Questions about Homedialysis...

[kristina]

I would just like to clarify some points about Homedialysis. I would appreciate your opinions,
and please do not hesitate to correct me if I am wrong.

I would like to know your opinions about Baxter and the NxStage treatments.

As I understand it there are two basic methods of Homedialysis:
Haemodialysis (HHD) & Peritoneal Dialysis (PD).
With PD there is a choice of either CAPD (four times a day) or APD (through the night, whilst asleep).

As far as I know Baxters support all these methods,
but I can only find that NxStage works with a catheder in the arm (does NxStage support APD?).

So, are there any differences between the Baxter-support and Nx-support?

Which method of Homedialysis is the most gentle to the body’s system?

Thank you very much, Kristina.

[KICKSTART]

Kristina , we dont have NX stage in this country so no need to worry about that one yet and as i understand it , its basically a small portable Hemo machine . Im not sure where you get the catheter in the arm from ? There are only 2 types of catheter , the pd one placed in the stomach and the HD one placed in the neck/chest area, which is usually done as an emergency measure if you have no fistula. PD is gentler on the system by far but the one draw back is it doesnt last forever , so at some point unless you have a transplant lined up , i expect you will experience both ! Unless you decide pd is not for you and go straight for hemo.

[kristina]

Thanks KK for your thoughts.

I have heard that PD makes the stomach swell-up.
Is this only with the day-time sessions
or is it also with the night-time-sessions (APD) ?

Also, what does it mean by swelling-up?

After the final day-time-session
is one left with the stomach swollen,
and if this is with APD, at night,
does one wake-up and have to go through the day
with a swollen stomach?

In other words, at what time is the stomach swollen precisely?

Thanks again from Kristina.

[Bruno]

Kristina, I can only tell you my experience which is that my neph sent me to PD first on the basis that it lets you live a relatively 'normal' life. It involves having a tube inserted into your abdomen which you use to pour in and take out dialysis fluid. The tube site is prone to infection. The alternative is HD, which I am on, and this involves having a fistula created on your wrist so that eventually there is access on your arm for blood to be taken out, dialysed in an artificial kidney and returned to your body via another access.
HD is regarded as less convenient by some but I should point out that there is sometimes no choice.
Again, from a purely personal point of view I was more than happy to miss PD and go onto HD.
It was good for me.

[KICKSTART]

Yes your stomach is swollen ..for ladies it looks like you are pregnant ! This is because you carry between 1.5ltr and 2. ltrs of dialysis fluid in it ! Some people on APD can go empty during the day , but most use extraneal in the day time. On Capd you will have fluid in 24/7. So pretty much either way , you will be carrying all that fluid around all the time. I have just read Bruno's post and would like to add a fistula is not always made in the wrist area ..more commonly its upper arm. Again i would like to say , i didnt mind pd but i hate hemo , i would go back to pd like a shot if i could. Its all about what you prefer !

[peleroja]

I personally think that PD is gentler on the body as it does not involve removing any blood.  As for "swelling up," when you carry 5.5 lbs of fluid pretty much 24/7, your body will swell just as a woman carrying a baby.  Since you never "deliver," you tend to have a pretty large belly all the time.  I also agree with Bruno in that you live a much more normal life than on in center hemo.

[Poppylicious]

HD is regarded as less convenient by some but I should point out that there is sometimes no choice.

Definitely - Blokey just couldn't get on with PD at all, but now he's using his fistula (this is the same chap who just three short months ago was still adamant he was keeping his chest line and NEVER having a fistula!) he's having the BEST dialysis and is much perkier.

I think you have to find what works for you.  PD can help you live a relatively 'normal' life, but on haemoD we get weekends 'off' so to speak.  It will depend on your situation and what your body can deal with.

As Kickie said, NxStage isn't yet available here but I believe it is being trialled in some regions. Perhaps it is in your area.

[Henry P Snicklesnorter]

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[KICKSTART]

Henry how long have you been doing pd ? Only you want to be very careful where and when you are doing your exchanges ! That blaise attitude to exchanges could lead you into big trouble ..peritonitis !

Kristina , the Hickman line he refers to is called a tunnel line over here  but for the most part you only end up with one of those as an emergency if no fistula is readily available or not yet been made.

[Henry P Snicklesnorter]

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[KICKSTART]

One can get off ones high horse. Ok so you may be careful , but i find it disturbing that you Drive , Operate machinery , Eat ? Ok so if you think you are being extra vigilant with your hygiene thats up to you . To drive and do an exchange is madness (you did put with no interruption to what im doing at the time)

[Henry P Snicklesnorter]

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[kristina]

Thanks very much for your kind replies.

Thanks, Bruno, for telling me about your personal experiences, that’s interesting,
because I would have thought everyone would go for PD instead of HD.

Thanks, KK, it seems, that it really is an individual thing.
So I gather the stomach is less swollen through the day with APD.

Thanks, peleroja, so, to recap, with PD the swollen stomach
and the risk of infection at the entry-site
seem to be the two minuses,
but on the plus-side is the convenience
and a greater gentleness to the body.

Thanks Poppylicious, so we are back again to what suits each of us best.
I get the feeling that many people would like to do HD at home,
and from what I gather the latest NxStage would cater for this.
I am very glad that Blokey is doing well now.

Thanks Henry, you are obviously a time and motion guru.
You make it sound so simple and you sound like a person who takes extreme great care.
I appreciate there are people who can do the most extraordinary things in difficult circumstances
and I know that when they are actually carrying out a very precise procedure
they are able to focus intensely for the whole time it takes to do that procedure correctly.
This said, you are certainly very brave to do your Dialysis in multiple locations such as you describe.
If I am able to manage this half as well as you do I shall be very pleased with myself.
Thanks very much for the detailed accounts, it’s food for thought.

Thanks KK for your comments about Henry’s Dialysis,
because this made the dialogue between you both very interesting
and brought out some interesting points
and I appreciate your concerns there,
because Henry’s methods are quite extraordinary.

Thanks again to all from Kristina.

[KICKSTART]

Henry , reading through other posts , its seems its not only me that points out you are going against all the advice given for doing exchanges. You mention driving along doing it ..so do you not wash your hands ? I know you mention the hand gel , but not only did we get shown and told to wash hands  for at least 5 mins we had a special anti-bacterial handwash (as well as the gel) to use. Anyway its your life , your exchanges and how you do them is up to you.

[Henry P Snicklesnorter]

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[KICKSTART]

Ok im drawing a line under this , it wasnt meant to be a battle of knowledge , i was just trying to point out some of the pitfalls , but you seem to have all the bases covered (i think thats a phrase you use?) After all what do i know 7 years v 17 months.

[murf]

In the city, it's a breeze. Traffic lights are my friend. If its near time to do an exchange, I use the time waiting on the red to hook up and unhook.
Is this legal. As you know in WA, you are not allowed to use a Mobile whilst driving, including at a red light.

[Henry P Snicklesnorter]

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[Henry P Snicklesnorter]

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[kristina]

Thank you, KK, Henry and Murf for your interesting dialogue,
I think it was most helpful what came out of it.

Henry’s experience shows us the flexibility of PD
and it showed also, no matter how flexible one might be,
using PD one still has to be extremely vigilant
with cleanliness to avoid infections.

I have recently found out that Baxters also do Home-HD,
but the machine is very large and most certainly is not portable,
(unless you have a 90-ton-truck like Henry...)
though they are working on smaller models.

Thanks again for all the information and good luck from Kristina.

[KICKSTART]

Kristina , ive posted somewhere else , the smaller model you refer too is the NX stage that you will read about on here , it was on the news the other afternoon , it has just started to arrive in this country and is the approx size of a typewriter. I expect it will be sometime though before it is widely used for home hemo.

[kristina]

KK, thanks very much for the information.

I do hope the Nx-Stage-machine becomes available
to give us a choice, and as I have mentioned before,
I believe Baxters are also working
on smaller models of a home-HD-machine.

It is interesting that some NHS-health trusts
only give their renal patients HD
& not a choice which would include PD.

I would very much like to know
why a group of renal physicians
would be against PD?

Some other NHS- trusts
have a completely different approach.

Why is there such a difference?

If you have any ideas I would appreciate your opinion.

Thanks from Kristina.

[calypso]

KK, thanks very much for the information.

I do hope the Nx-Stage-machine becomes available
to give us a choice, and as I have mentioned before,
I believe Baxters are also working
on smaller models of a home-HD-machine.

It is interesting that some NHS-health trusts
only give their renal patients HD
& not a choice which would include PD.

I would very much like to know
why a group of renal physicians
would be against PD?

Some other NHS- trusts
have a completely different approach.

Why is there such a difference?

If you have any ideas I would appreciate your opinion.

Thanks from Kristina.

I hope you get NxStage where you are as well. I was planning on doing that too but my NxStage training center won't accept me if I don't have a working fistula.

As for why some nephs are against PD, it may be because of peritonitis being so serious, or that PD is cheaper than hemo and therefore less profitable because they can't charge the insurance as much for it.

[kristina]

Thanks calypso.

I was told that endocarditis
is more serious that peritonitis
and patients get endocarditis
from HD and not PD.

So, it doesn’t quite explain itself yet
why some nephrologsts prefer HD?

Thanks, Kristina.

[Bruno]

Kristina, I'm in Australia and I believe that we are as advanced as any other country (World Leaders IMHO) in the treatment of chronic kidney disease - at least that is my experience. Having said that, I must also say I have never known of any neph that holds the view that HD is preferable to PD. I'd suggest to you that the situation might rather be that they are making an educated decision as to what course might be best for the patient given their assessment of what he/she might be capable of handling.
For example, we have two centres for HD at my hospital, one for home training the other for those who can't...my neph sends them both ways.
My preference was for HD but I got sent to PD as my neph's best choice for me, and the only reason I'm not on it now is because I have a hernia.
I mean, looking after yourself with PD or HD at home requires a high degree of skill and I reckon a certain type of courage and some people just can't handle that...I think doctors make that type of assessment every day of their medical lives.