fistula *and* PD access?

[Psim]

I saw the vascular surgeon awhile ago and he ok'ed me for either a fistula or PD. I told him I definitely want to go with PD, and he said sometimes people get both put in in the same operation, so I'd have a mature fistula available if anything went wrong with the PD. Has anyone here had that? Are there any down sides to it? (I'm in Canada, so he's not just trying to get more $$ for more procedures.) Thanks.

[Ginger]

When I began PD, I only had the PD cath placed as you can always have a chest cath inserted for hemo if anything goes wrong with the PD and hemo becomes necessary.  I had a fistula placed when I needed a nephrectomy and would not be able to continue PD until things healed from the surgery. I had the fistula placed about 3 months prior to needing it. Before I was able to return to PD, I received a transplant and the PD cath was removed about a month post transplant.  So, I presently have a functioning kidney and a still functioning fistula.

If I were you, I would only have the PD cath placed as that saves all your veins for later if needed.  Fistulas do not always work and why mess up your arms unnecessarily.

[jbeany]

I think it would just add one more thing to worry about.  Along with keeping the Pd access clean, you'd have to worry about the fistula clotting, and possible fistulagrams to unblock it.  Why have unnecessary surgery?  Even if you do have problems with PD, you can do the temp cath if you have to.

[Joe Paul]

Hmm, with dialysis I think its best not to take Anything for granted. If it were me, I would have both done, just in case. Better safe then sorry 

[KICKSTART]

I do PD and no one mentioned a fistula for just in case , and i dont think many other people will have both either. If you just want to do PD then tell them that , i cant see anything going wrong so why have both ?

[Psim]

Along with keeping the Pd access clean, you'd have to worry about the fistula clotting, and possible fistulagrams to unblock it.

Are fistulas likely to clot or give other problems even if you're not using them? Are there problems with the chest catheter (infection, or...?) that would make if much better to have a functioning fistula?

I'm starting to really wonder if it makes sense to have both done. Sometimes what looks practical to a doctor can be more difficult from a patient's point of view.

[Redbomb]

I had my fistula done three years before I had to start Dialysis.  Then when I did have to start, even though my fistula was mature it was narrowed in several places (we didn't know that) and the first time we tried to use it we infiltrated it.  I had to have a perma-cath placed while they worked on my Fistula.  I've had three fistulagrams now and I've just been able to use the fistula solely for about two weeks now.  I think if I had to do it over, I would have waited to get the fistula until I was closer to having to use it for an access.

(just my  worth.

[angela515]

Lots of great advice given, so I only got one thing to say... if it were me, I would only get the PD cath placed, and not the fistula.

[Black]

I'd ask the surgeon if he has reason to suspect that you will not be able to do PD.  There is no reason to have a fistula if PD is working for you.

Later, IF you know ahead of time that you are going to have to switch to HD then you can have the fistula surgery done.  If you don't know ahead, then a cath can be used until your fistula is ready.  In the meantime, work out your hands and arms, and try to get "Popeye" arms so your chances of getting a good fistula are much better. 

[fluffy]

its a good idea to have both, i was on pd for three years and due to infection i wasnt clearing toxins properly and i had to switch to hemo. while i was waiting for the fistula to mature i was pretty toxic.it kinda sucked. on the bright side tho i continued to do pd and could drink as much as i wanted due to the fluid removal and i did hemo only twice a week. they removed the pd cath tho and now i go three times

[AlasdairUK]

If you get both done, your fistula could pack up before you have ever used it as it might not mature. You have then lost an access site without ever having used it. I would just get the PD and you can have a fistula created if you needed it later on.

When you create a fistula you are messing about with your blood supply to your heart, if you are using PD you are not getting any benefit out of your fistula and possible complications may occur.

[Red from Canada]

A fistula is considered the "gold standard" for Hemo.  I had mine put in in 2003, years prior to needing dialysis.  I am now on PD, but have the fistula for backup if needed.  I would be leery of having both surgeries at once, but it would save a second hospital stay.