions mentioned below:
 

For Kidney Transplant below are some details –

NOTE: 
If the patient may need additional sessions of Dialysis apart from the above included, the cost for that will approximately USD 80 – 100 for each session.

If the patient may require Anti-rejection injection apart from the above included, the cost for each anti-rejection injection would be approximately USD 1500.

The number of Anti-Rejection Injections used in Transplant depends on the relationship of donor with the recipient.

Kindly find the below mentioned legal documents the patient needs to get from the country.

1. Passport and Visa for Recipient
2. Birth Certificate for the Recipient.
3. Investigation Reports done till now.
4. Undertaking letter from first degree relative.
5. Passport Size Photograph of the Patient.
6. Passport Size Photograph of the one who is giving undertaking letter.

Kindly Note: The above Estimated Cost is given according to the reports sent by you. Once the patient arrives in India, detailed investigations will be done and on the basis of same, final plan of treatment can be offered and the Cost of treatment and Length of stay will be On Actual.

Length of Stay for CABG Treatment: – Patient may need 3-4 days for consultation and detailed evaluation on ODP basis. Patient may require 7-10 days for CABG treatment in Twin sharing room in Hospital. Post-discharge, patient will have to stay in the guest house to recuperate and follow up for another 2 weeks on OPD basis Total length of stay in India will be approx 3-4 weeks.
 
Length of stay for Kidney Transplant- The patient will need to be in India for 8-10 weeks in total. The patient will need to be in the hospital for 7 days for the Transplant. Out of these, he will be in isolation room for 3-4 days post-surgery. The donor will need to be in the hospital for 5 days.

Inclusions:
1. The cost of all investigations related to the procedure.
2. The cost of the treatment
3. The doctor’s fee and Surgery charges.
4. The stay of patient and 1 attendant during hospital admission.
5. All meals for the patient and the attendant as per the available menu while in hospital.
6. Medical Consumables and Medicines while in hospital 
7. The fee for dietician and nursing while in hospital.
8. It also includes complementary Airport Transfers, Forex Services and assistance.
 
Exclusions:
1. Any consultation other than in discussion
2. Extended stay
3. Treatment for any other illness

On Arrival:
 
Patient and his attendants will be received at the airport by our Representative. Apart from the medical and nursing team, one Case Manager will take care of all the needs. We shall also assist them with the reasonably charged accommodation near the hospital. Patient and attendant may arrange 30-35 USD per day toward accommodation and food at Guest House.
 
Hope I have been able to give you a satisfactory answer to the query. Do kindly ask for any clarifications needed. I will be happy to answer & shall look forward to assist your patient in India.
 
 
Best Regards,
Abhik

+919899980057