Saturday, September 23

My dialysis therapy has begun


CONTINUOUS ambulatory peritoneal dialysis (CAPD) is not new in Malaysia. I got to know about it from an intensive awareness campaign by the Ministry of Health through television and other mass media about 30 years ago. This was long before I was stricken with kidney disease.

The video on television elaborated on the various type of dialysis treatments and interviews with patients who were undergoing them. One was haemodialysis. I already knew about it. Some relatives and my parents’ friends were on it. The other was kidney transplant.

However, there was one other treatment that was new to me. I found CAPD unusual where patients managed treatments by themselves in the comfort of their own homes. The catchy acronym was easy to remember. It has stuck with me since. Little did I know then it would affect me in a big way in the present.

When the nephrologist presented me with treatment options, making a decision was easy. Having remembered the awareness campaign from many years ago coupled with reading up on it extensively since the decline of my renal function began to accelerate, I unequivocally selected CAPD.

In many ways, I have benefitted from the awareness campaign. Like how I support awareness on disability-rights, I am all for educating society on kidney disease and the various treatment options available other than haemodialysis. This is the reason I openly share about my disease in this column and on social media. Who knows? The information may be useful to someone sometime in the future.

One month after the surgery to insert the Tenckhoff catheter, my wife and I went for a four-day training session at the CAPD unit of University Malaya Medical Centre. The training was supposed to commence two weeks after surgery but my wife was only able to take leave from work then.

Fine motor skills are required to manipulate valves and clamps several times during each of the four daily sessions. My limited hand function meant I am unable to perform peritoneal dialysis by myself. My wife has to step up to assist me. We spent eight hours daily learning under the watchful eyes of the staff nurses.

This method of dialysis is neither complicated nor difficult. One does not have to be a medical professional to do it. The processes have been structured in such a way that patients or carers can perform it with ease. Two crucial points to remember are to observe high standards of hand hygiene at all times and keep to the schedule as prescribed by the nephrologist.

Siti, the CAPD staff nurse who trained us, was strict. She was methodical. She drilled each step into us, taking pains to ensure we remember. Skipping one step or not doing it properly could lead to contamination of the equipment and consequently cause infection. Multiple infections could lead to the removal of the catheter. I would have to go on haemodialysis should that happen. This is one thing I am trying to avoid as much as possible.

We were also taught on caring for the exit site. This is where the catheter comes out from my abdomen. We learned to look for tell-tale signs of infection like inflammation and discharge. The site has to be cleaned and disinfected, and the dressing changed every day.

Any minor infection can be life-threatening. We are to go back to hospital immediately to get medical attention. If anything goes wrong during working hours, we could go to the CAPD clinic for treatment. Outside of working hours, I would have to go to the Nephrology Ward or Emergency and Accident Department, depending on the severity of the situation.

It has been one week since we started doing dialysis at home. We are still in the early days of my therapy. The results have not been very encouraging. We have difficulty in trying to keep to the schedule as my wife is working full-time. And I have yet to feel any difference after two weeks on dialysis.

Other than drawing out toxins from the blood, the peritoneal dialysis solution is also supposed to draw out fluid, taking over that function from my failing kidneys. Allowing the solution to dwell too long may result in it being absorbed into the body. There were several instances when the waste solution drained is less than the volume filled.

I will be going back for a review with the nephrologist next week. Hopefully, we can work out a more effective schedule or change the type of solution to allow it to work better for longer dwells. If there is any consolation, CAPD is only a temporary measure for me. The staff nurse wanted us to be familiar with this method of dialysis first.

I will be moving on to Automated Peritoneal Dialysis (APD) next month. This is where dialysis will be performed by a machine. I will be hooked up to it for about 10 hours straight, probably at night when I am in bed. One of the advantages of APD is that I do not have to carry two litres of solution inside me at all times. Hopefully, this will work out better for me.