PD for large person

Hello everyone,

I’ve read many times that PD does not work well in large people. What, exactly, is meant by “large”? My husband is 6’4" and about 208 lbs, not at all overweight. Is he considered to be too large for PD? I read so many horror stories about HD that I would hate to see him have to go that route…



Dear PT,

I saw that no-one answered your question, and wanted to see if I could help. I’m NOT a patient, nor am I a dialysis nurse, so I did a little research. At 6’4" with a weight of 208, your husband’s body mass index (BMI) is 25.3, which puts him at just slightly overweight.

I did a search of the published medical literature and found only one that seemed to address whether someone with a higher BMI would get adequate treatment with PD.

One study was in Advances in Peritoneal Dialysis 2003, vo. 19, p. 222-226, by Grzegorzewska AE and Mariak I. Titled, “Differences in clinical and laboratory data of peritoneal dialysis patients selected according to body mass index,” this small study looked at PD in people with BMI’s of 20-25, and 25-30. They found lower adequacy (Kt/V) in the larger patients, due to a higher volume of fluid in their bodies. Of course, your husband is right at the cut-off for this study.

Does your husband have any residual renal function? In patients on PD, this helps “add” to the treatment, and it is important to measure it periodically to see if and how much it is dropping so the PD dose can be increased to make up for it.

As far as “horror stories” about HD–that’s generally related to in-center treatment. I’m not sure what you’ve heard, but if your husband starts PD at home and at some point in the future wants or needs to stop PD and doesn’t get a transplant, there are 3 different HOME HD options that he may want to consider. You can read about them on this site at http://www.homedialysis.org/v1/types/.

Most patients never even hear about PD, so you’re already ahead of the game by doing your homework and finding out about all of the options. If we can help you more, please let us know.

Speaking from personal experience, your hubby isn’t too large for PD, I was about 250lbs and on PD for a little over a year, it took a few months to get things under control and get good cleareance but once that happened, things went fine so there is a chance that it could work well for your husband too. However, we are all different so of course there is a chance that it won’t work for him, but its worth a try

Good luck :slight_smile:

I’ve been on PD for a year and a half and have had absolutely NO problems. I hit ESRD because of a large kidney stone, blockage, uricemia and septicemia. Blew out one kidney, compromised the other. No lupus, diabetes, PCK or other long-term compromising disorders, therefore decent residual organ functions going into the infection.

I weigh 300 lbs (down from 365), am 6 feet tall and just turned 65. I have been obese basically since birth. I take a low dose beta-blocker, hydrochlorothiazide, 15,000 units of epogen twice a week, low dose hectoral, eat a low phosphorus diet along with some binders, have good albumin and hematocrit (for a PD person, at least) and maintain a Kt/V around 2.1 and 2.2. I do 4 3 liter 2.5 bags manually a day.

I have no twitchy legs, no skin itching and use temazepam alternating with lunesta most nights. I am the biggest person on PD in Arizona.

The point is, given some residual renal function and no long-term diseases, size doesn’t always matter.[/quote]

I’ve never been on PD, only hemo. I’ve never had any horror stories in over 3 years of hemodialysis nor have I seen too many, but, let me tell you, if I was starting over and I had no contraindications to PD, I would start with PD. Why? Well, because when your neph decides to start you on dialysis, you usually still have a fair amount of kidney function - usually about 10%. You may as well make use of it. PD works as a concept because most ESRD patients do have some “residual” kidney function. So, it’s reasonable to go with PD as long as you can until you either get a transplant or because PD isn’t enough anymore (or due to repeated infections) and hemo is needed.

The horror stories you hear about hemodialysis, say if your husband had to go on it, should be taken with a grain of salt. I can give you a number of horror stories from the PD world too, but the point is, these are all isolated cases. You have to keep in mind that many people who start hemodialysis are among the very sickest of patients. Those who start hemodialysis in a planned way, like your husband, with a proper fistula already in place and ready to go, usually don’t have horror stories. There might be some adjustment at first, but this isn’t a horror story. Some of the language people use sometimes is overly dramatic. For example, in the year before I started dialysis, I had heard from a person who said that the first time they put the dialysis needles in, her fistula “blew up”. As a result of hearing those kinds of things, I was a little apprehensive when I had to start dialysis. But once I did, I found out that sometimes, especially when the fistula is new, it’s possible to misplace the needle in the vein a little and then the tip punctures the other side of the fistula vein. When that happens, you get some infiltration of blood into surrounding tissue, and it swells. It’s easily taken care of. The big “blow up” story was just someones exaggerated tale recounted with overly dramatic language, as I later learned.

Anyway, there’s no substitute for your doctor’s advice. I don’t know if your husband is too big for PD to provide enough dialysis. Sometimes, the peritoneal cavity of the person just isn’t large enough to hold enough dialysate for the size of the person, or sometimes it’s a matter of the peritoneal membrane not having enough blood vessels to provide adequate dialysis. These are things that are hard to know in advance. There are small people who start PD and then discover it doesn’t work for them. Sometimes you just have to try it and see how it goes. It’s not really that big a deal to switch to hemodialysis afterwards if necessary. People switch to and from PD and hemodialysis all the time, so, choosing PD to start with is not like it’s an irrevocable decision.

In terms of home dialysis, it’s a lot easier to get into it via PD than hemo. To do hemodialysis at home requires more training and a lot more equipment (though less storage of supplies). It’s quite a bit more complicated than PD is. But on the other hand, if it turns out that your husband needs hemodialysis, don’t read or listen to the horror stories, and, once he’s comfortable with it, he can probably do it at home as I and hundreds of others do.

But again, let me emphasize that you have to decide in conjunction with your neph’s advice.

I wish your husband the best of luck.