My father is an 82 year old CCPD patient. He’s not a very happy man. He feels tired all the time, gets light headed, and doesn’t enjoy eating because of all the solution inside him. They’ve switched his solution around several times and he really doesn’t feel any better… perhaps worse, and he’s having a problem with toxin removal, as well.
I asked the center about switching to home hemo a year or so ago, and, due to his age, they downplayed it. I was told that it’s normal to feel tired and weak when you’re older; however, I was wondering if their response was motivated by monetary concerns? I’ve heard it takes at least two years to to show a profit on home hemo.
A new maching called NxStage is out, now, and it makes home hemo easier. I was wondering if it’s less expensive and if it would be practical for my Dad to switch from one to the other at his age? You can see by the look on his face that he’s just not enjoying life, and he’s mentioned that he wishes he would just have a heart attack and “get it over with”.
I’m not sure if patients on home hemo feel better than PD patients, but if they do, I thought it might be worth considering.
Some things that could affect your dad feels include:
– What is his dialysis adequacy? If his Kt/V is less than 2.0, he may not be removing enough wastes with PD and may need to add an exchange a day or consider changing to hemodialysis (see below).
– He could have low blood pressure. If so, it could make him feel lightheaded and weak. He could be using too strong a solution and getting too “dry.”
– He could have poor nutrition. If he’s not getting enough protein, he could be lightheaded and weak. If his albumin level is under 4 or especially if it is under 3.5, he is at risk of infection. He may need protein supplements. The dieititian should talk with him about how he can fit his meals around his dialysis. If he’s doing CAPD, perhaps he could eat between his drain and fill cycles.
– What is his hemoglobin/hematocrit? If he’s anemic (hemoglobin less than 36), is he taking EPO and iron?
– Is he weak because of he hasn’t been getting much physical activity? Would he be eligible for physical therapy or home exercise?
– Is he depressed because he doesn’t feel well, he’s not able to do the things he wants to do, and people are saying this is “normal” for people his age? The social worker is the one to talk with about prior activity level, rehabilitation goals, how he’s coping, etc.
I don’t think I’d accept that people who get older get tired and weak as an excuse. On the other hand, only he knows whether he has the quality of life that he needs to want to continue to do dialysis. If the burdens of the treatment exceed the benefits that he’s getting from it, he has the right to stop treatment and let nature take its course. This is a decision that I encourage patients to make with their loved ones and only after medical and psychological treatments have been done to try to improve the patient’s health and quality of life.
So far as how people feel on home hemo vs. PD and how a PD patient knows if PD is not working as it should, you might want to post your question to the home hemodialysis message board. I believe there are patients who were on PD before switching to home hemo who can respond to your question.