My dad is going on home dialysis and we have managed over the past couple of weeks to come to terms with PD, first the manual and then, maybe later, the night cycler. Then late last week a dialysis nurse encouraged him to choose home hemo. My dad’s nephrologist was already on board for PD and the surgery for abdominal catheter is scheduled. The nurse has plans to call tomorrow and change the surgery to the catheter for hemo, but we have decided to stick with/go back to the PD. My mom is going to catch the nurse in the a.m. before she changes things.
All this being said: Given my dad’s age (68) and his activity level (he works/owns a business, enjoys hobbies including trap shooting and travel) as well as his very independent nature, we have been leaning heavily toward PD. Just wondering if we are missing anything? He is diabetic (type II/ sometimes they call it type I because he has been on insulin for at least 15 years). He is “large,” I guess, but not so much these days. I have seen a couple of articles that suggest large size makes PD riskier? Also, he has cardiac issues–extensive heart damage from a heart attack 22 years ago–but they say his heart is great shape for the shape it’s in.
My question is, can anyone offer any insights to special considerations we might have failed to consider? Because he is diabetic? And, is there any treatment that is better or easier on the heart than another?
I feel stressed that I have encouraged an option and I want to make sure I am as informed as I can be.
This site has been incredibly helpful so far … we are just now beginning the real challenge, though, it seems.
Thanks in advance for any insights.
Hi Babboo,
Welcome to Home Dialysis Central. I’m glad you found us, and glad that your dad has chosen an option that will allow him to stay active. PD is a very good first treatment, very gentle on the heart, and can be done by people with diabetes. Plus, it is quick and easy to learn and gets people in the habit of caring for themselves instead of expecting the care team to do everything for them.
Home HD is also a very good treatment, and a small number of people do use it first, but the learning curve is steeper because it’s more complex. Done as daily or nocturnal treatment, home HD can also be very gentle on the heart (this is not the case for 3x/week standard treatments that only last 3-4 hours).
The choice of a treatment option is very personal and makes a big difference with regard to lifestyle. It’s best if the person with kidney failure makes this decision for him or herself–knowing that it’s always possible to choose a different treatment later if circumstances change or a treatment stops working as well as it did. (Do-over’s are possible. ;-))
If you haven’t seen our original articles, you may find them useful:
– Your Kidney Treatment: Your Choice - http:// www.homedialysis.org/resources/tom/200604/
– PD as a First Therapy - http://www.homedialysis.org/resources/tom/200602/
It’s natural to worry and to second guess a decision, but if your dad likes the idea of PD, giving it a try will let him see how it works for him–and also buy him time to get an HD access and switch treatments if he wants to later.
Dear Babboo, I chose to do PD at home & have also experienced HD (3 x week/in hospital). I hated HD as I wasn’t in control, the nurses did it all for me, although I was very ill at the time & probably not in a position to do dialysis independently. After 7 mths on HD I had a tenckhoff inserted & never looked back. Although I never tried the overnight cycler, I managed a part-time job doing 4 daily exchanges. I’m also in my early 40’s with 2 young boys…so a fairly hectic life. I did find though that I put on an extra few kilos doing PD as the glucose content/ extra kiloujoules in the bag were part of the deal. I also found my BSL were a little hard to control at times but was able to overcome these with the advice of my Endocronologist. Dori is right though when she says the patient shoud chose their own dialysis treatment. This is important. All the best to your Dad, acceptance is the main hurdle to overcome. I consider my illness & current dialysis treatment as another journey in my already fulfilling life. Take care. Aussie Angie.
Thank you, Dori and Angie, for your responses. I read the articles that were suggested and have passed them along to my family. I was especially happy to know that PD is a good choice to help retain residual kidney function.
Angie, I know we can switch if this is not right but your story about having done the hemo at one point and now doing PD successfully is very encouraging. I believe my dad has made the right choice. He is really good at controlling his blood sugar so I think he’ll be able to work with this too.
He feels so terribly awful right now and is looking forward to just about anything that will help make him feel better. I never knew that he would get to the point of feeling this awful. How long will it take for him to feel better? Any way to know? Angie, you were in the hospital for weeks? Will he be able to have treatment right after he has the catheter put in or will he have to wait for it to heal? I am wondering how much longer he has to tolerate this suffering. Surgery for the abdominal catheter is this Thursday.
(I am having trouble posting a reply after I log in. It says I do not have access to the boards but when I don’t log in, I have access. So I changed my username…)
Betsey
Dear Betsey,
Once you have the catheter placed it has to rest for 6 wks before you can use it. I had mine placed in Oct 2005 & started using it in Dec 2005. During my time on 3 day haemo I still felt unwell for the whole 7 mths. I remember the improvement happening when I began PD but I think it will take maybe a month before your Dad feels improvement, although in saying that everyone is different & if your Dad is as ill as he is now he may gain his wellness sooner. I definitely remember how much better I felt on PD. The haemo was too severe on my body (the dialysis is hard & fast) & PD is much gentler all round, especially kinder on the heart!
Anyway Betsey, I hope this answers some of your queries. Send me a private message if you want to chat more or alternatively I will keep an eye on this forum for any more posts from you. I don’t know much about the trouble you’ve been having posting. I know today I was writing a post & was logged out automatically, so had to log back in again before I could send. Take care, & all the best to your Dad from me. Cheers, Angie.
My mother has been on PD for five years and recently switched over to Home Hemo option.
Just like PD, Hemo Dialysis can be done at home, too. Except it is shorter, 2 to 3 hours, six times a week. It does seem more complex to train to do at home, however, we are learning it as it will give her better quality of living, and freedom. We watched our mother go through the PD for five years, she felt literally tied down, depressed along with other health issues because she couldn’t handle the volume.
She’s been doing the hemo treatments at the clinic five days a week, we can see the difference already. If you have already tried the PD option, start inquiring about the home Hemo options.
[QUOTE=Helen Kim;15024]My mother has been on PD for five years and recently switched over to Home Hemo option.
Just like PD, Hemo Dialysis can be done at home, too. Except it is shorter, 2 to 3 hours, six times a week. It does seem more complex to train to do at home, however, we are learning it as it will give her better quality of living, and freedom. We watched our mother go through the PD for five years, she felt literally tied down, depressed along with other health issues because she couldn’t handle the volume.
She’s been doing the hemo treatments at the clinic five days a week, we can see the difference already. If you have already tried the PD option, start inquiring about the home Hemo options.[/QUOTE]
Hello, thank you for your response. We are actually doing things the other way around… my dad originally planned to do home PD but then ended up having to do in clinic hemo to get “straightened out” before he could do the PD. We are starting the home PD soon, but I expect we’ll end up back at hemo, like you. How old is your mother? What are the circumstances? My dad is 68, diabetic with heart failure. We hope the dialysis will improve heart function and the rest.