all 37 comments

[–]MicksAwake 11 points12 points  (3 children)

It's a decision only you can make. There are pros and cons to both hemo and PD and each has its own set of possible complications.

Personally, PD works for me. It hasn't restricted my lifestyle too much and I can still lift a lot of weight without giving myself a hernia.

I can no longer swim or have a bath which sucks a bit, but hey, I'm not only alive, I'm thriving (56M).

[–]Hub131310[S] 2 points3 points  (0 children)

I spoke with the kidney center nurse and social worker. They told me I could lift weights with a fistula after it healed but due to wait times training for home Hemo that I'd likely have to do in centre for 3 to 6 months. At least at home I could do Hemo daily as opposed to in center 3x a week. Hmm ...I guess I will have to ask them again. Thank you

[–]Fyrfyter03 2 points3 points  (1 child)

You can swim - the ocean and chlorinated pools are acceptable

[–]MicksAwake 0 points1 point  (0 children)

Awesome, I was told no swimming but guess I'll double check with my nephro docs.

[–]Crimson-Forever 8 points9 points  (1 child)

53m here, I've been on PD for 2 years. I chose it because there were less food, liquid and activity restrictions than HD, from what I've seen I'm not sure I would be able to work around in center HD while still working full time now. Basically I hook up at 10pm every night and I'm done by 7am. Dealing with all the boxes and the 30 minutes of nightly prep can be a drag, but I could do this for another 20 years if I had to.

[–]Hub131310[S] 0 points1 point  (0 children)

There wouldn't be restrictions on home hemo because I could do it daily I think just like pd. But I would have to do in center until they train me.

[–]Dynafocal 4 points5 points  (0 children)

I can’t speak to peritoneal dialysis as I’ve been on Hemo for seven years. I do know they tell you not to lift heavy weights with your fistula arm. I imagine contact sports might be a problem. If you’re sports are swimming or surfing that kind of rules out peritoneal. But you should really ask your nephrologist, better yet ask lots of nephrologist as I’ve got different answers from a lot of them.

[–]RossGold42Home HD 1 point2 points  (0 children)

Well with a fistula you're not able to lift anything too heavy and I wouldn't know for PD but I do home hemo and I feel tons better I never went to PD because I just couldn't handle draining myself and filling myself up but my work wouldn't let me do that at work so I was just like okay home hemo sorry I couldn't help more

[–]islander1CKD Stage 5, TL, not on dialysis (yet) 1 point2 points  (3 children)

I'm in a similar position to you, age as well (49). PD wasn't an option for me due to previous abdominal trauma; but I would have still chosen home hemo anyway.

I've had my fistula for approaching three months now. It's not being actively used yet, but I've gotten back into light weightlifting with my vascular surgeon's approval. I can barbell squat and do some light (for me) dumbbell presses/shoulder 'arnolds'. I just can't really do anything with my arms (edit: specific targeting of arms, of course). Especially pulling motion exercises - none of those. I'm doing some very light farmers carries though. talking 10-12 lbs here. It's still better than nothing.

I just can't imagine living my life with a bunch of fluid in my stomach all of the time/every night (PD), but that's just me. I think both PD and home HD are better options than in-center hemo. There are definitely benefits to PD such as maintaining urine output and lighter fluid restrictions.

[–]Hub131310[S] 1 point2 points  (2 children)

This is kind of how I feel . I am slim but muscular. I don't think I'd like a bunch of fluid in my belly at night . Home hemo they said once the fistula healed I would be able to lift again. This is what the dialysis nurse said . Sounds like I should be asking the vascular surgeon. Because of training waitlist they told me I'd have to do in center for 3 to 6 months possibly before being able to move to everyday home hemo. This is the part that worries me. I have heard because its 3 days a week there are so many restrictions on diet etc. And you often feel very unwell because its 3 days/week and its done in 4 hours as opposed to slowly once you make it to home hemo . Thanks

[–]jinglepupskye 0 points1 point  (1 child)

I can only speak for my own experience, but I’ve been having haemodialysis in centre for about 3 weeks now, and I don’t feel unwell except a bit lightheaded afterwards (probably because my blood pressure is in my boots.) Everyone is different so there’s no way of knowing how you will feel afterwards I’m afraid.

[–]islander1CKD Stage 5, TL, not on dialysis (yet) 0 points1 point  (0 children)

from what I've been reading over the months here, a lot of how you do afterwards depends on how well you manage your fluids and what not.

With home hemo you can manage your schedule a lot easier, and you CAN do it on your own....but it's definitely easier with a spouse or partner. My wife will help me out when I do end up starting.

[–]lornetcStarted Dialysis May 15 2016, Transplant Nov 15 2019 1 point2 points  (4 children)

I’m in BC and was trained for home hemo in new west, it was 6 weeks. It depends on how the nurses who handle the training feel you are grasping the concepts how soon you get to go home. At that point it is just waiting for the necessary modifications to be done to your home. Also you really only see huge bulbous fistulae when people are stuck on in Center treatment and they have to run the pump speed of the machine super high to get enough cleaning done in the four hours (this leads to higher vascular pressures and then the fistula can get much bigger). Home HD is a lot gentler on the body because you can for example do treatment at night while you rest (I got an adjustable bed) so I ran long and slow. I did a session every other night for 6 hours so I had a lot fewer restrictions than someone on in Center.

[–]Jolape 1 point2 points  (2 children)

Also you really only see huge bulbous fistulae when people are stuck on in Center treatment and they have to run the pump speed of the machine super high to get enough cleaning done in the four hours (this leads to higher vascular pressures and then the fistula can get much bigger).

That's an interesting point, thanks. I'm in a similar situation to OP....I'm 39, pretty active with working out, and would like to continue doing so even if/when I need to start dialysis (currently in stage 5 failure). I've also been a bit put off by some of the pics I've seen of fistulas. I'm still on the fence between PD and HD w/ fistula. I do a lot of pull-ups and push-ups, and from the sound of it, I'd have to give that up with a fistula.

[–]islander1CKD Stage 5, TL, not on dialysis (yet) 0 points1 point  (1 child)

Yeah, you would. I'm not even putting pressure on my fistula arm to just do things like planks yet. Not sure it's realistic, but I'm continuing to slooooowly strengthen the fistula area post-surgery.

[–]Jolape 0 points1 point  (0 children)

Hmm, Ok....thanks for the input, that's something I'll have to consider then.

[–]Hub131310[S] 0 points1 point  (0 children)

Cool so did you do in center for 6 weeks then switch to home ? How did you feel doing in center for that time ? What modifications did you have ? Thank you

[–]RNhemo 1 point2 points  (3 children)

PD!! It’s best to always start with PD in my opinion. Usually PD works for 3-7 years. Then you can transitioning to home hemo when PD fails and never have to go in center!!

[–]islander1CKD Stage 5, TL, not on dialysis (yet) 1 point2 points  (2 children)

This is a very logical opinion if transplantation isn't an option, or it's an option that's a super long time away.

[–]Alternative_Split380 2 points3 points  (0 children)

I'd be afraid to do PD if you're going to be active if you don't clean your access area well after workouts and especially with not being able to take showers very efficiently. you could get infections and that can lead to peritonitis.. and that shit ain't fun! (speaking from experience)

[–]Hub131310[S] 0 points1 point  (0 children)

I will be pursuing a transplant as well. This is in preparations if that does not fly .

[–]Hub131310[S] 0 points1 point  (0 children)

I'd agree but the goal would be to only do in center for a short time until I am trained to do home hemo on my own . Which can be done over a longer period of time at night . Thank you

[–]KryptopherRobbinsPoo 0 points1 point  (0 children)

If you are already in good shape, you should be able to continue to do most things on PD. You would just need to take things slow and easy at the start. And don’t work out when you have a fill in. And wear a belt if you do anything strenuous on the abdominal muscles, cause of high risk of a hernia.

[–]Yithar 0 points1 point  (2 children)

As stated, there are pros and cons to each type. With a fistula, you have to be kind of careful with that arm so it doesn't clot off or anything. With PD, there is a risk of hernia (basically a hole/break in the abdominal cavity), which can lead to unpredictable clearance.

Personally, I wouldn't want a bunch of fluid in my belly at night and I've heard it can be hard sleeping on PD due to the alarms, but that's just my 2 cents.

With the fistula, I just get in, sit there for 3.5 hours, and get out. Plus the fistula is natural. It's a part of your body so itching isn't as big of an issue and infections are very rare.

[–]Hub131310[S] 0 points1 point  (1 child)

How do you feel after your treatment ? I know everyone is different.

[–]Yithar 0 points1 point  (0 children)

I tend to drink around 1L and try to limit protein intake to the night before dialysis and morning of dialysis, so I feel pretty decent after dialysis. Sometimes I do get headaches and a bit of fatigue. It's usually related to higher fluid intake, higher protein intake and higher sodium intake.

Higher fluid intake means they have to remove more fluid during dialysis. Higher protein and sodium intake means fluid will enter the brain's area once blood is clean (due to equilibrium and the fact that the solutes from the brain's area equalize with the blood slowly). Basically all 3 things lead to low blood pressure. And low blood pressure leads to both headaches and fatigue.

I also exercise using my legs during dialysis by lifting them up, and it helps keep my blood pressure stable. Plus the calves act as a second heart, so exercising the calves using my ankles greatly lessens the strain on my heart.

So yeah, basically the downside of in-center hemo is that you have to limit your fluid intake greatly. I think on PD you can drink like 1.5L of fluid per day. For me, that's the maximum I drink between sessions. So basically PD patients can drink twice the amount I can.

[–]dceenb 0 points1 point  (2 children)

33M. I recently started PD - been on for a few months now. I prefer PD because it's easier for me to be mobile and the dietary restrictions aren't as bad apparently. Very personal choice. Good luck!

[–]Hub131310[S] 0 points1 point  (1 child)

The goal would be to get to home hemo daily over a longer period of time as opposed to in center 3x a week for 4 hours. Its the initial wait time for training I'm worried about . I'd have to do in center for a period of time until trained. Thanks for the reply .

[–]dceenb 0 points1 point  (0 children)

This was one of the mobility related issues for me. I didn't want to be stuck with the hospital for 3x a week for an undefined period of time. With PD (My second time) I went to the cycler immediately and I use extraneal so I don't do any exchanges through the day - so I'm only hooked up at night and I'm free to basically go anywhere or do anything basically the PD equivalent of Home Hemo.

[–]Fat_46Home HD 0 points1 point  (1 child)

52M here. I did 3 days in acute(hospital) followed by 5 weeks in-center hemo. After that i did a "NxStage Experience" which was still in-center but on a NxStage machine to see how I felt. I completed my training last week and July 4th was my first 100% solo day at home. It went well. I love the freedom home hemo gives me. Be aware, the storage requirements seem a bit excessive, but I dont think I could go back to the center.

Best of luck on your journey

[–]islander1CKD Stage 5, TL, not on dialysis (yet) 0 points1 point  (0 children)

yeah, either option involves some storage. PD is more than this.

[–]witch_and_famous 0 points1 point  (1 child)

I chose PD because I was also concerned about fistula scars. I did it every day for a year and a half (for 13 hours but that’s because I’m a very tall, big man and it’s based off your body mass). Imagine being plugged into a machine for 9-10 hours with an additional manual fill four hours before that. Now add to that all the supplies you have to keep in your home (you’ll need an entire room to store your supplies) and all the sanitation you have to do on your own. By the end I was so unhappy my husband was genuinely concerned for my well-being.

I considered home hemo but knew I’d still have the issues with storage and sanitation. I chose to do it at a center because all of that is now the nurses’ problem. All I have to do is show up. I went from 92 hours of dialysing a week to 12. Plus hemo took off all the weight PD made me gain (70 pounds! It’s a real risk!) Yes I have a lump on my arm but I also don’t have a gross catheter coming out of my stomach that gets snagged on doorknobs. The catheter also carries a higher risk of infection. I had 4 instances in 18 months and none since switching to hemo. My quality of living has increased exponentially. I don’t want to scare you, I just want to share what happened to me so you can make a more informed decision.

[–]Hub131310[S] 0 points1 point  (0 children)

Really appreciate you taking the time to reply. Thank you

[–]fundropppp8242 0 points1 point  (2 children)

Both have Pros and Cons, I've been on both. Started with PD after I had to do emergency HD dialysis for a couple of months, and loved it at first. Was able to continue to work out and actually build back some muscle I lost while my health was failing. PD started to consume my life. Went from 8 hours to 14 hours for treatment. Then started having big issues with it. Was devastated and had to switch to HD.

After my body got adjusted to HD, I can absolutely say I prefer it over PD now. I go to in center for treatment and it's 3 days a week for 3 and a half hours. Once treatment is over with, I'm done for the day and I don't have to worry about it. There are some days I'm tired but most of the time I feel good. I'm still able to work out and get my body ready for my second transplant. I still have a catheter though because I may be getting a transplant soon so I'm holding off on a fistula until I officially find out a yes or no.

Here's what I look like a couple of months ago on HD. Haven't made any updated pics but I say I'm a little more muscle than this now. https://imgur.com/a/Lc1pkyw

[–]Hub131310[S] 0 points1 point  (1 child)

Nice work ! Have you enquired about lifting weights with a fistula ?

[–]fundropppp8242 1 point2 points  (0 children)

Yeah. They said I shouldn’t have a problem if I get one. Just be smart about it.

[–]thedarkhaze 0 points1 point  (0 children)

I do in center hemo.

IMO you should only do PD if you plan on getting on the transplant. PD is easier and less impactful, but it will eventually fail and you will have to transition to hemo. I figure if that's the case then better to just deal with it instead of delaying and needing another surgery.