What We Wish All Primary Doctors Understood About Peritoneal Dialysis

Some times, the biggest obstacle we face in encouraging a patient to choose Peritoneal Dialysis as a renal replacement therapy is not the patient or family. Often it is the well meaning PCP who tells the patient "Oh, you don't want that. You'll get infections." Now, not all PCP's say this, but enough that we offer lectures several times a year to educate doctors in other specialties about PD. As the largest provider of PD services in South Florida for many years, we have an outstanding reputation for success with Peritoneal Dialysis and a Transplant rate MANY times the national average. How are they related? PD encourages the patient-in fact MANDATES-that the patient be a part of their own care. It empowers a patient. We encourage them to work, and engage in their activities as before. They keep their insurance, and feel energetic and are encouraged at every turn by our team who ASSISTS their efforts to receive a transplant every step of the way. We have our own Transplant Nephrologist who follows the patient from the pre-transplant state all the way through post transplant and beyond. The patient feels a vital member of this very real TEAM. It combats the isolation being on dialsysi brings with it.

We choose, when we can, PD as a first option. Some advantages of PD over hemodialysis include: "Preservation of the vasculature. Those of us who are PD advocates recognize that it is a modality with a finite time. Going with PD from the start preserves the patient’s vasculature for hemodialysis in the future. Preserving residual renal function. PD is superior to HD for doing this for patients who still have some kidney function left. Lower cost. Dialysis providers acknowledge that PD is a more cost-effective modality because of lower overhead and fewer hospitalizations for patients. Patient satisfaction. This is usually higher among PD patients because of the freedom and flexibility offered by home therapy and a more liberal diet. Transplant outcomes. These are better for PD patients vs. HD patients." (Taken from Nephrology News and Issues) We have,at The Kidney & Hypertension Group, patients on PD for greater than 10 years who have chosen NOT to pursue transplant (or medically could not). Patients with zero urine output. These particular patients do well, exceed adequacy standards, and enjoy life. We avoid generalizations, and work hard to battle medical misconceptions regarding Peritoneal Dialysis. The national average for an infection is 1 per patient per 48 months. Our own rate of infection, even with this very large population of patients, is 1 infection per patient in 60 months. That is-1 infection every 5 years, on average. Since 1990, we have had 14 physicians as PD patients, and many nurses, and many, many spouses and parents of physicians. When it comes down to understanding the facts on making the choice, and it is explained clearly and directly, we find a physician almost always chooses Peritoneal Dialysis for himself or a close family member when it is an option. In fact, do this. Ask YOUR nephrologist what they would choose if they need dialysis. We already know the answer.