My mother has been doing pd dialysis 4 times a day at home since August 04. The doctors are concerned she is not clearing enough with just 4 exchanges a day and will need more dialysis soon. Doctors also told her she was not a good candidate for the machine at night, why I dont know other than the fact that she seems to have a problem with fluid and toxins seeping back into her body between exchanges. They are talking about a couple of quick exchanges done at night somehow to take up the slack. What exactly is this, is someone else doing it. My mother dreads the fact that she feels sooner than later she will need to go to hemo and she does not want that. Any advice. Thanks!
Has the dialysis clinic done a peritoneal equilibration test (PET) on your mother? This is usually during training or at the end of the first month of dialysis. The test may be repeated periodically. The purpose of the test is to find out how fast or slow the peritoneal membrane transports wastes from the bloodstream to the dialysis solution. It takes 4 hours to do the test and it is done while the patient is in the dialysis clinic. While in the dialysis clinic, the nurse will collect the drain fluid 3 times along with a blood sample. Results of the PET help the doctor choose the right PD treatment:
- A high or fast transporter removes toxins fast, but water poorly and would do best best frequent exchanges and short dwell times which means that the cycler machine at night would be best.
- An average transporter removes toxins and water OK and can do either CAPD (4 exchanges a day) or the cycler at night
- A low or slow transporter removes toxins slowly but removes water well and would do best with CAPD (may need an exchange at night), especially when natural kidney function declines.
Baxter has a machine called the Quantum that can be set up to automatically do the nighttime exchange so the patient doesn’t have to get up in the middle of the night. Here’s an article that discusses use of the Quantum: www.eneph.com/feature_archive/Peritoneal/v26n2p80.html. You can see a picture of the Quantum on the equipment page for PD on Home Dialysis Central at www.homedialysis.org/v1/equipment/pd_mach_01.shtml.
Hopefully whatever is done, your mother will get better dialysis so she can feel better and stay active. If your mother needs to do hemodialysis in the future, she might want to think seriously about home hemodialysis. As a PD patient she is used to having greater responsibility and control over her illness and probably likes that. She might want to read about home hemodialysis on this website, read patient profiles of those on home hemo, and visit the home hemo patient message board which is very active.