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  1. #1
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    Default too much dialysis

    Is there such a thing as too much dialysis such as doing 10 hr. txs as opposed to 8 hr txs? I have read that dialysis strips out vitamins and minerals etc., but with nocturnal dialysis one is eating so much better so does it balance out?

  2. #2
    Join Date
    08-17-04
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    Jane, one of the nephrologists I know who is a long-time home dialysis advocate has told me, "you can never have too much sex or too much dialysis." Okay, he's a character, believe me. But when you consider that healthy kidneys work 24/7, anything less than that can't be "too much."

    That said, it IS possible to remove too much fluid. As far as vitamins and such, it's important to keep track of the levels and replace anything that is getting deficient.

  3. #3
    Join Date
    07-02-04
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    Default Re: too much dialysis

    Quote Originally Posted by Jane
    Is there such a thing as too much dialysis such as doing 10 hr. txs as opposed to 8 hr txs? I have read that dialysis strips out vitamins and minerals etc., but with nocturnal dialysis one is eating so much better so does it balance out?
    Jane, you will need supplements/vitamins.....it takes sometime till they figure out how much you need.

    In a sense...my opinion, too much dialysis is possible.......for example, if labs show a KTV above normal and your dialyzing 4 hours and Dr. says you are elegible to cut down treatment time to 3 hours, would you?
    Gus Castaneda
    Hemodialysis initial Start: 1978
    Home Hemodialysis: 11/2004 - Present
    Http://www.dailyhemo.org



  4. #4
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    I would hope that patients would think twice before cutting their time. Remember that the National Kidney Foundation K/DOQI guidelines have a recommended minimum Kt/V of 2.0. We keep having to remind people that this is the floor...not the ceiling. We don't know what the ceiling is. Like Dori, I have heard from doctors who have been practicing for 30 or more years there is no such thing as too much dialysis.

    In fact, I don't put a lot of faith in Kt/V and here's why. The United States Renal Data System 2005 Annual Data Report states that in 1998 the number of dialysis patients with the minimum Kt/V of 2.0 was 80% and the annual mortality rate for dialysis patients was 21.54%. In 2003 the number of patients with a minimum Kt/V of 2.0 was 91% and the annual mortality rate was 21.07%. If Kt/V and the rest of the clinical indicators that the renal community has worked so hard to changes and have in fact improved made that much difference, I'd have expected the mortality rate to drop more than 0.44%.

    I'm not quoting these statistics to scare anyone, but to tell you that you hold your future in your hands. If a certain amount of dialysis takes you to the floor (which provides replacement of about 15% kidney function), wouldn't you want to have your blood cleaned better than that to increase your chance of survival and of living a better life?
    Beth Witten MSW ACSW LSCSW
    Medical Education Institute, Inc.

  5. #5
    Join Date
    08-17-04
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    Default

    Like Beth, I don't put much faith in Kt/V--because it is based on clearance of urea, a small molecule that freely diffuses between cell membranes, unlike pretty much any other molecule in the body. The most recent K/DOQI Guidelines for hemodialysis adequacy (which, Beth points out, is a minimum) still uphold urea as a marker, which I believe is very unfortunate. Perhaps phosphorus would have been a better choice. At any rate, it's pretty clear that with Kt/V, we're not measuring the right thing, or at least not in the right way.

  6. #6
    Anonymous Guest

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    Beth wrote:
    I would hope that patients would think twice before cutting their time. Remember that the National Kidney Foundation K/DOQI guidelines have a recommended minimum Kt/V of 2.0.
    Although we try to keep up with the literature, this is one that got past us. We were told in several units that the rec. min, was about 1.3.

    Beth wrote:
    The United States Renal Data System 2005 Annual Data Report states that in 1998 the number of dialysis patients with the minimum Kt/V of 2.0 was 80% and the annual mortality rate for dialysis patients was 21.54%. In 2003 the number of patients with a minimum Kt/V of 2.0 was 91% and the annual mortality rate was 21.07%
    Find this really hard to believe. Don't know many in-center patients that have a kt/V anywhere near 2.0. We always had about 1.6-1.8. When we became more educated, we saw that staff was not setting the tx up correctly ( i.e. left drip chambers low, forgetting to set other peramiters ) which caused alarms to go off. When we double checked everything staff did, kt/V went up to 2.0 At first, we thought something was wrong with the labs, but when we consistently got 2.0 we attributed it to a correctly set up tx with no or few alarms.

    Dori wrote:
    it's pretty clear that with Kt/V, we're not measuring the right thing, or at least not in the right way
    Can't say we felt any better at 2.0 then at 1.6. Agree there must be a better way to measure.

  7. #7
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    Default

    It was late and I meant to type 1.2 for the minimum Kt/V. I didn't realize I did this until I read Heather's message. Sorry, Heather and everyone else. A Kt/V of 2.0 was the recommended Kt/V for PD patients until just recently when the K/DOQI guidelines reduced it because studies hadn't found that patients with higher Kt/Vs in PD did better and patients were having to do daytime exchanges in addition to nighttime dialysis to each the Kt/V of 2.0. We'll have to see how the change affects their survival and hospitalizations. All I can say is that reading data from clinics doing nocturnal and daily dialysis where Kt/V is higher and other toxins are removed that can't be removed in conventional dialysis proves to me that 1) more dialysis is better and 2) we're not measuring something that makes more of a difference than Kt/V.
    Beth Witten MSW ACSW LSCSW
    Medical Education Institute, Inc.

  8. #8
    Anonymous Guest

    Default

    What is the thinking on GFR rate and creatinine levels for someone on PD ,3x in center, SDD, ND
    Thanks

  9. #9
    Anonymous Guest

    Default too much dialysis

    I just started on the Nxstage and for the first month my kt/v was .5 I run for two hours with 15 effluent, ff of 40 and run 6 days a week. Does this sound right to you all?

  10. #10
    Join Date
    07-02-04
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    Default Re: too much dialysis

    Quote Originally Posted by Anonymous
    I just started on the Nxstage and for the first month my kt/v was .5 I run for two hours with 15 effluent, ff of 40 and run 6 days a week. Does this sound right to you all?
    That sure sounds right, the KTV for daily-short is measured differently than that of 3x a week counterpart.....read this thread I started awhile back.

    http://www.homedialysis.org/boards/v...&highlight=ktv
    Gus Castaneda
    Hemodialysis initial Start: 1978
    Home Hemodialysis: 11/2004 - Present
    Http://www.dailyhemo.org



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