Dialysis not working.....now what?

[Kas]

Hi my partner started capd in February this year his creatinine was just on 1000 high phosphate and urea...the program has changed 6 times since February and we have just been told pd is not working as his creatinine is now well over 1000 we have been told hemo may be our only option does anyone have any advice on what to expect with hemp?

[kickingandscreaming]

Have they done a PET?  Do they know the character of his peritoneum?  I do PD and went through a number of different prescriptions before the one I'm currently doing. Have they tried using the cycler with many exchanges per night?  I do 5 "shorter" exchanges per night because I am a high-average transporter.  That has made a big difference.  I hope there's a way to tweak his program some more.  Personally, I'm not a fan of Hemo,  but I realize it's in my future if I live that long.  I'd just like to postpone it as long as possible.

[Charlie B53]

Forgive me but I have to ask a number of questions to better understand what he is doing.

How many exchanges, what solution and how long does he dwell before the next exchange?

Diet.  Has he been working on changing his diet to a more 'Renal Friendly' diet?

Dialysis alone may not make a huge difference if he is continuing to fill himself with toxic elements that are difficult to remove.  I haven't save the links but there are many threads addressing a more Renal Friendly Diet.  If all searches fail simply Google "Renal Friendly Diet'.  There are loads of information.  One example, starfruit, for normal people it is fine, it can KILL a Renal Patient.

PD can work well, but some people the membrane will not function near as well.  For some of those the program changes fail then they end up on Hemo dialysis.   Give the diet some serious thought and see if it helps.

[Fabkiwi06]

Also, is he on a phosphate binder and how many how often? With snacks too? Is his PTH also high? My was astronomical and it affected my phosphorus levels. We started Sensipar and they've come down substantially.

The diet stuff is overwhelming at first glance, but this is a great site to get a crash course. It is does say for hemo, but I'm on PD as well and when I'm needing to get numbers under control, this is really solid advice. Plus they have a recipe database.

https://www.kidney.org/atoz/content/dietary_hemodialysis

[Kas]

Thanks for the advice...will look at diet options....I'm not very familiar with a lot of the medical terms sorry his creatinine is over 1000 high phosphate potassium and Uric acid very low haemoglobin....he is doing 4 cycles a night currently using 2 green bags and a purple bag with a dwell time of 1 hr and final fill of 1000 MPs is still getting a low uf but with a manual drain uf is between 500 and 800 hope this explains our situation a bit better 😀

[kickingandscreaming]

Has he done a PET (peritoneal evaluation test) yet?  That would show what kind of peritoneum he has-- slow, average, high average or fast transporter.   This measures his adequacy in clearing solutes and fluids. 

My test showed me to be a high average transporter.  That meant that I needed many short exchanges to clear sufficient UF.  Making that tweak made all the difference--at least in fluid management.  Now I'm trouble clearing phosphate and my creatinine is very high.  So more tweaking in needed.   As my PD nurse is fond of reminding me. PD is not an exact science.  Trial and error.  Hemaglobin can be managed.  Is your partner getting regular EPO or similar?

[Charlie B53]

4 exchanges with dwells of an hour each is not a lot.  My Cycler runs 6 excchanges each of an hour with a final fill of Ico that I carry all day.  I am using the 6 liter bags.  You didn't mention what size bags he uses.

His program can be easily adjusted, the bag size can be increased, to provide much more dialysis.

You need to talk to his PD Nurse about this as this can easily be changed with the approval of his Neph.

Increasing the bag size and increasing the number of exchanges may also need to increase the total hours in the Cycler program.  These changes should make an improvement in his labs.  Help remove more excess fluids and toxins from his system and hopefully letting him feel better.






sp mod Cas