Time to start?

[openboat]

I got my latest labs back, GFR dropped from 18 to 14 in three months and the nephrologist wants me to go ahead and start PD.     I had planned to do home HD when necessary, but she said it's better to do PD avoid doing any vascular damage as long as possible.  It's the first time I've heard this, as yet PD and HD have been presented as equally good options.   

I think I'd be better off waiting to see if my transplant can happen soon enough.  I know I read somewhere that transplants do better if they happen before dialysis starts, but I can't find any links to that right now.  I'm waiting on a call from my transplant coordinator to see what she thinks, since my donor is almost done with the evaluation.

Any advice from the wise and experienced IHDers who started dialysis before a transplant?

[paul.karen]

Well im neither wise nor experienced but i wish you luck with whatever decisions arise for you.

I will say that many doctors and people differ when it comes to HD vs PD.  I think this is a personal decision.
I will be doing PD and also would like a Fistula just incase the PD goes bad or gets infected.

But i hope your New Kidney will make it to you before you have to start.

[Wallyz]

Home, extended hemo dialysis is the best therapy out there right now.  Work that direction.

[kellyt]

Receiving a transplant before ever doing/needing dialysis is the goal for nephrologists and surgeons when it is at all possible.  I was fortunate enough to receive a living transplant without ever having to do dialysis and the doctors/surgeons were thrilled.  Everything thus far has been wonderful.  I thought I was going to have to dialysis the night before transplant but the doctor said that if I had never done dialysis he would prefer not to.

My GFR at the time of transplant was 7 and it had been 7 for quite a few months.  My creatinine was 5.1.   I was still feeling quite while at both of those numbers, but my neph was holding a chair for me at the dialysis center he sees patients at since March 2008.  We were definitely ready, but fortunate enough not to need it.   I hope the same for you.   Good Luck.

[monrein]

I would absolutely choose a pre-emptive transplant if at all possible.  Dialysis isn't easy, not on the body, not on the mind, not on the veins.  If your donor checks out OK I don't see any downsides to bypassing D altogether.

[jbeany]

I can see your doctor's point - there are a limited number of spots you can have a vascular access, and once those are destroyed, it's difficult to get good clearances.  If you are more comfortable with the idea of doing hemo, though - wouldn't it work both ways?  If you can't do hemo anymore, then you could switch to PD.

[paddbear0000]

The big question is, how are you feeling? If you aren't feeling sick, why put yourself through dialysis at all if you don't have too. I'm only starting my second week of dialysis, but I can tell you, it sucks!!!