Frequency and duration of Dialysis

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Notso
Posts: 36
Joined: Mon Aug 03, 2015 2:34 am

Frequency and duration of Dialysis

Post by Notso »

I'm currently descending from stage four to stage 5 CKD (live in Australia) and am researching dialysis as best I can. Will be seeing the Renal Unit nurses soon who may help me however I am wondering whether more frequent and/or longer duration dialysis gives a benefit. I am pretty much looking at PD but am unsure whether CAPD or APD is the one for me. Can anyone tell me their opinion, particularly from personal experience?
chessnut
Posts: 26
Joined: Tue Apr 21, 2015 6:31 pm

Re: Frequency and duration of Dialysis

Post by chessnut »

Notso wrote:I'm currently descending from stage four to stage 5 CKD (live in Australia) and am researching dialysis as best I can.
I'm sorry to hear that. I hope you have time to understand properly your options.
Will be seeing the Renal Unit nurses soon who may help me however I am wondering whether more frequent and/or longer duration dialysis gives a benefit.
Certainly for haemodialysis, increased frequency improves its effectiveness given the same total time per week: so 5 sessions of 3 hours will be better than 3 sessions of 5 hours. Real kidneys work all the time, we are just approximating their function with the machine. The standard in-clinic routine is three times a week, which leaves a two-day (72 hour) gap between sessions once a week. Doing dialysis at home lets you do more sessions - I do five a week - which works well for me. Even then, I find the build up of fluids and toxins can be felt on the day's gap, leading to tiredness, a bad taste in the mouth, some sensations across the skin, etc. I'm sure that would be worse if I were in-clinic on only three days a week.
I am pretty much looking at PD but am unsure whether CAPD or APD is the one for me. Can anyone tell me their opinion, particularly from personal experience?
I don't have experience of these but, as I understand it, PD is a continuous treatment. CAPD involves manual exchanges several times each day. APD uses a machine to do exchanges, usually overnight. But I believe it is done every night.

(I did find the machine-less, manual operation for CAPD attractive! Though I settled for haemodialysis. with the main reason being that, when off the machine, I'm pretty much free of it. The fistula requires just a little care, whereas the permanent tube was less appealing.)
Grey
Posts: 450
Joined: Wed Mar 30, 2011 12:04 pm
Location: Chester

Re: Frequency and duration of Dialysis

Post by Grey »

I did APD for 2 years before transplant. I have bad veins but in any case hate needles so it was a no brainer for me. I also did not want to waste 3 hours a session and add 2 hours to get too the unit and then get back so all in all 5 hours a day for 3 days a week. APD is done while you sleep, no time wasted. And it turned out to be very efficient.
After a long time of waiting an anonymous donor has arrived in my life.
Words cannot express my gratitude to this lady and my paired exchange wife donor making it all possible
transplant 19th June 2015...Going very well mind you 2 years later
rheaybou
Posts: 1381
Joined: Mon Nov 14, 2011 11:04 am
Location: Doncaster

Re: Frequency and duration of Dialysis

Post by rheaybou »

From my personal point of view.

I was diagnosed and had to start dialysis within weeks, so was rushed into making a decision. Didn't want a fistula for HD and wanted to work full time if possible so picked PD, well APD(the overnight option)

Right from the start it was clear that this was not the mode of dialysis for me, however I stuck at it as it kept my life as normal as possible. The thing about the peritoneum is.....everyones works slightly differently. Transfer rates through the peritoneum will vary and this will impact on how effective it can be. I was classed as a fast trasporter so would remove then reabsorb the fluids and toxins.

More frequent exchanges via CAPD(5-6 a day done manually) helped but it does eat away at half an hour of your time. During the week I would do these at work sat at my desk....we would plan meetings around exchanges!

But ultimatley it was never going to keep me well, so I transfered to HD via a neck line while I waited for my TX(living donor) I did this in unit, 4 hours three days a week and did notice how drained I felt after and it gives you just 12 hours of 'kidney' a week which is never enough.

If I am to return one day to dialysis then I would consider home HD and overnight if possible, the reports show it is by far the best method.

But in the end it will be your personal choice based on what you want, the renal staff will do all they can to help you get the best treatment method for your medical and personal needs. Good luck
Now 35 with Alports and I had my first kidney-versary 18th feb 2013....I hope to have many more.

My living donor and his family are doing all well.

==
Alports.
wagolynn
Posts: 1326
Joined: Thu May 23, 2013 2:49 pm

Re: Frequency and duration of Dialysis

Post by wagolynn »

Hi Notso,

The comments above are good so I will not add any more.

Just a word of warning, you may not be suitable for PD, so don't make lots of plans until you know if you can or not.

Best wishes.
suz
Posts: 57
Joined: Fri Apr 10, 2009 7:33 am
Location: Australia

Re: Frequency and duration of Dialysis

Post by suz »

Hi Notso

I am a fellow Australian and spent nearly 5 years on hemodialysis. In my experience it is an individual thing and for me I did much better on 3.5 hours 3 times a week than 4 hours 3 times a week. There were a couple of people in my unit who did 5 hours 3 times a week, there was also one very elderly gentleman who had numerous health problems and after about 5 years on dialysis had an extremely poor quality of life. Against medical advise he decided that he was going to only have dialysis for 4 hours twice a week instead of 4 hours 3 times a week. He was told that it was unlikely that he would survive for long doing this, anyway 18 months later he is still going strong and his quality of life is much improved.

Regards Suz
Notso
Posts: 36
Joined: Mon Aug 03, 2015 2:34 am

Re: Frequency and duration of Dialysis

Post by Notso »

Thanks everyone. I can see I have a lot to learn on this journey and the most obvious thing so far is that it is very much an individual thing. I guess time will tell how it all works out and what is best for me.

Cheers to you all
cassie
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Joined: Wed Feb 19, 2014 6:27 pm
Location: Manchester, United Kingdom
Contact:

Re: Frequency and duration of Dialysis

Post by cassie »

Hi there,

Just thought I'd add my 2 cents...

I started off on APD and it was a pretty rough ride to be fair. I started off using a Baxter machine but this was very painful for me and felt like a horrible pulling/sucking sensation in my bladder/peritoneum area. I then moved onto Fresenius APD machine and this was better but I wasn't achieving the maximum benefit from dialysis and I still felt pretty rubbish.

I also got repeated Peritonitis which is a risk if you're on PD and Peritonitis is a very nasty infection and makes you feel very poorly. I had it 4 times in one year. I then moved to CAPD and peritonitis left my peritoneum so sensitive that all the machines hurt but I still didn't achieve a good dialysis rate and was very poorly.

I then developed a hernia where by a sac of fluid expanded my stomach after they upped my infill to 2 litres. I was rushed in for emergency surgery to have this sorted and woke up with a temporary line in my vein in my neck. I received Haemodialysis through this line and I was amazed at how painless the whole treatment was. I decided to stay on Haemodialysis and I had a Tesio line fitted on my chest. Haemodialysis via a Tesio line was painless and haemodialysis in general gave me an excellent boost and I was actually able to start doing normal things again. I never had a fistula fitted as my veins were never good but the Tesio served me very well for the duration I was on Haemo.

Everyone is different and I know people thriving on PD but it definitely wasn't for me. HD gave me energy and whilst it was a chore going to the hospital 3 times a week, there is an option to train and have home haeo (in the UK there is!) You can go on home haemo every night and this would give you an even bigger boost than just 3 times a week.

Hope this gives you an insight. :)
Chris In Trowbridge
Posts: 94
Joined: Fri Jan 03, 2014 10:46 am

Re: Frequency and duration of Dialysis

Post by Chris In Trowbridge »

Thx for posting that, how long was you on Haemodialysis via a Tesio line Cassie ?
Notso
Posts: 36
Joined: Mon Aug 03, 2015 2:34 am

Re: Frequency and duration of Dialysis

Post by Notso »

Thanks Cassie,

since I've posted I have been doing some research and was troubled to read about the incidence of infection and peritonitis associated with PD. From what I have gathered, the average is to expect peritonitis once every 2 or 3 years which in my opinion is just not cool at all. My leaning towards PD has a lot to do with where I live (a rural area) where we use bore water which is a bit hard and may need to be further filtered / purified for use with home HD. I would be interested to hear from long term PD folks to get there incidence of infection /peritonitis with PD.
DeanH
Posts: 67
Joined: Thu Feb 12, 2015 5:01 pm

Re: Frequency and duration of Dialysis

Post by DeanH »

Hi, can't really comment that much, but I was on PD for 12 months and I had no cases of infection.

Good luck with which ever one you choose.
MandyA
Posts: 185
Joined: Tue Dec 21, 2010 6:45 pm

Re: Frequency and duration of Dialysis

Post by MandyA »

Hi,

I did Assisted Peritoneal Dialysis for just over three years, and never had peritonitis.

I think this was down to a combination of luck and very careful care to keep everything sterile.

Mandy
wagolynn
Posts: 1326
Joined: Thu May 23, 2013 2:49 pm

Re: Frequency and duration of Dialysis

Post by wagolynn »

Hi Notso,
On HD, the incoming water has to be treated anyway, the water treatment pack is part of the installation. Manufacturers have equipment to cope with any type of drinkable water.
MandyV
Posts: 1717
Joined: Mon Apr 10, 2006 10:17 am
Location: Fulham

Re: Frequency and duration of Dialysis

Post by MandyV »

Hi - I did both CAPD and Apd for a total of nearly 6 years and did not get a single infection either of the exit site or peritonitis - I found it worked well for me because I like being autonomous and also travelling. I also have clotting issues which complicates HD.
There are also other benefits like PD preserves residual renal function which helps avoid or minimise fluid restrictions and it is gentle.
I never had any problems with pain and generally found it straight forward. I was very strict on hygiene but not ridiculous (I heard of people giving away their pets, something I would not have considered).
When I started I though that the CAPD would be best as I was only on 3 exchanges a day, as my clearance reduced I was told it was either 4 or APD so I changed to that but still used CAPD on occasion (generally if I was going away for a couple of days and didn't want to take my machine).
Overall I was delighted to be able to stick to PD until transplant and always am happy to promote it :)
Notso
Posts: 36
Joined: Mon Aug 03, 2015 2:34 am

Re: Frequency and duration of Dialysis

Post by Notso »

Thanks to you all. I am very appreciative that you take the time to give me your opinions and experiences.
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