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DEAR DR. ROACH: My daughter, age 44, has had chronic kidney disease since she was 10 years old. She had a renal transplant at 23, then another at 32. The second graft started gradually failing a year back. In January, she was diagnosed with ovarian cancer. This past month, she had a total hysterec- tomy, along with the removal of malig- nant tumors and nodules. She has since been on hemodialysis without any out- put of urine. What are the possibilities with peritoneal dialysis? Will this enable her to have a near-normal life? -- R.S.
ANSWER: Peritoneal dialysis uses the immense lining of the abdominal wall (the peritoneum) to act as a kind of kidney. A special dialysis fluid is instilled into the peritoneal space through a catheter. Excess potassium and acid, along with metabolic toxins that are normally removed by the liver, get diffused into the peritoneum and the dialysis fluid. The fluid is then drained through a second catheter, which removes these unwanted chemi- cals from the body.
This may be repeated multiple times at night through an automated machine (continuous cycler peritoneal dialysis, or CCPD). It can also be done manu- ally throughout the day (continuous ambulatory peritoneal dialysis, or CAPD). I've asked many kidney experts which type of dialysis they'd want if they needed it, and most pre- ferred peritoneal dialysis to hemodialy- sis. (The only ones who didn't prefer peritoneal dialysis wanted home-based hemodialysis.)
The main issue for your daughter is the surgical scarring from her ovarian cancer surgery. Scars greatly reduce the amount of peritoneal tissue for fluid to diffuse across and limit the effective- ness of peritoneal dialysis. Further- more, some women with ovarian can- cer have cancer disease within the peri- toneum itself, which would make peri- toneal dialysis a bad option due to concerns with the cancer treatment and
the risk of infection.
Experts recommend a peritoneal
catheter via laparoscopic surgery, which would allow the surgeon to see if she's a good candidate for peritoneal dialysis. Her cancer surgeon and kid- ney specialist need to discuss this.
DEAR DR. ROACH: My grand- daughter, who's only 18, experiences crashes with her blood pressure. She has to put on compression hose before she even gets out of bed, and she also requires a very strict diet. I know she gets these IV drinks that have some- thing to do with salt. I also know she had a lot of tests done, and a tilt table test showed postural orthostatic tachy- cardia syndrome (POTS). I'm not sure which medicine they're giving her; is this something that you can look into? -- R.W.
ANSWER: POTS has been more frequently diagnosed within the past five years, and experts believe that it's a frequent result of COVID infections, especially in younger women. Different people may have different major symp- toms with POTS. For people who have low blood pressure, like your grand- daughter, compression stockings as well as plenty of salt and water are the first-line treatments.
A graded exercise program helps many people but can be a problem for some. Medication isn't always needed, but midodrine and fludrocortisone are sometimes used symptomatically. However, these need to be used with caution. Most people will gradually improve, but there's a subset of people who may continue to have symptoms for even longer than a year.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column when- ever possible. Readers may email ques- tions to ToYourGoodHealth @med.cornell.edu.