We have been doing inhome hemodialysis for over a year now and my husband is doing well and we finally have it down stress free. My husband is now looking at PD as gentler on his heart (he has chf, diabetes in addition to renal failure - all Agent Orange related to his service in Vietnam). I want him to do what he feels is best for his heart, but concerned because he has never been someone to follow routines that require action several times a day and is an EXTREMELY restless sleeper. I guess if PD doesn’t work out we can always go back to home hemo. My question is, we are planning a trip across the US (a flight) to a wedding in May. How can he manage PD if he is traveling for about 10 hours?
Although some people do manual PD exchanges 4 times a day (around breakfast, lunch, dinner, and bedtime), most people who do PD do it using a cycler machine for 8-10 hours while they sleep. How long they tse the cycler daily is prescribed by their doctor. Some people have to do 1-2 manual PD exchanges during the day to get enough dialysis. Manual exchanges and overnight treatments can be adjusted somewhat to fit the patient’s schedule as long as the treatment removes sufficient waste and fluid. PD works best when the patient as some remaining natural kidney function. Before he attempts to switch to PD, he and his doctor need to know how much natural kidney function he has. His doctor could test for that. Once he gets a PD catheter, he would need to have a peritoneal equilibration test to determine whether manual or cycler PD would be the best way to remove wastes.
So far as restless sleeping, people on PD can reposition themselves while sleeping. If he rolls onto and crimps the line through which dialysate flows, the machine will alarm to alert him to change position.
So far as traveling, people can take a PD cycler with them when they travel and if they’re gone for longer than it’s possible to take solution and supplies, the company can ship to your destination. Here’s a blog about that.
KRV, does your husband still make urine? Without residual kidney function, PD is possible, but the truth is that it’s quite a bit less likely to succeed. This is why PD is generally done first, and then HD (preferably home).
Home HD should be very gentle on his heart, and the best way to make it gentler is to do longer treatments at a slow blood flow rate (250-300). If he’s a restless sleeper, longer daytime treatments could do the trick. Or, do short daily–but use our calculator to be sure that water is being removed slowly enough to protect his heart. Ultrafiltration Rate Calculator (UFR) - Home Dialysis Central.
If he does switch to PD, one day without treatment while you travel is probably not going to be a problem, but he needs to check with his PD nurse and/or nephrologist.
He produces very little urine. Luckily at our last nephrologist’s appointment my husband got more information about PD and lifestyle and it just didn’t mesh - I knew it wouldn’t. Thankfully, he’s decided to continue with the in home hemo we’ve done for the last 14 months with great success. I’m from the “if it ain’t broke, don’t fix it” philosophy. I really appreciate the great info provided to me on this topic. My husband keeps looking for a solution to his low energy, when it’s clearly his heart, which is only functioning at 25%. Thank goodness for our competent caring medical team and I appreciate this forum. He’s doing so well that the nephrologist gave his blessing for us to try 3 days/4 days/3 days etc regime. We’ll see if his blood work remains as good as it has after trying this. Getting an extra day every other week free is huge for both of us.
I wonder if his heart and quality of life would be better if he did nocturnal HD. Doing dialysis while sleeping provides better removal of wastes more gently on the heart and would interfere less with his daytime activities. There ways to secure the needles and blood leak detectors that help to make nocturnal home HD safer. There are several KidneyViews blogs written by patients and professionals about nocturnal HD. You can type “nocturnal” into the search field to find them at KidneyViews Blog - Home Dialysis Central.
You say he has 25% ejection fraction and has low energy. How is his albumin and hemoglobin? If his albumin and hemoglobin are low that could be contributing to his low energy as can lack of exercise. Many people with heart problems don’t know what exercise is safe and are afraid to tax their heart. Could cardiac rehab help him do and feel better? You might want to read this article and discuss cardiac rehab with him and his doctor.