The doctor sadi that you know more about this area and should be asked about my concerns.
What is the best fluid ot use to protect my membrane? What about using PD 6 days and one HD a week or less?
I have been on PD for 2 years, type II diabetic, and a bit heavy 266’ 5’10.5" (Fluid on wt) using Baxter PDII fluid mostly 2.5 and some higher. My clearance numbers have never been much above 1.7. I feel very good and staying active, having built a treehouse for my grandkids, etc. So, I feel as well as I ever have since starting PD.
As my urine out put decreases and my test numbers dip below 1.7 I am worried, as I like PD and want to stay on it as long as possible. I have lost 30lbs seeking enough loss to be further considered for a transplant. Blood glucone and other items are in balance and controlled.
Any suggestions as to fluids, theray or anything I can do to stay on PD is requested. Again, I hear that the old number was 2.0 and now it is 1.7. I feel very good and think maybe my number could be a little lower and still provide life support. WHat do you think?
You have asked a very important question about how to protect your peritoneal membrane. First and foremost, one must avoid getting peritonitis. You did not mention having had an episode so I hope that means you have not, and that would be very good. Even a single episode can do a lot of damage, causing scarring of the membrane and making it more difficult to function properly. You did mention peritoneal fluids, and these also are important to consider. The solutions you mention use glucose to help remove toxins and fluid. The lowest concentration of glucose is 1.5%, with more in the 2.5% and most in 4.25%. You want to avoid 4.25% altogether if possible. Some of the by-products of glucose as it breaks down in the body can also damage the membrane so that is why we want you to stay away from the higher concentrations. In order to do this, you must be careful about what you drink each day and how much salt is in your food. Less of both is best. When you still make urine, even if just a small amount, the kidney can help remove both water and salt as well as toxins. But as you loose urine output you loose these functions. Are you using icodextrin for your long dwell? I assume you are on the cycler and if so, you need icodextrin for your last fill (the day dwell). If on CAPD, you need icodextrin for your long overnight dwell. Icodextrin will help protect your membrane from the high concentrations of glucose fluid; thus you will use one less dextrose bag per day. Finally, you asked about clearances—that is the 1.7 you refer to. This number indicates how well your dialysis and urine are clearing some toxins. The target today is 1.7 and you are right, it used to be 2.0. It is important to measure your clearance 3-4 times a year at least and to note how much of this is due to your dialysis (PD) and how much from your kidneys (urine). As time goes by, you will eventually not produce any urine and it is important for the doctor to increase the amount of dialysis (PD) as the urine production falls to keep you feeling well. Falling below 1.7 is not recommended, but most important is how you feel. Even at 1.7, some do not feel well and need more to feel well. You are to be commended on your weight loss, both to help you avoid diabetes and increase chances of a transplant, but also because you will be more able to reach your target numbers in dialysis when you weigh less. So keep up the good work in that direction. I hope this helps you. You seem like a model patient who is physically active and interested in how to keep yourself in the best shape. Remember that staying on PD is a good goal as you await a transplant as studies have shown that those on PD do better than those on HD when transplanted. You did ask about doing HD once a week. I do not recommend that plan as it will expose you to the risk of two accesses (a PD catheter and a fistula—Never an HD catheter please!!) and HD is likely to cause you to loose your urine output very quickly due to the rapid changes in blood pressure during the treatment. Just stick with PD!! and good luck.
Judy Bernardini
Thank you for the quick response. I do feel good and want to stay on PD as long as possible. I guess when it comes to numbers it does matter how you feel.
Sadly, I have had 2 infections and changed my methods to avoid a repeat. I know that was bad, but all I can do now is go forward.
To me life is better on PD for many reasons. If the number has changed might it change again or some people like me live ok with 1.61 to 1.69? Regardless, I am going to minimize any 4.5 solutions and try to only use 1.5 or 2.5 going forward. I also have some fibrin at times, so I want to use the best solutions and do all I can to preserve my PD life. I am using dianeal pd 2 mostly and no tthe one you mentioned, unless that is a brand name? I use Dianeal PD 2 for the cycler and manual exchanges.
Thank you gain for your response.
Good. I think you are doing great on PD. Ask your physician and PD nurse about icodextrin. It is also called Extraneal and made by Baxter but available anywhere in the US. You should be using it for your long day dwell. And your prescription can (and should) be changed to compensate for the loss of kidney function and urine output so that you will continue to feel well on PD. Again, best of luck.
Judy
Will do. Thanks. My PD nurse has been my best resource and help.
I am sticking with PD and now using extraneal in my day time long dwell. I have sent the PD nurse another question that is still open. I hope she can review it and respond this week, as I greatly appreciate her advice. I am now using extraneal becuase of her advice and i know that it is far better for me.
Glad to hear you are feeling better. Let me know if I can be of further help in the future.
Judy Bernardini
I sent the other question to you, but I guess I just posted it. I hope you have a chance to read and respond. You are the one who helped me and exposed me to extraneal and I wanted to thank you for that and your advice. My other posting noted ny KTV test came back lower than 1.7 and I asked a question. My absorbsion is holding and I have had a result previously of 2.3 with cycler, and two day time exchanges. The next one was just cycler, but last fill was extraneal. What about a day time after 8 hours and then cycler, if needed to get a higher test number. I want to stay on PD and use extraneal to save my membrane. Any thoughts or suggestions would be greatly apprecaited, as are you.