Peritoneal Dialysis: A better option for many CKD patients

Published in Patient Story, Diabetes Care

Author: Staff

When George Hinderaker of Willmar was first diagnosed with chronic kidney disease (CKD) in his late 50’s he was referred to Dr. Eric Haugen, a Nephrologist with Affiliated Community Medical Centers in Willmar. For several years, Dr. Haugen worked closely with George to maintain his kidney function and monitor his glomerular filtration rate (GFR) which measures the stage of the disease. In 2013, Dr. Haugen said the words that George had been dreading to hear: “It’s time to start dialysis.”

George started hemodialysis at Carris Health - Rice Memorial Hospital on January 14, 2014. It’s a day he’ll never forget. For three days a week – every Monday, Wednesday, and Friday ¬– George would spend four hours connected to a machine that cleans and filters the blood outside the body.

On the days of his hemodialysis treatments, George would often come home exhausted and sleep the rest of the day. “It was kind of a washed-out feeling,” he said. “It took a lot out of me.”

That’s when Dr. Haugen suggested that George try peritoneal dialysis instead. Peritoneal dialysis, or PD, is an at-home method that uses the body’s own peritoneum (the lining of the abdomen) as a natural filter to cleanse the blood.

“Dr. Haugen told me I was a good candidate for PD,” said George, “but initially I balked at the idea.”

With PD, George explained, he would need to dialyze for eight hours a day, every single day, vs. four hours a day, three times a week. “I was worried about being married to dialysis rather than living a life.”

But, after mulling it over, George decided to give it a try. The main benefit, he said, is that the dialysis can be done at night, while he sleeps, rather than during the day. “It has really given me a better quality of life,” he said. “Now I’m just wondering why I didn’t do it earlier.”

With PD, a small flexible tube about the thickness of a pencil is surgically placed into the belly and a sterile cleansing fluid called dialysate is inserted into the abdominal cavity. This fluid pulls wastes out of the blood by the process of osmosis, diffusion, and ultrafiltration. The fluid stays in the cavity for several hours as waste products and extra fluid pass from the blood into the peritoneal cavity. Then, after the completed dwell time, the solution is drained from the cavity.

George started PD during the fall of 2015. First, Dr. Steven Bell surgically implanted the catheter into his peritoneal area, and after it was healed, he spent a few days training with the team of certified dialysis nurses at Rice. They taught him how to insert the dialysate, how to make sure the connections were sterile, and how to run the “cycler” at night.

A cycler machine pumps the fluid from the large 6-liter bag of dialysis solution and cycles it through the body while the patient sleeps. The machine automatically controls the amount of fill solution and the number of times (cycles) that occur over the prescribed treatment time. Treatment times can be anywhere from 8-10 hours with variable number of cycles. George has four cycles.

In the morning, before George detaches himself from the machine the cycler inserts another 2000cc “dwell” of high concentrate solution that stays in his abdomen for 12-16 hours throughout the day.

“With PD, I feel pretty good. I’m steady all seven days of the week and I don’t get that washed-out feeling like I did with hemodialysis.”

Supplies get delivered directly to his house every four weeks, adding to the convenience of the process.

George admits there are a few trade-offs that he has learned to live with. Although the cycler machine is portable, travel can be cumbersome because of the size and weight of the fluid bags. Also, because the catheter can’t be submerged in water, George isn’t able to take a bath or go swimming, though showering is not a problem. He admits he’s also put on some extra weight because of the high glucose content of the “dwell,” but, all in all, he feels that PD has been a good choice for him.

Today, at age 64, George has come to realize that he’s not an ideal candidate for a kidney transplant. “I was put on the active list at the U right about the time I started dialysis,” he explained. “But because of my age and excess weight, my name was transferred to the inactive list.” But, he keeps a positive attitude.

“I’m fortunate that my family is close by, and that I’m able to receive quality care so close to home. The support staff at Rice is tremendous,” said George. “They’re all very helpful… from the physicians like Dr. Haugen, all the way down to the receptionist who greets you at the door. The whole unit works together very well. It feels like a family.”

For more information about peritoneal dialysis, please contact the Dialysis Center at Carris Health - Rice Memorial Hospital at 320-231-4235.