Can starting nocturnal PD earlier in evening increase energy level?

My Dad often starts PD late in the evening, often after 9 pm.His program is 10 hours long. He’s very sluggish in the moring and rarely gets moving until around noon. I know some of that is just the affect of dialysis. However, I think if he started earlier, he would get more undisturbed sleep after his program ended and be less tired when he woke up. Is this worth a try?

I agree with your assessment. PD us a much more passive treatment that should have people waking refreshed. Unless you are using (4) 4.25% or some heavy amount of dialysis.

I am a social worker, not a nurse or doctor. I am wondering why your father is so sluggish in the morning. Have you reported this to his nephrologist and home training nurse? You mention his sleep. Are machine alarms keeping him awake or waking him frequently? My first thought would be whether his labs are in the normal range for someone on dialysis and whether PD is giving him good enough dialysis. Has he lost muscle mass and become weak and debilitated because he is only out of bed moving around 9 hours a day? His doctor or nurse may have suggestions for his medical needs. Depression can reduce motivation and interest in doing previously enjoyed things. Talk with the dialysis social worker if you believe he may be depressed. S/he should be able to help and/or refer him to a counselor where he lives.

Whenever we get a new dialysis transfer or a patient for rehab on PD in the SNF, they are getting EXCESSIVE dialysis. 10 hours on the machine, 2-3 bags of dianeal, huge fills…BUNs at 28-38 and Cr 5-6. Our patients are in the 60-80 with BUN and we have a 16.5 Cr and a 20 Cr. These people are out golfing, fixing their decks, feeling great staying out of the hospital. When normal
Patients get to these numbers a nephrologist would switch them to hemodialysis. You can chase lab values or you can chase a higher quality of life free from all the frills of overdialyzing. Always something important to remember.

Is the PD itself affecting his sleep (alarms, discomfort, anxiety) or is his sleep disturbed from other causes (such as uremia or apnea) or, is he just a late riser to begin with? He may be sluggish from getting poor quality sleep, depression, ESRD, or even from anemia. What else is going on with him? The dialysis itself shouldn’t be wiping him out too much unless he’s pulling off a lot of fluid by using high dextrose solutions. 9p-7a sounds like reasonable times to me. Are the labs indicating stability on modality? Is HE bothered by the hours he’s keeping?

His dialysis is going smoothly and his numbers are good. It appears from everyone’s responses that the timing isn’t the problem. I wanted to rule it out before we explored other reasons. He doesn’t move much during the day so I think it’s just lack of muscle tone and exercise, as someone else suggested.

Thanks for all the valuable input.

A program called Life Options that was administered by the nonprofit Medical Education Institute that also administers this website several years ago published a booklet called Exercise: A Guide for People on Dialysis. The booklet was written by Patricia Painter, a PhD exercise physiologist who did a lot of research on the benefits of exercise with people who have kidney disease, are on dialysis or have transplants. You can download it here:

MEI also has an exercise DVD for $10 that goes with the booklet. You can order it here:
Feeling Better with Exercise: A Video Guide for People on Dialysis (DVD)

He may be at risk of falling because he has become debilitated. Patricia Painter often discussed the cycle of deconditioning where someone who is weak and tired stops doing physical activities and then becomes unable to do much. The cycle can be broken by gradually increasing activity. You might want to talk with his nephrologist about a referral to physical therapy (better outpatient vs. home because of the availability of equipment) and ask him/her if s/he would think these exercises would be safe for our father. It might lift his spirits to have something to do that can help him gain strength and endurance and feel more hopeful.

What an excellent resource! Thank you for sharing it, and also for always being so will to help.

You’re very welcome. If you’re on Facebook, you might consider joining the Home Dialysis Central Facebook group. It’s a closed, members-only group so what you post there stays in the group and is not viewed by the general public. All you have to do to be welcomed to the group is answer 4 easy questions. There are almost 7,000 members currently. Among them are people on PD or home HD, their care partners, and dialysis professionals. It seems like someone is always online 24/7 and willing to offer advice and support. You can find the group here: Home Dialysis Central Discussion Group | Facebook