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12:13 AM Sat, Feb. 16th

Peritoneal dialysis allows patient to maintain independence and not have a restrictive diet

Kingman resident Michael Malerba is living a close-to-normal life, despite kidneys damaged by his battle over 30 years with high blood pressure.

Malerba became a patient at the Kingman Kidney Clinic two months ago and has learned how to do continuous ambulatory peritoneal dialysis (CAPD).

It is a manual form of kidney dialysis he does himself four times daily.

Some patients do CAPD once a day and use a machine at night while sleeping to perform continuous cycler peritoneal dialysis (CCPD).

"I was offered the opportunity to go on the machine," Malerba said.

"But I didn't want to be tied to it, so I do the manual exchanges four times daily usually at 8 a.m., noon, 4 p.m.

and 8 p.m.

"I'm a truck driver and make a couple of trips per week to Los Angeles.

I can take the stuff I need with me and do it in the truck."

He feels good and is able to do chores around the house, too, Malerba said.

Malerba learned about peritoneal dialysis from Dr.

Vijay Chamy, a local nephrologist.

Chamy said the procedure has been available for over 20 years and has advantages and disadvantages over hemodialysis, in which the patient is hooked up to a machine for 4-6 hours of blood cleansing two or three times per week.

"We insert a catheter into the peritoneal membrane in an outpatient procedure that takes 20-30 minutes," Chamy said.

"We then must wait four to six weeks to make sure we have a good seal that won't leak before training the patient to do the procedure.

"Peritoneal dialysis allows the patient to maintain his or her independence and not have a restrictive diet.

There's also no washed out feeling with it and it's easier on the heart (than hemodialysis)."

Other advantages with peritoneal dialysis include a more steady physical condition for the patient, no needles and about once a month clinic visits.

Disadvantages include four fluid exchanges per day for the manual treatment, a permanent external catheter, potential weight gain and the need to keep supplies at home.

"There also is some risk of infection, so the patient must wash his or her hands frequently," Chamy said.

"The patient also may carry around more fluid and look slightly pregnant as a result."

Registered nurse Linda Galloway is the peritoneal dialysis nurse in charge of the Kingman Kidney Clinic.

She said kidney patients learn at their own pace on how to do the fluid exchanges.

"They have to be able to do it well or there could be problems," Galloway said.

"We teach them the signs and symptoms to watch for.

"If the patient wakes up with swelling in the hands, face or feet, or is short or breath he or she knows there is extra fluid on board."

Three types of peritoneal dialysis concentrates are available.

They range from low to high in dextrose content.

"One with higher dextrose pulls out more fluid," Galloway said.

"A patient waking up without excess fluid would use the lower dextrose fluid to maintain themselves during the day."

The manual exchange is done while sitting down.

Infusion of the solution takes about 10 minutes and removal about 20 minutes, Galloway said.

Roughly three percent of patients seeking peritoneal dialysis are found to not be compatible for cyclers.

Use of a cycler at night typically removes 1,500-2,500 cubic centimeters of fluid, Galloway said.

Most insurance companies cover peritoneal dialysis.

Medicare pays 100 percent for it, but a patient who has been on hemodialysis and wants to switch normally takes three to six months to get the authorization, Galloway said.

"Peritoneal dialysis is good for someone first starting on dialysis," Chamy said.

"It preserves real kidney function.

"Once hemodialysis starts the patient begins to lose kidney function and urinates less, so peritoneal dialysis is ideal for anyone wishing to maintain their independence."