Combination of PD and HD

[Jie]

I wonder there is anyone who is doing both PD and HD. For example, a PD cycler during each night and a four-hour of in-center HD for a week. The night PD will remove enough fluid and minimize the fluid restriction. The one time HD per week will help remove the buildup of toxins. This combination may minimize the up and down of in-center HD and will be flexible enough for full-time workers. I am not sure this approach will have problems with insurances or the bottom line of for-profit dialysis companies. 

[Riki]

I wouldn't want to do both

[calypso]

I wouldn't want to do both

I have to agree. One of them is more than enough to go through, but both? Not a chance. Are you having trouble deciding which modality to pick, or which is "better" Or do you just want the best of both worlds? Keep in mind you'll get the worst of both worlds too! No one wants that!

[Jie]

I guess I want the best of both. This combination will not restrict fluid intake and have very little diet restriction too. It will be smoother than the 3 times a  week of in-center HD. Four hours per week for in-center HD is not too much time consuming. This approach is much better than 24 hours of PD each day. What things can go wrong?

[KICKSTART]

I cant understand anyone wanting both ? If you did APD (overnight pd)then you wouldnt be tied to doing it 4 exchanges a day . Besides they would A) never agree to it and B) not have the bed space.

[Riki]

PD is 24 hour dialysis, but you're not hooked up to something for 24 hours.  You can do it overnight while you sleep, or if you do bag exchange, it's about 20 minutes every 6 hours.  If I could, I'd go back to PD in a flash

[Jie]

For many patients without any residual kidney function, a 9-hour of cycler at night and 2 exchanges (6 hours per exchange) may not be enough to get a Kt/V above 2. I have 9 hours of cycler each night, resulting in a Kt/V of 0.96 from PD. If two exchanges are added during day time, it will not result in more than 0.9 additional Kt/V, not enough. Additional 4 exchanges per day time may need to get to a total Kt/V of 2 or higher. Realistically, I need at least 20 minutes to drain, let alone warming, cleaning and filling. At least a half of hour is needed for each exchange, plus warming and cleaning, it may take 40 minutes. That means 4X40 minutes, or about 2.7 hours per day for day time exchange, or 19 hours per week. This schedule will not work for a full time worker. If only 9 hour of cycler at night and plus 4 hour of in-center HD each week, it saves at least 14 hours per week.

Other benefits like no fluid and diet restrictions are huge positive for this hybrid approach. A lot of PD patients are forced to change from PD to HD completely due to inadequate of PD alone after a a number of years. This approach will make the transition much more smoother. 

Bed space is not an issue since it is in-center HD. The paperwork and finance may be a problem for this approach.

[Riki]

I did 10 hours on the cycler a night, and didn't need any exchanges through the day.  With the exception of phosphorus, which has never been stable, my levels were great.  I've no idea what my Kt/v was, and I don't now either.  I'm sure it was/is measured, but hasn't been told to me.  I did this for 4 and a half years.  By the end of that, I had no residual function at all.  I'd still be on PD if it weren't for a really bad peritonitis episode, that nearly killed me, made PD impossible.

[Jie]

Riki, you must be a fast transporter. Without residual kidney function, only a fast transporter can get by without day time exchanges. I was a low average transporter and now is a low transporter, needing a lot longer times to do PD.

[Riki]

I went to school as a child on PD.  I did 8 hours a night on the cycler then, and did one exchange at lunch time at the school.  The bag was warmed on a heating pad all morning in the staff room, and they made a cubby hole there as well for all my supplies.  This was before the twin bags that they have now.  You had to spike the bag, and you actually had to clamp and cut the line when you were done.  I think it was called the sure lock system, but I could be wrong.

I think you're right.  I am a high transporter, or was.  I had no problems with PD, and I miss it a lot.  I was making plans for university before I had the peritonitis.  I can't do it now because I have to be in dialysis 3 times a week.  I can't do both.

[KICKSTART]

I was a high transporter as well .I did 8 hours nocturnal and carried extraneal around all day , so really no daytime exchanges .....give me that over hemo anyday !

[Riki]

I couldn't use extraneal.. it dried me out.. *L*  but yeah, I'd go back to PD in a heartbeat if I could

[K9Wife]

Trust me when I tell you I understand your pain.  My husband and I married 3 years ago, after a year we TTC.  Did that for one year, was referred to fertility doc who tested my husband.  Turns out he has more than enough sperm, they just don't swim...we were told we'd need IVF.  My nephro denied it bc my TX was at 23% so we started the foster-adoption process.  After we completed the class we got orders to AK (he's AF, we were in NC when this started)...stopped the foster-adoption process in NC.  Found out 2 weeks prior to leaving for AK that I couldn't accompany him due to there being no nephro in Fairbanks, so, I dropped him off in AK and bought a house in my hometown in WA.  We're apart for 3 years.  I began the process of foster-adopting again by myself here in WA, and the week after finishing THAT class I was told my kidney transplant was at 14% and I would need dialysis again soon.  We made the choice to abandon the adoption right now (which was hard bc I'd already started getting the babies room ready) due to my deteriorating health and the fact that he and I were apart and he could not help me with my medical nor the baby.  I'm 26 he's 33 and there's a 3 year (at least) waiting list...being military it seems ALL the younger troops have kids.  It kills me that we can't be parents and experience that joy right now.  I'm at 11% function, just had a fistula put in (25 Oct) and still off dialysis. 

I hope you and your husband can have a child soon!!

[Joe Paul]

I guess I want the best of both. This combination will not restrict fluid intake and have very little diet restriction too. It will be smoother than the 3 times a  week of in-center HD. Four hours per week for in-center HD is not too much time consuming. This approach is much better than 24 hours of PD each day. What things can go wrong?

Jie, I had the PD and Hemo a few times during my short stay on PD. My doing both PD and Hemo was to, as you said, clear out more toxins and fluid build up, due to PD only working at the minimum. I see no more risk than the usual chance of infection associated with doing PD, and the extra time it takes to continue with dual treatments. I have to say only positive things about doing both, I did notice I felt better while it lasted, having to give up PD due to the continued low clearance of toxins and fluid build up. My insurance paid for both treatments, no questions asked.

[KICKSTART]

Trust me when I tell you I understand your pain.  My husband and I married 3 years ago, after a year we TTC.  Did that for one year, was referred to fertility doc who tested my husband.  Turns out he has more than enough sperm, they just don't swim...we were told we'd need IVF.  My nephro denied it bc my TX was at 23% so we started the foster-adoption process.  After we completed the class we got orders to AK (he's AF, we were in NC when this started)...stopped the foster-adoption process in NC.  Found out 2 weeks prior to leaving for AK that I couldn't accompany him due to there being no nephro in Fairbanks, so, I dropped him off in AK and bought a house in my hometown in WA.  We're apart for 3 years.  I began the process of foster-adopting again by myself here in WA, and the week after finishing THAT class I was told my kidney transplant was at 14% and I would need dialysis again soon.  We made the choice to abandon the adoption right now (which was hard bc I'd already started getting the babies room ready) due to my deteriorating health and the fact that he and I were apart and he could not help me with my medical nor the baby.  I'm 26 he's 33 and there's a 3 year (at least) waiting list...being military it seems ALL the younger troops have kids.  It kills me that we can't be parents and experience that joy right now.  I'm at 11% function, just had a fistula put in (25 Oct) and still off dialysis. 

I hope you and your husband can have a child soon!!

   I think you may have posted in the wrong thread ?