Clarification

Summary

The author discusses the pressures and considerations involved in switching from in-center hemodialysis to in-home peritoneal dialysis (PD), ultimately concluding that while PD is a valid option for many, it is not suitable for their personal circumstances.

Abstract

In the latest chapter of their ongoing dialysis story, the author reflects on the reasons behind the push for patients to adopt peritoneal dialysis (PD) at home instead of receiving hemodialysis at a center. The author had previously expressed skepticism about potential ulterior motives behind this recommendation but acknowledges new insights from Ann Litts, a former dialysis nurse, who clarified that the incentive is to free up limited chair time in dialysis centers for other patients in need. The author recognizes the scarcity of dialysis centers, especially in rural areas, and understands the practical benefits of PD in addressing this issue. However, they also emphasize the challenges associated with PD, such as the need for strict cleaning protocols, strong organizational skills, proficiency with technology, and adequate physical space for equipment and supplies. Despite PD being a good option for many, the author determines it is not the right fit for them due to various factors, including age, computer literacy, home size, and the absence of a backup support system. They call for their medical team to respect their decision to continue with hemodialysis and highlight that a significant percentage of PD patients eventually switch to hemodialysis due to issues like infection.

Opinions

The author initially suspected financial incentives for medical personnel encouraging patients to choose PD over hemodialysis.
After receiving input from a former dialysis nurse, the author understands that the push for PD is to alleviate the shortage of dialysis center chair time.
The author believes that PD requires diligence, strong organizational skills, and technological proficiency from both the patient and caregiver.
The author feels that PD is not suitable for them given their current life situation, including age, technological adeptness, home space, and support system availability.
The author points out that PD, while convenient and beneficial for freeing up chair time for others, has a non-negligible rate of complications and subsequent transitions to hemodialysis.
The author insists that their medical team should respect their personal treatment decision, implying a frustration with the current lack of respect for their autonomy.

Our dialysis story — chapter 19

Yesterday, I published Chapter 18 of our dialysis story, expressing my curiosity and suspicion about why we are pressured to change Ben’s dialysis from in-center hemodialysis to in-home peritoneal dialysis (PD). I questioned if medical personnel receive a commission or a gift for persuading a patient to choose PD.

I wasn’t accusing, as much as wondering.

Ann Litts, a former dialysis nurse, responded that the incentive was patient-centered, not financial. She pointed out that many more people need dialysis than there are centers or openings (chair time) in centers. For every patient they can convince to choose PD, there is a chair available for someone else.

I hadn’t thought of that.

Reading her comments, which I can no longer find in the responses thread, I realized I’ve never seen a dialysis center in a small town or rural area. Our city has a few centers, and there are some in the larger towns around us, but they have to serve all dialysis patients in a very large area. No doubt, chair time is scarce. It makes sense that doctors and dialysis counselors encourage patients to try in-home PD. Thank you, Ann, for setting me straight.

Successful PD requires diligence, particularly with cleaning protocols. Also, the patient and caregiver need to have strong organizational skills and be proficient with technology because the dialysis machine is essentially a computer with a pump. And it’s necessary to have the physical space next to the bed and away from pets for the equipment and a place to store the many cartons of supplies.

Peritoneal dialysis is an excellent choice for many. There’s nothing wrong with it. It was simply wrong for us. If we were younger, if Ben were better with computers, if our home were larger, if I were retired, and if we had a backup support system, we would try PD.

According to my research, infection (peritonitis) requiring hospitalization occurs in about 16% of PD patients, and 20 to 25 % of PD patients eventually transfer to hemodialysis. But that doesn’t mean it isn’t worth trying.

PD isn’t easy, but it can be convenient, and it opens a hemodialysis chair for someone else.

However, it’s time that Ben’s medical team respect our decision.

Our Dialysis Story: