Hemodialysis:Individual response to a standardised prescription

The need for keeping the ultra-filtration goal within prescribed limits of volume and speed has been thoroughly documented. Many dialysers confirm the unpleasant sensations/symptoms following organ stunning as a consequence of too rapid fluid extraction.

Less well documented is the assault on ones system of having all ones blood leave its rightful home to be circulated through a foreign object around 16 times in 4 hours. Whilst red cells may not possess nuclei they are nonetheless living cells with a lifespan of around 100 days in healthy individuals. Spare a thought for them: soft-membraned and flexible they are sucked from the dark interior of the satin-smooth endothelium-lined fistula to be squeezed under pressure in bright light through thousands of synthetic fibres only to be pitched back again to await another round. …

Anthropomorphic drivel? Maybe, but I had a read of the fine print on the pamphlet supplied by Fresenius with my new carton of capillary high-flux dialysers. Adverse effects may occur during dialysis and may result from factors specific to the patient. Indeed, many confirm the philosophy that a “one size fits all” is a limited way to approach a patient initiating dialysis.

The pamphlet goes on to describe symptoms to look out for: dyspnoea, chest congestion, bronchospasm, respiratory arrest, hypotension, tachycardia, nausea, flushing, bradycardia, urticaria, angiodema, ouch!!! - to name a few. I think most of us can confirm hypotension and nausea. The cautionary note continues: hypersensitivity or hypersensitivity-like reactions have been observed mainly in the first weeks of treatment with the dialyser …treatment intensity should be gradually increased to permit adequate adaptation.

While graded increase of treatment intensity is not a call to incremental dialysis it does make a plea to allow adaptation and adjustment to a highly invasive procedure.

I suspect many patients accept initial difficulty, strain and pain as par for the course; it need not be so. To pitch straight into full treatment within the first week or two is an assault on ones physiology (with one’s psychology already under strain) and would surely only be necessary in the case of acute or total kidney failure.

Ahh the early days of dialysis! being slapped around the face whilst being tipped upside down to persuade you to return from the peaceful place you got a brief glimpse of!
I like your post and remember starting on 3 hrs 3 times a week and steadily being brought up to 4 hrs. Been on it for 15 years now with a 2 year break. After some research I asked my Neph if instead of 450ml/min blood pump and 530 dialysate could we try 350 blood pump and 700 dialysate, see what happens after a couple of months. 3 weeks in and the LVH seems to has lessened, getting higher BP readings now, but I have also changed my diet to almost meat free, have stopped taking Omeprazole and am following a healthier diet too.
Basically, we are all so very different within that one size will never fit all. I believe one should be fully involved with their treatment plan but if they are prepared to trust the Neph and let him get on with it that’s their choice.
Never expect your Neph to be keeping up with all the latest news, he’s too busy!