Steve is running out of fistula access points. He has had two angioplasties of his last fistula - one in August, and one about a week ago. We're back up to running dialysis at a blood pump speed of 400 ml/minute. But we both know it's only a matter of time before that angioplasty runs its course and the fistula stenoses (narrows) once again.
The greater problems are these:
- Steve sustained a median nerve injury at the site of his last fistula placement, rendering his left hand only marginally functional, and nobody's eager to try that site again.
- Steve has NO central line access points available; all potential sites are narrowed from earlier central lines.
So these realities have prompted Steve's nephrologist, Dr. Smiley Thakur, to consider Peritoneal Dialysis. Steve's body mass is smaller now, and it could work - at least as an interim modality.
In Hemodialysis, the filter that performs the kidney function is external to the patient and looks like a long, cylindrical oil filter. In Peritoneal Dialysis, the filter is the patient's own peritoneal membrane - the membrane that lines the abdominal organs.
In "PD," no blood is exchanged. The dilysate runs into the patients abdomen via a catheter. Dialysate fluid mingles with the vascular peritoneal membrane where molecules meander back and forth, allowing for excretion of the patient's waste. After this "dwell" period where the dialysate fluid sits in the abdominal cavity, the fluid is allowed to run out and is replaced by fresh dialysate fluid to start the process once again. Ingenious!
PD is done daily. It can be done through the day as a number of individual "fills and dwells" - and it can be done automatically overnight. It's great for travel. It's technically easier than Hemodialysis, and requires less training.
We're now into the logistics of setting up the catheter placement, getting training, and trying the new modality in December. The ease of the treatments, although they are required daily, is very appealing to both of us.
So Steve and I move to a new chapter, tackling our challenges as we have in the past. With a little grumbling, a lot of irreverent humor, and boatloads of gratitude to have these modalities available. After all, he gets to live.
Linda Gromko, MD