PD or hemo? conflict of interest

My father is about to start dialysis. He is 77 years old. He would like to start PD at home. The kidney doctor is trying to persuade him otherwise. However his reasoning seems suspect to both my father and myself.

  1. The doctor owns the clinic.
  2. He doesn’t know a surgeon to do the surgery to install the shunt in his abdomen. ?
  3. He says that most hospitals will not be able to take care of the PD method if he is hospitalised. He implied that a family member would have to come and take care of him with dialysis. Please note we live in Chicago, Illinois.

My father is getting a shunt put in for the hemo method as a backup, but is concerned that he will get stuck with the method he doesn’t want. He is afraid to change doctors as time for dialysis is getting close.

Are these reasons valid? I don’t think he has given a medical reason to go hemo. Or are we being too suspicious?

Thanking all in advance.


Dear Eric,

I’m glad you found your way to Home Dialysis Central–your dad is lucky to have you as an advocate, asking questions on his behalf. I’m also sorry to hear that you and your dad have been frustrated in what should be a relatively straightforward request–to do the type of treatment he’s researched and believes will be best suited to his lifestyle. (Half of patients who do their homework before their kidneys fail choose PD).

Virtually every dialysis clinic in the U.S. (and many are owned by doctors) offers in-center hemo. But only about 1 in 3 clinics offers PD. Why don’t they all? Often because doctors who have not been trained in PD during their nephrology fellowship just aren’t fully comfortable with it. And what I’m sensing from what your dad’s doc said, is, he just doesn’t sound comfortable.

Nearly any general surgeon can place a PD catheter–it’s very simple surgery (much easier than the hemodialysis access surgery).

Also, most hospitals have an acute dialysis clinic that would send staff to another floor where a patient needed care (e.g., PD). I’ve never heard of a patient’s family needing to come in and do dialysis.

Most nephrologists will defer to the patient for a choice of treatment, because the patient is the one who will have to live with it. If your dad’s nephrologist is unwilling to let your dad have PD, I suggest you ask him right away for a referral to a nephrologist who will feel more comfortable with PD. Good luck, and please let us know how it goes.

Dori Schatell

In the Home Dialysis Central database, there are 14 clinics within the Chicago, IL city limits that offer one of the two types of PD. There are several other clinics in the suburbs of Chicago that also offer PD. Many nephrologists think that more patients could be on PD than are.

So far as inpatient dialysis is concerned, by Medicare regulation, every clinic must have an arrangement with a hospital to provide care for its patients when they’re hospitalized. When I worked in dialysis, our PD and hemodialysis patients were hospitalized in several hospitals in my area. Hospital staff in every hospital were willing and able to do PD treatments on hospitalized patients. However, I also knew patients who liked being in control so much that they preferred to do their on PD exchanges in the hospital if they felt well enough.

Like Dori said, I’d suggest that your father be firm about wanting to do PD. He should ask if he needs a HD access as backup to PD since it might never be used. Some doctors think it’s important to have an HD access while others don’t. If his kidney specialist drags his feet about allowing him to do PD, your father should change nephrologists right away. If his doctor won’t recommend another nephrologist who has PD patients, he or you should check out the Home Dialysis Central database for clinics in his area that offer PD. Visit one or more clinics and ask how to contact doctors who treat PD patients there. Talk with the staff (especially the PD nurse) about the training and follow-up, ordering, space requirements, etc. Ask to talk with PD patients about their experiences with PD, if possible. Make an appointment to talk with one or more nephrologists. See how each nephrologist listens and communicates. Ask questions to find out if the nephrologist encourages patients to assume as much responsibility as they’re willing to assume.

Finally, your father’s doctor may be making false assumptions about him. Even though professionals often believe that people your dad’s age need to have others take care of them, this may be because those patients didn’t know they had a choice. On the other hand, your dad has researched his options and believes that he would be the most satisfied with PD. In my opinion, he should be given the option to try it.

Like Dori said, let us know how things work out. Good luck!