DEAR DR. ROACH: My 96-year-old mother has stage 5 kidney disease (GFR is 12) along with congestive heart failure. She’s not your typical 96-year-old — she is sharp as a tack, still attends church weekly and is involved with the assistance league! She is going to need to start some type of dialysis soon.
We had heard that home peritoneal was easier on the heart than traditional hemodialysis. When I asked her cardiologist about this, he said he’d never been asked that question before.
Is home peritoneal easier on the heart? Which method is better at “cleaning” her blood? In your opinion which method is a better choice for my mom? — C.H.
ANSWER: The kidney’s major job is to remove excess fluid, salts and metabolic waste products from the body by filtering the blood through very complex physiology. When the kidneys fail, dialysis is a process used to take on the role of the kidney.
Traditional hemodialysis uses a machine to take over the kidneys’ job, taking blood out of the body, filtering it and diluting out the toxins against large amounts of fluids that approximate blood plasma. This process is very safe on the heart and is effective at removing blood toxins. Only a small amount of blood is outside the body at any given time.
Peritoneal dialysis uses the peritoneum, the lining of the abdomen, which contains the organs, to mimic a kidney by using large amounts of fluid inside the peritoneum to absorb wastes without needing to remove the blood from the body. This is also safe on the heart and effective at removing toxins.
I’ve asked many physicians, including kidney specialists, which method they would use if they had to have dialysis, and 100% have said peritoneal dialysis. There are two major reasons why.
The first is that outcomes are better. People generally live longer and have a better quality of life with peritoneal dialysis compared with hemodialysis. The second is time. Hemodialysis takes roughly four hours, three times per week at a dialysis center. Peritoneal dialysis is done by the person, and can be done either at nighttime or continuously during the day, which means much less down time for the person.
There are downsides to peritoneal dialysis. The patient must be both motivated and capable of performing the dialysis on their own. This requires good eyesight and some manual dexterity. There are potential complications of peritoneal dialysis, including infection of the peritoneum. Some people don’t have appropriate anatomy for peritoneal dialysis, especially those who have had one or more abdominal surgeries.
Some patients never hear about the option of peritoneal dialysis, and I think that’s a mistake, because it is an excellent choice for many.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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