PD vs NxStage?

[Sunny]

If you were just going to start dialysis, which would you choose and why?: PD or NxStage.
I have read plenty on both modalities of home dialysis both here and elsewhere. Which would you choose?
I wish I didn't need to choose at all, but it looks like my time with my own kidneys may be running out.

[Wallyz]

I would choose nX stage, extended therapy.  This is the mode that is seeing the best outcomes and the fewest diet restrictions.

[rookiegirl]

When I was Pre-dialysis a year ago, my mind was made up to do PD.  I just thought it was more suitable to my lifestyle.  A year later, I'm glad I made the right choice for me.  I like my 2 exchanges a day, no diet restrictions, and feeling great.

[cookie2008]

I tried pd it didnt work out for me so I am in center hemo now until my fistula matures than I am going to train and do nxtage with my hubby as my partner which I cant wait so he can be more involved with my treatments. 

[Dan.Larrabee]

I had to make the same choice myself, I picked PD. This was for one reason, I was pre-transplant. When they do the transplant, most surgeons will remove the PD catheter during the surgery. If they don’t, you can still take it out after the transplant is deemed as successful. If you choose hemo, you will likely end up with a graft or fistula. A graft and fistula are permanent, you will have them the rest of your life. That’s not something I wanted to deal with. There may be some exceptions, but they just don’t take everyone’s graft out after a transplant.

Funny turn of events though, I woke up after my “transplant” with my PD catheter removed, but no transplant, I had cancer. Now transplant is not an option for me and I have a graft and am using NxStage. NxStage hemo is a much bigger commitment than PD. I sit in my chair 5 days a week for 3 and ½ hours. PD would have been a half hour exchange and then it’s off to the movies. My choice for NxStage was not one of convenience as before, it’s now based on my health. I could not feel as good as I do now, with PD although lots of people feel great on PD. If you are not making the choice based only on convenience and your health could be impacted, this is something I would work with your neph on.

[petey]

My husband Marvin has tried a little bit of everything over the last 14 years -- in-center hemo, PD, transplantation, and now home hemo.  Each has its own merits and own drawbacks over the other modalities.

Marvin thinks transplantation tops the list as the best treatment (remember...NONE of these is a cure); with his transplant, Marvin felt close to "normal" (by "normal," I mean pre-ESRD, pre-dialysis, healthy-and-functioning-kidneys days).  But, with transplantation, there are an awful lot of drugs to take and they have some side effects.

For dialysis purposes, Marvin would chose home hemo as the top one.  He feels great now that he's been on home hemo for 20 months.  His lab work is perfect -- absolutely perfect -- and doesn't show on paper that he's a dialysis patient -- except for the creatinine and BUN (doc said Marvin's lab results were probably better than MINE in all other aspects -- and I'm the "healthy" one).  Fluid restrictions are lighter on home hemo, and energy level is much, much higher.  But, home hemo requires a lot of YOUR time and dedication.  You are responsible.  You are -- for the most part -- on your own.  It requires space in your home to store supplies.  It requires attention to detail ( you keep up with everything...supplies, flow sheets, etc.).  It demands independence and a huge commitment on your part (and that of your partner, too).  Marvin feels like he gets the best "cleaning" on a more frequent basis on home hemo.  Of course, you need an access for home hemo (permcath, graft, or fistula).  Marvin thinks the fistula is the best access (and he's had all three types, with numerous of each).  The fistula is under the skin, all "natural" (no plastic tube in there), and gives Marvin the best "cleaning."  Of course, then you either need to learn to cannulate yourself or have a partner who can cannulate if you're on home hemo.  Right now, Marvin's having a treatment...we have a busy, busy day ahead of us with lots of things that Marvin wants to do, so we got going at 4:30 a.m.  You can do that with home hemo because you set the schedule.  That's good.  But then, making the time every day (or, for us, six days a week) can get difficult.  I still work (teach school), so M-F, we have to do treatments in the afternoons or evenings.  On top of that, Marvin and I both volunteer a lot in our community.  He coaches a nine-and-ten-year old youth baseball team and also serves as the chairman of the county's Recreation Committee; I coach a six-seven-and-eight-year-old team and also serve on the town's historical committee.  Between practices, games, meetings, and my work, that leaves little time in every day.  Tuesday of last week, we started Marvin's treatment at 11:30 p.m.  (came off around 2 a.m.).  But, we have to get them in; we don't have the option of saying, "Well, I don't think we'll do a treatment today."

PD is, in Marvin's opinion, less intrusive on everyday living.  The multiple daily exchanges are much quicker to administer than a three-hour home hemo treatment, and if you're on the cycler at night, it's even less intrusive.  But, then the Tenckhoff catheter comes out of the abdomen, and that has some inconveniences of its own.  With PD, peritonitis is always a major concern (two cases of this caused Marvin to abandon his PD experience).

The dialysis treatment that Marvin liked the least -- in-center hemo -- was the one he was on the longest.  With in-center hemo, someone else does the work of giving you your treatment and is responsible for your supplies, your scheduling, etc.  This modality gives little independence and self-control to the patient (though some may like that).  Also, with in-center, Marvin would "peak" and "valley" every other day.  Just going three times a week didn't allow Marvin to feel "good" much at all.  The afternoon after a treatment, he was exhausted.  The next day (his "off" day), he felt some better...but by night, he was full of fluid and toxins again.  Then, he'd get wiped out the next day at treatment.  It was a vicious cycle for him (for the way he felt).  Also, on in-center, you pretty much have to take what you can get with nurses/techs.  If you get good ones, you're fine.  If you get sorry ones (and there are sorry ones out there), you're screwed.  Then, you end up complaining, fussing, demanding even.  Marvin's experience with in-center was that he had no control and very, very little say-so.  He didn't like that.

The only thing Marvin hasn't tried is nocturnal.  He says he wants to do nocturnal home hemo next.  He thinks that would be perfect for him.  It isn't "offered" in our area yet (what the hell are the powers that be thinking?  why aren't they doing what's best for patients?), but we're pushing for it.

Marvin says if you want more convenience and freedom, try PD.  If you want the best possible dialysis treatment, try home hemo.  If you want a passive type of treatment (where you just show up when you're supposed to show up and let someone else do it for you), try in-center.  Of course, he's on the waiting list for another transplant because that's his goal, but until we can get that, he's sticking with home hemo.

Look at your life, your readiness to take charge of your own life (or your desire to let someone else do this for you), your goals for your overall sense of "feeling good," and then decide.  Each person is different.

[Sunny]

I want the best possible dialysis treatment so I can feel better and I am willing to commit to whatever modality can give me that. I've been on the transplant list for 5 years and hope a transplant can happen prior to onset of dialysis, but it seems unlikely. With GFR currently 15, I need to choose a modality and prepare. I know a fistula takes time to mature which is why I wanted your opinion on what to choose. Who better to ask than you. Thanks. Anyone else want to chime in on this?

[jbeany]

I've only been on in-center and NxStage.  I'm diabetic, and my doc doesn't like to put diabetics on PD - it's too hard to control blood sugars and wt. gain.  Compared to in-center, NxStage is fabulous.  I had hardly any diet restrictions, could drink nearly twice as much fluid as with in-center, and had tons more energy.  I felt healthy.  I've just had to start back on in-center, and the restrictions on my freedom to dialyze when I want, eat what I want, and drink as much as I want are already driving me crazy.  The time I waste recovering from the treatment isn't making my day, either.  If you have the willingness to take charge of your own care, and the space and partner to do it, I'd choose NxStage over in-center.  I don't have much advice about PD, not having been on it.  I can tell you that you don't have to make either one a permanent choice.  If you start one or the other, you can switch.

[Rerun]

Pros and cons........                PD                              NxStage

Done at home                       Yes                                Yes
Done Alone                           Yes                                Not so much
Tons of supplies                      Yes                               More
Renal Diet                            Not so much                     Yes
Fluid Restriction                     Not so much                     Yes
More Level Dialysis                  Yes                                Not so much
Needles                                  NO                                 Yes and Yes
Mature time                   Catheter 4 weeks                  Fistula six months

I would try PD first and use up that option first.  Then go to hemodialysis.  I hate dialysis but I could tolerate PD.  I just have too much scar tissue to do it now.

Sunny, I'm so sorry you have to even do this.  I'm sure you will do well at whatever option you choose.             

[peleroja]

Rerun, what a great way of putting it in perspective!  As for me, all I ever wanted was PD.  I can handle one blood stick a month; I can't handle 2 sticks, 3 times a week, and the very real possibility of exsanguination.  That's my tuppence.

[paul.karen]

PD is my choice when my time comes.
Can eat and drink more (less restrictions)
Do it while you sleep no needles and Fistulas have more chance of infections and clogs.
Okarol put up a great article of PD vs Homehemo.  it is a long read but a good read that just made my decision much easier for me.  I will look for it and see if i can figure out how to add a link to it.

[paul.karen]

Sunny Read this thread it may help you out.

http://ihatedialysis.com/forum/index.php?topic=12627.msg216933#msg216933

P&K

[swramsay]

Hi Sunny,
From the research I've done so far, my goal is nocturnal home hemo dialyzing 6 - 8 hours overnight while I sleep. I have read and heard that that's about as close to normal as one can get. I just started training for short daily at home and eventually will switch to nocturnal at home.

[paul.karen]

Sadly Dialysis and the best treatments seem to be much like politics.
You have two different view points with both sides making there best argument for what is the best way/treatment.

i read this-they read that-this said this-that said that ect ect.
Like a politician who do/can you trust??

In the end i quess it all comes down to personnel decisions and reasons.
Good luck.
P&K

[drinkboy]

Everyone is different, but my choice would be PD.  From all the experience and things I have learned over the years with my mom, I would be most comfortable with PD.  But lifestyles, health issues, and comfort levels come into play for the option that works best for everyone.

Try to factor in as many scenarios as possible. I personally would not like to do hemo at the clinic because it is less convenient, takes up too much time, and can be draining on the body.  Home hemo seems to work for many people, but I know I could never do that because having my blood going in and out of a machine without a nurse, or people to assist me in case of a problem would scare me too much. Also, I know traveling with doing PD is not difficult, and I don't know how that works with home hemo.  If you travel a lot, then make sure you know how each option works.

Try to factor in your lifestyle and as many scenarios as you can,  and I'm sure you'll pick the best option for you.  You're right though, nobody wants to have to make this decision and choose.

[paul.karen]

This is a good read about what peoples thoughts and likes dislikes were and why they choose what type of dialysis they did.

http://ihatedialysis.com/forum/index.php?topic=9168.msg151567#msg151567