The Other Dialysis
One of the chief frustrations that I face doing dialysis is constantly having to explain to people that I don’t get poked in the arm with huge needles three days a week (seriously, they are huge). When I was at stage 4 kidney disease (the stage before end-stage), I was given a choice between the two modalities of dialysis: the more common hemodialysis, which is what most people think of when they hear the word dialysis, or the less common, and rarely discussed peritoneal dialysis (PD).
I was lucky enough to have a steady fiancé (now wife) to discuss the decision with, so we listed out the pros and cons of both.
- Easy to travel, book dialysis at any local clinic (worldwide)
- In-center and home-hemo
- Pulls off a lot of fluid
- Home-hemo has the highest survival rate
- In-center has nurses to cannulate the needles (poke you)
- Only dialyze 3 -5 times a week (in-center/home-hemo)
- Permanent fistula
- Fistulas often balloon up to be kind of ugly
- Huge needles (I have interviewed a couple of people who have done hemo; they are very large).
- In-center takes up many hours of the day three days a week (I think it is 4 to 6 hours).
- Home-hemo takes up many hours of the day about five days a week (less time in the chair, but more days per week).
- Must sit still the whole time (needles can shift causing pain or arterial damage).
- Higher risk of infection
- Care partner required to have training to assist with poking you with these huge needles
- Easy to perform alone
- Less risk of infection (with modern disinfectants)
- Home cycler allows for dialysis at night, while sleeping
- No ugly fistula
- Home PD is the second highest survival rate
- Easy to travel with supplies shipped to destination (for free)
- Semi-permanent catheter coming out of the abdomen
- Dialysis 7 days a week (to start)
- Weight gain (for most people)
- Often bad for diabetics (the dialysate solution is basically sugar water)
What We Chose
We ultimately chose PD because I wanted to still be able to work, so the ability to dialyze while I was sleeping appealed to me. And, I knew that I would be going on the transplant list to get a new (used) kidney, so I didn’t want to be left with an ugly, permanent fistula for the rest of my life.
Also, my wife (fiancé at the time) didn’t feel comfortable inflicting pain on me almost daily, by impaling me with these huge spears of needles (did I mention they were big?). I knew that I wanted to do home dialysis, to have control over my own treatment and give myself the best chance at surviving this crazy thing I have to do all the time.
I have been doing great on PD; it works really well for me. I have my diabetes under control with diet and exercise, and my doctor has slowly taken me down to dialyzing only four nights a week. Only FOUR!
How Dialysis Works
With hemodialysis, blood is removed from the body and run through a machine with dialysate solution to draw toxins and excess fluid out of the blood. Home-hemo requires large tanks for dialysate solution and room for an expensive (but free to use) water filtration system.
PD utilizes the peritoneal lining of the stomach to filter the blood. A catheter is inserted into the abdomen to allow the abdominal cavity to be filled with dialysate solution. Through osmosis, toxins and excess fluid pass from the blood stream, through the peritoneal membrane, and into the dialysate solution, which is then drained from the body, carrying with it all the nasty toxins and waste water that working kidneys would usually send to the bladder as urine. The used dialysate solution has a yellow tint, similar to urine, so I often refer to my catheter as my second penis.