Peritoneal Dialysis: a Do-It-Yourself Treatment to Kidney Problem

One Filipino dies from kidney failure every hour, or an average of 24 people per day.

The National Kidney and Transplant Institute of the Philippines (NKTI) said that 18,000 Filipinos are affected by complications from diabetes and hypertension leading to kidney failure.

In 2015, NKTI reported a 12 percent increase of kidney-related incidents where 18,603 patients were diagnosed with kidney failure.

But this does not stop Pelagio Rivas, a 65-year old retired seaman, who has lived with constant kidney problems from keeping a normal life.

In 2015, Rivas was diagnosed with onset kidney failure in Australia where he first learned about the peritoneal dialysis.

For patients like Rivas, lifetime treatment is needed to ensure survival.

There are three methods to replace kidney functions, namely, hemodialysis, peritoneal dialysis (PD), and kidney transplant.

Hemodialysis, the most common form of kidney treatment where a patient’s blood is purified and siphoned from toxins through a hemodialysis machine, would cost hundreds of thousands of pesos.

A lifetime procedure, patients need to undergo sessions two to three times a week where each session takes a maximum of four hours, with a cost of at least P3,000 per session. It would also take hours off from one’s day due to travelling to and from the hemodialysis center, putting patients at risk since they’ll be prone to several infections.

With the Cebu Provincial Government’s primary agenda on health, the Provincial Health Office (PHO) revisits hemodialysis’ alternative, peritoneal dialysis, which proves to be more beneficial, cost-effective and safer to the everyday working Cebuano.

Rivas, with the assistance from the PHO, was able to acquire and maintain a supply of needed fluids for the procedure through the Cebu Provincial Hospital in Carcar City.

“Gipaadto ko didto, para maka discount ko sa akung mga tambal” he said.

Solution

“We want to bring the solution to the people na sila mismo may makabuhat niana (peritoneal dialysis] sa ilang kaugalingong panimalay” said PHO Chief Dr. Rene C. Catan.

First introduced in April 2017, the PD program of the PHO aims to train and equip persons afflicted with kidney problems with the knowledge of proper PD procedures and care.

“Kadto gi-train ko dinha sa hospital, gipatan-aw ko nila unsaon paghabwa ug pag-inject,” Rivas recalled during his one-week training for PD procedures.

Compared to hemodialysis’ usage of man-made machines to filter-out impurities in the blood, PD uses the natural membrane of the abdomen, called the peritoneal membrane, in filtering out the blood’s waste by-products.

The PD procedure uses a special fluid, which is inserted through a PD catheter, called the dialysis access, where the fluid aids in the filtration process. After, the patient then excretes it through another bag where simultaneously new fluid is added through the dialysis access. The process of changing fluids is known as exchange.

“You are basically dialyzing 24/7. However, compared to the hemodialysis it costs lesser, lesser complications. You have control over your body and most importantly, is covered by the PhilHealth program,” said Dr. Rannie Gravador, PHO’s PD point person.

Under the PhilHealth’s PD first policy, PD covers a basic package rate of not more than P270,000 a year.

The basic expense of PD is only on the peritoneal fluid, which costs at least P254.

With two to three sessions a day, the estimated cost of PD a year reaches at least P277,000 as compared to the staggering P469,000 in hemodialysis treatments per year.

The PHO’s PD program emphasizes the two key components for successful PD, which is intensive training and strictness of sterility and cleanliness during the process.

“Before mag PD, i-insert pa man ang catheter by a surgeon and dapat gyud i-train ang mga pasyente sa saktong pamaagi,” Gravador said, pointing out the risks of infections.

“Basta limpyo lang gyud ang area ug ang pagtaod, you can do PD anywhere, at home or even at work,” she added.

Rivas only recalled two instances of infection since his start with the PD program in March 2017­­–where he exposed himself to dust while lifting a sack of cement and when he had to endure the strong waves during a pumpboat trip.

“Magbantay lang gyud ka sa imong lihok ug sa kaon, pero nindot gyud ang PD,” Rivas confidently said. “Maayo ang Peritoneal kay handy ug dili nalang ka muadto og hospital ug mas less gyud siya sa expenses.”

The PD program is readily available to be accessed in three major provincial hospitals in the province located in the cities of Danao and Carcar and in Balamban town.

Highly-trained staff and medical personnel are ready to assist those who wish to avail themselves of the program and be trained for the self-procedure. (CEBU PROVINCIAL GOVERNMENT)