Switching Dialysis Treatment
There are two main types of dialysis: peritoneal dialysis (PD) and hemodialysis. Some people who are on one type of dialysis treatment wonder whether another type of dialysis treatment would be more comfortable, result in better outcomes or better fit their lifestyle. For others, a switch in dialysis treatment may be needed because of their medical condition. Your doctor and healthcare team can give you more information and let you know if switching dialysis treatments could be right for you.
Reasons to switch
For many patients with end stage renal disease (ESRD), switching from one kind of dialysis to another is a lifestyle choice. Some patients prefer to treat themselves at home, which is where peritoneal dialysis or home hemodialysis (HHD) is done; while others would rather have professionals treat them at a hemodialysis center. Daily treatment is not a problem for a lot of patients who are on PD. Others may find daily dialysis is too much for them and would prefer the every-other-day schedule at the hemodialysis center.
Some patients consider switching dialysis treatment for medical reasons. Your doctor may recommend switching if he or she feels your current treatment is not cleaning your blood enough. Your doctor will check how effective your treatment is by looking at your blood work as well as your Kt/V and URR level. Kt/V and URR are used to measure dialysis adequacy, or how effective dialysis is in removing wastes. National guidelines recommend a Kt/V of at least 1.2 for three times per week hemodialysis treatment and 1.7 for peritoneal dialysis treatments, and a URR of at least 65%.
Your medical history and health conditions may also be reasons to switch. If you have diabetes or high blood pressure, your body may tolerate and respond to one type of dialysis treatment better than another. Sometimes people switch if there are changes in their medical condition or because of infection; such as, if a PD patient gets peritonitis and their peritoneal catheter must be removed.
When patients think about switching dialysis treatments for lifestyle or medical reasons, they believe their only option is to choose a different type of dialysis treatment. In reality, if you are happy with your current type of treatment, there are options that may make it even better for you. For example, if you want to stay on hemodialysis, but would rather not go to a dialysis center for treatments, you may be able to switch to HHD. You and your doctor can talk about the different choices you have.
Hemodialysis can be done at a dialysis center or at your home. At a dialysis center, you will be surrounded by health care professionals trained to watch over you while you are being treated. Your health care team will also run tests to see how well your treatment is working and to tell your doctor about any problems. In-center hemodialysis treatments lasts about three to four hours and are generally scheduled three times a week. Some patients use this time at the center to sleep, catch up on work, read or relax.
Home hemodialysis is just that: Hemodialysis that can be done in the comfort of your home. You must have a hemodialysis machine set up in your home to do this. You and your care partner will be trained on how to use and monitor the machine, as well as the sanitary practices that must be followed to lower the chances of infection. Many patients enjoy taking an active part in their treatment as well as the convenience home hemodialysis provides.
Peritoneal dialysis is done at home and can either be manual or automated. PD is performed by filling the peritoneal cavity with dialysate through a permanent catheter that is surgically placed in the abdomen. After a few hours, the dialysate is drained and fresh dialysate is put in. For patients on continuous ambulatory peritoneal dialysis (CAPD), these exchanges are done manually, four to five times a day. PD patients also have the option of having these exchanges automated. Automated peritoneal dialysis (APD) uses a machine called a cycler that automatically fills and empties the dialysate from the peritoneal cavity while the patient is asleep.
Can you switch?
Your doctor will determine if you need to switch treatment programs for medical reasons. Your doctor will review your medical history and consider your current health. If your doctor sees that you are keeping to your current treatment program then that will give you a better chance of switching. By eating right, taking your medicines, not missing dialysis treatments and following your doctor’s advice, you can make your current treatment program more effective and increase the chances of making a successful switch.
Making the switch
Switching from one type of dialysis treatment to another can be challenging. In some cases, you may have to wait several months before you can make the switch. If you are on peritoneal dialysis and wish to switch to hemodialysis, you will need surgery to create a vascular access. If you choose an arteriovenous (AV) fistula, which is considered the gold-standard access, it can take several months for it to heal and grow strong for hemodialysis. Some doctors advise that end stage renal disease (ESRD) patients have the surgery to place an AV fistula, even though PD is their current treatment option. In case a person on PD needs to switch to hemodialysis for any reason, the vascular access will already be in place. An arteriovenous (AV) graft is another vascular access option that only takes a few weeks to heal. Until the access is ready for hemodialysis, the patient can still use PD. If there is a situation where a person is no longer able to use PD, a central venous catheter can be placed for immediate use for hemodialysis.
Patients who switch from hemodialysis to peritoneal dialysis will need to have a PD catheter placed. This is usually done as an outpatient procedure, and requires two or more weeks healing time before it can be used. The patient will stay on hemodialysis until the catheter is ready and he or she has been trained on how to do PD.
Learning new methods for your treatment (particularly if you opt for at-home treatment) will take training and patience. Also, your body will need to adjust. You may not feel as well as you did for a few weeks. This can be discouraging. Talk to your doctor and health care team about any concerns you may have.
When switching is not possible
For some patients, switching from one type of dialysis treatment to another is not possible. Medical reasons and your lifestyle may not make you a good candidate for switching. If you wish to switch but discover you cannot, discuss your concerns about your current treatment with your doctor. Your doctor may be able to make adjustments to your current dialysis treatment so that you can have a more comfortable experience and feel better.
Switching dialysis treatments may help you change your quality of life as well as improve your condition. Whichever dialysis treatment you choose, you will still need to follow your doctor and health care team’s advice to make any switch successful.