I was on PD from 1999 to 2005 and then had to switch to daily nocturnal home hemo after a series if exit site, tunnel and peritoneal cavity infections and subsequent loss of filtering ability (hardly any UF). Since then I have been on daily home hemo.
My nephrologist suddenly suggested a couple of days back that we try putting a PD catheter laproscopically and try PD.
While this has me all excited because I would prefer PD any day to hemo, I wanted to check if this was at all possible. Does the peritoneal membrane and the entire system in there ‘recover’ so-to-speak? My neph says maybe the adhesions that had formed might have dissolved.
I understand your wish to return to PD. However, the reasons you give for its’ discontinuation in the 1st place make it unlikely, in my view, that there will be a normal or ‘reconstituted’ peritoneal cavity sufficient for trouble-free PD to be resumed.
Adhesions don’t, in my experience, resolve or disappear.
The PD membrane sounds as if it has seen its best days by 2005 and the PD membrane, once all UF ability has been lost (as you stated was the case in 2005 and the reason for the NHHD transfer), does not usually recover.
If you are adamant that your nephrologist try, one option to consider might be a laparascopic ‘look see’ first with the placement of a catheter at that time if all looks pristine … but my guess is that it won’t look nearly as good as you might hope - or nearly good enough to countenance an easy return to PD - if at all.
You might like to pose this question to Judith Bernardini - our PD guru - and one much better at answering this question than I.
Thanks Dr. Agar. Judith Bernardini said it is possible but she does not know any statistics on this. She suggested the same that you did - to get a laproscopic surgeon to check and see what the status is and then decide.
I had wondered this as well as I had real bad Peritonitis and wondered about the likelihood of ever being able to do PD again. Thanks Dr. Agar for your response with this.
Thanks for your note. You will see, too, that Kamal floated the same question to Prof. Judith Bernardini in the PD expert threads.
Judith was a little more ‘upbeat’ on the answer, and that is from someone with as many clinical years as I have and with an ‘only’ specialty in PD. My own nephrology/dialysis and transplant service in Geelong is a broader ‘church’ and covers all options. Thus my experience in PD is more dilute as my interests are spread more broadly over all these areas … though my personal interest is more in HD and, specifically, home HD. As a result, I would certainly absolutely respect her views and opinion, and I agree that, sometimes, it does happen that peritoneums can improve sufficientl to re-use.
However, I think I’ll stick to my guns and say that, given the circumstances outlined in Kamal’s original post: repeated peritonitis, adhesions and complete UF failure over 5 years … that recovery sufficient to support re-visiting PD is, in my view, though ‘possible’, very unlikely. I would certainly be seeking a laparascopic ‘look-see’ at the cavity first - though I would be doing so with no great expectation of finding a pristine, or even viable PD cavity sufficient to expect good PD again.
And … even ‘look-see’ laparascopic surgery to ‘check’ would not be without some risk of perforating bowel, especially if there were to be adhesions of the bowel (likely) and if the in-cut keyhole(s) were to inadvertently land atop a segment of bowel which was adhesed to the peritoneal surface of the anterior abdominal wall. That risk is real, and would need factoring in to and decision to look inside.
This clearly matters in situations like a failing transplant, where consideration is being given again to ‘which’ dialysis.
Incidentally, Dori’s team and I are working on an iPhone and iPad App to guide dialysis choice. We’ll keep you posted.
Wow, Dr. Agar, I did not know that laproscopic ‘look-see’ had so many risks. I am tending to think that if I am not going to get clearances as good as I am getting currently with my daily nocturnal home hemo, then why bother even looking?
I didn’t know about the risk of a laparoscopic procedure after peritoneal adhesions, either! It makes sense, though. I think we need to add this to the book the next time around. I learned something new today!