NEW FEATURE: Ahead of World Kidney Day, Orlando VA Launches Inpatient Peritoneal Dialysis

Marine Corps Veteran Mario Melendez, who served from 1965 to 1971, became the first patient to receive the treatment at the facility.

“I had no idea that I had diabetes when I got separated from the military,” Melendez shared.

Years later, after retiring, Melendez learned his kidneys were failing. By 2017, Melendez's condition had worsened. A prostate cancer survivor, he eventually began peritoneal dialysis, or PD, a home-based kidney replacement treatment that filters waste from the blood when the kidneys can no longer do so.

PD differs from traditional hemodialysis (HD) in several aspects. Hemodialysis is typically performed at an outpatient dialysis center three times a week using vascular access to circulate blood through a machine. In contrast, PD uses a soft catheter placed in the abdominal cavity to instill and drain a cleansing fluid. Waste products, electrolytes, and excess fluids move across the peritoneal membrane during the process.

Because PD works slowly and continuously over eight to 11 hours, it can be gentler than hemodialysis and often results in fewer side effects. Many patients perform PD at home each night using a cycler machine while they sleep. Successful treatment requires training, proper catheter care to prevent infection, and the ability to safely operate the equipment.

“At 8 p.m., I connect to the machine, and it runs for about 10 to 11 hours while I sleep,” Melendez said. “By 6 in the morning, I disconnect.”

“It’s a world of difference,” Melendez said after receiving treatment at the Orlando VA. “I can get up, walk, and function. The staff is great, it truly feels like a team.”

Until recently, Veterans on PD who required hospitalization were often transferred to a non-VA hospital to continue treatment, which could lead to fragmented care.

“We lacked an inpatient peritoneal dialysis program,” said Dr. Monika Aggarwal, Chief of Nephrology at OVAHCS. “As a result, Veterans didn’t have the option to receive inpatient care at the Lake Nona campus.”

Launching the program required months of preparation, including securing specialized equipment, developing clinical protocols, creating electronic order sets, and training inpatient nursing staff.

“A significant amount of effort went on behind the scenes,” Dr. Aggarwal stated. 

Dr. Aggarwal acknowledged the contributions of Dr. Ritu Soni, Amanda Medland, PharmD, Bethalin Gardose, RN, Roshni Crisnoel, RN, and Mariamma Alexander, RN, for their pivotal role in delivering the service to Veterans. “This was a top priority for us,” Aggarwal reiterated. 

For Melendez and his wife, the change brought peace of mind. Living near the Lake Nona campus, they previously expected he would be transferred elsewhere if hospitalized.

“It was a delightful surprise that they were able to stay here,” Dr. Aggarwal said. “That was the primary reason we opened this service.”

Keeping Veterans at the VA also improves communication among providers, Dr. Aggarwal added. “All of Mr. Melendez's doctors are located here. Everyone has access to the same medical record, which ultimately improves care.”

The inpatient PD program lays the foundation for future expansion. Orlando VA leaders hope to develop a full outpatient peritoneal dialysis program, increasing home-based dialysis options for Veterans with chronic kidney disease.

As World Kidney Day approaches on March 12, health care professionals encourage Veterans to focus on prevention. Managing diabetes and high blood pressure, maintaining a healthy weight, staying active, and getting regular checkups can help protect kidney health.

Veterans seeking more information are encouraged to connect with their nephrology team.

For more information, please visit: VA Orlando Health Care | Veterans Affairs, subscribe to receive email updates by clicking here, like us on Facebook at: @OVAHCS, follow us on Instagram at: @OVAHCS, or on Twitter at: @OVAHCS.

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Established in October 2006, the Orlando VA Healthcare System (OVAHCS) was designated a 1a facility (most complex) in 2021, with more than 5,660 employees and an annual budget of $1.5B and serves more than 131,000 Veterans in Central Florida. The Orlando VA Medical Center at Lake Nona provides outpatient, inpatient and emergency services. Lake Nona’s 65-acre medical campus encompasses 134 acute inpatient beds, providing complex Medical/Surgical/Mental Health specialty care, advanced diagnostic services, and a large multispecialty outpatient clinic as well as a 120-bed Community Living Center, two Mental Health Residential Rehabilitation Treatment Programs/Domiciliaries (60-beds located at the Lake Nona Campus and 58-beds at the Lake Baldwin Campus). Outpatient services are provided at a Health Care Center in Viera, a Multispecialty Community Based Outpatient Clinic in Daytona Beach, and five Community-Based Outpatient Clinics located in Clermont, Lake Baldwin, Kissimmee, Deltona, Palm Bay and Tavares.