PD vs HD

If PD is is easier on your body than HD why would anyone use HD?

A few of reasons pop into my head right off - first, I don’t think the medical profession urges patients to opt for PD - possibly due to their lack of knowledge, or maybe lack of profit (Dr’s get more $$ if they see patients “in clinic”). Secondly - some people are afraid, or unable to take control of their own care.

Research has shown that most nephrologists have little experience with anything other than in-center hemodialysis in medical school and nephrology training programs. Like most of us, they are most comfortable encouraging people to do what they know works. Right now about 92% of patients do in-center dialysis. This means that many nephrologists have never taken care of a home dialysis patient (PD or home hemo). However, there is a push to change the education that future nephrologists get about options for treatment. Hopefully more will be added to their training programs about home dialysis and as there are more clinics that offer home therapies, they’ll spend more time in clinics seeing how well home patients do physically, emotionally, and vocationally.

So far as physician fees are concerned, if the doctor sees a home patient one time a month at a clinic appointment (what most clinics schedule for home patients), the doctor gets the same payment from Medicare that he/she would get if he/she had seen an in-center patient two to three times that month (the rate is the same for twice or three times). The only way the doctor makes more is if he/she comes to the clinic every week to see patients, which is much more time consuming.

Here are some reasons why some people choose not to do or can’t do PD:

  • Abdominal surgeries – There may be too much scar tissue for the lining of the peritoneum to transport enough wastes and excess fluid.
  • Heavy people – People that are large may not be able to get enough dialysis with PD.
  • Body image – Some they don’t want to have a PD catheter because it negatively affects how they see their body, people on PD don’t have as flat a stomach as they used to, and there is a tendency to gain weight if you don’t limit sweets.
  • Storage space – You need to have space to store a month or more supplies which includes many boxes and they have to be stored in a place that doesn’t get too hot or cold.
  • Some people prefer home hemodialysis which allows them to have the flexibility to arrange their dialysis around their other responsibilities.
  • Oher people don’t want to have anything that reminds them of dialysis in their home (supplies, machine) and want someone else to take care of them so they choose in-center hemodialysis.

The good news is that no matter what your personality type and medical needs, there are options to choose from. We hope that patients are told about all options. However since we have heard that patients aren’t always told, we designed this website to help spread the word.

Thank you for your replies, your replies are so helpfull.
My husband is ready to talk to the clinic doctor about PD & having a catheter inserted.

He was shown a film & given a booklet to study. He was also told that I must be with him when he starts PD training. Is this usual.

I remember one poster who said the nurse would not allow her to be with her husband at this time.

I was under the impression that the patient must learn how to do PD by him/herself.

I guess it’s a good idea when both learn PD, but didn’t know it was required.

I think it’s an excellent idea to have more than one person know how to perform the process. I remember once when I was in the hospital a nurse came in to “start my dialysis” she hadn’t cleaned the work area, masked, washed her hands, and was reaching for my access when I stopped her cold. Fortunately, I was alert and able to stop her - but if I hadn’t have been, she would have exposed me to possible peritonitis just by her lack of awareness. I then took over the process myself. My daughter-in-law is my back up, she is also a nurse; we have this arrangement if I am ever in the hospital and unable to perform dialysis for myself - she will be their to do it for me.

So many patients are afraid to speak up even just to tell the nurses & doctors to wash there hands before touching them.
There is a false sense of security & a sense of feeling safe in one of the most dangerous places to be when sick.
Thousands die each year from in hospital infections which could easily have been prevented.

Good for you for speaking up.

Not everyone can do PD. It is not effective for everyone (one of them people being me). I am only on HD now because PD wasnt giving me adequate clearances. If you are doing ok on PD, stay on it!