The ups and downs the PD access v. a hemo access

[Lillupie]

Alright,
 I feel I should really explain this. I get most patients go to hemo for whatever reason. I choose PD, and still do after spending almost 5 months on hemo.

There are many misconceptions over one modality over the other. However, there are still many drawbacks to both. Bthith can change something about your appearance and not in the most pretty way. PD can possibily make you look pregnant, hemo can make your arm not look attractive. Both can possibly have some weight limitations. Hemo, I guess they do not want you to lift anything over a certain amount on that one particular arm, On PD, there are weight restrictions for me, because I am prone to hernias. Hernias are a downside to PD.
 Remember no 2 Patients are the same. What works for you, may or may not work for me. THis is what I have been told and have had experince with.

Now, let me tell you about the pros and cons on both, for me is:
Yes you can get a infection with both PD and hemo. Unless you have a fistula, that is saying you have a fistula withOUT any access problems.
I chose PD because I didnt want to get 2 needles 3 times a week.
yes, with hemo, if i got a fistula right away, I would not have a foreign tube at all, it would be all me. And from what I know and have been told a fistula lasts and is only as good as your veins are. If not, then you can get a graft.
Do you all mean there are no infections at all with a graft?

Here this site says only 10% of the patients on PD get an infection that is so bad that the catheter has to be replaced.
http://ndtplus.oxfordjournals.org/content/1/suppl_4/iv23.full

I do hear a lot of people who work in hemo as well as those who are hemo patients putting down PD saying "there is a risk of infection". Yes, however I believe the infection (this was told to me by my nurse) on PD is lower then on hemo. This may be because so many patients actually do have a permacath instead of a fistula, or even a graft.
The difference is, if I do get a infection with PD, guess who I can only blame? Me. I cannot point my finger at any doctor, nurse, over busy; under paid tech. It is my fault, and only my fault for not using precautions when hooking and unhooking doing an exchange. (of course, there are exceptation, like PaulKaren at one time with his nurse not tighting the catheter, making it leak on his bed) Now, with PD, you are trained step by step how to avoid getting an infection. It is up to you as a patient to follow through. Yes you have to wear a mask and wash your hands with antibacterail(sp) soap, and you cannot let anything toouch the end of your cathether when it is exposed, and always replace the mini cap. After aehile this will become second nature to you. As soon as you connect you can take your mask off.
 There are various ways you can hide the PD cathether. I switch by letting it freely move around in my underwear (not very long though), using different kinds of tape to tape it up, or you can (i havent yet) use a PD belt to put it in place.
 I am encouraged to shower, unlike the permacath on hemo. I was told/taught at the 2 PD clinics I have been a patient at to not use dressing in the shower and it is a must in the shower to wash the exit site with antibacterial (sp) soap. You also can get a medicated cream to put over the exit site.

Now for hemo, the short time I was on it, I refused to get a fistula. Again, i personally dont want a ugly arm. The permacath was placed. I personally didnt have a problem with the permacath. It felt really, really akward though and took time getting used to.
 I didnt have a problem, because my house didnt ever have a shower. (ok I lived in Detroit at the time, my grandmothers house is from the 20s, no shower, cast iron tub with feet. There was a hose connecting to the facuet, we just bent down and washed our hair over the tub, and I took a bath) I know you are not suspose to with a PD catheter.

So, my question to all on here since starting the great hemo dialysis, never ever had to go to a access center or back to surgery to adjust your access or get a new/different one?

Now, I might of chose PD from the start, however it had its ups and downs like the rest. Yes I am more prone to hernias, which it has been a good two years since ive had to have that fixed and had to go on hemo, I did get the infection one time. Again my fault, when putting heaprin in my bag, the needle poked out and stabbed me and I kept going like nothing happened. That is how i got my infection. Oh and the very begining I went on the ride at the state fair that caused me to go upside down and my catheter went into my chest, so back to surgery I went to get it back into the pelvic region. My problems were in the begining of dialysis and now I am used to it!

Lisa

[rsudock]

Everyone has to choose what modality is good for them. I think across the board the medical community feels that the gold standard of dialysis is hemo with fistula access. I am sure there are studies that compare the different type of dialysis. (Any body want to insert that study for me?)


As far as your fistula being ugly I guess beauty is in the eye of the beholder.   Personally using the buttonhole technique on the fistula really helps reduce the anerysums that can form. Myself and  few other members have posted pics of our fistulas and some don't look so bad. (We posted them for Dom, she wanted to know what they look like) I have had my fistula for 10 years. I have never needed a fistulagram or corrective surgery. (knock on wood)  I was very lucky to have a great surgeon.

[cytoxin]

I've done PD, got an infection so bad I had to remove my Cat and switch to Hemo, which I am doing now thru a PermCath. I cannot wait to get back to PD.  Showering is a pain, I use saran wrap to cover up the site.  When I was on PD the main problem I had was with sleeping.  The machine always kept me up at night, don't have that problem with Hemo, but my time for when it is done is right in the middle of the day, so it's more inconvenient to me, even though it's only 4 hours, compared to the 8+ hours PD takes.

As for the problems that people say about it changing your appearance, I didn't have any problem, besides the obvious of having a tube sticking out of your stomach.  I always went dry during the day and even when I did have fluid in me for dwell it wasn't that noticeable (granted I'm fairly thin and athletically built)

The Nephro I spoke with said the preferred method here is to have PD access if possible, not Hemo.

[cath-hater]

My neph always told me that the major diff between the 2 is the life style. If you are an active person working full time and have a fairly busy schedule (not dialysis related), than PD is for you.  Like I said in a similar thread, I work full time and can't see how I can fit in HD with my full time work schedule.

I would like to hear from an HD person who works full time and tell us what it's like on the days they have to dialyze. 

[KarenInWA]

My neph always told me that the major diff between the 2 is the life style. If you are an active person working full time and have a fairly busy schedule (not dialysis related), than PD is for you.  Like I said in a similar thread, I work full time and can't see how I can fit in HD with my full time work schedule.

I would like to hear from an HD person who works full time and tell us what it's like on the days they have to dialyze.

I'm new to this whole D thing, and I do HD 3 times a week after work and work 40 hrs a week.  I work from 7-4, and am hooked up on the machine by 5-5:15.  I get off 4 hours later.  Yes, it makes for a long day, but I am lucky in the fact that as soon as I'm free, I can get up and walk out to my car and go home.  I don't have to sit there and recover.  I go home, have a quick bite to eat, then go to bed.  Yes, it kinda sucks that I have to do this, but it is what it is and it sure beats living in a mental facility!  I couldn't see myself doing PD every single day for at least 8 hours a day.  I don't sleep that long except on weekends! And being tied to my home for a third of my life just sounds depressing to me.  As for the fistula, mine is in my upper arm and is still developing.  I'd rather have my arm look a little weird than have my slender figure hampered by carrying fluid in my tummy.  I am a bit vain about that, as my slenderness has always been a part of me, and I am not about to give that up just yet.  Not for dialysis, anyway.  I usually wear long sleeves of some sort, anyway, so I'd rather the arm be a little ugly than my stomach!

So far, I have adjusted to HD just fine.  I don't know if my neph is conservative with the Rx for it, or if I just adhere to it well.  No crashing, no feeling like crap afterwards, none of that.  I just feel like my normal self these days.  So far, so good.

KarenInWA

[bette1]

When my kidneys first failed I went on PD for 7 years.  I had two catheters.  I did very well, worked full time and everything. 

After my first  transplant failed I went back to PD, but was hypersensitive to infection.  I kept getting infection and I'd have to have catheter replaced over and over.  The last straw was when I got and infection in my catheter before I'd even used it. 

I'd always avoided getting a fistula but mine isn't bad.  You can barely see it.  With the buttonhole technique, I didn't get a big ugly vein.  I always freak out little kids by letting them feel that thrill. 

I think both catheters are intrusive into your life, but I't easier to live with a Hemo catheter, in my opinion.

[cath-hater]

bette -

I read your signature and noticed you have FSGS. Is your 2nd transplant still working now? What happen with the first one? How long did it last? If the 2nd is still working now, what did the docs do to get it to work? I ask because I had a failed transplant due to my FSGS. The docs tried pheresis but didn't work on me. Went through hell. Debating if I should go through it again.

[Bajanne]

I had no choice, since the only modality here is in-centre haemodialysis.  So the choices here are fistula or graft, and the state of your veins make this choice.  I have a graft.  However, because of several aneurysms I have had to have the graft line changed about 3 to 4 times.  Actually, the vascular surgeon is checking out a present aneurysm.  I was hoping I wouldn't have further surgery, and he too wants to wait a bit.  The nurses are cautioned to steer clear of it and it has not been posing a problem.
The patients who have fistulas have some really horrid-looking things on their arms (at least to me)  I would prefer a fistula for the longevity, but the looks!!!!!

[Poppylicious]

I would like to hear from an HD person who works full time and tell us what it's like on the days they have to dialyze.

Okay, so technically I'm not the one on haemoD, but since my Blokey is and never comes here I'm answering this on his behalf ...

 

Blokey works full time, weekdays.  He goes straight from work to dialysis (thirty miles from home) and tends to get home anytime between ten-thirty and eleven-thirty, depending on how long he had to wait before they hooked him up and whether he popped into the shop on the way home.  He has to leave work a tad early (a matter of half an hour or so) on MWF but work have been very accomodating (particularly as he doesn't fall asleep on the job anymore!) and he often works through lunch.

He doesn't seem to have any problems on haemoD and can still drive immediately afterwards.  He's always pretty alert when he gets home MWF and we curl up together and watch trashy tellybox programmes, even though I have to be up at the ungodly hour of 6am. 

Being on haemoD means that we have Tuesday and Thursday evenings to arrange other things (nights out, etc., although Blokey tends to be more tired those evenings) and we don't have to worry about going away at the weekends (day or night) or what to take with us (except the medication, but we can just throw the whole Poppylicious-proof friendly medication box in the boot of the car.)

It works for us and we're very positive about it.  But then we have to be, since PD didn't work.