Question Dialysis

[Tommymac]

Diving has always been a big part of my life. I started when I was 13 yrs old and I’m now 77 yrs old. Diving has changed for me. No longer wreck diving in the great lakes, now its shallow water <20 feet beeper diving (metal detecting). The issue now is that I have been on Dialysis for 2 1/2 years and will be going to PD dialysis soon. I have been told by doctors that I could still dive in salt water but not fresh water. I really don’t like dry suits. Are there any others divers out there in the same boat. I served on the Oriskany during Vietnam, and wish I had dove it when I was in better health. Today I feel its too much too late for me. I live in WI and will start spending Winters in Palm Coast FL.

I should add that I am not diabetic and my Kidney failure was due to high blood pressure (pressure cooker career in LE)

 

[Mobulai]

Sorry to hear about your troubles, and I hope you find a good way to keep diving and enjoying it

Out of interest

I have been told by doctors that I could still dive in salt water but not fresh water.

Did the Doctors indicate this with regards to thermal stresses of cold freshwater or was it just a clear line between salt and fresh?

 

[Duke Dive Medicine]

Diving has always been a big part of my life. I started when I was 13 yrs old and I’m now 77 yrs old. Diving has changed for me. No longer wreck diving in the great lakes, now its shallow water <20 feet beeper diving (metal detecting). The issue now is that I have been on Dialysis for 2 1/2 years and will be going to PD dialysis soon. I have been told by doctors that I could still dive in salt water but not fresh water. I really don’t like dry suits. Are there any others divers out there in the same boat. I served on the Oriskany during Vietnam, and wish I had dove it when I was in better health. Today I feel its too much too late for me. I live in WI and will start spending Winters in Palm Coast FL.

I should add that I am not diabetic and my Kidney failure was due to high blood pressure (pressure cooker career in LE)

There are pathogens in salt water too, so you'll still need to exercise caution if you continue diving - monitor for signs of site infection and peritonitis, don't dive in areas known to be contaminated, and avoid warm, brackish water that would be more likely to contain vibrio vulnificus (a virulent bacteria). I'd also be concerned about other effects of hypertension like cardiomyopathy if your blood pressure was high enough for a long enough period to cause renal failure. Have you been cleared by a cardiologist as well? If you're in western Wisconsin, you're probably reasonably close to Hennepin County Medical Center and Mayo Clinic, both of which have physicians who are trained in assessing divers. I'd recommend that you check with one of them if you haven't already. DM me if you'd like contact information.

Best regards,
DDM

 

[Tommymac]

BP is under control. No significant heart issues (Thanks Mom and Dad)
I will have to decide if it’s worth the risk in salt water and how enjoyable will diving be with all this in the back of my mind. Everything is a calculated risk, such as riding my motorcycle.

 

[Tommymac]

Sorry to hear about your troubles, and I hope you find a good way to keep diving and enjoying it

Out of interest

Did the Doctors indicate this with regards to thermal stresses of cold freshwater or was it just a clear line between salt and fresh?

The issue is not cold, but rather risk of infection with a tube coming out of my stomach. This is what gets hooked up a machine so I can do dialysis at home instead of going to a center and getting poked.

Thank you for your concern.

 

[Orodreth]

I am concerned about pressure difference that can cause a squeeze in PD tubings. Better to check with your nephrologist but I assume cold/warm or salted/fresh water all have some level of risk of peritonitis due to the tubing. Similarly, there are some case reports about an unbalanced pee valves that caused pseudomonas cystitis due to water backflow from the tubing. Is it possible for you to have hemodialysis via an AV fistula. A safer alternative maybe?

It is up to you to properly handle tube connectors and keep them as disinfected and sealed as possible. In my opinion there will be always some risk of infection.

Can not comment on cardiac effects, it is also up to your nephrologist to approve you are fit to dive on this issue.

Best regards

 

[kinoons]

I’m normally the first to say that most medical problems can be overcome to allow someone to keep diving, but in this instance I think it’s going to be tough.

As noted the risk for infection is the biggest concern.

The risk of getting a severe infection during the first year of dialysis was 35% for CAPD, 25% for APD and 11% for home HD patients. During five years of follow-up, the hazard ratio of severe infection was 2.8 [95% CI 1.6–4.8] for CAPD and 2.2 [95% CI 1.4–3.5] for APD in comparison to home HD. Incidence rate of severe infections per 1000 patient-years was 537 for CAPD, 371 for APD, and 197 for home HD patients.

Severe infections in peritoneal dialysis and home hemodialysis patients: An inception cohort study

Objectives Infections are the most common non-cardiovascular cause of death among dialysis patients. Earlier studies have shown similar or higher risk of infectious complications in peritoneal dialysis (PD) compared to hemodialysis (HD) patients, but comparisons to home HD patients have been...

journals.plos.org

This is only one set of research, but it gives you a ballpark of the risk you’re looking at with that access in your abdomen. I’ll be willing to bet dollars to donuts no one in the study was diving either. It’s a WAG, but I’d surmise that diving will only increase that risk, and peritonitis is not something you want to deal with, as it carries a high risk of disability or death itself.

The issue of damaging your access when remote from care also needs to be considered.