Does Peritoneal Dialysis Have Any Advantages or Disadvantages Over Hemodialysis?

[okarol]

Question: Does Peritoneal Dialysis Have Any Advantages or Disadvantages Over Hemodialysis?

Answer: There are a few advantages and disadvantages of peritoneal dialysis over hemodialysis.

The advantages are:

No need for vascular access: This is a major advantage especially for people for whom the creation or maintenance of a well functioning vascular access is difficult. Vascular access related complications are the most common cause of hospitalization in hemodialysis patients. Multiple access failure, either due to thrombosis or narrowing of blood vessels, is the major reason hemodialysis patients are switched to peritoneal dialysis.

Less dietary and fluid restriction: Peritoneal dialysis is a continuous process of removing excess fluid and toxic material from the body, mimicking the work of native kidneys. This property of peritoneal dialysis allows patients to be less restricted in their food and fluid intake.

Better blood pressure control and less cardiovascular stress: Fluid overload is the major cause of congestive heart failure and uncontrolled blood pressure in hemodialysis patients. The ups and downs of fluid accumulation and the removal of fluid by hemodialysis are also stressful to the heart. In peritoneal dialysis, there is less fluid accumulation and the removal of fluid is slow and continuous. Thus, the stress on the heart is less and blood pressure is better controlled.

Increased mobility: As peritoneal dialysis is a self-administered mode of therapy, patients can adjust their treatment according to their own schedule. They do not have to go to the center; they can do their dialysis almost anywhere (car, office, home etc).

The disadvantages are:

Infection: Peritonitis, exit site infection and tunnel infection are the major complications of peritoneal dialysis. Serious and frequent peritonitis, either due to fungal or bacterial infection, is the main reason to discontinue peritoneal dialysis and switch to hemodialysis.

Nutritional complications: The combination of daily loss of protein in the peritoneal dialysate and decreased capacity to intake food due to increased intra-abdominal pressure, protein energy malnutrition has been observed in some peritoneal dialysis patients. Hyperlipidemia (increased cholesterol and triglyceride levels) has also been observed in these patients, especially during the initial period of treatment, and is due to high peritoneal glucose load. This high glucose load also causes excessive weight gain in these patients.

Chronic back pain and hernia: Increased intra-abdominal pressure secondary to peritoneal fluid can cause chronic back pain and/or abdominal hernia in some patients.

Question answered by Yalem Woredekal, MD. Dr. Woredekal is an Assistant Professor of Medicine and a Medical Director for the King County Ambulatory Hemodialysis Unit. She has also been a dialysis patient for the past 17 years and is currently on daily dialysis.

http://www.aakp.org/aakp-library/peritoneal-advantages-over-hemodialysis/

[goofynina]

I believe one of my advantages is that i feel like i got my life back.    

Oh please please please just dont give out too soon 

[carson]

ok, so here's my question:
I've been on PD for 10 yrs and now they want to switch me to Nocturnal home hemo siting poor membrane function. Now, the only blood values that are out of whack is the PTH. It's 400, was 300 last month. They're concerned because my bones keep slipping out of joint! Everything else is fine though. Knowing I have a HUGE fear of needles, they're going to put in a central line with which they can do plasma exchange in hopes of a transplant work up and eventual transplant.
I'm horrified of hemo. I don't know how I'll do. I don't know if I'm making the right choice or if they're kind of bullying me into it. I still have many questions and only have until MOnday to give an answer. I don't have any time to find out what I want to know because I work so much and my hospital is 2 hours away.
I like the idea of having a bath or swimming; having a flat tummy. I like not having to do manual exchanges during the day as well as the cycler. I like only having to be hooked up to a machine for 5 nights a week instead of 7. I like the prospect of not having to do dialysis again at all after my new kidney is in place.
I DON"T like the idea of having my blood leave my body, having a line in my chest that is more visible than the PD catheter, having my PD catheter removed (sore tummy muscles), and finally I don't like the idea of taking time off work and falling behind with my bills when I just got caught up!!!
Any thoughts on this will be gratefully accepted...

[jbeany]

I don't get what PD vs hemo has to do with your parathyroid numbers!  Besides, my PTH is up, and I'm on home hemo on Nxstage - hemo is no guarantee that the PTH will drop.  You need Sensipar or Hectorol for that.  Is your URR dropping?  (Do they do that with PD?  However they judge the effectiveness of your dialysis for PD, anyhow.)  If you aren't getting a good clearance, then I can see it.

I don't think swimming or tub baths are an option with a central line/ perma cath anyhow - only if you get a fistula or graft that's enclosed by skin.  That means surgery and, yes, needles.

You also make it sound as it they are pushing you into hemo in order to get the transplant work-up.  I don't get why they can't do the work-up while you are on Pd.

[okarol]

It sounds as though the permacath is needed to do the plasmapheresis - in order to get you to where they can do a transplant - is your PRA high? I would ask a lot more questions - don't rush into anything you don't fully embrace.

[paddbear0000]

The doctor mentioned something about high peritoneal glucose load. What is this and would this affect a diabetic's blood sugars in some way? As a result, would PD not be a good choice for a diabetic?

[jbeany]

That's why Pd wasn't an option for me - I'm a brittle diabetic.  My doc didn't want me on PD at all - he said my blood sugar would be too hard to control with PD.  It also has a tendency to make diabetics gain a lot of weight, and I needed to lose it, not gain it.  The gastroparesis was an issue as well - I'm queasy enough without pumping extra fluid into my stomach.

[stauffenberg]

The connection between switching form PD to nightly hemodialysis and high PTH values is that with nightly hemodialysis you get infinitely bettre dialysis than you could get with any amount of PD, so the PTH will come down.  In reare cases of intractable elevated PTH surgery on the parathyroid gland may be required.

I had dialysis via a permcath from 1996 to 2003 and found it completely comfortable and free of serious problems.  You cannot bathe or swim with it, but it does not show at all through your clothing.  A major advantage of hemodialysis over PD not mentioned in the earlier posting is that hemodialysis produces a very dramatic improvment of the blood values immediately after treatment to nearly normal values, while with PD the values never come close to normal.

[fluffy]

you could always opt to have a couple of your parathyroid glands removed, thats what they wanted to do to me. right now im doing pd and hemo and it seems to be workign so far. hemo isnt as bad as i thought but i do prefer pd

[carson]

You're right on the money, Okarol, regarding plasmapheresis and my PRA. They have offered this option to me (apparently not offered to everyone where I am) and my neph feels I should go for it. They all know my absolute fear of needles and have suggested the permacath to do the plasmapheresis and figure why not hit two birds with one stone and do some home hemo on me at the same time. This will, hopefully, help with my PTH as well as my PRA when including the IVIG treatment. As it is with PD (10 yrs now) I use only 2.5%, do 6 exchanges/day and I still retain water. 4.5% doesn't work for me nor does the Icodextrin (also called Extraneal) so I think this is why everyone's pushing for the nocturnal hemo. I don't know what to do but it's making me feel sick thinking about it. I was supposed to give my neph an answer yesterday but I couldn't call long distance from work,

thank you, Stauffenberg, for the positive things you had to say about this. I'm quite afraid but it's the only way I'm ever going to get a kidney (PRA is at 97%). I don't think I have much choice anymore...

[paddbear0000]

That's why Pd wasn't an option for me - I'm a brittle diabetic.  My doc didn't want me on PD at all - he said my blood sugar would be too hard to control with PD.  It also has a tendency to make diabetics gain a lot of weight, and I needed to lose it, not gain it.  The gastroparesis was an issue as well - I'm queasy enough without pumping extra fluid into my stomach.

Thanks for the info! That's one less option I don't need to stress over whether i should go with it. I too am a brittle diabetic and that seems to be the last option i need.