Why are there not more people on PD versus HD?

[HouseOfDialysis]

I was having a discussion with my Clinic Nurse about this and she's alarmed by how many folks on hemo don't know about PD as an option. I've always wondered that if they are physically viable patients, then why not make the move to PD from in-center hemo? Home hemo I would encourage as well, but I would move anything towards independence as much as possible.

There are quite a few younger people at the hemo clinic that I see from when I walk out of the Home Program building. I see their arms wrapped up in cellophane or gauze after their treatment.

Anyways, my nurse tells me that several nephrologists have put patients right to hemo, be it emergencies or not, and never even put PD on the table as an option. I would think care providers would outline all possible modalities, and let the patient have some input since it is their lives after all.

So why aren't more people going after PD or more home dialysis than in-center? Is it because they don't have to be as pro-active? Do they not know? Physically unable?

I think the ratio of in center HD to PD patients is greater than 10 to 1, and I'd like to see that swing around if possible. I'm just sayin'.

[Stoday]

50% of ESRD patients in my area are on PD. Maybe that's because I'm in the UK where the medical profession has no financial incentive to increase the proportion of patients on HD.

[Trikkechickk]

I would not want to have all that fluid dwelling in my gut.

[HouseOfDialysis]

I barely notice it, actually. Only if I move too swiftly for my center of balance, that's when I actually notice...

[Deanne]

I think my neph assumed (correctly) that if I need to go on dialysis, I'd choose PD. The conversation went something like this: Her: "If you need dialysis, you want PD, right?" Me: "Yes." end of discussion.

[tyefly]

My doctor did just the opposite...   "when you start Dialysis let me know what clinic you want to go to and we can see if there is a opening....."    My insurance company has classes for pre-dialysis people.. there they talk about all the options....  but not Home Hemo....as they said there was no one who did home hemo.. just PD... after the class I was given a appt to see a surgeon for a fistula and was told that fistulas are the best... when I went in to the surgeon he did ultra sound on my arm ... and never did talk to me about PD...  really no one did...
 

[KarenInWA]

I am a youngish new Hemo patient.  I do not want to do PD because I don't want to look pregnant (I have always been slender, and do not want to lose that part of my identity) and I do not want to be hooked up to a machine for at least 8 hrs a day *every single day* which to me sounds like hell.  So far, I am doing fine on in center hemo.  I know I am lucky.  My treatments so far have been boring and uneventful, which is just fine with me.  I get to catch up on my reading, which isn't so bad after all.  I have only had labs done a couple of times, and the #'s show that the D is working.  I am getting epo and iron for my anemia, and Zemplar for vitamin D.  The only thing I need to figure out is if I am eating enough protein, but even for being on this less than a month, my alubumin was only slightly below normal.  Not too bad for a newbie!

KarenInWA

[jbeany]

PD does horrible things to diabetics - it messes with their blood sugar and makes them gain huge amounts of weight.  Hemo does neither of those things, which makes hemo a better choice for the majority of diabetic ESRD patients. 

Anyone with abdominal scarring may not qualify for PD, either. 

Plus, don't forget that plenty of people start on PD but end up with repeated infections so that they have to switch to hemo.

You are right, H of D, that part of it is lack of information, though.  Plenty of docs prefer to funnel all their patients into the same path, so the docs don't have to think too hard!  They do love that one-size-fits-all approach.

[bette1]

I think it is a shame when patients are not informed of the option of PD or home hemo, but I can think of many reasons why young patients would choose hemo over.

I've done both PD and Hemo, so I can see the pros and cons of each.   The advantages of Hemo is that you get to be free of dialysis whenever you are out of the clinic, so you get four days a week free of dialysis  PD would be difficult for someone who has small children at home that they need to care for.  I found that after I had my daughter, I wanted my home to be a dialysis free zone.   

I was on PD a long time, and is a lot of work, and some people may not want to do that.  Plus, I hated the cycler.  I didn't mind doing the 4 exchanges a day because I was able to work that into my schedule. 

[Bill Peckham]

Medicare's financial incentives are aligned to encourage PD but it has dwindled to a bit more than 7% of the census today (over 90% using incenter, between 1 and 2% using home hemo).


I've heard a lot of explanations as to why but Tyefly's experience is very common. Studies show that when people are told about PD they are much more likely to want to start dialysis using PD. The conditions for coverage require that providers tell people about all treatment options - even ones not offered by that provider - but how that information is conveyed varies a great deal.

[Poppylicious]

It's all horses for courses really isn't it?  I realise that things are different in the States, but those younger people you see with their arms wrapped up in gauze may know about PD but be unable to do it/choose not to do it.

My Blokey can't do PD; it just doesn't work for him and we struggled through a couple of emotionally painful and physically challenging months of trying to make it work.  He would love to be able to do PD and I would love for him to be able to do it (although I've made no secret of the fact that I prefer him being on haemoD) if it made him happier/healthier/better.  As it happened, he improved dramatically the moment he started using his fistula.

One of the best things for us is that weekends are dialysis free.

 

If people aren't being told their options, then yes, something isn't right.  There should always be a choice, if the choice is applicable.

[mykey711]

Well if you read all above, you get the idea. There are pros and cons to both types of dialysis and treatment choices are individulized based on choice, lifestyle, mental disposition, ability, preexisting diseases and surgery, cost, and physician preference. Myself, I am apprehensive about hemodialysis for issues of nausea and vomiting, fluid and diet restrictions, and driving to a boring center 3 days a week. Also the cathetar looks more disfiguring.
The biggest downsides to peritoneal is drain pain and having to stay hooked up for 8 hours at night or late afternoon and evening.
a

[FindingNeverland]

I did PD nine years ago and last year when I started dialysis it was an emergency situation so I had to start on hemo but I was given the choice to switch later on. Given my past experience, I did not want to do it again. Personally I did not gain any sort of independence from it, I was stuck to a machine all night long and half an hour in the afternoon, which meant I could not go out with friends, I couldn't participate in after school activities, I could spend weekends anywhere, etc. Then there's the pain of setting the machine up each day, writing down my vitals, stuff I don't want to deal with. I also felt too full and would never eat, which drove my mother insane with worry and in turn drove me insane... I know she meant well, it was still aggravating none the less. Also I couldn't hear the machine alarm, I have a hearing problem where I can't hear high pitched noises so my mom invested in a baby monitor, I was 17 at the time, talk about embarrassing when friends came over. The one thing I hated above all was having that stomach catheter, I hate, hate, hated it. So this time around I stuck with hemo, I only do treatment three days a week for three hours, I go in early morning and get out just before noon so I have the rest of the day to go about my business. My weekends are open, I can go out at night, I can pretty much do what I want with no worries of having to be tied down to a machine.   

[lawphi]

My husband did PD for two years, but developed too much scar tissue after surgery.

We switched to home hemo as soon as possible. 

[galvo]

Thank you all for sharing your experiences and thoughts. Very valuable.

[Lillupie]

yeah,
 I think about 90% of those on dialysis are on hemo. Many people i have met at the hemo centers do not know anything about PD as an option. Most places I know dont make a big deal about it or they make it seem like hemo is the ONLY option.

I have been on PD since 2007. I have has two hernia surgeries.  My second surgery was in 2009. Lol, I had 2 cathaters, the permath in the chest, and the PD one, of course. And would you believe my center pushed the hemo so much that they wanted me to get a fistula! I got nagged to get a fistula, and I repeatedly told them "I am NOT staying here on hemo, but going back to PD". They said "oh but you can take the fistula whereever you go". Really? you mean to tell me that I am going to get another surgery for somehting that I may or may not need for years to come?" I mean come on! And I dont regret not getting a fistula for one minute since that. Since then I have been on PD wihtout a problem. No need for a fistula. (that was just a side story). Can you believe that? lol

Lisa

[del]

Information on all dialysis options should be made available to people and they should have a choice.  PD does not work for everybody and even if it does work at the beginning there is no guarantee that it will keep working (hubby's worked for 2 1/2 years).  Not everybody wants the body chjange that goes with PD or the fact that they are responsible for the treatments and have to ahve the supplies in their home.  Same goes for home hemo. You are responsible for the treatments and having the supplies in your home.  Some people don't want that.  Some people have to do in center because of medical reasons.  You should be informed of all options and make the best decision with your dialysis team as to what is best for you.

[Ang]

you have to take which option your neph advises/suggests will give the best outcomes.
me was always haemo, pkd ,kidneys were 27/28 centimetres huge.
the bonus for was knowing 3 times a week i had to go to my volunteer job for 5/6 hours ,
not having to worry exchange here,there and everywhere.
not to mention the risks of infection with PD

[Chris]

when I was diagnosed and given the options in the hospital if I wanted PD or Hemo I did not know anything betwen the 2. They gave me little information and the only question I could come up with is Can I still go swimming? That's how I made my decision, but after joining here I still thik I made the correct one even though I was going to school and was active riding my bike or walking to dialysis. The thing is I would not have the room for all the supplies and do not care for the tube coming out of my abdomen. I think I like it or feel better when someone else is monitoring and doing something like this on me when I have no support at home. I will go back on hemo when the time comes.

[lawphi]

House-  have you called CMC Charlotte and Wake Forest about listing yet? 

[rsudock]

All the reasons why I don't want to do PD...

1)don't want a catheter in my stomach...too vain for that.

2)with my type of autosomal recessive polycystic kidney disease I have other internal organs affect by the disease so, PD is not a good option for me.

3) I don't really want to do dialysis everyday...it is already such a mentally draining disease having to deal with it everyday no thanks

4) Don't want to turn my house into a hospital

5)Don't want to turn my significant other into a nurse

[Bruno]

Here in Oz you are offered a choice and both options are explained in some detail including training classes. The doctors recommend PD as a first preference and warn that it has some drawbacks such as scarring and infection. In my case I didn't get past the surgeon who spotted a hernia and directed me to the HD fall back.
Based on my experience of CKD I'd suggest to anyone starting down the same path to try PD first because it certainly lets you live a nearly normal life and go to HD as a fall back solution.
I'm assuming those choices are available to you as they are in Oz.

[texasstyle]

Well for us, with other medical complications I kinda like the fact that my husband sees a nurse at D sessions, and he sees the Dr. as well. Kinda like "extra protecion" lol. I know a lot of people seem to wonderful on PD and that is great. I guess it's good to have all the types of options available for what ever suits your need best.

[Lillupie]

2)with my type of autosomal recessive polycystic kidney disease I have other internal organs affect by the disease so, PD is not a good option for me.

5)Don't want to turn my significant other into a nurse
[/quote]

What does number 2 mean? How would other internal organs have anything to do with you doing PD?

I think Pd is the only home choice that you can do alone, and noone else in the house has to deal with it, or needs to help you.

[Lillupie]

Here in Oz you are offered a choice and both options are explained in some detail including training classes. The doctors recommend PD as a first preference and warn that it has some drawbacks such as scarring and infection. In my case I didn't get past the surgeon who spotted a hernia and directed me to the HD fall back.
Based on my experience of CKD I'd suggest to anyone starting down the same path to try PD first because it certainly lets you live a nearly normal life and go to HD as a fall back solution.
I'm assuming those choices are available to you as they are in Oz.

I completely agree. Start with PD, and especially if you have residual kidney function left. PD helps keep the residual kidney function longer then hemo.  THat sucks about your surgeon and your hernia. You could of got the hernia fixed before going on PD. Oh well. Ive had two hernia surgeries since starting dialysis. But atleast I got a taste of hemo, and a break from doing dialysis every single day.

Lisa