Your cause, Support Organ and Tissue Donation, has reached 7,500 members!!!

Your cause, Support Organ and Tissue Donation, has reached 7,500 members! I got this notification in my facebook tonight and how very appropriate!

I had just left our PD(Peritoneal Dialysis) office and had to wait at a usually long traffic light. I looked over to my right and next to me at the light was a former primary HD patient of mine. Since I had seen this fellow I had heard that he had received a Kidney Transplant via the list. I hit my horn quick we rolled down windows and we had a short exchange. I said Congratulations on the transplant.
As a Dialysis Nurse it is such a thrill and so satisfying to have a connection with a patients that are transplant recipients. It is the ultimate Option and it is the way it should be for all ESRD Patients. In our PD office in the past 6 months there have been 5 Patients transplanted. Again it is so so Awesome!!!

PD Cycler Time Commitment

I wanted to talk a bit today about an option inside of options. For ESRD patients there are four basic options: Transplant, PD(peritoneal dialysis),HD(hemodialysis) and to do nothing and go without treatment.
Some may notice that my order puts PD in front of HD and my reason for this is that PD would be my choice before HD and I would recommend PD before HD to anyone seeking my advice. This choice is based upon a lot of PD advantages but in short it is the kinder and gentler dialysis.
Once PD has been chosen there two options inside of PD. CAPD(continuous ambulatory peritoneal dialysis) these are manual bag exchanges usually done four times throughout the day.
The other is CCPD(continuous cycling peritoneal dialysis) these are automated exchanges while connected to a small machine overnight.
When I begin the CCPD training for patients there seems to be a common misconception as to time commitment needed to receive adequate CCPD. The patient mindset seems to be that whatever their normal sleep time is will be equal to their total CCPD treatment time. When doing CCPD it is very common that your total treatment time can be nine or more hours. This is because the nighttime cycler prescription is written for several cycles and each cycle has a drain/dwell/fill time and again this is necessary for the Patient to receive enough dialysis.
Once the Patient understands this requirement it is almost never enough to deter them from doing CCPD. I think that this PD shortcoming in information can be avoided in the future by including this cycler information in whatever options program your system may provide. Hopefully this post will help too!

Home Hemodialysis

Hemodialysis treatments preformed at home is not a new concept at all, in fact I have known some patients that were doing hemodialysis(HD) at home as early as the late 1970's. The home HD option has become more widely used. I am very encouraged about this because it is a perfect transition mode of treatment for people on Peritoneal Dialysis(PD that for a number of reasons can no longer continue PD.

I am very excited of late as I have on good information from Doctors and staff that a home HD program will be starting in my area (Rochester NY) using the Next Stage equipment! Enabling the former PD patient to continue dialyzing at home is great because these folks have been running their own show, for the most part doing their dialysis treatments around their own schedule and not that of an outpatient hemodialysis center. With the next stage machine patients can travel just as easily as they could when on PD as this system does not need a special water treatment for dialysis. Another great benefit of home HD is that the patient can do more frequent shorter treatments at home instead of long treatments three days a week. These shorter more frequent treatments are a much better dialysis process for the body because there are less fluid management problems (osmosis) and better control over the removal of toxins (diffusion). Again not as good but similar to PD where in most cases you are dialyzing 24/7.


In most home HD programs you must have a partner that is trained and will be with you for all treatments. Some home programs offer the option of doing the treatments at night and they are monitored by health care staff remotely. As a Dialysis Nurse it is a great thing that the option of Home Hemodialysis is increasing in availablity.

The Peritoneal Dialysis Option

When a person reaches the point where they have been categorized as ESRD(End Stage Renal Disease) and it has been determined that they must start Dialysis treatment to stay alive there are two treatment options. One is Hemodialysis(HD) usually where the Patient has a scheduled treatment time at an outpatient treatment center three times a week for most commonly 3 to 4 hours each treatment.


The other option is Peritoneal Dialysis(PD). In this treatment the blood stream is not accessed directly. A special tube(PD Catheter) is surgically placed in the Abdomen and via this tube Dialysate solutions are exchanged in and out of the Peritoneal Cavity. The Peritoneum is a membrane that encompasses our internal organs and this membrane is the natural filter that makes PD possible.


These treatments are done at home. The person does the treatment by themselves or with the assistance of a partner. Treatments can be preformed in two ways, Manual exchanges of Dialysis solution 4 to 5 times a day or automated with a PD Cycler mechanically doing the exchanges for you usually while you sleep.


With the Hemodialysis Option you have to comply to the outpatient treatment center schedule, there are more dietary restrictions and there can be more drastic physical reactions to the treatment such as extremes in blood pressures,nausea,electrolyte imbalances.
With Peritoneal Dialysis your treatment can be worked around your own schedule,you can travel more easily with PD. I think the single most important advantage to the PD option is that you are always being dialyzed like your kidneys it is a natural process occurring inside you.
One disadvantage is that in most cases patients are usually on PD for only a few to several years and then if not transplanted they have to move to Hemodialysis. This is usually because after some time the Peritoneum lessens in its ability to adequately preform the dialysis commonly because of infection(Peritonitis.


As a Nurse working in both PD & HD for 5 years, personally if I had to made the choice I would opt for the more natural treatment PD at first if I could. There are many more specifics to these options but I feel like I have covered the basics for now. Thanks, Joe Macomber RN