My Dad on Peritoneal Dialysis

Convinced that peritoneal dialysis would be the best dialysis treatment for my dad, my aunt, a physician based in Bataan, ordered my dad to go to Bataan so that the insertion of the peritoneal catheter on his abdomen can be performed already.

She wanted it bo be done in Bataan so she could monitor his condition.

My father's peritoneal catheter insertion was just timely because he needed to have a dialysis immedietely since his creatinine level was on a very high of 12.

I followed my father to Bataan the following day so I can be trained to do the peritoneal dialysis at our house.

It was a tedious process. I have to infuse his abdomen through the opening in his catheter 500 ml of liquid solution called the dialysate after six hours all the wastes that accumulate through the infused liquid should be drained out .

The drained liquid should be measured and it should be equal to 500 ml.After draining all the solution, a fresh solution will be infused again. The same procedure is done every six hours, four times a day.

I have to perform my father's peritoneal dialysis at 6am, 12nn, 6 pm and 12 am. The whole procedure last for an hour.

While I was doing my father's peritoneal dialysis, I know that it is something we have to do for the rest of his life, so at that time I was contemplating on quitting my job to become his full time caregiver.

My aunt got information from my father's nephrologist that their is a machine called the cycler that is available to perform my father's peritoneal dialysis. It is program to do the dialysis at night while my father is sleeping. My aunt told me that it would be best that before my father goes home to Quezon City that machine is at our house already.

I went home while my father was left in the house of my uncle, my father's brother. My uncle, who is a nurse will do the peritoneal dialysis on my father. My aunt cannot do it for my dad because she is very busy attending to her many patients.

As soon as I reached Quezon City, I immedietely contact the pharmaceutical company that distribute the cycler. The machine can be used for free provided that the dialysate and other solution used for peritoneal dialysis will be bought from them. The pharmaceutical company was expecting my call because my father's nephrologist informed them beforehand about our interest in availing the machine.

I was too shock to learned from the pharmaceutical representative that a month's supply of the dialysate will cost P45,000 a month. Clearly, that amount is something we cannot afford even if my aunt will be helping us with the expense.

We have no choice but to transfer my father from peritoneal dialysis to hemodialysis.

After trying continuous ambulatory peritoneal dialysis we've discovered that:

1. Although the procedure can be done at the comfort of our own house by a trained family member, it is really expensive compared to hemodialysis.

2. It is a tedious process. It takes an hour to finish and it has to be performed four times a day. There are some instances wherein patients on peritoneal dialysis should be drained six times a day.

3. There is a high risk of developing infection. There could be a leak in the catheter, an opening in the catheter can be a way for bacteria to get into the body.

4. My father was uncomfortable with the whole procedure . He feels his carrying an extra weight on his abdomen due to the 500 ml infused in his body.

The above stated information is based on our personal observation and this is not written to discourage the use of peritoneal dialysis. There are some instances that there are some people with whom hemodialysis is not the suitable type of dialysis for them.

The Difference Between Peritoneal Dialysis and Hemodialysis

Dialysis is a medical procedure done on an individual whose kidneys have lost the ability to function normally. It is done for patients suffering from end stage renal disease or chronic renal disease until a kidney transplantation is done or the only means of health support for those whom a kidney transplant is inappropriate.

There are two types of dialysis: the peritoneal dialysis and a hemodialysis but both operates under the same principle: the diffusion of solutes and the ultrafiltration of fluids across a semi-permeable membrane.

Diffusion is the movement of water from an area of greater concentration to an area of lesser concentration. Blood flows through one side of the semi permeable membrane while a dialysate travels through the other side. The semi-permeable membrane contains holes of various sizes. Small particles and fluids passed through the membrane while big particles like red blood cells and proteins cannot go through the membrane.

Peritoneal Dialysis

In peritoneal dialysis, the semi permeable membrane of the peritoneum or the abdominal cavity is used. A dialysate enters the body through a hollow tube called a catheter. The peritoneum is filled with tiny blood vessels that continuously supply fresh blood through osmosis and diffusion. The waste materials and toxins from the blood move towards the dialysate. These waste materials are drained out of the body through the catheter and replaced with a fresh dialysate. The whole process will be repeated again and is called an exchange after a prescribe period of time.

There are two types of peritoneal dialysis:

1. Continuous Ambulatory Peritoneal Dialysis - this can be performed by you or with a partner. A sterile plastic tubing and a bag which contains the dialysate is raised over the patient's shoulder ,through the force of gravity the dialysate enters the gravity through the catheter. The dialysate is allowed to stay in the abdomen for a period of time to allow the toxin to diffuse to the dialysate and then is drained out to an empty plastic bag.

The exchanges between the fresh and drained dialysate takes place four to five times a day.

2. Continuous Cycling Peritoneal Dialysis - a machine called a cycler is used in this procedure. A cycler circulates the dialysate solution inside the peritoneum at a fixed interval during the night. The exchanges happened during the night while an individual is sleeping and a cyler tubing is attached to the peritoneal catheter. At day time, a fresh supply of dialysate is infused into the abdomen and the individual can be free to perform his activities for the day.

Hemodialysis - in hemodialysis blood is pumped out of the body by a hemodialysis machine. The blood passes through a dialyser which serves as a filter. Inside the filter are semi-permeable membrane where toxins can passed through and become a part of the liquid solution called the dialysate. The clean blood is then returned to the body.

My Ray of Hope

I've cried buckets of tears the day I've found out about my father's end stage renal disease.

I knew that either we'll have the kidney transplantation or it's a lifetime of dialysis for my dad.

My mind was tired trying to figure out how to raise a million pesos for the kidney transplant. I even thought of selling our house.

With kidney transplant still an unreachable goal - I focused my attention on how to stretch our budget to accomodate my father's dialysis and medications.

I surfed the internet looking for information about dialysis.

I've learned that there are two kinds of dialysis - peritoneal dialysis and hemodialysis.

I'll explain the difference between the two in my next post.

It occured to me that peritoneal dialysis might be cheaper than hemodialysis because it's a procedure that can be done at home and can be performed by a trained member of the family. Unlike hemodialysis which is done either in a hospital or clinical facilities with doctors and nurses. And since I'm a medical technologist, I would be qualified to do peritoneal dialysis for my dad.

We talked to my aunt about our decision to have peritoneal dialysis and since she's a physician she talked to some of her surgeon friends if anyone of them can perform the operation of putting a peritoneal catheter for my dad for free. My good aunt even told us that she's going to help us with all of my father's expenses.

My Initial Reaction

Upon learning about my dad's condition - anger was my first reaction.

I was angry at myself for failing to see my father's deteriorating condition.

Was I that blind not to notice that he was steadily losing weight? Don't I have the slightest idea that men in their 40's should be monitored for their blood pressure?

Did I not pay attention to my college professor that hypertension destroys the kidneys? that end stage renal disease is not only the result of diabetes ? that creatinine test is used to determine the condition of the kidneys?

And yes, I was angry with God too. After my mom's death...he wanted my dad's life too. How can he be cruel? I was certain that death is the end of my father's illness that there will be no more cure for him.

We couldn't afford a kidney transplantation and we don't know how long we will be able to sustain his dialysis treatment and medications.

What Is An End Stage Renal Disease?

An End Stage Renal Disease is an illness wherein the kidneys have loss its ability fo perform its normal function. It can no longer filter the blood that pass through the kidneys and excrete the toxins through the urine out of the body.

My dad had an end stage renal disease as a complication of his hypertension. Other conditions that may lead to chronic renal failure are:

Diabetic Nephropathy - diabetes can cause permanent damage to the kidney

Lupus - a chronic autoimmune disease

A prolonged urinary tract obstruction

Some of the symptoms of a chronic renal failure:

1. Poor Appetite *

2. Vomiting

3. Increase in Urine Output or no urine output

4. Shortness of Breath*

5. Recurrent Urinary Tract Infection*

6. Edema or Tissue Swelling *

7. Headache

8. Muscle Pain

9. Fatigue *

10. Irritability*

11. Bad Breath*

12. Urinary Incontinence

13. Insomnia

Those with asterisks are some of the sypmtoms that my dad exhibited when he was diagnosed with an endstage renal disease.

Some of the Laboratory Tests requested for him are:

1. Blood Tests - which includes Complete Blood Count, Electrolytes, Creatinine, Urea

2. Nuclear Glomerulus Filtration Rate

3. Urinalysis
4. Renal or Kidney Ultrasound

An End Stage Renal Disease can be treated only with a kidney transplantation while dialysis is the procedure done to rid the blood of toxins which under normal circumstances are eliminated by the kidneys.

How He Was Diagnosed with an End Stage Renal Disease

In November 2006, my family met up with my aunt's family to visit our dead loved ones for the All Saints' Day.

My aunt, a physician, noted that my father was losing a lot of weight. She told my father to go to her clinic so she could do some work-up with my father to determine what was the reason behind his rapid weight loss.

Maybe it was because I often see my father that I wasn't able to note the physical changes happening in him. I asked him if he feels sick, he just told me that he doesn't have appetite for food, he feels tired and he find it difficult to breath at a times.

There were times in the past months that he would have swollen feet but we dismissed it thinking that it was his rheumatism.

The results of the lab test show that he has an elevated creatinine, high level of blood urea nitrogen, and his red blood cell count is below normal.

My aunt referred my dad to a nephrologist- a specialist on kidney disorder. The nephrologist gave my dad medications for his hypertension which was just diagnosed , an erythropoietin injection to normalize his blood count and other medicines. He was then ordered to return to the clinic after a week with the results of a new set of laboratory exams ordered for my dad.

On his next visit to his doctor, the nephrologist noted that there where no change in the laboratory results and that the creatinine level got more elevated. He then ordered a nuclear glomerulus filtration rate test or a nuclear gfr for my father.

We had his nuclear gfr taken at the National Kidney Institute and Transplant Institute.

My dad called me in the office and informed that according to the test, only 8 percent of his kidneys were functioning and that he needed to have a dialysis the soonest time possible because his creatinine level is now at seven when the normal level should be below 1.3.

His kidneys were damaged as a complication of his hypertension. Since only 8 percent of his kidneys were functioning and that the condition is irreversible; he is now suffering from an end stage renal disease.

Why I Started This Blog

My father had kidney transplantation three years ago. At the onset of his end stage renal disease, we (his immediete family) viewed it as a great burden.

I remember how heavy my heart was when I heard for the first time that he was suffering from an end stage renal disease and would require a lifetime of dialysis. My immediete reaction was how are we going to finance his dialysis and other medications. If we won't be able to sustain his treatments he would die.

Papa is now our only parent after my mom died of breast cancer over a decade ago. I couldn't bear the thought of losing another loved ones.

But our greatest burden turn to our greatest blessing! It was an extraordinary journey for our family that we wish to share with other people experiencing the same situation we had few years ago with the hope that they will find inspiration from our story.