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okarol
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« on: March 25, 2009, 02:43:28 PM »

Starting Dialysis: What You Need to Know

By Charlotte Szromba, MSN, CNN, APRN-BC

When to start kidney replacement therapy (KRT)
Currently chronic kidney disease (CKD) is classified into five stages based on a common measure of kidney function which is the estimated glomerular filtration rate (eGFR). It is the rate kidneys are able to filter out waste from the blood and is based on the creatinine value in the blood, age, race and gender (NKF, 2002). Normal eGFR is 125 mL/min and a lower GFR means a loss of kidney function. We will concentrate on stages 4 and 5.

Stage 4 CKD – eGFR less than 30 mL/min
This stage of CKD is considered fairly severe and it is important to meet with a nephrologist and a healthcare team on a regular basis for monitoring and treatment of complications of CKD, such as anemia, bone disease, malnutrition, acidosis and decreased sense of well-being (NKF, 2002).

The National Kidney Foundation K/DOQI clinical practice guidelines for CKD recommend individuals who reach stage 4 CKD (eGFR less than 30 mL/min/1.73 m2) should start getting ready for kidney replacement therapy (KRT) by learning about treatment options such as hemodialysis, peritoneal dialysis and kidney transplant (NKF, 2006). A referral to a surgeon to create an access for hemodialysis or peritoneal dialysis may be needed at this stage to allow time for the incision to heal and the access to develop.

It is also important during this stage of CKD to protect the kidneys from additional damage by following the advice of the healthcare team regarding diet, medications, blood pressure control and lifestyle changes. Individuals can sometimes remain in stage 4 CKD for several months to years without progressing to stage 5.

Stage 5 CKD – eGFR less than 15 mL/min
This stage generally means kidney failure and the need to start KRT to replace lost kidney function. Some common symptoms include poor appetite, nausea or vomiting, worsening fatigue, increased edema in legs and feet, increased shortness of breath and more difficulty controlling blood pressure. These are all symptoms that indicate KRT is needed.

Types of Kidney Replacement Therapy
• Hemodialysis can take place in an outpatient dialysis center or at home
• Peritoneal dialysis takes place in the home setting and may involve a cycler machine
• Kidney transplant involves the surgical placement of a kidney from a donor in the abdomen
• Non–treatment involves a decision by the individual and the healthcare team to decline any type of KRT.

Decision for type of kidney replacement therapy
It is important to learn about the available therapies by talking with the healthcare team, reading information, attending classes and using the Internet to understand all the options. The physician and healthcare team can provide guidance, but the ultimate decision is up to the individual. It is important to consider lifestyle, personal capabilities, support system and personal preference when making the decision for the type of KRT.

Hemodialysis
Types of Hemodialysis
• In-center hemodialysis lasts three to four hours and is done in an outpatient dialysis unit three times a week. A typical schedule is every Monday, Wednesday and Friday or every Tuesday, Thursday and Saturday.
• Home hemodialysis lasts two to three hours each time, usually five to six times a week. This option has many variations.
• Nocturnal hemodialysis is done at night for six to eight hours, three times a week. This is done in the home setting, however, some dialysis centers are beginning to offer this option.

Preparation for hemodialysis
Vascular access surgery is done to create a path for the blood to be cleaned during dialysis then returned to the body. The surgery is done ahead of time so the incision can heal and the access can develop so it can be used for dialysis.
There are three types of vascular access.
• Fistula surgically links an artery and vein together and is placed in the upper or lower arm and is considered the best type of vascular access. It lasts a long time and has few complications, but often takes several weeks to months for the fistula to be ready to be used for dialysis.
• Graft is a type of hollow tubing surgically placed under the skin linking an artery to a vein, providing a permanent access for dialysis. This option is often used if there is a problem with the size of the patient’s blood vessels.
• Central venous catheter is a small hollow soft tube placed into a large vein in the neck or shoulder that allows access to the blood stream. This type of vascular access is usually temporary and can be used immediately after placement. However it is associated with many complications such as infection or clotting (Breiterman-White, 2006).

In-center Hemodialysis
Advantages
Three treatments per week, four days off.
Treatments are done by trained nurses and technicians.
Meet and spend time with other hemodialysis patients.
No equipment or supplies stored at home.

Disadvantages
Travel to dialysis center on a fixed schedule in all kinds of weather.
Limited fluid intake and diet restrictions to follow.
Permanent access in the arm where needles are inserted for hemodialysis treatment.
Possible discomfort such as headache, nausea, cramps and “washed out’ feeling.
Trips must be planned in advance so arrangement for hemodialysis treatment at destination can be made.

Home hemodialysis
Advantages
Treatments are done in your home on your schedule.
No traveling to dialysis center, only monthly check up in clinic. Treatment is done in the comfort of your home.
Same person helping you and placing needles in your arm each time.
More frequent dialysis avoids large shifts of fluid as in three times a week and allows fewer restrictions on diet and fluids.
You learn enough for you to be in charge of your care with advice from healthcare team.

Disadvantages
You are responsible to do the treatments as prescribed five to six times a week.
You and your partner must be trained to handle equipment and do the treatment. Partner must be available for each treatment.
Storage space must be available in the home for equipment and supplies.
Some plumbing and wiring changes may be necessary in your home, newer machines require less changes.

Peritoneal dialysis (PD)
Types of Peritoneal Dialysis
CAPD – continuous ambulatory peritoneal dialysis is done manually usually three to four times a day, each exchange of fluid takes 20 to 30 minutes.

CCPD – continuous cycling peritoneal dialysis is done at night, using a small machine at the bedside.

Preparation for PD
A hollow tube called a catheter is surgically placed through the wall of the abdomen and this is the permanent access for PD. It is generally placed about one to two inches below the navel and to one side. The catheter remains in the body all the time and about two to four inches of the catheter extends out of the abdomen. The surgery is usually done three to six weeks ahead of time so the incision can heal.

Peritoneal Dialysis
Advantages
No need to travel to center three times a week. Schedule is more flexible. Treatment is done in the comfort of home.
Fewer food and fluid restrictions than incenter hemodialysis.
No need for needle insertion.
Easy to do PD when you travel.
Can dialyze when you sleep with CCPD.
Blood pressure control may be better since it is a continuous therapy.

Disadvantages
Need to schedule exchanges/cycler into your routine seven days a week.
Catheter is permanent and external.
Storage space is needed in the home for equipment and supplies.
Some risk of infection.
May gain weight due to glucose content in the dialysate solution.

Kidney Transplant
Types of Kidney Transplant
• Living related or living non-related transplant - the kidney is donated by an individual who is a close tissue match to the recipient.
• Deceased/cadaver transplant – the kidney is donated by an individual who decided to donate his/her organs when he/she die. The waiting time for this type of transplant can be one to five years depending on blood and tissue type.

Advantages
No dialysis treatments needed with a working kidney transplant.
Fewer diet and fluid restrictions.
Closest thing to having own kidneys, may feel healthier with more energy.
Allows for a normal schedule with less clinic visits.

Disadvantages
Risk of major surgery and stress of waiting for a kidney match.
Need to take anti-rejection medications every day, some side effects may be noted.
Risk of rejection, donated kidneys can fail and dialysis may be needed.
Possible changes in appearance due to medication side effects.

Non-treatment
Individuals who are severely ill or have many health problems may consider this option. Anyone with a chronic illness may struggle with a sense of hopelessness at times and feel any type of dialysis will not add to the quality of their life. There may be a fear of the unknown and what the future may hold. Often the healthcare team can suggest a trial of dialysis for a short time. If a person over time continues to believe treatment for kidney failure will not bring a better quality of life, then talking with the family and healthcare team about preparing for a peaceful passing is important. Symptoms can be managed as they occur and the person is kept as comfortable as possible through palliative or hospice care.

Selecting the treatment that is right for YOU
Learn the facts about the types of kidney replacement therapies and talk to your healthcare team about the choices. Talk to your family and friends to help decide which option fits your lifestyle and future goals. Think about your own skills, general health, abilities and family support and select a treatment that best fits with you.

References
1. Breiterman-White, R. (2006) Vascular access for hemodialysis. In Molzahn & Butera (Eds) Contemporary Nephrology Nursing: principles and Practice (pp 559-577) Pitman, NJ: Anthony J. Jannetti Inc.
2. National Kidney Foundation (NKF). (2002). NKF K/DOQI Clinical practice guidelines for chronic kidney diseases: Evaluation, classification and stratification. American Journal of Kidney Diseases, 39(2) (Suppl. 1), S1-S266.
3. National Kidney Foundation. (2006). NKF K/DOQI Clinical practice guidelines and clinical practice
recommendations, 2006 updates, hemodialysis adequacy, peritoneal dialysis adequacy, vascular access.
Retrieved on Jan 25, 2008 from http://www.kidney.org/professionals/KDOQI/guidelines_upHD_PD_V.
4. National Kidney Foundation (2007). NKF K/DOQI Clinical practice recommendations for diabetes and chronic kidney disease. American Journal of Kidney Diseases, 49(2)(Suppl.) S10-S11.
5. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) (2008). Kidney Failure: Choosing a treatment that’s right for you. Retrieved on January 3, 2008 from http://kidney.nih.gov/kudiseases/pubs/choosingtreatment/index/htm.

Charlotte Szromba MSN, CNN, APRN-BC is a nurse practitioner and a consultant for Nephrology Clinical Solutions.

AAKP has several resources for you and your loved ones regarding treatment options, including the Understanding Your Hemodialysis Options brochure and the Understanding Your Peritoneal Dialysis Options brochure. These brochures provide a description of hemodialysis and peritoneal dialysis as well as an in-depth explanation of the available hemodialysis treatments and peritoneal dialysis treatments. These brochures also offer a detailed explanation of the various physical, emotional and social aspects associated with each treatment. In addition, they include the benefits and drawbacks for the various treatment options.

Visit www.aakp.org to download electronic copies of the brochures. You can also call 800-749-AAKP to request free copies be mailed to you. These brochures are available in English and Spanish.

This article originally appeared in the May 2008 issue of Kidney Beginnings: The Magazine.

http://www.aakp.org/newsletters/KB-The-Magazine/Feature-Story/Starting-Dialysis/index.cfm
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Admin for IHateDialysis 2008 - 2014, retired.
Jenna is our daughter, bad bladder damaged her kidneys.
Was on in-center hemodialysis 2003-2007.
7 yr transplant lost due to rejection.
She did PD Sept. 2013 - July 2017
Found a swap living donor using social media, friends, family.
New kidney in a paired donation swap July 26, 2017.
Her story ---> https://www.facebook.com/WantedKidneyDonor
Please watch her video: http://youtu.be/D9ZuVJ_s80Y
Living Donors Rock! http://www.livingdonorsonline.org -
News video: http://www.youtube.com/watch?v=J-7KvgQDWpU
kitkatz
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« Reply #1 on: March 25, 2009, 03:46:53 PM »

Any choice is pretty much going to suck.
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lifenotonthelist.com

Ivanova: "Old Egyptian blessing: May God stand between you and harm in all the empty places you must walk." Babylon 5

Remember your present situation is not your final destination.

Take it one day, one hour, one minute, one second at a time.

"If we don't find a way out of this soon, I'm gonna lose it. Lose it... It means go crazy, nuts, insane, bonzo, no longer in possession of ones faculties, three fries short of a Happy Meal, wacko!" Jack O'Neill - SG-1
kristina
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« Reply #2 on: March 28, 2009, 06:48:22 AM »

Thanks for pointing everything out so accurately. Very much appreciated! Kind regards and thanks again from Kristina.
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                                          ...  Oportet Vivere ...
arwen2424
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« Reply #3 on: August 03, 2010, 09:52:16 AM »

Hi, I'm a woman in my late 30s. I have ESRF and I'm on dialysis 3 times a week.

I've been on dialysis for more than 5 years. So, do you think I'm unrealistic if I choose to die?
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okarol
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Photo is Jenna - after Disneyland - 1988

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« Reply #4 on: August 03, 2010, 11:49:35 AM »

Hi, I'm a woman in my late 30s. I have ESRF and I'm on dialysis 3 times a week.

I've been on dialysis for more than 5 years. So, do you think I'm unrealistic if I choose to die?

Yes.  :cuddle;
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Admin for IHateDialysis 2008 - 2014, retired.
Jenna is our daughter, bad bladder damaged her kidneys.
Was on in-center hemodialysis 2003-2007.
7 yr transplant lost due to rejection.
She did PD Sept. 2013 - July 2017
Found a swap living donor using social media, friends, family.
New kidney in a paired donation swap July 26, 2017.
Her story ---> https://www.facebook.com/WantedKidneyDonor
Please watch her video: http://youtu.be/D9ZuVJ_s80Y
Living Donors Rock! http://www.livingdonorsonline.org -
News video: http://www.youtube.com/watch?v=J-7KvgQDWpU
kitkatz
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« Reply #5 on: August 06, 2010, 01:54:14 AM »

Hi, I'm a woman in my late 30s. I have ESRF and I'm on dialysis 3 times a week.

I've been on dialysis for more than 5 years. So, do you think I'm unrealistic if I choose to die?


Sweetie, I went on dialysis in my late 30s, I am now 11 and a half years with hemodialysis. I am 47 now.  So speaking from experience it has been worth every moment I get to spend my life with my family and my friends!
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lifenotonthelist.com

Ivanova: "Old Egyptian blessing: May God stand between you and harm in all the empty places you must walk." Babylon 5

Remember your present situation is not your final destination.

Take it one day, one hour, one minute, one second at a time.

"If we don't find a way out of this soon, I'm gonna lose it. Lose it... It means go crazy, nuts, insane, bonzo, no longer in possession of ones faculties, three fries short of a Happy Meal, wacko!" Jack O'Neill - SG-1
MooseMom
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« Reply #6 on: September 14, 2010, 12:26:38 AM »

Any choice is pretty much going to suck.

Hear hear!!
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« Reply #7 on: March 13, 2011, 12:56:40 AM »

Stories like these are invaluable for patients before they start Dialysis, but they never speak about the one big post-Dialysis issue: dealing with staff and patients.

Because lets be hoinest, that's where the trouble can begin.

Experts on the subject never discuss bad stickers, inappropriate behavior, and just your run-of-the-mill, all-American wackaloons.

I sense a blog post coming on...
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Stacy Without An E

1st Kidney Transplant: May 1983
2nd Kidney Transplant: January 1996
3rd Kidney Transplant: Any day now.

The Adventures of Stacy Without An E
stacywithoutane.blogspot.com

Dialysis.  Two needles.  One machine.  No compassion.
MooseMom
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« Reply #8 on: March 13, 2011, 01:18:45 AM »

Stories like these are invaluable for patients before they start Dialysis, but they never speak about the one big post-Dialysis issue: dealing with staff and patients.

Because lets be hoinest, that's where the trouble can begin.

Experts on the subject never discuss bad stickers, inappropriate behavior, and just your run-of-the-mill, all-American wackaloons.

I sense a blog post coming on...

And that's why I plan to do HD at home.  I've got my basement all set up with a fridge, a microwave, an HD TV and a Netflix compatible playstation 3.  I have had my laundry/storage room redone, so I have all the storage space I could possibly need.  I have no desire to be around staff and/or patients.  I intend to go into hermit-mode while I dialyze and let my husband bring me treats and cater to my every need. :clap;
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"Eggs are so inadequate, don't you think?  I mean, they ought to be able to become anything, but instead you always get a chicken.  Or a duck.  Or whatever they're programmed to be.  You never get anything interesting, like regret, or the middle of last week."
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« Reply #9 on: May 25, 2011, 09:24:44 AM »

To be honest, I would have preferred home hemo, but I cannot stand the thought of sticking myself every day.  I know I would screw it up somehow.  I gave serious consideration to peritoneal, but the risk of infection dissuaded me.  So am using in-center hemo three times a week.
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« Reply #10 on: March 29, 2012, 09:20:41 AM »

I want to do home hemo, but I am really afraid of infection.  My house is cluttered, and we have three cats, hos clean do things need to be?  I was doing ok, but admittedly things h.ave been means  lately.  I keel passing  out on the couch after dinner, I'm exhausted, and have never  been neat.  I would have to sit alone in the guest bedroom squadron everyone, every night for hours, if I home dialized.  I am afraid of having to stick myself, or my husband doing it.  I am getting my AV fistula on April 13th.   Do people have trouble sticking after so many years on HD?

 Sometimes I'm good, and sometimes I want to hide under the covers!. I'll get used to it.
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35 years old, first dx w/  chronic renal insufficiency at  28, pre-dialysis

born with persistent cloaca--have you heard of it?  Probably not, that's ok.

lots of surgeries, solitary left kidney (congenital)

chronic uti's/pyelonephritis

AV fistula May 2012
Kidney Transplant from my husband Jan. 16, 2013
Howard the Duck
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« Reply #11 on: March 29, 2012, 09:38:13 AM »

My house is clutter central.  Not "Hoarders" cluttered, but definitely on the spectrum.  I also have a dog.

I do home hemo with no problems.  I keep the area around the chair where I dialyze clean and keep the dog out of the room until I am hooked up. 

As far as the sticking, to me sticking myself was not a big deal.  I maintain that if you stick yourself, you can control how the needle insertion feels and that removes some of the fear issue.  But everyone is different. 

As far as infection - the only infection I got was when I was in-center and got a staph infection in my catheter.  Less chance of infection if you and your care partner are the only ones working with your access instead of any random tech.

I want to do home hemo, but I am really afraid of infection.  My house is cluttered, and we have three cats, hos clean do things need to be?  I was doing ok, but admittedly things h.ave been means  lately.  I keel passing  out on the couch after dinner, I'm exhausted, and have never  been neat.  I would have to sit alone in the guest bedroom squadron everyone, every night for hours, if I home dialized.  I am afraid of having to stick myself, or my husband doing it.  I am getting my AV fistula on April 13th.   Do people have trouble sticking after so many years on HD?

 Sometimes I'm good, and sometimes I want to hide under the covers!. I'll get used to it.
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MomoMcSleepy
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My son Roddy McSleepy at 6 months! sry pic sidewz

« Reply #12 on: March 30, 2012, 09:32:53 AM »

thanks, cattlekid, good to hear!  You let the dog out once the hook-up starts?  Maybe I can do that, although cats climb....we'll play it by ear...thanks for the response.
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35 years old, first dx w/  chronic renal insufficiency at  28, pre-dialysis

born with persistent cloaca--have you heard of it?  Probably not, that's ok.

lots of surgeries, solitary left kidney (congenital)

chronic uti's/pyelonephritis

AV fistula May 2012
Kidney Transplant from my husband Jan. 16, 2013
Howard the Duck
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« Reply #13 on: March 30, 2012, 03:21:27 PM »

The dog wants nothing to do with me while I am on the machine.  I think it's the noise it makes. It's not loud but i'm sure it's not a good pitch for dog ears.  Either that or he knows that I'm sick.  He just lays on the couch near my chair and gives me sad looks.

thanks, cattlekid, good to hear!  You let the dog out once the hook-up starts?  Maybe I can do that, although cats climb....we'll play it by ear...thanks for the response.
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MomoMcSleepy
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My son Roddy McSleepy at 6 months! sry pic sidewz

« Reply #14 on: April 04, 2012, 11:09:09 AM »

 :thx;

hopefully the kitties will also stay away and play elsewhere...although when I cry or am sick in bed, they jump on my belly and sniff my face...they look panicked if I'm moaning and groaning, and lay with me.   But they do hate machines....
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35 years old, first dx w/  chronic renal insufficiency at  28, pre-dialysis

born with persistent cloaca--have you heard of it?  Probably not, that's ok.

lots of surgeries, solitary left kidney (congenital)

chronic uti's/pyelonephritis

AV fistula May 2012
Kidney Transplant from my husband Jan. 16, 2013
Howard the Duck
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Make me the person my dog thinks I am

« Reply #15 on: May 01, 2012, 03:59:30 AM »

arwen2424   Only you can decide if you have had enough.  But consider EVERYTHING before making that decision.  There is a post here on "quality of life" that folks have talked about their life on dialysis - you may want to take a look at that as well.  But to give up just because you are on dialysis isn't cutting it.  Others here have said they have been on D for years and years.  Me, only a little over two.  Still waiting for the transplant call to come.  And while dialysis, of any type, is a major life changer, it isn't a reason to quit life.  Grumpy
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Make me the person my dog thinks I am
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« Reply #16 on: August 04, 2012, 11:59:36 PM »

What does it mean when they say changes to appearance under disadvantages of Kidney transplant due to anti-rejection drugs?  Does this mean I will end up gaining more weight than I already have?  :Kit n Stik;
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« Reply #17 on: August 05, 2012, 11:31:21 AM »

Hi, I'm a woman in my late 30s. I have ESRF and I'm on dialysis 3 times a week.

I've been on dialysis for more than 5 years. So, do you think I'm unrealistic if I choose to die?

As inconvenient as dialysis three times a week may be, I reckon dying would be an even bigger inconvenience, so therefore I'd say you were being very unrealistic in choosing to die. I plan to live forever, and so should you!
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« Reply #18 on: September 01, 2012, 02:15:23 PM »

Clara- on the change of appearance,I asked my transplant coordinator about this (she has had a kidney transplant). I have an aunt that has had a kidney transplant and these to women have the same body type. My aunt's changed after transplant.
My coordinator told me it's the anti-rejection drugs.
Their body type is bigger belly, with skinnier arms and legs. My aunt tried to get rid of her belly but the different things she tried didn't seem to work. She has had her transplant for almost 15 years.
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After a hard fight to not start I started dialysis 9/13
started on PD
hoping for home hemo starting to build a fistula 1/14
cause PKD diagnosed age 14

Wife to Ed (who started dialysis 1/12 and got his kidney 10/13)
Mother to Gehlan 18, Alison 16, Jonathan 12, and Evalynn 7. All still at home.
www.donate2benefit.webs.com
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« Reply #19 on: September 07, 2012, 07:47:13 PM »

Thanks Sydnee :)
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YellowRose
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« Reply #20 on: September 08, 2012, 08:34:36 PM »

Clara,
After my first transplant, I got "moon face", I gained about 15 lb and had a hard time to get rid of it.
Rose
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Dec 1993 start with CAPD
May 1995 1st transplant
Jan 2007 start with CCPD
April 2011 start with Hemo
Sept 2012 2nd transplant
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« Reply #21 on: February 05, 2013, 03:19:34 AM »

Hi, I'm a woman in my late 30s. I have ESRF and I'm on dialysis 3 times a week.

I've been on dialysis for more than 5 years. So, do you think I'm unrealistic if I choose to die?

It is certainly your choice but I do think it is not realistic. I have been where you are. Most of have been. I'm 43 and been on dialysis for about 12 years. I'm active and if you saw me you would never guess I have the Heath issues I do. I guess what I am saying is there is life WITH dialysis. It all depends in what you make it. I urge you not to give up. But I have felt the same way you do now. So let us be your buddies to see if you can enjoy life continuing dialysis. You never know when a big break thru will happen and we all could benefit from some new technology!!  Hope is the key!!  I hope you carefully look into yourself and decide what is best for you and your life. Cheers G. And you are commended for accepting dialysis for the last 5 years!!!! 
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Geoffrey Campbell
Diagnosed with ESRD at 26
Transplanted in 1999 rejected 2001
In center hemodialysis since late 2001 3X a week 4 hours late evening 3rd shift
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« Reply #22 on: September 25, 2014, 04:35:19 AM »

Hi, I'm a woman in my late 30s. I have ESRF and I'm on dialysis 3 times a week.

I've been on dialysis for more than 5 years. So, do you think I'm unrealistic if I choose to die?

Im 34, can't have children, single and still living with my parents - i feel i have no hope, no chance BUT can't live with the pain anymore.  Due to many operations ive got so much scare tissue that  haemodialysis is my only option.
I dont think your being unrealistic but your not the only one - Im starting to think thats the way forward - POSITIVE THINKING, its sucks but whats the other option - death? 
Each to their own and all but remember -



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kristina
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« Reply #23 on: September 25, 2014, 07:58:21 AM »

Hi, I'm a woman in my late 30s. I have ESRF and I'm on dialysis 3 times a week.

I've been on dialysis for more than 5 years. So, do you think I'm unrealistic if I choose to die?

It would be very unrealistic, because you don't know yet, what the doctors might find out tomorrow ... or the day after tomorrow...
Another point is, that  - for example - I was told in 1972 (after I was diagnosed with chronic proliferative glomerulonephritis),
that my diagnosis of chronic proliferative glomerulonephritis was practically a "death sentence", because hardly anyone ever survives with this disease...
But I instantly started to see as many doctors, specialists and nephrologists as I could possibly see ...
and one medical Professor gave me his personal medical opinion  that I should "go strictly vegetarian"
(... he could not prove it scientifically, but he believed firmly that becoming a strict vegetarian was the only way forward to survive in ESRF...)
I took his advise and after all these years, I am still here, I have not even started with dialysis or transplant or anything else yet ...
... but I certainly have been a very strict vegetarian ever since...
I mention this, because we never know what might happen tomorrow or what the future holds for us...
... and personally speaking, I must admit that I am much too enquirous to miss anything about the future...
I do hope you feel a little better soon and I send you my  very best wishes, Kristina.
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Bach was no pioneer; his style was not influenced by any past or contemporary century.
  He was completion and fulfillment in itself, like a meteor which follows its own path.
                                        -   Robert Schumann  -

                                          ...  Oportet Vivere ...
bionikki
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« Reply #24 on: August 27, 2017, 09:16:13 AM »

My docs are watching my function and keep saying that I had to have the fistula (which clotted twice and I had to have additional procedures) but are now putting the breaks on actual dialysis. What can I do to get them to either move me to dialysis or fighting to just get me on the transplant list?
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