Are there any weight lifting restrictions with PD? I have a patient who runs his own farm, on hemo now with a catheter (started after harvest season was over). He looked as if his kidneys were going to open, and with a short try, is back on dialysis. He is aware of the weight limit restrictions with a fistula and graft, and states that there is no way he can farm with those restrictions. SO, I brought up PD, and now I’m wondering if there is a weight restriction with PD
The weight restrictions with a fistula or graft are typically told to patients when getting an access and generally relates to allowing the access to heal. I haven’t been able to find any research that has stated that lifting weight over any set amount increases the risk of damage to the vascular access. In fact, I’ve known patients with vascular accesses (fistulas or grafts) who were weightlifters and I worked with an HD patient who did a thousand push ups to prove to himself that he could do it, all with a vascular access. Exercising a fistula is one way to help it mature faster.
Weight lifting restrictions with PD probably have more to do with concerns about hernias. Research has shown that some people are more (or less) prone to hernias than others. One way to limit the risk is to limit intra-abdominal pressure, which can be done by exercising when dry and not using too high PD volumes. Even coughing or straining raise intra-abdominal pressures more than lifting 50 pounds. Here are a couple of abstracts that discuss some things that increase risks in PD patients:
[I]Adv Perit Dial. 2003;19:130-5.
Complications of peritoneal dialysis related to increased intra-abdominal
pressure.
Mahale AS, Katyal A, Khanna R.
Division of Nephrology, University of Missouri, Columbia, Missouri, USA.
Peritoneal dialysis (PD) is associated with a number of complications, some of which can be attributed to raised intra-abdominal pressure. Intra-abdominal pressure is highest during coughing or straining–activities which, fortunately, are transient. High pressure, primarily due to high volumes of PD solution, can predispose patients to hernias, dialysate leaks, and back pain; it can also cause altered mechanics of breathing. This article reviews those various complications and their management.[/I]
and
[I]Nephron 1986;44:129-135
Intraabdominal Pressures during Natural Activities in Patients Treated with Continuous Ambulatory Peritoneal Dialysis
Zbylut J. Twardowski, Ramesh Khanna, Karl D. Nolph, Antonio Scalamogna, Michael H. Metzler, Thomas W. Schneider, Barbara F. Prowant, Leonor P. Ryan
Departments of Medicine and Surgery, University of Missouri, Harry S. Truman Veteran Administration Hospital and Dialysis Clinics, Columbia, Mo., USA
Intraabdominal pressures were measured during natural activities in 6 men, age 24-62 years, treated with continuous ambulatory peritoneal dialysis. The pressures were measured with a pressure transducer secured at the level of the umbilicus in the supine, sitting, and upright positions with 0-3 liters intraperitoneal fluid during talking, coughing, straining, changing position, walking, jogging, exercycling, jumping and weight lifting. Coughing and straining generated the highest intraabdominal pressures in every position. The pressures with weight lifting were proportional to the magnitude of the weight lifted up to 50 lbs, but were lower than those during coughing and straining. The pressures were generally higher with greater intraabdominal fluid volumes, especially with jumping and coughing. Exercycling was associated with lower intraabdominal pressure than was jogging, and the pressures were only minimally influenced by intraperitoneal fluid volumes. The results of this study can be used as a guide in establishing preventive measures in patients with intraperitoneal fluid to decrease complication rates related to raised intraabdominal pressures such as dialysate leaks, hernias and hemorrhoids.[/I]
You can read about exercise for people on dialysis on the Life Options website under free materials. There’s even a booklet about prescribing exercise:
http://www.lifeoptions.org/catalog/catalog.php?prodCat=booklets
i am a patient and have had 4 hernias with PD. I think it depends on how strong you are to begin with. The athlete, Shad ireland lifts weights, i think and has a fistula.
Hope this help, Lisa
From what I gather from reading the literature, they’ve found that some people have an inherited tendency to have tissues that are not that strong. When you add PD solution, sometimes even without adding weight, those patients develop hernias more easily than others. I don’t know if there’s a way to tell who those people are unless they know if there is a family history of hernias.
Well i dont know. I started at Henry Ford, and when i had my PD cath put in, the surgeon said yeah you can lift as much as you want. Then i switched centers, and the new PD center told me at the time, you cant lift no more then 15lbs. I really think it depends on how strong your muscles are where you are lifting.
Lisa
I would say no weight restrictions if they are not full if they are full I would recomend a pd belt and just have them be careful and monitor the site. [QUOTE=Unregistered;17293]Are there any weight lifting restrictions with PD? I have a patient who runs his own farm, on hemo now with a catheter (started after harvest season was over). He looked as if his kidneys were going to open, and with a short try, is back on dialysis. He is aware of the weight limit restrictions with a fistula and graft, and states that there is no way he can farm with those restrictions. SO, I brought up PD, and now I’m wondering if there is a weight restriction with PD[/QUOTE]
It’s important to help patients keep their jobs. The patient should physical requirements for their job are with their nephrologist and share these suggestions, which I’ve read as suggestions in the literature.
It would seem that significant weight restrictions could be unnecessarily burdensome for many patients and I would think that cases would have to be considered on an individual basis after the patient has been evaluated by the physician. Then again, this type of decision does seem to be subjective and could vary widely based on the judgment of licensed personnel. I’ve encountered a wide range of restrictions that all involved individual evaluation. I too, have not been able to find any conclusive evidence that would indicate a universal standard.