APD vs. NxStage

I am stage four and trying to figure the best treatment for me (and my wife). Has anyone strated on APD and then swithced to NxStage ? If so what do you see as the pros and cons of each.
Some concerns I have about APD are 1) will I be able to sleep with the dialysate going in and out (also I have a tendancy to toss and turn a lot), 2) I understand there is a 30 lb. lifting limitation on PD patients. I can see this as a problem for me.
Some concerns I have about NxStage are 1) will I be able to do the cannulating ( is it VERY painful in the beginning (my center uses buttonholing), 2) is the setup and actual treatment a LOT more complicated than APD ?
I keep jumping back and forth between the two. Need your help.

Hey Bill, I started nxstage hemo training the first of April this year and can tell ya that I feel great wonderful. I did in-center hemo for 23 months and felt miserable most of the time. Now life is 1. refreshing, 2. enjoyable 3. worth planning for the future. After a short time setting-up the machine, cannulating, making batchs etc, the sessions go VERY smoothly. I watch tv, chat with my wife, etc. If you have any questions, please feel free to send me a note. I will respond as quickly as possible. Mike p.s. I’m retired military, 30 yrs, E-8, so I don’t play any mind-games with e.s.r.d folk, just ole fools. lol


I was on APD before Nx Stage. The big difference is whether you generate urine and how the amount. Many people are very successful on both types of PD especially if they are still generating urine.

I do not generate urine and as a result cycled for 7 hours in the evening and had 3 manual exchanges during the day. It was very time consuming. Because of all the dextrose solution I gained 60 pounds. Another complication was that each of the two years I was on PD I broke a foot.

When I was originally contemplating modalities during the failure of my first transplant, my transplant neph indicated that if she had to choose HD over PD she would choose HD. At the time Nx Stage and short daily were merely dreams on the drawing board.

After getting past the self cannulation fear and having been on Nx Stage for over a year, I wish I would have been able to make the choice five years ago. I wasted a lot of my life on PD and added significant stress to my family.

I hope you posted your message on the PD message board too, since I’m sure you will find many who love APD and what it does for them.

Good luck, Erich


A few additioinal thoughts.

I love to swim. Swimming with a fistula is much safer than swimmiing with a pd catheter sticking out of your belly.

While on PD my son was 4 and my daughter was born. I never concerned myself about picking them up and let me tell you my boy started out big and hasn’t stopped growing. Now that he is almost 8 and weighs 90 pounds I’m glad I don’t need to worry about a weight restriction.

There is significantly more material to store doing APD than Nx Stage. Consequently there is more recycling to deal with too.

Traveling is similar for each modality. Both companies ship your dialysate to your destination and you bring your machine.

There are more steps to Nx Stage and self cannulation than there are to hooking up a PD catheter. But once learned the short term a daily steps seem as simple as unzipping your pants, shaking when your done and washing your hands. Simple habits.

The cannulation is scaring but after you push yourself through the fear it simply is no big deal. Below is a brief description of my first time cannualting:

The first time I had to stick, I held the surgically sharp tip with my right hand just above the bulging vein in my left bicep. I just held it there. After some time I tried to imagine my hand moving forward at the correct angle. I tried not to think about the razor sharp metal slicing layers of skin until I felt a “pop,” the feeling described to me when the needle bursts through the vein wall allowing blood to flash into the connected tubing. I was instructed that at that point I would know when to stop pushing. “But, how would I know?” “What would keep me from continuing right on through the opposite wall skewering the Triceps brachii like some tender piece of marinated tenderloin?” The answer given was that I would just know, which was comforting, not!

After a few more very long seconds of what on the outside must have looked like a Zen meditation trance but on the inside I knew what was really going on - panic and a mental image of me throwing the needle out of my hand and lifting my butt of the seat and hauling it on out of there. Instead, I took my leap of faith. I thrusted my extended fingers forward while my left big toe searched for a table leg to wrap around to calm itself all the while I silently screamed, “I do not like this “Sam I am.” I do not like big needles in my ham.” But before I could butcher any more Seuss it was over. Some magical force stopped my forward motion leaving the needle right in the middle of my vein. I sighed. My arterial bloodline was secured. After a few moments of quiet celebration I reached for another needle to secure my venous bloodline. When both lines were set and the machine was on, I leaned back into my chair exhausted but smiling. . . I had scaled the Mountain and found that my life was better for it. Six out of seven days I scale that same mountain but each day the slope flattens just a bit.

Thank You For The Reply
You said you weren’t to concerned about lifting on PD. My center has a 30 lb. limit (they said I could cheat a little if I was dry). I like to fish and lift a 45 lb trolling motor and my half (a friend helps with the other half) of an 80 lb. 12’ aluminum boat. Concerned this may cause problems.
Do you use the buttonhole technique (my center promotes this) ? If you do, how long did it take to establish ? Were you able to sleep OK with the APD cycler ?
I am at the point where probably in the next year (or less) I will have to make a decision whether or not to get a fistula (due to healing time before use) OR if I choose PD, waiting for a while (ie.closer to dialysis) to get a catheter for the PD. Having a hard time deciding. What about getting a fistula and then if I later decide to go with PD, just not using the fistula (trying to cover all bases). Would that make sense ?
REALLY appreciate any advice you can give me. Particularly because you are the ONLY person who has responded to me that has been on both PD and NxStage.


Here are a few more thougths based on your recent post.

The lifting restrictions are really something you and your doctor will have to work out.

If you have urine production you may want to start with APD. As you may have found out from the pd listserve, many patients truly thrive on both forms of PD. It is the underutilized modality.

If you choose PD then don’t get a fistula until you choose to do hemo. Fistula surgerieis are invasive and they don’t always work. Placing a PD catheter is done under a local and in my case by a physician’s assistant as opposed to full blown surgery. My first fistula surgery on my lower left arm didn’t work and I needed another. The second surgery worked and I now have a six year old fistula on my upper left arm.

Now if you choose hemo then depending on the speculated timing of starting hemo, you’ll want to get the fistula started so that it will mature when you are ready to start. This way you won’t have to mess around with permacatheters which can be easily infected. You don’t want to get an infection because you might die and Rigors (sp?) are no fun.

I started with hemo because I unexpectedly lost my kidney function in 4 months due to FSGS. I maintained a permacath for the first six months because I was waiting for a transplant from my wife. Unfortunately after I received my transplant the FSGS (which had not been diagnosed at the time) recurred and shut down my wife’s donated kidney. After that I had the fistula surgery.

My wife and I trained for home hemo on a full size Fresinius Machine and fought with my doctor to allow me to go from 3x to 5x a week because I felt so much better with more dialysis. Eventually he agreed.

After a year, my transplanted kidney which had shut down a year earlier started to reject and I became very anemic. After removing the kidney we switched to PD because hemo was taking too much of my wife’s time and my son was 3 years old at the time and need her attention. She also had to go back to work.

As I mentioned earlier I did PD on cycler 7 hours a day plus two to three manual exchanges (I have no urine production). We travelled to Disney World (I did exchanges in the Magic Kingdom) and Jamaica with PD and I adopted my newborn daughter, but with all that dialysis I never felt good.

After another failed kdiney tranplant at University of Wisconsin I switched back to hemo while my incision healed. My fistula hadn’t been used to two years but it was ready and raring to go when I needed itagain.

While in-center I found out about Nx Stage while reading Nephrology News and found a provider, DaVita @ Home, and switched.

As a father of a seven year old boy and a three year old daughter Nx Stage and short term daily hemo have given me the energy to keep up with them. I’m no longer the dad that can’t pitch in coach pitch baseball with my son. Now I’m my daughter’s full time caregiver. The only problem with Nx Stage is that my 2.5-3.0 hour runs get in the way of my active life.

My clinic is developing a protocol for nocturnal. I can’t wait to shift to night time so that I can free up another three hours of my day. I just may be able to get back to work.

One other item that may be of interest to you is libido. My libido and ability to take advantage of it was not so good with PD. Below is a post from my blog, Tasty Kidney Pie, which describes what NX Stage has done for my libido.

After saying all this, remember that many people thrive on APD, so please ask these same questions on the PD listserve.

Good luck, Erich

I recently wrote this letter to NxStage’s President/CEO Jeffrey Burbank. After rereading it I thought well let’s just post it and see if anyone else has seen the same results.
Here goes. . .
I’d appreciate you forwarding this brief note of thanks to Jeffrey Burbank.
You can find my personal story on Home Dialysis Central where I highlight many of the positive changes that NxStage has brought to my life -
But, one thing that I’m really thankful for, which you don’t see too often on the listserves, is the return of my libido. I’m note joking here. When it is gone you don’t really miss it, but when its there you wouldn’t want to lose it for the world. So, Jeffrey thank you very much.
By the way, I mean this in the purest sense. I married the girl who became my high school sweetheart in 1981.
Anyway, you may want to pursue this angle a bit more in your marketing. Who needs Viagra when you have a NxStage instead of one of those three times a week machines?
Thanks again. I think I hear my darling calling. Erich Ditschman
By the way I received a nice response from Jeffrey.

I just want to send a shout out to my Nx Stage homies about how delighted I am not to have a PD catheter protruding from my belly.
First I’ll tap my inner optimist and give the shout out. Our Great Lakes are a joy to swim in, but perhaps a nightmare for a PD Nurse. They are generally pretty clean except after a rainfall when you have to worry about combined sewer overflows and non point source pollution - the stuff that runs off our lawns and streets which is often loaded with heavy metals, grease and pesticides. But, from a PD nurses’ perspective not only do you have to be worried about what naturally may be found in the lakes but you have to be concerned with what your fellow swimmers my be adding. Anyhoo, a PD catheter just is an invite for unwanted critters to enter into the peritoneum. I am delighted that I can swim in our beautiful Great Lakes and not have to worry about a catheter. Fistulas Rock!

personaly I would not go back to in center dialysis after using the nxstage system. I have a dog and was told that pd would be more prone to infections and they would recomend getting rid of pets. My dog is part of the family.

Ray Harris

[quote=RayHarris;14102]personaly I would not go back to in center dialysis after using the nxstage system. I have a dog and was told that pd would be more prone to infections and they would recomend getting rid of pets. My dog is part of the family.

Ray Harris[/quote]

I agree with you! I have 2 doggies and they spend they’re time on my laps all the way through treatment and Nxstage is the perfect fit! That’s why I call my Nxstage cyccler “Wonder Hua Hua”…its small as my two small hua huas…hehehehe

Hey Gus
It might be time to revisit that old dog posting from a year or so back and put up some new pictures(-:


[quote=beachy;14108]Hey Gus
It might be time to revisit that old dog posting from a year or so back and put up some new pictures(-:


Hi Beachy, just recently I uploaded a short movie of my 2 Hua Huas…

…Be sure to turn the sound up!