Regeneration of peritoneum

[gilders]

The average lifespan of peritoneum for PD is 5 years. But can it regenerate if left unused due to a successful transplant or a period of HD.
I am currently in the process of trying to get a living donor transplant, but I'm also being encouraged to start dialysis. I don't want to use up any of the "life span" of the peritoneum while waiting for transplant. But if I know that the peritoneum can regenerate when I get a transplant (or rather if I get a transplant) I would be more agreeable to going on PD now.

[kickingandscreaming]

Can you supply a link to that information?

[Charlie B53]

Ditto.  Documentation Please.

I have heard such tales, but then again I have heard of people STILL on PD almost 20 years.

Damage to the peritineum caused by infection and/or high sugar solutions lead to unsuitability for continued PD.  Controling infection, avoiding excessive fluid consumption requiring the use of higher sugar solutions to remove that fluid go a long way in preserving function.

Every Nurse on my PD Team just laughs when I ask this very question,  telling me that I have nothing to worry about as long as I keep doing as I am, staying well within range, keeping infection free.

[gilders]

Hope I didn't cause any offence with mentioning the 5 years average "usability" of the peritoneum.

I had a meeting in the PD dept about 2 weeks ago and a home visit from a PD nurse 4 days ago. It was during this home visit that the nurse said that "on average you can stay on PD for 5 years before the lining isn't efficient enough"
I do know that I have read this quite often online, but after having another quick google, I've found this 5 year figure appear often on forums rather than in medical literature, but there must be some nurses or drs giving out this 5 year info as I'm definitely not the only one to hear this if forums are to be believed (the 5 year average has also appeared on this forum).
As for medical websites (such as www.kidney.org.uk) it mentions things like "Some people have been successfully treated with PD for over 10 years", then goes on to say "Generally, around half of the people who start PD stay on PD for around 2-3 years"

There is so much conflicting statistics online that I tend to believe what my drs/nurses who deal with patients everyday tell me. In this case I was told 5 years average. I hope this low figure is due to patients not following the protocol strictly (which I would do) rather than it becoming unusable in 5 years after following the correct techniques everytime.

It is encouraging to hear patients being able to use PD for MANY more than 5 years.

[kickingandscreaming]

Speaking for myself, it's not the <5 year lifespan of the peritoneum that I'm questioning.  I have heard the same thing. What I questioned was your statement that the peritoneum can regenerate to be fully used for dialysis again. 

[beckums70]

I have read that Lisinopril, which most people with auto-immune disorders or who are on PD usually takes, helps maintain the integrity of the peritoneum, as well as avoiding infections and high dextrose solutions. 

I wonder if doing PD less often or at lesser volumes (thereby stretching the peritoneum less) also help preserve the peritoneum? If so, and a person could get adequate dialysis while dializing less often, it seems like a good way to prolong the life of PD. 

I did ask my transplant nephrologist if I could return to PD if a transplant wasn't successful.  He said that there was no way to tell for sure, since the scar tissue from transplant could prove problematic in the future. 

[gilders]

Speaking for myself, it's not the <5 year lifespan of the peritoneum that I'm questioning.  I have heard the same thing. What I questioned was your statement that the peritoneum can regenerate to be fully used for dialysis again.

Hi kickingandscreaming. I never stated that the peritoneum can regenerated, I was asking if it could. I see the confusion though as I didn't put a question mark at the end 

[kickingandscreaming]

Hi kickingandscreaming. I never stated that the peritoneum can regenerated, I was asking if it could. I see the confusion though as I didn't put a question mark at the end

As far as I know, it can't, and I've never read or heard anything to the contrary.

[Simon Dog]

Speaking for myself, it's not the <5 year lifespan of the peritoneum that I'm questioning.  I have heard the same thing. What I questioned was your statement that the peritoneum can regenerate to be fully used for dialysis again.

Some of us only got 6 months.  In my case, it was not membrane failure, but a membrane that never worked that great which became apparent when my residual dropped.   I always felt sorry for those folks on hemo.   Now, I are one of them     It's not as convenient as PD, but no where near as bad as I was lead to expect, especially since I escaped the clinic.

[Charlie B53]

I'm on PD and still very scared of needles.  Period.

[Simon Dog]

I'm on PD and still very scared of needles.  Period.

I was too.   I still don't like them but I have become used to puncturing(*) myself as a normal part of life.

* - Clinic staff are trained not to use this word to describe the process 

[kickingandscreaming]

You know, it's not just fear of needles.  I don't have a fear of getting a needle from someone else.  I don't like to watch it happen, but I don't faint or even balk.  But there is something very counter to life itself to penetrate one's self with a sharp object.  It just isn't right. I think I would need a brain transplant to be able to move to that level of compartmentalization.

[Simon Dog]

You know, it's not just fear of needles.  I don't have a fear of getting a needle from someone else.  I don't like to watch it happen, but I don't faint or even balk.  But there is something very counter to life itself to penetrate one's self with a sharp object.  It just isn't right. I think I would need a brain transplant to be able to move to that level of compartmentalization.

I think your attitude could change after you force yourself to do it a few hundred times.   After a while, you just treat your arm like it is your patient and not part of you.   In the long run, self-stick is better than stick by the person of the day, though no-stick is better.  Sure wish I could have stayed on PD.

[kickingandscreaming]

I think your attitude could change after you force yourself to do it a few hundred times.   After a while, you just treat your arm like it is your patient and not part of you.

Hey, SD, would you  be willing to describe your process for self-cannulation?

[cassandra]

Am I okay to but in here? Cos SD said exactly what I've been thinking and 'teaching' fellow patients for a long time. Mainly because thinking about my whole body as not actually being me, but the patient, it makes Nonsense the only way I can deal with it. (Sex becomes a bit of a problem probably because of that too though, but I can live without sex, not without D, and hubby can't live without me)

Anyway, it works. Not wanting to be dependend on other people helps too, being angry with them too 

My process of cannulation with buttonholes differs from the sharps.

With sharps, wash arm, dry arm, spray Xylocaine (lidocain & prilocain(?) on entire fistula, prime cycler, set up needles (wet) plasters, 4 dry gauze, 10 gauze soaked in chloorhexidine, pickers etc. Connect all lines, bp, weight etc. Wash hands thoroughly, feel and look where to stick the needles, clean thoroughly with chloorhexidine gauze. Take back eye needle, hold the wings between fingers and stick in fistula about 45 degrees. First soft (meat and skin) than a bit tough (or really, really tough depending on age fistula) than you feel nothing, you'll get some blood moving in the needle, and you are in. Move slowly the needle in with the flow of fistula. Stick end of needle tube between teeth and tape needle in place. Repeat with second needle.

Buttonhole next time, hubby came home who'll need some care and attention 

Love, Cas

[Simon Dog]

Hey, SD, would you  be willing to describe your process for self-cannulation?

• Wash hands and fistula arm with antibiotic soap
• Tape three 2x2 folded gauze on each buttonhole, soak with saline, go eat dinner
• Wash hands with antibiotic soap
• If in clinic, ask staff to go take a break and come back when I have my lines in
• Remove tape.    Clean arterial and venous with alcohol wipe
• Put on mask.
• Clean arterial again with alcohol.   Pick scab if any with picker on endcap on dull fistula needle
• Clean arterial with alcohol wipe.    Insert buttonhole needle, flip it over, put on first piece of tape.
• Flush arterial with saline, being sure to suck out any bubbles in the line (I use 7cc saline in a 10cc syringe so I have room to pull the bubbles)
• Finish taping arterial
• Repeat above steps after "put on mask" with venous line

Actually, I usually do the clean/scab pick on both arterial and venous then proceed to the final clean and puncture.

Flipping is safer with a blunt needle, but can damage the vein when done with a sharp.  I find that flipping lowers my arterial and venous pressures by 10-20 points.

[kickingandscreaming]

Thank you both.  Not sure I understand all the subtleties, but sobeit.

[jcanavera]

Been a while since I've been here.  So far PD for my wife is going well.  Just over 2 years.  Doc never gave us an expected estimate on how long PD would work for us.  I was told that they hope we could stay off the stronger fluids which would extend peritoneum life.  As time has gone on we have moved from all greens and an occasional bag of red to just using yellow.  Doc is happy that yellow works well for us.  If we see 3-4 days of lower UF and weight gain, we will go with 2 yellow and 1 green.  That will pick up another 200-300 UF and we will be back on track.

Jack

[Charlie B53]

PD 3 1/2 years  6 liters green   6 liters yellow   2 liters Ico

Some days I feel at bit 'dry', I have to watch my weight and blood pressures as I can get light headed when a bit 'dry' so either drink more that day and if still feeling light use all yellow that night.

The 6 days in the hospital with a peritoneal infection scared me straight,  I am making VERY sure I am even more careful now.  The thought of damage forcing me into hemo is very scary.   Otherwise, my team tells me I should expect to stay with PD a very long time.

[amanda100wilson]

I was on PD for 8 years.  One of the big factors as to whether PD provides adequate dialysis is if you have residual renal function, which acts to 'supplement' the action of PD.  After that time, it gets harder to achieve adequate fluid removal.  Obviously to preserve the peritoneal membrane, you use the lowest sugar solution bags you can, but as it starts to decline, you have to go up on strength to achieve the same effect.  The use of icodextrin (extraneal) can help since it allows for a long day dwell ac the rate of movement of fluid across the membrane starts to speed up.  I started out as a low average transporter but over time, this changed so I was a rapid transporter.  This is a pretty usual progression, acknowledged by a doctor at a medical conference discussion;  it is not a failure on behalf of the patient.  Obviously there are people who exceed the average, and those who last longer than the average.

Another reason that the use of PD is limited to 5 years, is because increase beyond this timeframe, it is considered to increase the risk of someone developing EPS (encapsulating peritoneal sclerosis)

http://www.cuh.org.uk/cambridge-transplant-centre/transplant-programs/encapsulating-peritoneal-sclerosis-eps

It is rare, but those of you who knew Brisn Riddle, will know that he died of this and its associated complications.






sp mod Cas

[Whamo]

I've been on PD for six years, and it appears I'll be going back to hero.  I'm on on/off the transplant list which is a better way to go, but I'm reluctant to turn off my immune system.  But
life has bumps in the road, and this is just another big one.  I spent the last month recovering from surgeries: skin cancer (barnacles on my lower leg); plastic surgery (covering the large wound with artificial skin; and
a skin graft (taking skin from my thigh and covering my lower leg wound with it that saves recovery time).  It's been a long, hot summer without exercise and with opiates for the pain.  I'm recovering now without the opiates, thank God.  I hated missing all the great beach days and big South swells.  The surfer in me is so frustrated.  This Saturday my friend and performer, Boo Stubbs, is going to lead a jam session at San Onofre, in the early evening, and I hate missing the guitars, banjos, and bongo drums.