Even though Jason has been on a strict 1100 calorie diet for months, he has been unable to lose weight. We briefly considered weight loss surgery, but have chosen not to go that route. We are afraid he will never be able to reach his target weight for transplant while getting the extra calories from peritoneal dialysis.
Jason's labs have shown that he's not reaching optimum dialysis adequacy. The remedy would be to try adding a half hour to his already 10 1/2 hour treatment time overnight. The doctor called this "cruel and unusual punishment", so did not order the change. We are still doing a manual treatment in the daytime as well.
Because of these reasons, we have made the difficult decision to begin steps towards switching to hemodialysis. This would be done at the dialysis center, rather than in our home. There is an option of doing home hemodialysis at some point, but the training and procedure seem rather daunting.
We are planning for Jason to do nocturnal dialysis at the center. He would sleep at the center three nights a week, while getting an eight hour treatment each time. This type of hemodialysis is easier on the body since it's longer and slower. Patients normally feel much better this way. He would likely be there from 9pm-5am.
Jason has an appointment next week with radiology for a vein study. We will meet with a vascular surgeon the following week. The surgeon will decide whether a fistula or graft access is better for Jason. The next step will be an out-patient procedure to place the access. This access site will heal over several weeks before being used.
We are thankful that we have time to adjust to this change before it actually happens. Peritoneal dialysis has been beneficial for Jason in many ways. I could personally do it indefinitely, but it no longer seems best for his future health. We are grateful there are other options to help move toward transplant.
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