Peritoneal Dialysis At Home

It's just about the end of August and I've been on peritoneal dialysis (PD) for about 6 weeks now.  It has been a bit challenging, but with the support of my family, I've been getting through it just fine.

The more common type of dialysis is called "hemo-dialysis" - which is using an external machine to directly filter the blood.  This method typically is done at a center three times a week.  Each method has it's own pros/cons, but we felt that PD was the best for me and my situation.


What is PD?

So, what is peritoneal dialysis?  It's a type of dialysis which relies on the transferring of toxins through the peritoneal membrane into the dialysis solution that is filled into the peritoneal cavity.   In PD, a soft plastic tube (catheter) is placed through your abdomen into the peritoneal space.  This catheter installation was the surgery I went through back in June.  As the body heals from the surgery, tissue will surround the catheter and will be the base to hold it in place.

Initially, PD is done roughly every four hours each day (except during the night time).  And it takes about one hour to perform the dialysis.  The process is fairly simple:

1. I clean my self and prep the area where I will perform the treatment.

2. I drain the dialysis solution that currently resides inside me.  This solution actually contains the toxins which will be expunged once the fluid completely is drained out.

3. Lastly, I fill my peritoneal space with fresh new fluid for the next round of dialysis.

The big thing with PD is that you are your own technician and it is of utmost importance to keep the catheter site extremely clean.  There isn't any defense if bacteria gets inside the tube.  If that occurs, it isn't the end of the world because I would be given antibiotics and treat the issue, but getting infections inside the peritoneal space compromises the ability to do dialysis.  It's pretty crazy -- I have to take all sorts of precautions to ensure this doesn't occur.  For example, cleaning with special solution and changing the bandages daily is a must,  I cannot go swimming in any public pools, each month I have to soak my shower head in a bleach based solution to get rid of any bacteria which normally wouldn't cause any issues for everyone.  

The other big physical impacts to PD on me is the effect it has on my body.  Due to PKD, my kidneys have enlarged quite a bit which is taking up a lot of room inside of my abdomen (and it's causing a lot of heartburn).   So, because the treatment is filling up my insides with a special solution, my stomach area has stretched out quite a bit!  Honestly, it looks like I'm pregnant -- my stomach sticks out very far than normal.  I am currently carrying around 1.5-2L of fluid inside of me at all times.  That's the same amount of fluid is a big bottle of coke (weights about 4 lbs).  At 2L of fluid, I can't eat a normal size meal and can't really drink that much water etc.  So, I've decreased the treatment to 1.5L, and it's made a big difference!  But none the less, I am carrying a lot of extra weight and my abdomen is extremely tight with lots of fluid.

Aside from the physical limitations I've mentioned [and there are more :)], the biggest thing that has impacted me was the time it took away from me.  Roughly 4 hours a day, 28 hours a week, 112 hours a month, etc. is dedicated for this treatment (initially, it does get much better over time when I convert from this "manual" process to doing it via a PD machine).  This is a significant amount of time!  It's a little more than a part-time job!  And while I'm doing the treatment, I am very limited to what I can do.  I have to wear surgical gloves, masks, etc. while I'm doing it to minimize the risk of infection.  So it's not like I can just continue working as normal while I'm doing this (I work on a computer generally).

But, I had a general idea of some of the limitations (not all) before I went forward with PD.  So, I knew I had to come up with a plan to utilize the time (as much as possible while maintaining the requirements of minimizing infection).  What I started doing while performing the treatment was simply reading books -- which is something I had wanted to do (reading more) for a while now, just never got around to actually do it.  I could continue my "clean" state while reading a book - So, my PD sessions became an opportunity to break from whatever I was doing and feed my mind - it was AWESOME!

Reflecting a bit on my PD experience, it was probably one of the best things that has recently happened to me:

1. It completely alleviated any of my food restrictions - I COULD EAT ANYTHING I WANTED, just not a lot of it due to the space issues :).  This alone was game changing.  As a result of my kidney failure, I had to be very careful as to what I could consume as my body could not regulate the toxins, electrolytes, etc within my body.  If your body doesn't maintain an extremely sensitive balance, something catastrophic could happen: like a heart over, no continues!

2. It forced me to be a much more scheduled individual.  As part of my mission to continuously improve the version of myself, I wanted to really optimize one area of my life: My daily schedule.  I had built some bad habits of wasting some time here and there, going to bed late, waking up a later, etc.  Changing one's habit is a really hard thing to do, but PD forced me to just move forward because my treatment timings had to occur at certain times.  So, I started structuring my days in accordance to them -- what time I had to wake up, what time I went to bed, what I did throughout the day (because I was losing 4 hours a day), etc.

3. PD gave me an opportunity to just sit quite for a second (when I wanted to).  We live in a world that is moving faster than it has ever done, and it is only going to move faster in the future.  So, it's extremely important take a moment each day to quite the external world, reflect, meditate, etc.  This ability really allowed me to appreciate each day and all of the little things in them to the point where, mentally, I became a stronger and better person.


Is PD ideal?  Certainly not!  But, it has allowed me to update myself in various ways where I couldn't push myself enough to actually do it.  So, for that, I am super happy about it all.  

And I'd like to make one thing clear -- this wasn't a pure "ME" thing -- my lovely wife Sarah really had to pick up the slack and take on some of my responsibilities as a result of PD.  So her support was really critical.  She really was a huge part of this all.  And our daughter Serena really is an amazing angel about it all.  She calls the treatment "Daddy's medicine" and wanted to learn and be as much of a part of it all as she could.  She would wear gloves, clean herself up, wear a mask/etc. and would sometimes sit in the room with me and keep me company.  It was truly an amazing thing to see such a young little thing have such a huge capacity!  I can already see it, she's going to be a super hero when she gets older.

Despite the limitations that come along PD, the benefits I am getting out of it outweighs the negatives by 100X.  Life's curvy paths have a strange way to lead you to exactly where you should be - if you let it and walk it mindfully.




Hassan Shaukat