Why I chose peritoneal dialysis

Abstract

In August 1998, my family doctor scheduled me for a complete physical after noticing that my blood pressure readings had been elevated the last two visits.When I returned for my follow-up, he advised me that my creatinine and protein numbers were alarming, and he referred me to a nephrologist.

My nephrologistdiagnosed me with end-stage renal disease so advanced that I only had 10% kidney function remaining.After I got past the initial shock, we discussed dialysis options.

My first thoughts were purely cosmetic.As a middle school physical education teacher, my arms and legs are often exposed at work.I wanted to avoid the enlarged veins of hemodialysis if I could.With peritoneal dialysis (PD), the catheter would be hidden under my clothing.The thought of having the somewhat expanded stomach due to the peritoneal fluid did not bother me much.

I read that PDmight provide better clearances, possibly providing me with more energy.Since my job required me to be outside often and could be physically demanding, I wanted the mode of dialysis that would allowme to drink more fluids and give me the best chance at increased energy levels.

During those first days, there seemed to be a basic feeling within the community of patients and healthcare providersthat every dialysis patientends up quitting their jobs, even patients like me with careers and good benefits.I reflected on my brother's experience.Jonathan was on PD during college.In addition to the usual rigors of the college curriculum, he worked with the university band and was a member of a fraternity.Like him, I believed that PD treatment would give me the betterlevel of wellness so I could continue working.

I strongly considered what most people regard as the major drawback to PD—that I would have to do PD nightly and be responsible for lugging heavy boxes or bags of fluids at home.Iknew it would be a pain sometimes, lugging all the supplies.I knew that I would have to regularly miss activities whenever I would have to “hook-up.” Essentially, I would have to resign myself to becoming room-bound at night.Still, the pros outweighed the cons and I decided that PD would be the best mode of dialysis for me.

When I initiated PD in 1999, I was a little nervous about having to be so meticulous with the self care. The only complication I had was a case of peritonitis that was resolved without too much difficulty. Before long, I felt the benefits. PDgave me the most flexibility to be free on weekends so that I could travel. My mode of treatment was the continuous cycler-assisted dialysis, but I performed manual exchanges whenever I traveled by air. I estimate that between 2000 and 2004, I took 40 flights around the country, performing manual PD each trip.

In February 2006, the doctors removed my catheter following a successful kidney transplant. This catheter had been my lifeline for seven years! My success with PD can be attributed to extensive patient training, persistent and thorough monitoring by my doctors and nurses, and strict compliance as a patient.

My parents are in their 70sand have no kidney problems, but all three of their children do.My other brother, Sulva, wasdiagnosed with ESRD in 2000 and received a transplant in 2008.Jonathan, who has been an ESRD patient for 27 years but is only 43 years old, is on the transplant waiting list. He has a lot of life left in him, but his veins are practically used up and he is running out of options.In contrast to what may had been the case in the early days of dialysis, today,withexcellentcare andwith the advancements in the kidney world, it is feasible for patients to outlast their veins.Everyone knows that access care is crucial but as patients, we want care of the very first vein or any subsequent vein to be taken with the thought in mind that this person may have the capacity to live for decades.I am hoping Jonathan gets the call for the transplant soon and, in the meantime, we remain desperate but hopeful for the promise of innovative medical technology to assist him and patients like him.