When starting dialysis

[jambo101]

Which for me will be happening as early as next week i was wondering do they start you with the full 4 hour treatment or do nthey give some time leading up to the full treatment.

[Michael Murphy]

I started at 3 hours with 15 minute increment until I got to 4:30.  One other thing far worse then the treatment was the worry I went through the night before and on my way to the first dialysis session.

[Kathymac2]

I can't answer your question, but I would like to commiserate. I'm trying to hold off on starting peritoneal dialysis until after the holidays. Not sure if I'll make it, but I'm giving it the old college try. I have to have another surgery to externalize my buried peritoneal catheter and I'm not looking forward to that. My best wishes for strength and courage as you start this new chapter of your life.

[iolaire]

I don't recall the timing, but they start you off with smaller gauge needles and build up to the final 15 gauge needles over a few weeks (assuming your access allows the larger needles).  So that blocks you from the largest needles for a bit.  Also they should be providing you with a good bit of training initially, that's a good time to start to learn how to take some control over your care.  Hopefully if they see you interested in learning they will respect your wishes more.

[kristina]

If I remember correctly, I was very slowly and gently introduced to dialysis, at first in "smaller dosages" and around the third time the four hours were finally introduced.
Good luck and all the best wishes from Kristina.

[jambo101]

My trip to the nephrology nurse has now become an every Friday event, questions were answered, seems like when dialysis does start it will be 2 hour sessions for a few weeks, at the moment she just sticks needles in the maturing fistula to toughen it up..

[Mr Ken]

I can't answer your question, but I would like to commiserate. I'm trying to hold off on starting peritoneal dialysis until after the holidays. Not sure if I'll make it, but I'm giving it the old college try. I have to have another surgery to externalize my buried peritoneal catheter and I'm not looking forward to that. My best wishes for strength and courage as you start this new chapter of your life.

Why hold off??? PD is painless. I do not understand what you mean by externalize the catheter... Is it in place and healed?

[Simon Dog]

There is a technique in which the external end of a proactively placed PD cath is left under the skin and the skin is sliced open, the end brought outside the body, and fittings attached when it is time to start PD.   PD can be started very soon after a lifting operation, but has to wait a week or three after a from scratch installation.

[Kathymac2]

Thanks Simon Dog for the explanation of what is a buried PD catheter.  I have to laugh Mr Ken when you ask "why hold off" (on starting dialysis).  I'm pretty sure you are one of the more adamant about not liking being hooked up for long periods of time and about poor interactions with clinic staff. Even if PD turns out to be painless as you say, I feel no need to start dialysis sooner rather than later.

[Mr Ken]

  I'm pretty sure you are one of the more adamant about not liking being hooked up for long periods of time and about poor interactions with clinic staff. Even if PD turns out to be painless as you say, I feel no need to start dialysis sooner rather than later.

Excuse me......... You are right I absolutely do not like being hooked up to the hose for long periods of time BUT I ALSO KNOW I GOTTA DO IT. and I due do it..... I have good interactions with the staff it is the social worker who the problem lies. He is lazy and does not want to help.

News flash it is not YOU who feels no need to start dialysis. IT IS YOUR BODY THAT WILL TELL YOU... If you are being told you should start dialysis, you already had the hose put in, then your body is starting to build up toxins that you may not notice any ill feeling. There is a training period too with PD.

Good luck....

[Kathymac2]

Mr Ken, I had the PD catheter put in two years ago when my GFR went down to 15. Now my GFR is at 9 and my nephrologist is OK with me waiting on starting dialysis until after the holidays. If I was symptomatic I would start today but thankfully I am still OK. You are right in saying that since this disease is chronic i may not realize just how bad I am feeling until I start to feel better when I start dialysis. I don't anticipate too long of a training period since I was a nurse for 40+ years and I understand sterile technique. I'll just have to learn the practicalities of the day to day treatments.

Thanks for the good wishes. 

[Charlie B53]

There is always the potential problem, that your buried PD Cath may not work once brought out.  The body sometimes tries to 'fill in holes', growing material which may block the holes of the cath, preventing function.

Part of the proceedure to expose the business end of the Cath will be to pass fluid through it into your abdomen, then to drain that same fluid out.

Depending on the success of this 'exchange' your PD Team will advise you further.

Keep Positive thoughts.

[kickingandscreaming]

I had a buried catheter for PD.  It was a big problem because fibrin formed while it was buried and the catheter wouldn't fill or drain-- initially.   I needed to get a replacement catheter and start over.  On the bright side, the "reveal" of the catheter is surgically no big deal.  Good luck.  A lot of moving parts.

[Mr Ken]

Mr Ken, I had the PD catheter put in two years ago when my GFR went down to 15.

Two years ago........ That is a long time not to be using the hose.......... GFR of 15 = D time.... Surprised the Nephrologist was okay with it hovering it around that number with no D.

Now my GFR is at 9 and my nephrologist is OK with me waiting on starting dialysis until after the holidays.

GFR of 9 that number could quickly tank and you go into acute kidney failure.... Each person drinks there own cup of tea but the number is very low........ Fortunately there is only about a couple weeks left for the holidays.....

I don't anticipate too long of a training period since I was a nurse for 40+ years and I understand sterile technique. I'll just have to learn the practicalities of the day to day treatments.

It is not just about learning clean procedures. You will be doing manual exchanges.... Plan on min two weeks.

Ken

[Kathymac2]

There is always the potential problem, that your buried PD Cath may not work once brought out.  The body sometimes tries to 'fill in holes', growing material which may block the holes of the cath, preventing function.

Part of the proceedure to expose the business end of the Cath will be to pass fluid through it into your abdomen, then to drain that same fluid out.

Depending on the success of this 'exchange' your PD Team will advise you further.

Keep Positive thoughts.

Yep. I am keeping positive thoughts. I am generally a pretty lucky person. I have been married to the same wonderful guy for 47 years, have all the material possessions I need, and have lived with kidney disease all my life without significant problems. Now I am 67 years old, I have six and a half years on the transplant list and facing the start of dialysis. Things could definitely be worse. Whatever happens with my PD catheter, I will make the best of it.  I am just hoping that I don't have to do hemo dialysis.  I did chemotherapy for six months in 1975 and that about did me in. The clinic setting for hemo dialysis seems so similar it actually makes me physically sick to my stomach to consider in-clinic hemodialysis. Well, like everyone else, I'll do whatever I have to do and get through it.

[Kathymac2]

I had a buried catheter for PD.  It was a big problem because fibrin formed while it was buried and the catheter wouldn't fill or drain-- initially.   I needed to get a replacement catheter and start over.  On the bright side, the "reveal" of the catheter is surgically no big deal.  Good luck.  A lot of moving parts.

I know this is a potential problem, especially with how long I've had the catheter buried.  I won't be surprised if I need a replacement catheter. If I do need a new catheter, then so be it.

Thanks for the good wishes. I hope I do as well on PD as you have.

[Kathymac2]

Mr Ken, I had the PD catheter put in two years ago when my GFR went down to 15.

Two years ago........ That is a long time not to be using the hose.......... GFR of 15 = D time.... Surprised the Nephrologist was okay with it hovering it around that number with no D.

Now my GFR is at 9 and my nephrologist is OK with me waiting on starting dialysis until after the holidays.

GFR of 9 that number could quickly tank and you go into acute kidney failure.... Each person drinks there own cup of tea but the number is very low........ Fortunately there is only about a couple weeks left for the holidays.....

I don't anticipate too long of a training period since I was a nurse for 40+ years and I understand sterile technique. I'll just have to learn the practicalities of the day to day treatments.

It is not just about learning clean procedures. You will be doing manual exchanges.... Plan on min two weeks.

Ken

My kidney disease has been very slowly progressive. Until recently, I have been hopeful i would get a transplant before starting dialysis. Now it seems that won't happen. My nephrologist is keeping a close eye on me and I can contact her at any time if I run into problems. I'm hoping for the best.

I think two weeks seems reasonable when learning manual exchanges.  I hope the experience will be as painless for me as it has been for you.

[Charlie B53]

I did PD for 3 1/2 years.  Manuals the first year then went on to the Cycler.  Sadly an infection from Hell caused me to have my PD Cath removed and an Angio-Cath put in so to immediately start In-Clinic Hemo.

Surprisingly, In-Clinic Hemo seems much much easier and far less time consuming than daily PD at home.  I now have all those evening hours and NO machine to be tied to all night.   A few hours three days a week seems far less imposition on my time than doing PD so I cannot complain too much.

Granted there were changes I had to make in my diet and fluid intake, but I have managed quite well and think I am doing just fine with it.

I bring a lot of Qwap to the clinic with me.  Beside my blankie, pillow, seat cushion, I always have my laptop and headphones so I can watch. documentaries.  Staff laughs as once seated and turned on I'm gone. lost in my own little world until it is time to start getting disconnected.  So the time just seems to fly by.

[Mr Ken]

Surprisingly, In-Clinic Hemo seems much much easier and far less time consuming than daily PD at home.  I now have all those evening hours and NO machine to be tied to all night.   A few hours three days a week seems far less imposition on my time than doing PD so I cannot complain too much. [/quot]

Very true!!! Of course when you are being sold the benefits of PD the people in teh know seem to slide by the above facts. PD is a lot more time consuming...... But there are some advantages that keep me away from HEMO..... No matter how you slice the tomato dialysis sucks all the way around.

Granted there were changes I had to make in my diet and fluid intake, but I have managed quite well and think I am doing just fine with it.

I still have problems with fluid intakes.... I GET THIRSTY....... Body says give me fluid.......

I bring a lot of Qwap to the clinic with me.  Beside my blankie, pillow, seat cushion, I always have my laptop and headphones so I can watch. documentaries.

For my clinic visits I bring lots of attitude.... I just liek them so much.... My D nurse says I am one of their better patients then laughs for some reason............

Ken