Saturday, November 20, 2010

Steve's Next Chapter: Peritoneal Dialysis

When I first really learned anything about "Renal Replacement Therapy," the conference speaker urged us to think of kidney transplant, Hemodialysis, and Peritoneal Dialysis as somewhat interchangeable. Of course, the three modalities are not the same; transplant is by far the best in patients who qualify and can find a kidney.

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.
That could leave Steve - in a pinch - with a groin catheter. Again, nobody's first choice.

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.

Take care,
Linda Gromko, MD


  1. Linda,
    I did PD successfully for 6 years and only went to HD because I developed leaky hernias along an old abdominal surgery scar. I think PD is great and would go back to it in a heartbeat if I could. I never had an infection from it --neither peritonitis nor exit site, so if you're careful (and I know you are) you can avoid those problems. Since Steve isn't walking around much the hernia issue is unlikely to be a problem, however, as he progresses in his mobility, you might consider an abdominal support...I used a very wide elastic hernia support belt that fastened with velcro to ease stress in that area.

    Good luck with this. I hope PD will work. Relief from needles and HD can ve great.

    Hugs and hope,

  2. Thanks for the encouragement, Miriam. PD does seem to have some real advantages. We just had a power outage lasting about 2-3 hours! Gravity doesn't require electricity, and that would be a relief. Gravity as a good "fall-back" position? Sorry. Hope you're doing well. Linda

  3. LOL. We've had a couple of power outages during HD sessions and they scare the heck out of me. They were due to lightning strikes. Regarding PD -- One of the reasons I chose to do manual exchanges when I was on PD was because I was concerned about there being an earthquake at night while I was using a cycler -- we lived in L.A. at the time. We had lived through the Northridge quake before I went on dialysis and as a result I had visions of the machine flying across the room and taking my catheter with it. I felt much more in control not having to rely on electricity to do my treatment and not being connected to a machine.

    As an aside, we were better able to travel when I was on PD and I also did exchanges at my office when I was working. I know you aren't ready for travel now, but you may be sometime in the future. With PD, it's pretty easy.