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Switching from PD to Hemo

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  • Switching from PD to Hemo

    Has there been anybody that has switched from PD Dialysis to Hemo Dialysis and what were your experiences. I have been on PD for over a year now and it is kicking my butt. I am a type diabetic also so it throws my blood sugars out of control, even with doubling my insulin. The water weight retention in body is bad to, last week I took off ten lbs of water weight, That it will hurt to stand and walk like that. I have good UF's on the night cycler, last night was 2000ml's for my UF but still retain water like no other. Then too it feels like a 10 lb sack of potatoes in your gut doing PD diaylsys. SO I am think of going over to Hemo? Anybody been down this road switching over?

  • #2
    @jamminj PD therapy can be challenging if blood sugars are not tightly controlled and fluid/sodium intake is not limited. You are still able to remove fluid as evidenced by your UF but if you are taking in fluid and salt, no longer making urine and blood sugars are above 200 PD can be challenging, especially if you are reliant on high dextrose solutions to control fluid volume. You may be a good candidate for use of an Icodextrin exchange on your long day dwell which would eliminate one or two of your traditional dianeal exchanges, enhance your UF and lower the amount of glucose you absorb. You would need to discuss this potential option with your Nephrologist. I would also recommend completing a 24-48 hour diary of your oral intake both food and fluid and blood sugars then review it with your renal dietician. It sounds like there may be opportunity to decrease or change some of your intake to reduce volume, address glucose and fluid absorption. I would make sure your diabetes MD and Nephrologist both review your blood sugars so your care is coordinated and insulin needs addressed if that is not already part of your overall care plan. It takes a team to manage everything and you are working hard to keep your health on track. Sometimes switching from one modality to another is the best clinical option and if that is the case for you I would encourage you to work with your dialysis team to ensure you have a permanent hemodialysis access placed and try to avoid placement of a CVC for if possible. A permanent hemodialysis access typically takes 6 - 8 weeks before it can be utilized so if you can stay on PD until you have a permanent hemo access ready for use that would be the best plan unless you can make changes to enhance your current PD regimen. Good luck and thank you for sending in your question. Your story will likely help others in the same situation.
    M Cassin RN CPDN
    Nashua NH