Which is Best? Hemodialysis or Peritoneal ?

[IrishGirl]

I know the basics of each one. But really, how do you decide ? And is one better then the other? It seems Peritoneal is better since you can do it at home and still travel, etc but you must do it every single night. And there is the risk of peritonitis...Hemodialysis is going to an institution 3x a week and they have such huge fluid shifts....both seem interruptive. If I have to pick, which is best? I dont know how long you can do the Peritoneal....I always thought it was just temporary until you get a transplant. Is one better for the kidney then the other one? Has anyone done both and has an opinion about them ?

[KT0930]

I've done both, and for me and my family, peritoneal wins hands down. Fewer fluid and diet restrictions; easier to travel with; and much easier on the body as far as the fluid balance. As for peritonitis - follow the instructions given to you in training to the letter; keep your exit site clean, and it should not be an issue. I had one case of it in 15 months, and while it was VERY painful, they treat it very quickly with antibiotics put into your bag of fluid, it dwells for 6-8 hours, is drained out, and you're fine. I was better within 24 hours and back to normal within 48. It's not the end of the world. Eventually, the peritoneum can wear out, requiring a switch to hemo. I've heard of people doing PD for up to about 15 years, but I think the average that a neph will tell you is somewhere around 8-10 years.

The way you decide is by taking a good, long look at your lifestyle and deciding what's important to you regarding each type of treatment. Do you want to travel? Do you want to have a less restrictive diet and fluid intake? Do you want more time at home with your family? Do you want to try to continue to work? Do you want to avoid needle-sticks (except for Epo shots)? For most people, yes answers to these would point to PD.

But if you want to go and get your treatment then forget about dialysis for the next day or two; or you feel the need to have someone else do your treatment for you, rather than you being completely responsible for it; or you enjoy interacting with fellow patients, then hemo may be the right choice. Those who have done hemo can give you better advice there than I can.

Also remember that there is the option of home hemo now, and NxStage makes that almost as portable as PD. I know, I probably just made it more complicated, right? Sorry!

[Adam_W]

For me, it's definitely home hemo. I've done in-centre 3x/week, and I couldn't stand it. That being said, I've never done PD. I've heard very good things about it, and I've heard some not so good things (peritonitis, etc.). I may have to switch to PD eventually because it's very hard to get a hemo access working with me (however, my current graft is starting to wake up again-I'm on my machine right now and I'm getting the best performance that I've had from my graft in a LONG time). If I do PD, I will do CCPD so I can do it at night and not have to do any dialysis during the day. I'm on NxStage, and although there are a lot of supplies and the machine is heavy, I've successfully traveled with my machine. It usually depends most on what the patient is able to do, and their lifestyle. Even though in-centre hemo was awful for me, it works just fine for others. Same with home hemo and PD-they work for some, but not for others.

Adam

[karen547]

I was going to do PD- Had the surgery for the catheter and everything. Then immediately it was taken out since the 'doctor' ''didn't know'' I had a shunt because I was born with Spina Bifida. I now have a nasty scar on my stomach. I do hemo now obviously. I don't mind it as much now. I hated it when I first started. I was terrified of needles, being around other ppl and have them bleeding, the whole thing was so scary at first. Now I don't use any EMLA cream nor any spray and ppl look at me like I'm so brave lol! I like most of my techs, although there is one lady whom I now call Nurse Cratchett with the Ratchet- she is just plain mean sometimes. I guess for some hemo is a bit life invasive, but I thankfully don't mind it so much yet....

[KT0930]

I was going to do PD- Had the surgery for the catheter and everything. Then immediately it was taken out since the 'doctor' ''didn't know'' I had a shunt because I was born with Spina Bifida. I now have a nasty scar on my stomach. I do hemo now obviously. I don't mind it as much now. I hated it when I first started. I was terrified of needles, being around other ppl and have them bleeding, the whole thing was so scary at first. Now I don't use any EMLA cream nor any spray and ppl look at me like I'm so brave lol! I like most of my techs, although there is one lady whom I now call Nurse Cratchett with the Ratchet- she is just plain mean sometimes. I guess for some hemo is a bit life invasive, but I thankfully don't mind it so much yet....

Is the scar from taking the catheter out? They took mine out when I had my transplant, and the scar is smaller than the cath was.

[kitkatz]

I have been on hemodialysis for nine years now. I was not given a choice because I have had five abdominal surgeries.

[petey]

Also remember that there is the option of home hemo now, and NxStage makes that almost as portable as PD. I know, I probably just made it more complicated, right? Sorry!

Thanks, KT, for bringing up option #3 -- home hemo.  My Marvin has done all three types (though the PD didn't last very long -- only a couple of months -- he had major problems with his caths for PD -- first one kinked and had to be surgically straightened twice then finally removed and second time with a PD cath he got a BAAAAADDDD case of peritonitis -- after that, he gave up on PD).  He did in-center hemo for 12 1/2 years.  We've now been doing home hemo since last July.

For Marvin and me, home hemo is definitely the way to go! We love it -- we love the control, the freedom (lifestyle and "extra" fluids), and we love being at home finally!  Marvin said if he hadn't had cath problems with PD that he probably would have stayed on that.  By the way, he's had two PD caths placed (exact same place) and his scar from that is about the size of button and an inch or two below his bellybutton.

I agree with KT, though.  Weigh all the options (and don't forget home hemo) and see which one fits you and your lifestyle best.  Good luck to you!

[KICKSTART]

I have done PD fpr three years and i love it ! You have to decide what fits in with your lifestyle the best i think.

[MyssAnne]

I've been on PD for 2 years, and while I"ve had trouble with it, I much prefer it to hemo. I prefer the less restrictive diet,
the options available, if i wanna do manuals, I can do so, I can travel either way, manual OR the cycler, and it's every day,
which means I get better results, and feel better than I did on hemo (which I did when I had catheters replaced)

[oleboy]

It's like Kickstart said it must be a choice that you make, I started in clinic Hemo, but because my caregiver had to take off from work to take me and pick me up, her work place fussed about it, so now I am on a Baxter Cycler and love it I do PD at night and my days are free.

[jbeany]

Do remember that you aren't making a binding decision.  If you start with PD and have problems with it, you can switch to hemo, and vice versa.  I think the time restrictions on in-center hemo make it an unfavorable option for most.  You have to be there when they schedule you - you have to wait around for them to be ready to treat you - you have to do things their way.  PD or Home hemo both give you more control over your schedule.  Also, given the gas prices these days, you have to consider the savings in money in not driving to the center 3 times a week.  How far is the center from your home?  Mine is an hour away, and if I hadn't switched to home hemo, I have no idea where I would have gotten the money to continue driving to clinic!

[flip]

I'm one of the few who prefer in center hemo. I'm only five minutes from the center and they are usually waiting when I get there. Even on dialysis days I have mornings, evenings and nights free. Since I still have some residual kidney function, I don't have to be too restrictive with my diet and I can skip a treatment or two (for travel) with no ill effects. I can't do home hemo because I don't have a caregiver.

[NolaGail]

When it came time to make the decision, I chose PD.  My catheter was placed last September.  I have had in-hospital hemo (25 years ago).  I am one of the fortunate ones, my function returned and has slowiy dwindled away over time.  I am around 11% right now.

I looked at the ability to stay in the workforce, flexibility to travel, and which one would be a good fit for me.

I am not complaining about my catheter by any stretch, but it looks like I may get my transplant before I have to dialyze, so I only have had to 'put up' with getting my cath flushed every two weeks so far (and the wonderful site care).  If I do get my transplant in the next few months, this will only have been a minor nuisance.  Like I said, I am not complaining.

NolaGail

[stauffenberg]

PD has many problems which hemodialysis does not.  Many patients on PD suffer from a clinical condition known as 'dialysis fatigue,' because the need to be using the bags, again and again, day in, day out, without a break eventually drives them up a wall.  With in-center hemodialysis, you are not so intimately involved in your treatment, since someone else is performing the dialysis on you, and you only have to deal with dialysis for twelve hours a week, instead of constantly, as is the case with PD.  When I was first in the hospital for renal failure I remember seeing other patients doing PD and they seemed never to be able to stop; one patient would drift off to sleep during his exchange and by the time he woke up, he had to do another.  Life becomes worthless when you never have to stop treating yourself with medical procedures just to stay alive.

There is also the problem of having a bloated abdomen, which can become so extreme that the dialysate can cause a hernia.  The dialysate uses glucose to create the fluid gradient, so you gain calories from your treatments, push yourself towards type 2 diabetes, ruin your control if you have type 1 diabetes, and elevate your cholesterol levels.

The worst problem with PD is peritonitis, which can be enormously painful, can damage the interior of the peritoneum permanently, and can even cause death if not treated quickly.  There is in principle no way to guarantee that this does not happen, since even with the most sterile technique of attaching and unattaching the connections, peritonitis can be caused by germs that naturally reside inside the peritoneum!

Home hemodialysis is the best method, both medically and psychologically, if your center has it available.

[Ang]

haemo dialysis here  as  abdomen  is  124 cm  around  so  pd  was ruled  out,  ah  yeah  5ft  tall  as well

[mariannas]

haemo dialysis here  as  abdomen  is  124 cm  around  so  pd  was ruled  out,  ah  yeah  5ft  tall  as well

I'm 5'0 as well (and very petite) and PD is no issue for me.  I love it.  I dread the thought of having to ever be on hemo so I am keeping my fingers crossed that I keep doing well on PD.  I really like that I have almost complete control over my dialysis.  As long as I get my required exchanges in within a 24-hour period I am good to go which is nice if I have a change in my schedule. 

[karen547]

JBeany- I don't know if you had this available to you- but at my clinic there is medical reimbursement checks you can get for driving to the clinic which is nice since any extra money i can get IS GOOD. You fill out a sheet daily and write down how many miles it is both ways to and from clinic- comes to be about 250 bucks a month for me, if I choose to fill in the sheet.

[Bajanne]

Well, where I live the only possibility is in-centre haemo.  But I must confess that I know that this would be the best for me.  I am not a very organized person and to me is it simple just to get myself to the unit and let others do their stuff.  What would be great for me would be nocturnal in-centre dialysis.  Then my days would be free.

with haemodialysis, my only responsibility is to maintain a proper diet (handle fluid restriction!)

[jbeany]

JBeany- I don't know if you had this available to you- but at my clinic there is medical reimbursement checks you can get for driving to the clinic which is nice since any extra money i can get IS GOOD. You fill out a sheet daily and write down how many miles it is both ways to and from clinic- comes to be about 250 bucks a month for me, if I choose to fill in the sheet.

That must be a state program - there's no reimbursement for driving costs here.

[del]

The type of dialysis you chose is basically a personal choice between you and your neph.  Hubby has done pd - for almost 3 years until his peritoneal cavity stopped working.  He had to change to in center for 6 years and for the past year and a half we have done nocturnal home hemo. Of it all he prefers the nocturnal home hemo.No driving. Very few restrictions on fluid and food ( basically none!!!) and the freedom of having every day free because dialysis is done while you sleep.  he had no problem with in center.  Fluid gain was not a problem for hm . He rarely had more than 2 kg on even over the weekend.  Biggest problem for us with in center was the drive. Over an hour. Nocturnal hemo also does a better job of cleaning the blood because it is a longer time at a slower pump speed. No issues with phos at all. Actually his is a little low now!!!  You get at least one night a week off as well.  Hubby gets 2.  He does 5 nights a week but he does 3 on , one off, 2 on one off.  You are in control of the times you hook up.  If he had a lot to drink and it is supposed to be his night off he can still no on the machine.

With any home dialysis you have supplies and machines if you are on hemo or the cycler.  This bothers some people having to look at the "stuff" every day. He just looks at it as it's a part of his life. 

[kitkatz]

JBeany- I don't know if you had this available to you- but at my clinic there is medical reimbursement checks you can get for driving to the clinic which is nice since any extra money i can get IS GOOD. You fill out a sheet daily and write down how many miles it is both ways to and from clinic- comes to be about 250 bucks a month for me, if I choose to fill in the sheet.

For 250 dollars a month I would make sure those forms were filled out regularly!

[karen547]

Lol Ya. I just sometimes get busy with other things going on and forget but YA it does help.