I'm Good but Slow

"I'm good but slow." That's how I summed up what Dr. Butman told me today about the results of a two-day test I did last week. I had to collect my urine for 24 hours, hook up at 6 p.m. so I'd finish at 4 a.m., go into the PD clinic for the nurse to take samples of the fluid in my peritoneum and for me to conduct two manual exchanges. All that to find out if I am dialysizing (clearing toxins) well and how permeable my peritoneal membrane is (how quickly toxins are passing through the membrane).

On the first count, I'm excellent. The KT/V value is considered good if it's 1.8. Mine was 3.8. But as far as my membrane goes, it's "low average."

This is disappointing, since if I were high average, I could eliminate the mid-day exchange. I could go all day from morning to evening hookup on the cycler without having to concern myself with dialysis. Had this been the case, I would have switched to a different solution called Extraneal, which can sit in the peritoneal membrane all day and is not reabsorbed.

I asked Dr. Butman if my membrane might change, if I might in time become a high average. He said that it's just the way I am, like having blue eyes.

He did say that he might consider having me dry during the day, that is, being like a non-dialysis person, who does not have fluid sitting in the peritoneal membrane. You see, as it is now, when I get up in the morning, I have two liters of dialysis solution in me. I drain this during the mid-day exchange and put two liters of clean fluid back in, which are extracted when I hook up at night. The reason for doing a mid-day exchange is that the fluid cannot sit in the peritoneal membrane for more than eight hours. After that time, toxins and fluids start to get reabsorbed by the body, thereby defeating the whole purpose of dialysis.

There is controversy surrounding the dry-during-the-day approach. The membrane should be kept moist so that when it is used, it is more supple and flexible, thereby meaning that patients should keep fluid in them during the day. Dr. Butman counters that, if you're constantly using the membrane, it gets worn out, so why not keep it dry during the day, thereby not using it during the day. It's hard to say which strategy is better for the patient on a medical basis, though I sure can tell you that, from an emotional and social perspective, going without the mid-day would be so wonderful.

Dr. Butman said he would be thinking about me on Thursday, when I meet with the transplant surgeons at UCLA. "Keep your eys on the prize," he said.