Question about starting dialysis

[dialysistech]

I was just wondering when you were told you needed to start dialysis were you ever offered PD? Or is it something you were told about after you already started hemo? It seems a lot of the new patients that start at my center were never offered PD and have no idea what it is. PD is sometimes a great option for a very active person. Thanks for reading. 

[Pam]

I was offered PD. My Dr was the first in this region to offer it. I chose hemo and he is the Director of the unit. In the last month there have been 3 people that switched to PD. The reasons I chose to do Hemo were
1..I did not want to turn part of my home in to a medical supply place
2..I'd rather go incenter 3 times a week and not think about it the other days
I guess I'm one of the lucky ones, I am in my 6th month and I've never been infiltrated or crashed. The worst thing has been a couple of bad headaches. I have button holes that work like a charm. I feel  good and live one day at a time. The thing that puzzles me is the button hole issue. I would have not know about them if not for this site and my center does not encourage them. But i won that one!

Pam

[Brightsky69]

My doc expected me to start PD because he knew how active I was. I had to do hemo at first because I got a tunnel infection with my PD cath.

[Wallyz]

PD was discussed in the hospital, but becasue I am large (6'5", 120+ kg.) it was rejected.  Home hemo was only discussed after a couple months in center.

[Restorer]

Less than a month after I was diagnosed with kidney failure, and well over a year before I started dialysis, I was given info about PD and in-center hemo, as well as transplant options. That was one of the few areas where my neph did a good job.

[RichardMEL]

I was just wondering when you were told you needed to start dialysis were you ever offered PD? Or is it something you were told about after you already started hemo? It seems a lot of the new patients that start at my center were never offered PD and have no idea what it is. PD is sometimes a great option for a very active person. Thanks for reading. 

I was diagnosed 13 years before I actually started dialysis, but actual dialysis options weren't discussed until I was invited to a seminar around a year or so before I was originally due to start. I went with my mother and they had a bunch of pre-dialysis patients there (and some who had already started) and they went through everything - from dialysis options, to diets, to social work talk, to transplant.. the whole thing (they even brought a machine in, and samples of the 15 guage needles for us to look at and freak out about  ). I thought it was REALLY good to be honest. They had a hemo nurse, home hemo trainer and PD nurse explain the various options, benefits, pros and cons of each and we got a big booklet with the slides and information in there to take with us to think about.

At the end of that seminar I actually had a one on one chat with the PD nurse and discussed my particular issues of eyesight and co-ordination, and we agreed that PD was probably not a good option in MY situation.

At least I had an understanding of the options and what the deal was.. and luckily I had lots of time to prepare mentally and emotionally. I know those who suffer acute renal failure aren't given that kind of heads up.

[Brianna!]

I think my center talked about pd. "Talked." They never went into it. I want to do pd, but then I would have my huge fistula scar for nothing. I wish they told me more about PD before I started dialysis, though.

[billybags]

Before the time came for my husband to go on dialysis he had to go to a meeting at the hospital along with other patients. they were talked through both options, hemo and PD. We also had a nurse come to the house and explain a lot more about PD. He had three fistulas inserted in his arms in 2 months, none were good because he has very small veins so the answere was to have PD. When the time came the PD worked fine for him. Ok you have alot of box's and ticky tacky in your house but you also had "freedom" We are both retired and doing 4 exchanges a day did not make a lot of difference to our lives. At first we had the nurse come every week to our house to check every thing was ok, that dwindled off to once a month. He went along ok for about 3 months then he was given an over night cycler, he never seemed to do very well on that. The nurse kept tweeking it, any way we went on holiday to Greece, did manuals and he got a very nasty e-coli bug. To cut a long story short he had to have his catheter out, go on emergency hemo, which he hates with a vengeance. Three months down the line he is having his catheter replaced next week. I think you have to go with what your neph advises. PD does not suit every one the same as hemo doesn't not suit every one either. What I think is important is that the patient has a choice.

[Des]

Here in South Africa they do not prefer/like/promote PD at all. The docs say it has a high infection rate.

But with all the info that I got on IHD I will insist to have PD.... If it is at all possible with my PKD. Some people do have problems.....

[Ken Shelmerdine]

Some NHS trusts activeley do a big sell on PD because it PD costs the NHS far less than in centre haemo. This was my experience. Similar to Richardmel I went to a small seminar for pre-dialysis patients where all the aspects of Haemo and PD were explained and overall was vey educational. But it was quite obvious and clear that they were doing a big push on PD.

[RichardMEL]

Thanks Ken. Interesting to read your perspective on your seminar experience. My impression at mine (on the other side of the world) was more what is best for a particular person's situation. Home Hemo was perhaps the slightly preferred method, though PD was also pushed (oh I just remembered they went through the cycler and CAPD). I don't really recall an emphasis more on pushing PD over Hemo though (but this was 6 years ago and so much has happened since then).

[cookie2008]

My doctor talked about in center hemo, home hemo, and pd. Which I have done all 3. 

[Goofy]

TO:  EVERYONE WHO IS RESPONDING TO KICKSTARTS QUESTION ABOUT QUITTINE................

..............this is exactly why you are all here.  People need somewhere to go to get "real" answers; not just what the medical profession tells you.

The more people on the site gives you a chance to tell them of your experience or even just hold their hand when they need it.

So anyone who is upset and wants to leave should think about posts like dialysistech.

[peleroja]

When I was first diagnosed 6 years ago, I had 18% function.  Unfortunately, my neph prescribed Zocor for my high cholesterol, and one month to the day later I ended up in the hospital with rhabdomyolisis.  After 11 hours in ER, they finally figured out what it was and came to me at 11 pm and told my my kidneys were failing and I needed immediate dialysis.  At 12 am I had a groin catheter put in, and at 1 am I had my first dialysis.  Two days later they gave me a permacath, and I was on hemo for 3 months.  I had been leaning toward PD (Kaiser has a choices class where they tell you about both), and when I found out how large the needles were for hemo, that definitely decided me.

I had to have a pre-sternal catheter because I was too large for an exit site in my abdomen.  I got so used to it that when it had to be removed due to pseudomonas, I requested my next one also be a pre-sternal catheter.

As for why many patients never find out about PD, many nephs have a vested interest in hemo centers, which is why they don't bother telling their patients.  The almighty dollar is more important to them.

[mk]

Like RichardMEL I attended a seminar that reviewed all the advantages and disadvantages of treatments for ESRF, including living donor transplant, PD, home hemo, in-centre hemo, , and even doing nothing. Without presenting a  distinct bias and presenting facts, it was clear that the preferred choice to feel the best for a patient, with no clinical restrictions, was that same order. But they didn't say that, it was stressed as a personal choice.
Mary

[bevvy5]

We were totally ignorant that there was any option other than in centre hemo, even though hubby's kidney function had been running at about GFR 25 to 30 for about 10 years.  When it "crashed" in January and dialysis became an inevitable outcome, we went to a seminar on choices, which included PD, hemo, transplant and "managed care," in other words, doing nothing.

PD was, for us, a no brainer choice and seemed to be the favoured option among the two nurses and social worker that ran the seminar. 

[Restorer]

I'm glad I made the decision I did (for PD). I didn't have any seminars demonstrating the differences, or even any real advice or opinions from my nephrologist. Maybe a seminar would have been biased toward hemo - the area I was living when I was diagnosed has a large number of older people for whom PD wouldn't be a good choice.

[ardyce]

I started on in-center Hemo.  The only thing the doc. said to me was I needed dialysis.  I told him that I did not know anything about dialysis and he just walked out of the room.  After I was on hemo, a PD nurse came and talked to me about PD when I was on a hemo treatment.  I was surprised that someone had not told me about PD.  Needless to say I did not even talked to the doc about changing to PD.  I feel that the doc does not have a wealth of information.

I would have picked PD from the start if I had known about it.  It has enable me to keep me full time job and do the travel requirements of my job.

Ardyce

[dialysistech]

Thank you all for the great information keep it coming. I always try to ask the new patients if they are aware of PD as an option. I know in a few causes some were never offered it. So people don't have the space in their homes for the supplies. We have some videos that people have taken home to view. Not many have decided to change to PD. 

[Hanify]

I started dialysis suddenly, so went straight to Haemo.  I'd never heard of PD, and I remember when the doc first bought it up he said 'some people have a body image problem with PD'.  I was talking to my sister after he had gone and we were discussing what he could have meant.   I remember saying to her 'surely you don't walk around with something in you do you?'  Oh to be that naive again....

[Ken Shelmerdine]

My impression at mine (on the other side of the world) was more what is best for a particular person's situation. ).

Yes Richard I should have mentioned that the big sell towards PD is notwithstanding a patients suitability to it.

 It's interensting isn't it that the more costly tratment (in centre haemo) is pushed in countries with private medicine where the owners of the centre stand to profit more from it whearas the opposite is the case with social medical care where the cost of haemo is the main obstacle. 

[kristina]

I am still pre-dialysis and I am
thankful that I have a chance
to learn about some subtle
financial motives "in place".