Peritaniel dialysis.. Is it safer?

[Danielondialysis23]

I'm 23 and I started on hemo for my first 6 weeks on dialysis till my pd port was healed an ready to go.. Now I've been at home doing pd for the last 2 weeks on my own and I've been getting mixed signals from many about pd.. What I wanna know I's it better health wise? Do people live longer on pd? My nurse said I can drink more and my eating is more flexible. Is that true? Any help on anything you guys can tell me about pd, what I should look out for or tips, will be greatly appreciated thank u.. Sorry for bad grammar/spelling

[Lillupie]

hello,
 Im sorry you are 23 on this. I started a month before turning 25, and I will be 30 in November. I have been on pd for 5 years now. To me, yes, PD is to say, safer. Although there are people on here who would disagree with me. YOU dont want that neck permacath in. That itself causes a lot of infections or has  alot of infections. The permacaths dont last as long without the risk of infection. If you decide to stay on hemo they will want you to get a fistula. There is a lot of complications with that as well.
 A lot of it has to do with lifestyle. Would you rather be stuck to a chair 3 x a week for 3-4hrs a day or do a little bit each day or just at night while you are sleeping. The PD does keep your residual kidney function longer then does hemo. And you do get to eat more and have less fluid restrictions.

Lisa

[bleija]

when i first started dialysis, i started strait out the gate with pd and my creatnines always ran in the 5s< our system 1 is ideal> i stayed there for about a year and ahalf. in the 5 months i was on hemo it jumped up to 11 and 12 range...im still having issues with residual hemo issues. i had pleurisy almost constantly when i did in center, even still i have a chest tightness when i try to breathe deep breaths
Also there was an article a long while back that said PD givews the patient the same life expectancy as a person w/o any kidney issues at all.
Personally for me PD wins hands down no competition whatsoeverr.
The biggest issue with it though is infection, u have to become an OCD germaphobe in your treatment area. Even now post transplant, i am still ocd about cleanliness
hope this helps
oh and i was 18 when i started, and got my kidney for my 22nd birthday.

[M3Riddler]

I'm 23 and I started on hemo for my first 6 weeks on dialysis till my pd port was healed an ready to go.. Now I've been at home doing pd for the last 2 weeks on my own and I've been getting mixed signals from many about pd.. What I wanna know I's it better health wise? Do people live longer on pd? My nurse said I can drink more and my eating is more flexible. Is that true? Any help on anything you guys can tell me about pd, what I should look out for or tips, will be greatly appreciated thank u.. Sorry for bad grammar/spelling

I was on PD for 13 years. Like anything, it doesnt last forever. Changes take place in the peritonium right after dialysis is started. Some people handle it well and can perform PD for many years such as myself and others find that its not the type for them and can only lasts months to a few years.  Each body is different.
I was no longer able to do PD due to developing a condition called EPS - Encapsulating Peritoneal Sclerosis. It is very rare and many nephrologists do not know about it. The ones that do rarely inform their patients of what it is as it is so rare.
I then had to switch to Hemo.  I do home hemo now. I am not on a diet of any type and can eat/drink whatever I choose since I dialysis 6 days per week.   One thing to remember is the more dialysis you get the better you will be long term.  The 3 x in center is barely adequare as you only dialyze up to 12 hours a week.  Does that sound like what your kidney do??     
I have been doing dialysis for over 20 years.  I have had 3 transplants and still kicking.   
I believe that education is the key. We must educatie ourselves instead of waiting for someone to educate us.  We should be in charge as much as possible and work with our nephrologists and other docs/nurses to make the best decisions together.   

Regarding safety, any dialysis you must be as clean and sterile as you can. This is usually where the iissues come from.  You cant be 100 percent, but you sure can try.

///M3R

[PatDowns]

Daniel - I suggest you read the following essays by Peter Laird, MD.  He is a physician with esrd and, while on home hemodialysis, his writings are based on facts.   Be sure to check out his web site - www.hemodoc.com.

Once knowledgeable about the pros and cons of all the treatment options available (incenter conventional hemo/nocturnal hemo-home hemo/pd-living related/cadaver transplantation) your decision should be based on what works best for your lifestyle.  Just remember, no matter which treatment chosen, take control of your care and be responsible so you can stay as healthy as possible.

http://www.hemodoc.com/2012/05/dialysis-related-infections-peritoneal-dialysis-poses-more-dangers.html

http://www.hemodoc.com/2011/04/congestive-heart-failure-complicates-peritoneal-dialysis-treatment.html

http://www.hemodoc.com/2011/01/is-peritoneal-dialysis-the-optimal-choice-for-america.html 

[wbdoug]

Hi Daniel
I have been doing pd for just over 1 year. The only thing I can say to you is PAY ATTENTION TO CLEANLINESS DETAILS!!!! In the past year I have done my pd dialysis in the middle of the desert, motel rooms and a bunch of campgrounds and no infections. I am proof that you can do it almost anywhere and still not get infected as long as you do what you were taught when training to do pd. Do this and you will be fine. PD in my opinion gives you so much more freedom.

Bill

[Joe]

Daniel, I can't add much to what has been said. I've been doing PD for the past year and think its great. It allows me to do my dialysis at home, not have a strict diet and be pretty loose with my fluids. Still have things I would like to eat, like chocolate and bananas but have to watch the diet to some degree.

As wbdoug said, keep things clean and you will do ok.

[bevvy5]

I don't think there's a definitive answer to your question.  PD works well for some people for years.  For some it works well for a while.  For some it never works that well.  For some it doesn't work at all.

You really just have to see how your numbers are and how you feel.  But as far as lifestyle goes, it is definitely less restrictive than hemo, even home hemo.

And yes, since you are the one taking care of yourself, you're the one that, for the most part, determines whether or not you have problems with peritonitis.  Don't get sloppy is the only suggestion I can make.

BTW, I'm not a D patient, but my husband has been for three years, started on PD and has been a home hemo patient for about nine months now.

[Danielondialysis23]

Thank you all very much.. Love this site

[Poppylicious]

But as far as lifestyle goes, it is definitely less restrictive than hemo.

Only when it's working well though!   

Daniel, Blokey and I found that haemoD was less restrictive than PD, but I think it depends entirely on your circumstances, lifestyle and other commitments.  What works for one, doesn't necessarily work for others and there is no 'one size fits all' when it comes to dialysis.  As bevvy rightly says, there is no definitive answer; it's what works for you.  Good luck with your PD and stay clean!

[Desert Dancer]

Im sorry you are 23 on this. I started a month before turning 25, and I will be 30 in November. I have been on pd for 5 years now. To me, yes, PD is to say, safer. Although there are people on here who would disagree with me. YOU dont want that neck permacath in. That itself causes a lot of infections or has  alot of infections. The permacaths dont last as long without the risk of infection. If you decide to stay on hemo they will want you to get a fistula. There is a lot of complications with that as well.
 A lot of it has to do with lifestyle. Would you rather be stuck to a chair 3 x a week for 3-4hrs a day or do a little bit each day or just at night while you are sleeping. The PD does keep your residual kidney function longer then does hemo. And you do get to eat more and have less fluid restrictions.

I think this is as compared to conventional in-center dialysis. I don't think PD's results stack up at all against a modality like nocturnal, where outcomes are equivalent to a cadeveric transplant. And as far as the risk of infection from a permacath, I don't see where the risk is any greater than with a PD cath. They're both catheters; they're both invasive and preclude things like swimming. I'll take 15 gauge needles over peritonitis ANY day.

[bleija]

i went swimming with my pd cath at the ocean and in a pool, you just have to bde very clean, cant swim in community pools, but if its urs or even a friends and theres minimal ppl, then no biggie, pd never limited me from anything that i wouldnt do normally. transplant is wayy better
risk of infection is with any way you choose, a ctah can out fistulas are there.

[Lillupie]

Im sorry you are 23 on this. I started a month before turning 25, and I will be 30 in November. I have been on pd for 5 years now. To me, yes, PD is to say, safer. Although there are people on here who would disagree with me. YOU dont want that neck permacath in. That itself causes a lot of infections or has  alot of infections. The permacaths dont last as long without the risk of infection. If you decide to stay on hemo they will want you to get a fistula. There is a lot of complications with that as well.
 A lot of it has to do with lifestyle. Would you rather be stuck to a chair 3 x a week for 3-4hrs a day or do a little bit each day or just at night while you are sleeping. The PD does keep your residual kidney function longer then does hemo. And you do get to eat more and have less fluid restrictions.

I think this is as compared to conventional in-center dialysis. I don't think PD's results stack up at all against a modality like nocturnal, where outcomes are equivalent to a cadeveric transplant. And as far as the risk of infection from a permacath, I don't see where the risk is any greater than with a PD cath. They're both catheters; they're both invasive and preclude things like swimming. I'll take 15 gauge needles over peritonitis ANY day.

Buuut, I can shower on PD, unlike the permacath on hemo. I do think your resisdual kidney function lasts longer on PD then on nocturnal. I dont think after 5 years on nocturnal I would still be peeing. I still pee after 5 years on PD. YEs they are both catheters. As far as I know the permacath for hemo, you can take care of it as much as you can and still get an infection. With PD, YOU and Only YOu are dealing with your catheter. It is up to you to wash your hands and wear a mask. I dont have nurses and various techs dealing with my catheter. I have had one and only one catheter for the last 5 years! One infection and yes that was caused by me, and I know what I did wrong. Another thing my PD catheter does not fall off.
Nocturnal is another option if it is available in your area. The fistula is the best with that, for me, I still dont like the restrictions on hemo. I personally dont care to go to a centers 3 evenings (6-8pm at night) out of the week and leave about 3am.

[amanda100wilson]

Mortality statistics indictate that PD does not give any greater greater life expectancy than in-unite three times per week dialysis.  More frequent dialysis,, the more the better gives life expectancy comparable to having a deceased donor transplant.  However, in the short term PD is a good option since it is more flexible for diet and fluids and fits more easily into lifestyle.  however, PD only really works well for someone who has residual renal function.  once that is lost, PD is not so effective, plus over time.  furthermore, the peritoneum  deteriorates and does not work so well.    Iwas on PD for eight years and my wellbeing really went downhill after that.  I am now doing short daily haemo at home and am planning to,switch to nocturnal in the near future. 

I do wonder how accurate statistics really are, so ce they may not take into account t the age of the patient and co-morbidities.  I have had ESRD for 23 years and am still here so I am already beating those odds.  personally, even knowing what I do now, we're I to live though this period of my life again, I would probably still opt for PD as a first choice, given the convenience that it offers, but I would have switched to home haemo more quickly, since the fours years that I was on PD after I lost my residual renal function, I felt like I was dying a slow death.
 

[Jill Marie Evans]

I've heard that some people who are doing home hemo have to do it more slowly and so it takes longer. Why, and what is the difference?

[bevvy5]

I've heard that some people who are doing home hemo have to do it more slowly and so it takes longer. Why, and what is the difference?

We're still pretty new at the home hemo game, less than a year but I'll chime in.  For my husband, because he can hemo more often and for longer sessions (he runs overnight) he can run his pump speed at a lower rate and with a lower concentration of dialyste.  So instead of drastic ups and down like you get in a clinic/hospital setting, where they're pulling off a lot of fluid and toxins because they only have you for 12 hours a week, if you dialyze at home, you can not stress your body as much by taking longer.

If you think about it, working kidneys work 24/7.  It's the ideal way to clear toxins and fluids from your body.  If you can get closer to that with longer, slower dialysis, it's much easier on you.

I'm sure you will get better explanations from those more expert than me but that's my basic understanding.

[Jill Marie Evans]

Thanks, bevvy....that's probably what I will want to do, if I can.

[Riki]

I was on PD for almost 5 years, until I developed a rather nasty peritonitis infection, caused by a nurse who didn't follow procedure when changing the extension tubing on my catheter.  The tubing was defective and it fell off  Instead of starting over with a new tubing, she just put the old one back on.

I would go back to PD in a heartbeat if I could.  I was about to start university before the peritonitis infection, but I'm not able to now because of scheduling.

I'm actually doing better on HD than on PD, but I do miss the freedom of being able to go where and when I want, and not having to worry about being back in time for dialysis.  Because I had no residual function in the last couple of years I was on PD, I had to watch my fluid intake, but my numbers were still good enough that I wasn't restricted a whole lot food wise.  I'm still not that restricted, though I have discovered that going on a lemonade binge is not a good idea.. *L*

Swimming was a nono for me, but showering was no big deal while on PD.  I was actually told to take the dressing off in the shower, and clean the site with antibacterial soap, then when I got out of the shower, dry it well, and put on a new dressing.  As long as I was taking care of the exit site, I never had a site infection.  Before that, when I was required to have sterile dressings done by the nurses, I had several site infections.  If you have a central line (or neck cath as some call it) you can't shower.  I had one for a year and a half, and I had sponge baths, and my mom washed my hair for me in the kitchen sink.  I was quite happy to get the fistula going so I could be rid of the thing.

As for life expectancies, I started PD for the first time in 1991, when I was 12, I've had 2 transplants, as as of last May, I was on dialysis for the 3rd time for 8 years.  I've had ups and downs in that time, but for the most part, I'm feeling really well

As said before, the dialysis experience is different for everyone.  It all depends on how well your body copes physically with the changes, and also how you cope mentally with what's going on.  Keeping a positive attitude, which I admit is extremely difficult to do at times, does help with your overall feeling of wellness.  At least, it has helped me.

[amanda100wilson]

there is an infection risk with any method.  the permacath is usually only used for short-duration access be ause the complication risk is so high.  for HD the gold standard for access is a fistula,but even with that there are infection risks, and again, they don't last forever and often need interventions to keep the going.  I definately feel better on SDHD than I I did towards the end on PD.  I grew to hate the P D catheter with a vengeance.