My husband Marv is 78 years young. He was born with PKD. In 1992 his kidneys failed and he went on hemodyalysis at California Pacific hospital in San francisco. In 1993 I donated a kidney. Surgery was at the same fine hospital. In 2014 kidney failed but lasted a good 20 years! He went on perateneal dialysis and has not been happy. He said it is very time consuming. We are a very active family w/ many friends and trips planned. Taking the machine and having shipments delivered has been a hassle. He is a 6’ 4" and weighs 220 and is in good health for his age. Because of his weight and height he is on PD - 9 to 10 hours a night. We go to bed at 8pm so he can go to the gym at 8am every day. He just had a fistula put in today so he can switch to Hemodialysis. After reading the forums he is hoping he made the right decision. Do you find many patients switch from PD to HD?
Dear Karren
Thank you for your question … it is one that is quite often asked and I addressed (most of) your question quite recently in one of my many blogs for the Home Dialysis Central Blog site, ‘KidneyViews’.
You will find this link takes you to the relevant blog page. Just click on the link or copy and paste it to your browser. Let me know if this doesn’t adequately answer your question(s).
Dr. Agar, Thank you for the quick reply. My husband said he wished he had read your article before he went on PD. We are fortunate to have two dialysis centers within 10 miles of our home. The Baxter/Well Bound center he used are wonderful folks - more like family but I think they understand why he wants to change to in-center HD. As long as we’re healthy and mobile we want to travel. Having our home free of all the PD products and accessories is another plus. On the other hand I certainly understand why some people opt to do home PD.
I am in the process of changing over from in-cinic hemo to home PD. I am 5’10" and weigh 76 kg. I continue to make a normal amount of urine (1600 cc). I expect to be on a cycler to start with for 8 hours a night. Here are the reasons I chose PD:
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Simplicity. No needles, sticking or partner required. Simply load up the cycler and hook up via the implanted catheter. Certainly, antiseptic safety protocols must be observed just as in home hemo. I agree the catheter is a disadvantage over a permanent fistula access. I have a working fistula and can always convert to home-hemo at some point in the future.
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Freedom. I expect to be on the machine when I begin for 8 hours a night mostly while I sleep. My normal sleep pattern is about 6 hours. I expect to wake an hour or two before the machine is finished. I can move around while tethered to the machine (about 20 ft). If I need to make an trip overnight or for a couple of nights, with a little planning I can perform manual exchanges and not deal with the cycler. In fact, after a couple of weeks on the cycler and after I receive my permanent prescription I may end up with manual exchanges to replace the cycler – if my prescription is good enough.
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More kidney friendly. I firmly believe that in-center treatment does nothing to help what little kidney function I have left. That may be true for home hemo as well. I was originally diagnosed with AKF in 2/14. My GFR was 6. In addition to trauma I had a rare form of lymphoma that infiltrated my kidneys with lymphocytes that was supposedly the cause of my AKF. I took chemo treatments and am now in remission. My onc doctors tell me the lymphocytes are no longer present in my kidneys. Since completing chemo I have observed an improvement in my kidney funtion. My last GFR was about four months ago and was measured at 12. I started PD with three one hour training/treatment sessions and one full 8 hour overnight treatment. Just from that I noticed an increase in urnine output (kidneys working more). My nephrologist tell me that PD will be less harsh on my kidneys. My hope is that I will continue to see improvement in kidney function.
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Improved feeling. After coming off of in-clinic dialysis for 3.75 hours I feel like I have run a marathon. I am totally drained. My experience with coming off of PD was that I felt normal again.
It turns out that I discovered after a few PD treatments I had an inguinal hernia that I was not aware of which caused leakage out of my peritoneal. I have seen my surgeon and am scheduled to have it repaired this week. He tells me I can return almost immediately to PD after the repair surgery.
While I certainly respect Dr. Agar’s opinion as he expressed in his blog I believe PD is right for me based on the facts I know for sure about my situation with PD: a) it is much simpler than home hemo, b) I will have greater freedom, c) I feel 100% better and d) the potential exist for improved kidney function (more so than in-center and maybe home hemo). The fact that most people lose urine output after a year or so on hemo dialysis speaks volumes to me that hemo does nothing to help your kidneys. It remains to be seen if PD will have he same effect, but I am told by my local nephrologist that PD will be more kidney friendly.
I will report back after I get my permanent prescription and have more experience on with PD.
Thanks.
- Max
I am in the process of changing over from in-cinic hemo to home PD. I am 5’10" and weigh 76 kg. I continue to make a normal amount of urine (1600 cc). I expect to be on a cycler to start with for 8 hours a night. Here are the reasons I chose PD:
-
Simplicity. No needles, sticking or partner required. Simply load up the cycler and hook up via the implanted catheter. Certainly, antiseptic safety protocols must be observed just as in home hemo. I agree the catheter is a disadvantage over a permanent fistula access. I have a working fistula and can always convert to home-hemo at some point in the future.
-
Freedom. I expect to be on the machine when I begin for 8 hours a night mostly while I sleep. My normal sleep pattern is about 6 hours. I expect to wake an hour or two before the machine is finished. I can move around while tethered to the machine (about 20 ft). If I need to make a trip overnight or for a couple of nights, with a little planning I can perform manual exchanges and not deal with the cycler. In fact, after a couple of weeks on the cycler and after I receive my permanent prescription I may end up with manual exchanges to replace the cycler – if my prescription is good enough.
-
More kidney friendly. I firmly believe that in-center treatment does nothing to help what little kidney function I have left. That may be true for home hemo as well. I was originally diagnosed with AKF in 2/14. My GFR was 6. In addition to trauma I had a rare form of lymphoma that infiltrated my kidneys with lymphocytes that was supposedly the cause of my AKF. I took chemo treatments and am now in remission. My onc doctors tell me the lymphocytes are no longer present in my kidneys. Since completing chemo I have observed an improvement in my kidney funtion. My last GFR was about four months ago and was measured at 12. I started PD with three one hour training/treatment sessions and one full 8 hour overnight treatment. Just from that I noticed an increase in urnine output (kidneys working more). My nephrologist tell me that PD will be less harsh on my kidneys. My hope is that I will continue to see improvement in kidney function.
-
Improved feeling. After coming off of in-clinic dialysis for 3.75 hours I feel like I have run a marathon. I am totally drained. My experience with coming off of PD was that I felt normal again.
It turns out that I discovered after a few PD treatments I had an inguinal hernia that I was not aware of which caused leakage out of my peritoneal. I have seen my surgeon and am scheduled to have it repaired this week. He tells me I can return almost immediately to PD after the repair surgery.
While I certainly respect Dr. Agar’s opinion as he expressed in his blog I believe PD is right for me based on the facts I know for sure about my situation with PD: a) it is much simpler than home hemo, b) I will have greater freedom, c) I feel 100% better and d) the potential exist for improved kidney function (more so than in-center and maybe home hemo). The fact that most people lose urine output after a year or so on hemo dialysis speaks volumes to me that hemo does nothing to help your kidneys. It remains to be seen if PD will have the same effect, but I am told by my local nephrologist that PD will be more kidney friendly.
I will report back after I get my permanent prescription and have more experience on with PD.
Thanks.
- Max
Dear Max
I am glad you are ‘going home’! That’s the point - home. It doesn’t matter if it’s PD or HD … It’s home.
If you can manage at home - on either modality, PD or HD - either (at home) is better than dialysis in a clinic.
We encourage and support all home options, whether home HD in its many and varied formats, or home PD as either CAPD or APD … either and both.
If the choice is PD, then CAPD might suit some while APD might suit others … though I reckon, if I were doing home PD, I’d be doing APD. The point is, both work. The even bigger point is, either and both offer self-care, self management, and are at home.
If the choice is HD, then there are a variety of options available … though I reckon I’d be choosing a long, slow and high frequency mix.
It’s whatever fits your lifestyle best. Neither is better, nor worse, if it fits best with your living style, your aspirations, and your family commitments.
Good luck.
Dr. Agar,
Thank you for those words of encouragement. They are certainly much appreciated coming from you! I’ll post here in another month or so after I’ve “been home” for a while.
- Max