Answer: There are several types of dialysis available to patients who have or may be approaching end-stage renal disease (ESRD) – one option is peritoneal dialysis (PD). To answer the vital question of whether or not PD is right for you, you need to consider the following questions as a guide:

Has someone made clear what kidneys do for your health?

The life-sustaining functions of our kidneys include removal of water, nitrogen wastes such as urea, uric acid and creatinine. When reduced by worsening kidney failure, a buildup of these “chemicals” makes the patient sick with what has been called “uremic poisoning.” Also, normal kidneys make important hormones like EPO (erythropoietin) that causes our bone marrow to produce red blood cells. In uremia, one of the problems is anemia because of not having enough EPO.

Does the word “dialysis” mean anything special to me?

To avoid death in uremia, treatment with dialysis (from the Greek word to pass through) allows removal of water and wastes from blood either in a machine outside of the body (hemodialysis) or into fluid inserted inside the abdomen (PD). To do PD, the blood inside normal capillary linings on the inner surface of the abdomen is exposed to a rinsing fluid called dialysate. PD “sessions” or “exchanges” can last for up to six hours with treatment performed every day or more intensively at night during sleep. In hemodialysis, the blood is pumped through tubes made of sausage casing while dialysate is pumped around these tubes. The tubes are contained in a disposable dialysis cartridge while a dialysis machine pushes (pumps) blood and fluid through the cartridge. Repeated hemodialysis treatments usually performed three or more times a week for about four hours, can keep a kidney failure patient alive for a quarter-century and longer.

What about getting a kidney transplant?

If your heart and other organs can go through the surgery, and your mind is intact, nearly all nephrologists (kidney doctors) would advise a kidney transplant as the best way to treat your uremia. That’s great if you have a healthy donor in your family, but if you wait for a deceased person’s kidney, it could take years, meaning your life will depend on getting dialysis.

Suppose I am tired of it all and just want to go to the “Big Sleep?”

That is your right. Should you decide you would rather not continue with doctors, hospitals, surgery, and the struggle to stay alive, that is OK and you can be made comfortable during your last days. Nearly all kidney failure patients, however, would rather try to live to see their grandchildren marry or mortgage paid off.

Which is better, hemodialysis or PD?

Not an easy question. And the best and longest studies show survival is about the same with each kind of dialysis, at least for the first five years of treatment. There are differences for the elderly and those with diabetes, but, overall, either treatment can produce satisfactory living for a long time.

So, how do I choose?

At the least, you should have had the chance to watch both kinds of dialysis treatments in action (with the patient’s permission of course). Observe each step of the startup and what is expected of the patient during treatment. PD patients must do more work in connecting and disconnecting the bags of dialysate from as frequently as every hour to as little as four times a day. Are your hands able to open and close jars? Are your eyes good enough to read what is in the various dialysate bags that you may use? Can you keep good records of your weight, the number of fluid exchanges, and your temperature? If done properly, PD can be a treatment done in your home. So can hemodialysis. But the plumbing, room for a machine, and general support required are much greater for hemodialysis. In the United States, home hemodialysis is slowly disappearing in favor of going to the growing number of neighborhood hemodialysis centers.

My doctor has told me to start PD and that’s it (isn’t it)?

No! Federal and State planners want each patient to pick the treatment they feel will be best. To do this, you really have to go through the bother of learning difference and actually seeing dialysis in action. Even if your doctor has a preference (and all of us do in most cases where choice is possible), the mission is to give you enough information to make your own decision.

OK! So how does AAKP fit into making this decision?

AAKP will be happy to provide past medical articles regarding the specifics of types of dialysis available to patients. If you would like more information on PD, request the brochure Understanding Your Peritoneal Dialysis Options from the AAKP National Office at (800) 749-2257 or info@aakp.org.

Answer provided by Eli A. Friedman, MD. Dr. Friedman is chief of the Division of Renal Disease for State University of New York, Downstate Medical Center and serves as chairperson of the AAKP Medical Advisory Board.

The Dear Doctor column provides readers with an opportunity to submit kidney related health questions to health care professionals. The answers are not to be construed as a diagnosis and, therefore, alterations in current health care should not occur until the patient’s physician is consulted.

This article originally appeared in the January 2006 issue of aakpRENALIFE, Vol. 21, No. 4.

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