Thursday, December 17, 2020

Those on Peritoneal Dialysis, beware of laxity due to fatigue


Peritoneal Dialysis is a wonderful therapy. Who would have thought that the body has a membrane within that is suitable for dialysis? It's as if Mother Nature by itself wanted to take care of the scenario where kidneys stopped working. I have always been fascinated by how dialysis can be done by no external machine and simply two litres of sugar water.

Those on Peritoneal Dialysis should consider themselves lucky that they have access to this therapy where there are no needles, fewer diet and fluid restrictions, no regular visits to the hospital, no intra-dialytic complications like cramps, hypotension and so on, no dependence on others for your dialysis. What's not to like?

Well, there are people who hate this modality. Their experience has not been good. They are happy with Hemodialysis. I fully understand.

However, for those on PD, I have a word of caution. Beware the laxity that sets in due to fatigue.

First, I will recount a personal experience. 

I started PD in 1999, a few months after my failed kidney transplant. Nobody told me about this therapy. I learnt about it on the internet. This always bothers me. Why aren't patients who are diagnosed with kidney failure even told about this modality? Why is the default always hemodialysis? Why not let the patient decide? 

I got to know about PD on the internet and asked my nephrologist if I could do PD instead of hemodialysis after my kidney transplant failed. He said Yes. 

I settled into a very comfortable life on PD. My life became completely normal. I started working full time. I was traveling. I was playing Table Tennis.

A few years down the line, I was introduced to Harish Natarajan who was at that time heading Baxter's Renal Division in India. I was using Baxter's PD Fluid. Harish and I stayed in touch over email and phone calls. Baxter organised a PD conference in Hyderabad and Harish invited me to attend. While waiting for one of the sessions to start, I was chatting with Harish and his colleagues from Baxter when Harish told me that I needed to then be very careful about my hand hygiene and basic sterile precautions as this was typically when fatigue set in and people tended to take chances and not adhere to the protocols completely. This could result in infections which were typically very difficult to treat.

I made a mental note. But maybe did not do too much about it.

About a year later, the Tsunami happened and a few months after that I got my first exit site infection and a series of infections followed. The Pseudomonas Aeruginosa bacteria (see picture above) was my nemesis during the next year or so where we tried to save my PD catheter and my Peritoneal Cavity function. We did not succeed and I had to give up PD.

While there are doubts about why the infection happened - whether it was due to the Tsunami water or the carelessness that set in due to the fatigue - it is true that the infections made me lose my access to PD forever. This was a devastating blow for me as I loved the therapy and the freedom it gave me.

So, I would like to say to all those on PD. Never ever take chances with hand hygiene. Do the hand wash - all the six steps - very diligently. Never take short cuts. Make sure you are cleaning your exit site as per the protocol prescribed to you. Do not miss even a single thing advised by the doctor or your PD Clinical Coordinator. 

Remember, even a single mistake can cause you to lose access to the entire therapy for life. Even a single instance is enough for a bacterium to make its home in your body. And this is one unwelcome guest that rarely leaves your home. 

2 comments:

Unknown said...

Thanks, very interesting article. Can you share your experience on how you mentally accepted PD?

Considering manual PD is an everyday 4hrs X 3 cycle process.. which psychology means one would be in a Dialysis mode 12hrs a day (i.e. 24 hrs / 2 days) compared to 4hrs per 2 days in HD mode.

I have seen my own dad not able to accept getting into PD due to the above psychological norms, inspite of its medical advantages (compared against HD)

Kamal D Shah said...

I honestly found PD to be much better psychologically compared to HD. I did not have to go to as hospital, I could do things on my own without having to rely on a technician, there were fewer diet and fluid restrictions, no needles, no intra-dialytic complications. I really loved it compared to HD. So for me, it was not really an issue.

However, to answer your question, while the dialysis is happening for many more hours, the patient is 'doing' stuff related to dialysis only for 1.5 hours, right? The rest of the time, they can go about living their life - work, exercise, have fun etc.

If we make sure that this 'rest of the time' is spent in a normal manner, I think this problem can be resolved to a large extent. We should not think as if dialysis is going on during that time. Just live life as if nothing is happening. There are anyway no physical symptoms to say something is happening, right?

Plus make him see the benefits over HD like I mentioned in the first paragraph above.