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.