Skipping pd treatment

[Seaweed]

I got a question , and I know everyone is different , but has any one. Actually skip a pd treatment.

When I started night pd. They had me at 2000 per fill  ( 4 exchanges) and 1000  I would carry during the day ,
My uf was around 1100-1200. And my urine out put 24hr. 1700

Since then I had a hernia which they cut back to 1500 exchange and none during the day. My uf is still 1100
The hernia has been fix and my exchanges remain the same at the volume of 1500 and I don't carry during the day

I make no delusion that my kidneys aren't damage but I also think excessive pd doesn't mean it's better either

[Wat76]

Wow, I just asked the same question basically and  did not get many responses. I would like to know others routine as well, will keep monitoring your post.

[Wat76]

I feel the same way, I don't think more is better.   I watch my diet and know that I can't control all toxins that enter my body, however, my PD is to remove toxins and not fluid.  I feel I can do 5 days a week and still pass the adequacy test.  I have skipped treatments and my adequacy test numbers are great.  Just want to know how others who has been doing  PD a long time does it.

[Charlie B53]

I've been doing manuals for 15 months and started using the cycler two weeks ago.  My team tells me that tho my old labs have always been great, that since using the cycler they are even better.

All I can tell you is since starting PD I am NOT SICK. 

It's a P.I.T.A. to get everything together and connect.  My evening ends way too early,  but no more manuals interrupting my day, and I AM NOT SICK.

I've missed a manual once in a while, got too busy, lost track of time, etc. no big deal if you don't make a habit out of it.

I suspect that I could skip a night with the cycler and it wouldn't make a whole lot of difference other than the 3 or 4 pounds of water I can gain during a day.  I still P, just not very much, someday up to a liter but usually far less.

I wouldn't skip a session immediately before labs are drawn, that may show up in the labs, but a week before, I doubt if anyone could tell.

Whatever you do, be carefull,

Take Care,

Charlie B

[Joe]

I would skip a treatment from time to time, but only when my cycler broke and I had to wait for the new one to be delivered. Always felt a bit puny the next day, but could still function. It's not something I would recommend regularity, but occasionally you can get away with it.

[amanda100wilson]

On a regular basis not a good idea, but the odd one, should not be a problem.  Your clinic nurses may not agree, but we are the ones living it and you have yo do what you have to do.  Just don't miss consecutive ones.  Just bear in mind with adequacy tests.  They are a snapshot in time, so unless you are skipping right before the test, they may show up as good, whereas if you skip away from the test, adequacy may not be good even though the results at the next adequacy test after that may be ok.

[marlinfshr]

I've had my share of skips. I'd laugh because they always called me a model patient, always doing my exchanges.

The way I look at it is how are my numbers? They have always been good, my creatinine and BUN had been steadily going down so why not? I usually tried to be good approaching adaquecy tests but slipped up a few times right before hand and the numbers still came back the same so I just went with my life.

Unfortunately, i just had a bypass (unrealated, as I can thank the genetics from my mom for that) and all the tests leading up to it including the shock from the surgery was a lot for my weak kidneys to handle. Sure enough, my neph assumes my kidneys are dead and they ordered my last shipoment from baxter---a lot of red and green with no yellow and put me on a strict liquid reduction. So now i'm back to 4 exchanges/day, am not alowed to drink much and they must be red and green. They also want me dwelling for 6 hours. Before I was allowed to dwell for 2 or 3 hours.

Of course I'm emptying early and still going empty through the day. I've even cheated a bit and skipped one of the treatments and am starting to drink more. I feel GREAT. AND I'm starting to pee-- 1 1/2 liters/day last time and i may hit 2 today. Hopefully they put me back on the 2 exchanges/day which I had all summer.

This past summer I was doing some work on a charter boat--15 hour days+ and felt great. Yes, I skipped some exchanges because I was busy. Life happens and I needed a few bucks. I believe we're not of the same mold and every one of us has a different situation as to why we are going through this. I am deffinately not a DR but I'm the one living with this and I really don't see a problem as long as my numbers are in check AND I feel great. Understanably, DR's go by the book and we are all the same. The other DR's at the clinic were trying to get me on 4 exchanges the whole time but my DR held out until my operation and I wasn't peeing right afterwards. They kept claiming that that was the protocol and everybody had to do it. I say F the protocol and listen to th the patient.

haha, nothing can stop me from fludging my sheet and writing down a few false exchanges to make them happy. All is good.

Do i recommend doing any of this? No!, But we are all different and once again I feel great.

I really would like one of those DR's to ride along on an offshore charter one day (especially when it's rough) and see what kind of work is actually involved in taking care of 6 clients who may have never been and trying to catch them a catch of fish which may include tuna, marlin and mahi-mahi. On your feet for 15 + hours on a rocking and moving boat is not exactly the easiest job. And i know I could do it right now, with the exception of a slight soreness where they opened up my chest. So that is the only thing keeping me in now. I'm back to feeling GREAT!

[Deanne]

I'm off dialysis now, thanks to a transplant, but when I was doing PD, I used a cycler and had to take my thumb drive with me to my appointments. I was tempted to cheat, but didn't see how I could get away with it. They reviewed the log files. I never thought I needed to do dialysis every night, either.

[marlinfshr]

I still wonder if there can be too much PD treatment for those whose kidneys still function. Last fall after only a few month's of my 4 exchanges I ended up going onto 2 manuals/day and my PD nurse said minimum of 2 hours and that I could get by with dwells of only a few hours max for those 2 exchanges, allowing me to do it at my convenience. I felt great!

Now, because of a heart bypass, I am back to 4/day and the new nurse wants them at six hours/exchange--all thanks to my kidneys taking forever to get going again after my operation. i now feel I am urinating everything I take in but I don't think they believe me as my DR has been convinced my kidneys are dead. She did say if my tests come back good that she will move me to 3/day and again to 2/day if they continue being good. I know before that I had a KT/v of about 2.7 with 3 exchanges when she moved me to 2 since then my KT/V has been between 3 and 4.07 and my hemogloben had been holding in the 13/14's without any boosters.

What has me worried is that I hear PD is not a long term option and usually can only be done for a few years, then back to the dreaded HD. Hopefully I can get transplant before my PD capabilities wear out but I've only been active since Jan this year.

So I wonder if having fewer treatments for those who still have kidney function is better then the standard 4 times a day. Would 2/day double the amount of time CAPD is doable as well as lessen the chance of peritonitis with less handling of the catheter. Also wondering if using less dialysis fluid at times (such as knocking 500ml off an exchange) can be better as well. Perhaps a little less pressure on the membrane. I will admit to doing that a few times as well when doing late afternoon/evening exchanges and planning to have a decent dinner -- something that is hard for me with what seems like a two liter bottle of soda sitting in my gut while trying to eat!

[Wat76]

I still wonder if there can be too much PD treatment for those whose kidneys still function. Last fall after only a few month's of my 4 exchanges I ended up going onto 2 manuals/day and my PD nurse said minimum of 2 hours and that I could get by with dwells of only a few hours max for those 2 exchanges, allowing me to do it at my convenience. I felt great!"

 i spoke to my Doctor and he told me that I can change back to CAPD and do 3 exchanges vs 4.  The reason being is everything you mentioned in your post. Protocol does not work for everyone, I am a slow transporter and doing PD on the cycler with 1.5 bags only are too much for me.  I am going to try the manuals, do an adequancy test and see if there are differences.  My numbers are great.

[grannyM]

This is a question I did ask pd nurse and the answer was do what is ordered.  I had a situation where I could not get home so was not able to do my regular pd treatments.  I did what I could and felt fine and it was just before lab day and all was fine.  I never call it a skip but an adjustment to daily living.  If it works in if not I don't sweat it.   I watch my weight, and how much I put out during the day, and the more I drink the more I put out.  My UF's are always low on the cycler.  As a disclaimer... I do not advise anyone to change their Dr's. order of treatment.  I would not be a good example of following orders.

[Whamo]

   Everyone is different.  Perhaps you can get away with it once in awhile.  I don't like to miss. 

[Simon Dog]

There is some evidence to suggest that less hemo dialysis in a patient with residual function may delay the loss of that residual, but I am not aware of any evidence suggesting this for PD.