Night time Peritoneal Dialysis, The Cycler!

1. Night time Peritoneal Dialysis, The Cycler! The short answer is quite likely to be yes. Many patients find that they are offered hemodialysis by their consultant as their first (or sometimes their only) choice. This is possibly because the consultant wants you to be in a controlled environment, which is not a bad thing in itself. (Although some people say it is because hemodialysis clinics are big business, as they are funded in the US by the government.) The number of patients on peritoneal dialysis is certainly much lower than those on hemodialysis, and also lower than expected based on how the treatments work (only one in ten dialysis patients receives PD treatment). For many renal failure patients, peritoneal dialysis is in fact a perfectly viable option, and it can free them up to travel, have holidays, hold down a full-time job, and avoid regular time-consuming visits to a kidney clinic. But I've had a transplant and it failed! Well, research by several different groups of scientists shows that there is no difference in survival rates between those who are new PD patients and those who switch to PD after a failed transplant. Nor was there any difference in the number of patients who managed to continue on PD program. But I'm overweight! Unfortunately being obese is becoming more common (especially among Americans), and as you probably know, one of the main causes of kidney failure is type 2 diabetes, which also causes obesity. However, you do have to be a bit more careful if you are overweight, as you may be susceptible to infections caused by the catheter, and the risk of peritonitis is higher if you are overweight. One possible solution is to use a chest catheter (called a presternal catheter). But sadly it is a fact that the more overweight you are, the lower the survival rate is. Younger patients with a weight problem have a better chance, but it does seem that for older obese patients hemodialysis may be a better option.

2. But I'm a bit old (in my 80s)! By itself, age should not be considered as a barrier to peritoneal dialysis. Unless you suffer from trembling hands or have joint pain, which makes handling the PD equipment difficult, it seems that many older patients are quite capable of setting up their PD sessions. You do have to be able to lift the PD bags however, which might make things difficult for some elderly patients living by themselves. Apart from these points, don't rule out PD on age alone. But I've had a hernia! Then you have to have it fixed - usually by the mesh treatment under local anesthesia. And why not have the access point fitted at the same time? Research shows that this repair and fitting process is a safe and effective way to commence peritoneal dialysis. And if you get a hernia after starting PD, it doesn't necessarily mean you must switch to hemodialysis. It is recommended that if you do need a hernia repaired after starting PD, you should carry out your PD sessions lying down for several weeks afterwards. Doing this reduces the pressure on the stitches, giving the mesh a better chance of doing its job and fully repair the hernia. But I've had peritonitis! Unfortunately, this is a bit more of a show-stopper. The peritoneal membrane may have been scarred, ruling out PD as an option. If you get peritonitis during the early stages of starting on PD, you will probably have to switch to hemodialysis. So sometimes, PD is possible, but it is not as usual an option in these circumstances. But I'm blind! Being visually impaired makes using a cycler a bit difficult, unless someone comes up with one that speaks to you. Poor vision is often a problem for those with diabetes, as this is a known side effect. On the other hand CAPD is perfectly possible if you are blind, as everything is down by hand. You may need extra training and have to use prefilled syringes, but it can be done. In conclusion, if you are told you must take hemodialysis, ask why peritoneal dialysis is not an option. Often the reason might just be "because we offer hemodialysis". Ask exactly why you personally can't have PD. It's your choice.