I hope these aren't dumb questions

[bevvy5]

Greg (hubby) has been on the cycler for  a week now.  We had a home nurse visit today and she went over his latest blood work with him, etc.  Potassium is good, phosphorus is high normal, so much much better than it was.  Hemoglobin is good and aranesp shots have been reduced from once a week to once every 10 days.  Urea levels were good.  Protein was low so encouraged to eat more protein and if it doesn't rise, possibily to look at supplements.  His prescription is five 2000 ml exchanges of 2.5 solution and then extrarenal 7.5 for all day.  He's feeling good, everything's going well.

The nurse discussed whether he was willing, in the future if need be, to have a longer time, say 9.5 hours instead of 8 for treatment, if an extra exchange became necessary.  She mentioned briefly that patients run the gamut of two years on PD to over 10, no crystal ball, which was no surprise to us.

My question is this and I've been reluctant to ask the doctor or nurse because Greg doesn't really like to even have the possibility that PD will not work forever mentioned.  What makes PD stop working?  Other than some sudden horrible infection or something traumatic like that?  Does the peritoneum just "wear out?"  How do you know?  Do your blood work numbers start declining? 

If this has been discussed somewhere, I apologize.  I tried to do a search but couldn't come up with the right buzz words, I guess.  Thank you in advance.

[paul.karen]

hello Bevvy

Yup from what i gather the peritoneum does wear out.  Some people have been on dialysis (pd) for over ten years.  I also have this same fear.
I do five exchanges of 2500ml over 9 hours using 1.5.  Just had my KT/V and im at 2.65.  But sadly that good number is due to me still urinating alot.  The actual dialysis number was only .8. Did that make sense?  So as my urine output decreases i hope i can have good numbers.  Or i will have to go to hemo.  I cant do much more then the 9 hours a night im doing mainly cause i work fulltime.
Welcome to IHD.
P&K

[peleroja]

Welcome to the group.  Yes, the peritoneum does finally wear out, possibly due to age, overuse, or multiple peritonitis.  I was once in contact with a man who had been on PD for 17 years, but he had also never had peritonitis.  They know your peritoneum is wearing out when your Adequest number (Kt/V) goes too far down below what they like (1.7 to 2 or above is where they want it).   I've been on PD for 6 years and they are just beginning to tell me my numbers aren't so good.  We shall see.

[looneytunes]

Hi Bevvy...I can't add much to what the others have said.  My hubby has been on PD now for about 19 months.  He has not had any peritonitis. He is on a cycler for a total of 10 hours doing 11,500 ml of 1.5 or 2.5, depending on his BP and fluid retention symptoms (swelling).   But his neph says that if his kt/v drops below 1.8 or his albumin level goes below 2.0 he will have to go back on hemo.  So far, we have managed to keep it going but it is a big fear for both of us because he is so much better on PD than he was on hemo. 

Best of luck to you both! 

[KICKSTART]

Ive just been there , got the t shirt , after four and a half years on PD i have come to an end and had to start hemo . There is no given reason why it stops at different times for different people. Im not old ! , never had peritonitis or any other problems . You just wear your peritoneum out. !

[Restorer]

I'll just throw in my experience here:

I've had peritonitis four times, all probably from the same bug that never got fully eradicated. Each episode after the first seemed to decrease my PD effectiveness. For at least a week after each, my peritoneum swelled and I wasn't able to drain very well. Manual dialysis used to be effective for me, but then it just stopped working well enough - I absorbed too much fluid and couldn't dialyze enough of anything else. Switching to a fairly aggressive prescription on the cycler has worked for me, but I won't be able to do PD forever.

[Jie]

As I mentioned in another post, my clinic has a patient who has done 17 years of PD and another patient with 16 years of PD.  They continue to extend their record.  So, it is possible to do PD for a long time. Just avoid infection and avoid using the high % solution as much as possible.     

[KICKSTART]

You've got to admit though 16yrs and 17yrs is exceptional and not average .