Home dialysis helps educators remain active

Home dialysis helps educators remain active

By Laura Urbani
FOR THE TRIBUNE-REVIEW
Monday, September 1, 2008

September is a busy time for teacher Chrystal D'Angelo as she welcomes her fifth grade students to Cardinal Maida Academy in Vandergrift. In addition to preparing lesson plans and memorizing all the new names, D'Angelo still finds time for daily dialysis treatments.

At the age of 21, D'Angelo was diagnosed with kidney failure.

"They think I had a strep infection in my kidney," said D'Angelo, 33, who is on the waiting list for a kidney transplant.

D'Angelo is able to keep her full-time teaching position because she uses peritoneal dialysis, which is done at home on a nightly basis.

"A lot of people don't really know about it," said Jane Crowell, regional manager at the Fresenius Medical Care of Latrobe, which is located at Excela Health Latrobe Hospital.

According to the National Kidney Foundation, dialysis begins when a person loses 85 percent to 90 percent of kidney function. The kidneys clean the blood by removing fluid, minerals and waste. They also make hormones that keep the bones strong and the blood healthy. When a kidney shuts down, wastes and fluid build up in the blood.

Most people are familiar with hemodialysis, which is when patients go to a hospital or clinic three times a week. Their blood is pumped out of the body into an artificial kidney machine and then back into the body.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, peritoneal dialysis became widespread in the 1980s. Peritoneal dialysis uses a catheter that is inserted into the abdomen, usually near the belly button. The catheter helps pump a dialysis solution, which contains a sugar called dextrose, into the abdomen. The abdominal cavity is lined with a membrane called the peritoneal, which allows waste products and extra fluid to pass from blood into the dialysis solution.

"You use the peritoneal membrane as your filter," said Crowell. "Men understand it as an oil change."

The fluid is left in the abdomen from four to six hours. Then the fluid is drained in a process called an exchange, which takes 30 to 40 minutes. Most patients require four exchanges a day.

"Because they do this every day, it is more like your kidneys," said Crowell. "It's a more effective way."

There are two forms of peritoneal dialysis -- continuous ambulatory peritoneal dialysis (CAPD) and continuous cycler-assisted peritoneal dialysis (CCPD).

CAPD uses gravity to make exchanges several times throughout the day. CCPD uses a machine (called a cycler) to make exchanges while the patient sleeps.

The patients come in once a month to see the doctor, social worker, nurse and dietitian.

"They can come in more often if they need to," said Crowell.

Last March, St. Vincent College professor Joe Reilly was faced with making the choice of which type of dialysis he wanted. Without hesitation he choose CCPD.

"This form appealed to me," said Reilly, 63, of Latrobe. "I can lead a normal life. I take care of it while I'm sleeping."

Reilly, who developed kidney failure from complications with diabetes, admits to being a little intimidated by the machine.

"When I first saw the tape on how to use it, I thought I'll never use it," said Reilly.

Reilly and D'Angelo credit Susie Rodgers, a home therapy nurse, with making the transition to peritoneal dialysis an easy one. Rodgers walks patients through each step of the procedure to ensure that they can safely and efficiently manage the dialysis at home.

"It's a team effort," said Rodgers.

Although the exchanges occur during the night, patients do have to get used to a feeling of a full abdomen.

"There's always fluid in their belly," said Crowell.

For D'Angelo and Reilly, the most difficult adjustment has been dealing with the alarm that sounds whenever the catheter becomes crimped while they are sleeping.

"That gets a little annoying," said D'Angelo, who admits she likes to sleep on her side.

Patients do have to watch their diet, although it is not as restrictive as hemodialysis.

"You have to be careful with high phosphorus foods, which is dairy," said Crowell.

"I had to cut out broccoli and Brussels sprouts. Darn," said Reilly laughing.

"It's so different from the hemo side," said Crowell. "They are very restrictive on a hemo diet because they only do it three days a week."

Hemodialysis patients need low potassium levels.

"On hemo you can only have four cups of fluid a day," said Crowell. "With PD you can drink a little more."

Patients experience few complications. The most common is peritonitis, which is an infection of the peritoneal membrane.

"You can get infections," said D'Angelo. "I have had some of those sometimes. You have to keep it really clean."

"We treat them at home so they stay out of the hospital," added Crowell.

According to Crowell, 102 patients at the clinic receive peritoneal dialysis. If at any time they no longer want to do the peritoneal dialysis, they may switch to hemodialysis.

"They can choose throughout their life what they want to do," said Crowell.

Patients are encouraged to live their life exactly as they did before the start of dialysis. With the help of peritoneal treatments, they are able to maintain an active lifestyle.

"It's not the end of the world to be on dialysis," said D'Angelo.

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