[QUOTE=Unregistered;19129]Hi Ms. Bernardini,
I wanted to find out if you have had experience with diabetics going on PD?
My father will need to start dialysis soon and hasn’t yet come to grips w/it. He is really anxious about hemo and I have heard that PD may be a little gentler on the body. But, since the sugar solution that is used in PD would likely interfere w/his diabetes, I’m not sure he would be a good candidate?
My dad is in his 70’s has had diabetes for many years, is overweight and has had heart issues. Have you ever had any patients like that do PD? And did they tolerate it well?
Also, I’ve read up about PD, but I don’t understand where a cycler comes into play? Can you explain that?
thanks in advance for your help.[/QUOTE]
Reply from J. Bernardini:
Yes, I have known many diabetic patients on PD. About 35% of the patients at our clinic had diabetes, and that is common at many PD clinics. Studies have shown that diabetic men do as well on PD as on hemodialysis (HD). But you are right that most of the solutions used in PD are sugar-based so the insulin dose must be adjusted. There is one solution in the US that does not affect the blood sugar and that is often helpful for diabetics but all PD patients must use some sugar-based solutions as well.
Your father is right that people often say PD is “gentler” than HD. That is because HD is an intermittent dialysis, only done for a few hours every 2-3 days usually. PD is a continuous dialysis, 24 hours a day, 7 days a week, more like your own kidney function. Thus with HD there are a lot of ups and downs for many patients after having a lot of water, salt and toxins or poisons removed in a short time. PD patients do not experience those ups and downs since they are always having dialysis.
As for your last question about the cycler, it is a small machine that sets on a bedside table beside the bed and provides dialysis through the night for the patient. If your father chooses the cycler, he would connect to the cycler every night and it would take about 20 minutes. He could then read or watch TV or go to sleep when ready. When he was ready to get up in the morning, he would disconnect from the machine which takes about 5 minutes. He would then be free all day—the machine would have delivered solution to his belly before he disconnected in the morning so he would continue to have dialysis all day but not have to do anything usually. Cycler dialysis is often called APD or automated peritoneal dialysis, or sometimes CCPD for continuous cycler peritoneal dialysis. Some people do not like to be connected to a machine and prefer the daytime CAPD----which means continuous ambulatory peritoneal dialysis. Four times a day, about once every 3-5 hours, they “exchange” the solution in their belly and this takes about 40 minutes. Patients may choose either APD or CAPD at most clinics, and they may switch from one to the other when needed or preferred.
Hope this information helps answer your questions.