Why is PD given step-motherly treatment by nephrologists?

I met a 24-year old guy a couple of days back. He was diagnosed with kidney disease about 5 months back and has been on hemodialysis ever since. They are trying a dose of steroids to see if his native kidneys revive. Till then he will have to be on some form of dialysis.

I asked him if they had considered Peritoneal Dialysis (PD). He hadn't even heard about it! I wasn't surprised. I knew about this step-motehrly treatment given by nephrologists for some inexplicable reason.

Just what is it about PD that makes it a second class citizen in the eyes of nephrologists? I am really not sure.

I wasn't told about PD at all. I got to know about it from the internet. Sadly, what was in 1997 hasn't changed even after thirteen years. The number of people on PD has definitely increased since then. But the increase can be described as pathetic at best.

I am a huge believer in Peritoneal Dialysis. I would, honestly, have never survived this long if I was on conventional, in-center hemodialysis. The punishing diet and fluid restrictions along with the process of dialysis itself with the two thick needles in your arms and the four hours of severe boredom can play havoc with your mind along with your body. PD, for me was the savior.

There are people who can't stand PD. They hate the thought of having a tube sticking out of the stomach. Which is totally all right. To each his own. But atleast give the option. Let the patient decide. Explain both the options and let the patient decide. Why make the decision yourself?

This is really unpardonable. I have no idea why this is done. Why, just why, don't nephrologists tell patients about PD?


John W said…
I'll give you a very cynical clue why they don't mention PD - commissions from hemodialysis clinics they work with or profits form their own clinics.
Anonymous said…
I would have to agree with John. I asked my dad's doctor the same question - why is my dad on haemodialysis at the hospital when he could easily afford a PD machine(+nurse if needed) at home. i was given a ton of reasons including possibility of an infection, insufficient training facilities in Hyd - all of which were absolute bogus reasons IMHO.

Apparently, PD is only recommended if regular haemodialysis is no longer feasible - which adds an unfortunate halo to PD that PD is used only for those that have no alternative.

The most recent issue my dad now faces is a failed fistula and the doctors are searching for a good vein they could use. In all their mighty wisdom, the doctors at Apollo Hyd did not know what Kamal had in his arm for his dialysis and here i am researching through the net to see if I can find any more information on how that fistula procedure is to be done.

Thank you Kamal for the very informative blog though and good luck in your Swiss trip - If you have seen "The Secret", you'll know its really easy to make that trip - all you have to do is ask :)
Kamal D Shah said…
Dear Anonymous,

Thanks for your comment!

Absolutely dumb excuses for not mentioning PD! The infection bogey really deserves a separate post.

About your dad's fistula, have you shown it to a vascular surgeon? I strongly recommend Dr. P. C. Gupta at Care. He is really very good.

Send me an email in case I can help in any way.