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...everything you need to know about doing dialysis at home.
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PD uses the inner lining of your abdomen (the peritoneum) as a dialysis filter. The peritoneum is lined with tiny blood vessels. Wastes and extra water in your blood can flow out of these blood vessels, through the peritoneum, and into special fluid that you put into your abdomen. Then you drain the fluid, and the wastes, out of your body.
To do PD, you’ll have a soft plastic tube, called a catheter, placed in your abdomen or chest by a surgeon (read more about catheter placement and bathtub catheters). You’ll learn how to use the catheter to fill your abdomen with a sterile fluid called dialysate. Most people use about 2 liters of dialysate for each treatment.
After you put the dialysate into your abdomen, it stays there for a few hours. The period between putting fresh fluid in and taking used fluid out is called dwell time. While you go about your day, the fluid will collect all the wastes and water it can hold. Then you drain out the used fluid and put in clean fluid. This process is called an exchange. There are two types of exchanges:
See how PD works. Reused with permission from Kidney School™.
Catheter placement can be done as outpatient surgery so you won’t need to stay in the hospital. Some people have little or no pain afterwards; others have pain for a few days.
Ask the surgeon who puts in your catheter to put a “transfer set” onto your catheter at the same time. A transfer set is a tubing extension with a valve that will open and close the catheter. Having a transfer set will make it easier for you to get started with PD. You should also ask the surgeon to make sure the catheter won’t exit your body at your belt-line or under a skin fold. This will make your catheter much more comfortable and easy to live with, as well as to keep clean.
After surgery, your PD training nurse will check your catheter, flush it with fluid, and teach you how to change the dressings until it heals (usually about a week or so).
Once your catheter is placed, you’ll have one to two weeks of training. Your PD training nurse will teach you how to:
A PD nurse will be on call 24 hours a day if you need help.
When you first begin to put fluid in, you are likely to feel very full and even stretched. After a week or two, you’ll get used to the fluid and it won’t bother you.
PD is the most common type of home dialysis. It is offered in every state. There are about 5,600 dialysis clinics in the U.S., and about 40% train people to do PD. Find a center near you.
In the U.S., a large part of the cost of PD is paid for by the Medicare ESRD Program. Most Americans (93%) qualify for these Medicare benefits, no matter how old they are.
Cost for you: Do you have a job with a health plan? If you do, your health plan will pay first for your first 30 months of dialysis treatments. Medicare, if you choose it, will be secondary. That means it will pay all or some of the balance left over after your health plan pays (if the charge is something Medicare pays for). Depending on your insurance plan, you will most likely have some co-pays.
If you don’t have a health plan through an employer, PD can really help you cut the costs you have to pay for dialysis. Why? Most people under age 65 can’t get Medicare until the 1st day of their 3rd month of dialysis. Those 3 months of treatments can cost tens of thousands of dollars! But if you choose PD, Medicare will start to pay on day 1 of treatment. If the timing is right, Medicare may even pay for your catheter surgery.
Even though it is not easy, read your health insurance policy. Some health plans charge co-pays per day for PD. You may be able to avoid plans like these if you read the fine print.
TIP: Life Options offers a free 108-page booklet called A Kidney Patient’s Guide to Working and Paying for Treatment. Download it here.
Cost for your clinic: Medicare pays your clinic a fee for each dialysis treatment it provides. The fee covers the cost of treatment plus the cost of the medications and supplies you use during the treatment. Because the fee covers all of those things at once, it’s called a bundled payment. The bundled-payment system may help more people choose PD for treatment, because clinics are able to make more money when people feel better and use fewer meds. Both of these tend to be true on PD.
You can do PD at home, at work, or when you travel. Manual PD exchanges do take time each day, but you can choose the time to fit your schedule. PD with a cycler at night lets you do your treatments while you sleep so that you can leave your days free. Once you’re trained, you’ll only have to go to the clinic once a month to check your lab tests and treatment logs. You’ll also need to allow time to check your supply levels, order supplies each month, and receive the shipment.
Supplies for PD will be brought to your home once a month. You will need to be able to store about 30 boxes that are about 1 foot by 2 feet, plus a couple of smaller boxes with other supplies.
The boxes are heavy, since they hold bags of fluid. They must stay dry. If you keep them in a basement, use shelves or a pallet—not the floor. A closet will do. Or, just line up the boxes against a wall in a room where they are easy to reach.
You can do PD without a helper. Even blind people can do PD with assist devices. If you have someone who can help you, he or she may train with you. They can also help you gather supplies, move boxes, set up the cycler (if you use one), or in some cases, do your exchanges.
The most important factor in whether you are suited for PD is how much you want to do it. If you have had many or complex abdominal surgeries, you may not be able to do PD. If you are a large person, it may be hard to get enough dialysis with PD. Have a hernia? It must be fixed before you start PD. Sometimes PD can cause a hernia. If so, there is a way for you to keep doing PD while it is fixed.
Interested? Learn about how to choose a home dialysis clinic.
We've developed this chart to show you the pluses and minuses for each of the dialysis types and in-center hemodialysis so you can weigh your options.
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