Joe Dialyzer on PD

P D an Awesme Option!!!

Are the days of kidney dialysis numbered? | Health Tech - CNET News

Are the days of kidney dialysis numbered? Health Tech - CNET News

Moment of Truth

I am a Nurse working full time in a Home Peritoneal Dialysis program. A large part of of my job is training new patients to do their treatments at home. Also in our system it is often necessary to train a spouse or assistant caregiver to aid the patient or sometimes completely control the treatment process.

There are many aspects to delivering and maintaining continued safe practices inside the realm of Peritoneal Dialysis but I believe the most important thing overall is the actual connection and disconnection of the patient catheter to the Peritoneal Dialysis system. This is what I refer to as "the moment of truth" and I actually use this phrase when training patients.

Infection (Peritonitis) is the number one problem that a Peritoneal Dialysis(PD) patient may encounter while on this modality of treatment. If a patient does develop Peritonitis they may be able to remain on PD with the aid of Antibiotic treatment, they may have to come off of PD temporarily to heal and rest their system or they may not be able to do PD at all again.

There are several ways that the PD patient may contract peritonitis but a very common reason is a touch contamination during connections and disconnections to the system. The patient connection is accomplished in a matter of seconds but must be continually meticulously executed using sterile technique in an attempt to continue on this modality of dialysis.
The mechanics of the connections are quite simple and very user friendly. There are differing brand names of PD equipment but the patient to system connection is very similar across the board. At the moment of truth the patient or caregiver has to remove a sterile cap from the end of their patient line and remove a sterile cap from the PD system line and make a safe quick connection. Once this union is made the circut is closed off to the outside world and the exchange of PD fluid can now occur in a sterile fashion. At the end of the PD fluid exchange the same careful technique is used to disconnect from the PD fluid line and a new sterile cap is placed onto the patient line. These patient to PD system connections are basically the same whether using a manual or automated PD system.

That's all for now on this topic. In one of my future posts I will discuss preparing for the "moment of truth". So to all you PD patients and PD trainers never fall short of that meticulous PD mindset.

Nasal mupirocin prevents Staphylococcus aureus

If you are a Peritoneal Dialysis patient or a PD Nurse you may want to mention this study in your clinic and ask for the opinion of the professionals in the office. 
J Am Soc Nephrol. 1996 Nov;7(11):2403-8.

Nasal mupirocin prevents Staphylococcus aureus exit-site infection during peritoneal dialysis. Mupirocin Study Group.

[No authors listed]

Abstract

A total of 1144 patients receiving continuous ambulatory peritoneal dialysis in nine European centers was screened for nasal carriage of Staphylococcus aureus. Two hundred sixty-seven subjects were defined as carriers of S. aureus by having had at least two positive swab results from samples taken on separate occasions, and were randomly allocated to treatment or control groups. Members of each group used a nasal ointment twice daily for 5 consecutive days every 4 wk. The treatment group used calcium mupirocin 2% (Bactroban nasal; SmithKline Beecham, Welwyn Garden City, United Kingdom) and the control group used placebo ointment. Patients were followed-up for a maximum period of 18 months. There were 134 individuals in the mupirocin group, and 133 individuals acted as control subjects. There were no differences in demographic data, cause of renal failure, type of catheter, system used, or method of exit-site care between the groups. Similarly, there were no differences in patient outcome or incidence of adverse events between both groups. Nasal carriage fell to 10% in those subjects who received active treatment and 48% in those who used the placebo ointment. There were 55 exit-site infections in 1236 patient-months in the control group and 33 in 1390 patient-months in the treatment group (not significant). S. aureus caused 14 episodes of exit-site infection in the mupirocin group and 44 in the control group (P = 0.006, mixed effects Poisson regression model). There were no differences in the rate of tunnel infection or peritonitis. There was no evidence of a progressive increase in resistance to mupirocin with time. Regular use of nasal mupirocin in continuous ambulatory peritoneal dialysis patients who are nasal carriers of S. aureus significantly reduces the rate of exit-site infections that occurs because of this organism.

PMID: 8959632 [PubMed - indexed for MEDLINE]

If PD fails: Think about home HD

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Some people happily do peritoneal dialysis (PD) for 10, or 15, or even 20, years. But many who choose PD stop after just 2–3 years.¹ The peritoneum may fail, or they may have "buyer's remorse" if PD doesn't fit their lives the way they hoped it would.

If this happens to you and you don't have a kidney transplant donor lined up, you'll need to switch to a form of hemodialysis (HD). Why not home HD?    

Quality of life on PD vs. HD

When making a switch from PD to HD, it makes sense to think about how your quality of life will be affected.
Standard in-center HD three times a week for 3–4 hours can be a "default" treatment. People may end up with it and not even know that there are other options.² But PD is always done as a conscious choice. A study of why people choose PD in the first place found these reasons:³

• Flexible schedule
• Convenience of being home
• Option of nighttime treatments

Statements from people who do PD bear out these key points:

"[In-center] hemodialysis wore me out, to where I couldn't do much other than go to treatments and sleep. Then I found PD, which no one had ever talked with me about before—and after a little research, I made the switch. It was the BEST choice I ever made. I now use a cycler at night, and work during the day."

"I had a terrible time on [in-center] hemo. I was scared at first because I wasn't sure if I could be in charge of my own care. But the difference is night and day for me. I have taken charge, and not only do I feel better physically but emotionally and spiritually too."

"Personally, I prefer PD to even the thought of HD. PD does not interfere with my lifestyle as much as HD would. I am very busy and tell people that I do not have time to sit on a machine for 4–5 hours 3 days a week. I do PD at night on a cycler and am dry during the day so can forget about dialysis during the day. I am able to continue all my activities and work. If I were on [in-center] HD I would have to quit work and would be unable to be as active as I am."

One study looked at quality of life in 60 people on PD and 60 on HD.⁴ It found that those on PD had a much better quality of life in the areas of:

• Stress
• Sleep
• Social function
• Major depression

And, on a scale of 1-10 (with 10 being high), people on PD rated their overall satisfaction at 8.02. Those on standard in-center HD rated theirs at 7.25—significantly lower.⁵ Why choose a treatment with which people are less satisfied?

Survival on PD vs. in-center HD 

A new study matched 6,337 pairs of people who started PD or standard in-center HD in 2003. It found much better survival on PD than on HD.⁶ This was even more true for those under age 65, those who did not have heart disease, and those who did not have diabetes.
While those on PD don't seem to fare any worse after switching to in-center HD,⁷ why not aim for better?

Types of home HD

Medicare rules as of 2008 require people with kidney failure to be told about all of their treatment options—and where to get them.⁸ But we suspect that this is not yet happening everywhere. If PD is no longer working for you, and you need to make a switch, knowing your home options can help you choose a treatment that will fit your life:   

   small home hemo machine

1. Conventional home HD (CHD) – This treatment is done 3x/week. A huge plus of PD is getting treatment all or nearly all the time, so you don't have "ups and downs." CHD 3x/week will give you ups and downs. Just 3 treatments also means more fluid and diet limits and meds to take. And, just 3 treatments raises your risk of sudden cardiac death on the day after the 2-day no-treatment weekend by 50%.⁹ You can schedule treatments when you want, though, and be at home.
2. Short daily home HD (SDHD) – A small machine (about the size of a microwave – see below) is used to do 2–3 hour treatments 5–6 days a week. You won't have ups and downs,^10,11 can have a more normal diet and fluids, and won't need as many blood pressure pills¹² or binders. While it can take as long as 6.67 hours to feel well again after standard HD, those on SDHD felt well in 30 minutes or less.¹³ Studies find that survival on SDHD is much better than standard HD or PD—in fact, it's about the same as deceased donor transplant!^14,15   
3. Nocturnal home HD (NHHD) – HD treatments are done for 6–8 hours at night while you sleep, 3–6 times/week. Slow, gentle treatments are easy on the heart—and clean the blood so well that no special diet or fluid limits may be needed,^16,17 and blood pressure pills can be stopped.¹⁸ People feel well about 10 minutes after NHHD treatments.¹³
   
   Most who do PD use a cycler at night. NHHD is the closest to this, in terms of lifestyle. People who switched from PD to NHHD had higher levels of protein in their blood, higher hemoglobin levels (with less EPO). They had lower levels of phosphorus—even though they didn't need binders.¹⁹ NHHD was not any more of a burden than PD. Finally, like SDHD, studies have found that survival on NHHD is about the same as deceased donor transplant.^21,22

Barriers to home HD

Dialysis needles. The most obvious barrier in switching from PD to home HD are the dialysis needles. Some programs permit home HD using a catheter. HD catheters at home are safer than in-center.²³ Learning how to put in your own needles if you have a fistula or graft puts control in YOUR hands and removes a lot of the pain and fear. You can read about how to do this in our articles:

• Dialysis Needle Fear: Easing the Sting²⁴
• Dialysis Needles, Self-Cannulation, and the Buttonhole Technique²⁵

If you are going to have to have needles anyway for HD, you might as well get the benefits of longer and/or more frequent home treatment!
Needing a partner. Many programs require a partner for home HD. If you don't have one, look for programs that do not require this. Or, see if you can do in-center nocturnal treatments (3x/week) in your town. This gives you most of the pluses of home treatment with no need for a partner.

Finding a home HD program. Not knowing where to find home HD can also stop you. Look at the "Find a Clinic Near You" database on Home Dialysis Central to search by type of treatment and zip code.

Both PD and home HD have been growing. We have kept track of the numbers of home programs since we started Home Dialysis Central in 2004, and this is what we've seen: 

Treatment	'04	'09	% Growth
CAPD	1460	2143	46.7
CCPD	1428	2126	48.9
3x week HHD	294	765	160.2
Daily HHD	37	537	1351.3
Nocturnal HHD	73	274	275.3

There are about 5,000 U.S. dialysis clinics. In 2004, about 30% had some type of PD. Today, about 45% do. Growth has been much higher in home HD, but only about 15% of clinics offer some type of home HD.

Conclusion

You may or may not want to switch from PD to some form of HD. But if you need to for some reason, it's good to know that there are home HD treatment options that can help you keep the freedom, flexibility, and control of PD.

References

1. Jaar BG, Plantinga LC, Crews DC, Fink NE, Hebah N, Coresh J, Kliger AS, Powe NR. Timing, causes, predictors, and prognosis of switching from peritoneal dialysis to hemodialysis: a prospective study. BMC Nephrol. 2009 Feb 6;10:3.
2. USRDS 1997 Annual Data Report, USRDS Dialysis Morbidity and Mortality (Wave 2), 53.
3. Wuerth DB, Finkelstein SH, Schwetz O, Carey H, Kliger AS, Finkelstein FO. Patients' descriptions of specific factors leading to modality selection of chronic peritoneal dialysis or hemodialysis. Perit Dial Int. 2002 Mar-Apr;22(2):184-90.
4. Noshad H, Sadreddini S, Nezami N, Salekzamani Y, Ardalan MR. Comparison of outcome and quality of life: haemodialysis versus peritoneal dialysis patients. Singapore Med J. 2009 Feb;50(2):185-92.
5. Juergensen E, Wuerth D, Finkelstein SH, Juergensen PH, Bekui A, Finkelstein FO. Hemodialysis and peritoneal dialysis: patients' assessments of their satisfaction with therapy and the impact of the therapy on their lives. Clin J Am Soc Nephrol. 2006 Nov;1(6):1191-6.
6. Weinhandl ED, Foley RN, Gilbertson DT, Arneson TJ, Snyder JJ, Collins AJ. Propensity-matched mortality comparison of incident hemodialysis and peritoneal dialysis patients. J Am Soc Nephrol. 2010 Mar;21(3):499-506. Epub 2010 Feb 4.
7. Van Biesen W, Dequidt C, Vijt D, Vanholder R, Lamiere N. Analysis of the reasons for transfers between hemodialysis and peritoneal dialysis and their effect on survivals. Adv Perit Dial. 1998;14:90-4.
8. Medicare and Medicaid Programs; Conditions for Coverage for End-Stage Renal Disease Facilities; Final Rule, from CMS. Accessed 3/2010.
9. Bleyer AJ, Russell GB, Satko SG. Sudden and cardiac death rates in hemodialysis patients. Kidney Int. 1999 Apr;55(4):1553-9.
10. Okada K, Abe M, Hagi C, Maruyama N, Ito K, Higuchi T, Matsumoto K, Takahashi S. Prolonged protective effect of short daily hemodialsyis against dialysis-induced hypotension. Kidney Blood Press Res. 2005;28(2):68-76.
11. Goldfarb-Rumyantzev AS, Leypoldt JK, Nelson N, Kutner NG, Cheung AK. Crossover study of short daily haemodialysis. Nephrol Dial Transplant. 2006 Jan;21(1):166-75.
12. Fagugli RM, Reboldi G, Quintaliani G, Pasini P, Ciao G, Cicconi B, Pasticci F, Kaufman JM, Buoncristiani U. Short daily hemodialysis: blood pressure control and left ventricular mass reduction in hypertensive hemodialysis patients. Am J Kidney Dis. 2001 Aug;38(2):371-6.
13. Heidenheim AP, Leitch R, Kortas C, Lindsay RM. Patient monitoring in the London Daily/Nocturnal Hemodialysis Study. Am J Kidney Dis. 2003 Jul;42(1 suppl):61-5.
14. Blagg CR, Kjellstrand CM, Ting GO, Young BA. Comparison of survival between short-daily hemodialysis and conventional hemodialysis using the standardized mortality ratio. Hemodial Int. 2006 Oct;10(4):371-4.
15. Kjellstrand CM, Buoncristiani U, Ting G, Traeger J, Piccoli GB, Sibai-Galland R, Young BA, Blagg CR. Short daily haemodialysis: survival in 415 patients treated for 1006 patient-years. Nephrol Dial Transplant. 2008 Oct;23(10):3283-9.
16. Geary DF, Piva E, Tyrrell J, Gajaria MJ, Piccone G, Keating LE, Harvey EA. Home nocturnal hemodialysis in children. J Pediatr. 2005 Sep;147(3):383-7.
17. Warady BA, Fischbach M, Geary D, Goldstein SL. Frequent hemodialysis in children. Adv Chronic Kidney Dis. 2007 Jul;14(3):297-303.
18. Nesrallah G, Suri R, Moist L, Kortas C, Lindsay RM. Volume control and blood pressure management in patients undergoing quotidian hemodialysis. Am J Kidney Dis. 2003 Jul;42(1 Suppl):13-7.
19. Wong JH, Pierratos A, Oreopoulos DG, Mohammad R, Benjamin-Wong F, Chan CT. The use of nocturnal home hemodialysis as salvage therapy for patients experiencing peritoneal dialysis failure. Perit Dial Int. 2007 Nov-Dec;27(6):669-74.
20. Fong E, Bargman JM, Chan CT. Cross-sectional comparison of quality of life and illness intrusiveness in patients who are treated with nocturnal home hemodialysis versus peritoneal dialysis. Clin J Am Soc Nephrol. 2007 Nov;2(6):1995-200.
21. Pauly RP, Gill JS, Rose CL, Asad RA, Chery A, Pierratos A, Chan CT. Survival among nocturnal home haemodialysis patients compared to kidney transplant recipients. Nephrol Dial Transplant. 2009 Sep;24(9):2915-9.
22. Johansen KL, Zhang R, Huang Y, Chen SC, Blagg CR, Goldfarb-Rumyantzev AS, Hoy CD, Lockridge RS Jr, Miller BW, Eggers PW, Kutner NG. Survival and hospitalization among patients using nocturnal and short daily compared to conventional hemodialysis: a USRDS study. Kidney Int. 2009 Nov;76(9):984-90.
23. Perl J, Lok CE, Chan CT. Central venous catheter outcomes in nocturnal hemodialysis. Kidney Int. 2006 Oct;70(7):1348-54.
24. Dialysis Needle Fear: Easing the Sting, Home Dialysis Central. Accessed 3/2010.
25. Dialysis Needles, Self-Cannulation, and the Buttonhole Technique, Home Dialysis Central. Accessed 3/2010.
26. Copland M, Murphy-Burke D, Levin A, Singh RS, Taylor P, Er L. Implementing a home haemodialysis programme without adversely affecting a peritoneal dialysis programme. Nephrol Dial Transplant. 2009 Aug;24(8):2546-50.

Copyright © 2010 Medical Education Institute, Inc. All rights reserved.

NKF Healthy Tips!!!

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Four Ways to Eat Healthier if You Have Kidney Disease

The nation’s sports fans are focused on the Final Four in April, but for those with chronic kidney disease, National Food Month is an opportunity to learn about the first four dietary nutrients to monitor with these tips from the National Kidney Foundation.

1. Protein

Getting the right amount of protein is important to your overall health and how well you feel. Your body needs the right amount of protein to:

• Build muscles
• Repair tissue
• Fight infections

Your doctor may recommend that you follow a diet that has controlled amounts of protein. This may help decrease the amount of wastes in your blood and may help your kidneys to work longer.
Protein comes from two sources. You will need to get some protein each day from both of these sources:

• Animal sources: eggs, fish, chicken, red meats, milk products and cheese
• Plant sources: vegetables and grains

2. Sodium

Kidney disease, high blood pressure and sodium are often related. Therefore, you may need to limit the amount of sodium in your diet. One tactic to accomplish this is to learn how to read food labels so you can make lower sodium choices when you shop for foods. Sodium is a mineral found naturally in foods. It is found in large amounts in table salt and in foods that have added table salt such as:

• Seasonings like soy sauce, teriyaki sauce and garlic or onion salt
• Canned foods and some frozen foods
• Processed meats like ham, bacon, sausage and cold cuts
• Salted snack foods like chips and crackers
• Most restaurant and take-out foods
• Canned or dehydrated soups (like packaged noodle soup)

3. Potassium

Potassium is an important mineral in the blood that helps your muscles and heart work properly. Too much or too little potassium in the blood can be dangerous. One of the kidney’s jobs is to regulate the amount of potassium in your body and eliminate excess in the urine. When your kidneys begin to lower in function you may need to assist them by monitoring potassium in your diet. Foods that contain higher amounts of potassium are fruits and vegetables.

4. Phosphorous

Your kidneys also have the job of removing excess phosphorus from your blood. A high blood phosphorus level may cause your skin to itch and your bones to lose calcium which increases the risk for breaks. If you have CKD stage 3-5, eating fewer foods that are high in phosphorus, is very important and will help lower the amount of phosphorus in your blood.
Phosphorus is found in large amounts in the following:

• Dairy products such as milk, cheese, pudding, yogurt and ice cream
• Dried beans and peas such as kidney beans, split peas and lentils
• Nuts and peanut butter
• Beverages such as hot chocolate, beer and dark cola drinks

New Study Suggests Peritoneal Dialysis May Offer Significant Savings to Medicare

New Study Suggests Peritoneal Dialysis May Offer Significant Savings to Medicare

May 13, 2009

by Astrid Fiano, DOTmed News Writer

The Clinical Therapeutics Journal is publishing a new paper, "The Financial Implications for Medicare of Greater Peritoneal Dialysis Use" by Nancy Neil, PhD, Steve Guest, MD, and several associates. The paper details the use of in-home versus in-center dialysis, including the patterns of dialysis utilization and the results of a budget-impact analysis that indicate if the peritoneal dialysis (PD) share of total dialysis were to increase to 15%, Medicare could yield over one billion dollars in savings over five years.

Dr. Steve Guest, Medical Affairs, Baxter Healthcare, Renal Division, McGaw Park, IL, spoke to DOTmed about the issues and findings in the paper. Dr. Guest first explained that providing care to patients with end stage renal disease (ESRD) is very costly due to the therapy itself but also for the care required to manage the oftentimes concurrent advanced co-morbidities. The overall impact to Medicare is significant as the ESRD Medicare patients represent less than 1% of Medicare enrollees but consume approximately 7% of Medicare resources as measured by payments for medical care billed to Medicare in a given calendar year.

"However, in reality," Dr. Guest said, "the differences in Medicare expenditures between peritoneal dialysis and in-center hemodialysis are very complex with resources being applied to a variety of cost centers."

For example, Dr. Guest described peritoneal dialysis as being most dependent upon disposable resources such as the dialysis solutions and supplies, used to perform the therapy at home. By comparison, in-center hemodialysis is most dependent upon fixed resources, in which investments have been made in bricks and mortar facilities, water treatment capabilities, hemodialysis machines and in-center staffing requirements. "The cost of an unused investment is high and so as not to waste those investments, they must be used to repay the capital outlay." The article is an analysis of these more comprehensive fixed resources used for in-center hemodialysis that include:

-- the facilities in which the hemodialysis is performed;
--the capital investment in the machines themselves;
--the supporting equipment necessary to treat municipal water to become medical grade water and the equipment needed to prepare the dialysate from this treated water;
--ongoing maintenance of the facilities and machines;
-- health personnel, including nurses, technicians, medical assistants, receptionists, etc.

PD does not have the same requirements for a special facility as the home is the site of care. However, Dr. Guest points out that while there is less of a capital investment for peritoneal dialysis, there are significant costs for PD therapy nonetheless: "These costs impact the dialysis providers if they are supplying the patient's dialysis supplies for peritoneal dialysis. But other economies can be realized with home therapy, such as a ratio of 20 patients to 25 patients per nurse for peritoneal dialysis compared to four to six patients per staff member for in-center hemodialysis."

Dr. Guest further detailed the findings regarding the differences in spending. "The differences in spending for hospitalization, outpatient use of erythropoiesis stimulating agents, vitamin D injectables, iron and vascular access reveal that the medical care provided to patients receiving in-center hemodialysis is more costly than that provided to patients on the home-based peritoneal dialysis therapy". Additionally, transportation costs were analyzed as in-center therapy such as hemodialysis requires the typical patient to present to the center at least three times per week for their hemodialysis treatments while peritoneal dialysis, as a home-based therapy, generally requires a patient to visit their nurse and physician only once per month. "This alone represents at least a 12-fold higher monthly cost of transportation for many in-center hemodialysis patients."

"Medicare expenditure differences in favor of peritoneal dialysis compared to in-center hemodialysis are significant" and Dr. Guest states may have been attenuated due to the fact that, in the United States, it appears that peritoneal dialysis patients are generally healthier overall than patients receiving in-center hemodialysis.
In the paper, it is mentioned that factors influencing the lesser use of PD include physician bias and lack of patient awareness due to insufficient exposure to full dialysis options education. Dr. Guest spoke of addressing the factors. "In testimony we recently submitted to the record for the House Ways and Means Committee, we provided recommendations to strengthen the education received by patients living with kidney disease who are Medicaid eligible. Medicaid accounts for one third of the starts on end stage kidney disease. As peritoneal dialysis patients rate greater satisfaction with this therapy compared to in-center hemodialysis, we point out the benefit of both increasing patient satisfaction and reducing overall Medicare costs as the Medicaid eligibles transition onto Medicare after 90 days".

In House testimony by colleague James Sloand, M.D., Medical Affairs U.S., Baxter Healthcare Dr. Sloand referenced that the lack of education about different modalities has been one of the significant reasons for underutilization in the U.S and surveys have shown that only 25% of patients on hemodialysis recall receiving information about the more cost-effective and cost-efficient peritoneal dialysis option. Dr. Sloand also commented that dialysis patients are a vulnerable and an underserved population that would benefit from improved influenza and bacterial pneumonia immunizations and greater vaccination rates could result in reduced risk of hospitalization and death from infections, which could further reduce Medicare expenditures

PD = Peritonitis Myth.

Don't be swayed away from the kinder gentler treatment because of misinformation.

CKD Legislation

Thank you to everyone who submitted letters to their state representatives regarding the proposed Chronic Kidney Disease (CKD) education legislation. Our voices were heard and we are excited to announce very positive results! The final bill, Kidney Disease Education (KDE), went into effect January 1, 2010, and includes much needed benefits for both patients with Stage 4 kidney disease and health care providers.

The legislation states that Medicare will cover up to six one-hour face-to-face pre-End Stage Kidney Disease (ESKD) education sessions concerning modality choices. This legislation is designed to ensure that patients will have the opportunity to actively participate in their choice of therapy. In particular, the sessions should be designed to provide comprehensive information regarding:

* The management of comorbidities, including delaying the need for dialysis
* Prevention of uremic complications
* Options for renal replacement therapy (including peritoneal dialysis, home hemodialysis, in-center hemodialysis, as well as vascular access options and transplantation)


The KDE bill also allows for health care providers to be reimbursed for providing CKD education to Stage 4 CKD patients. Health care providers will be reimbursed at a rate of approximately $108* per individual session (HCPCS code G0420). Group sessions (between 2-20 people) will be reimbursed at a rate of approximately $26* per person (HCPCS code G0421).

Together, we were able to ensure this landmark legislation became law and help over 900,000 people in the United States with Stage 4 kidney disease. Now, more than ever, patients will be empowered to select a therapy option that best meets their needs and lifestyle.

If you would like to learn more about the new Kidney Disease Education (KDE) bill and how Baxter can assist with your education program, please contact your local sales representative at 1-888-736-2543, option 4.

New Modalities?

Wow a wearable Kidney???

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