Extended hours HD

Hi there,

I’m a HHD patient in the process of switching to nocturnal.

I’m currently doing 6hrs every other day 240 pump speed and my labs have been pretty good.
I still have good really urine output, so i don’t remove any fluid at all (not even the wash back)
I know that nocturnal is great for removing fluid slowly and safely, but my question is, will my clearance alone be enough to justify doing 8hrs every other night and having to take heperin (i don’t currently use any anti coags)
I’m planning to drop my pump speed to 220 when i start nocturnal, so that will help my fistula, which in itself is a good thing.
I’m just curious, because i don’t know anyone with my situation.

Are you adding your urine into the KtV calculation? The test is call Kru, and part of our QLHD is reducing the amount of dialysis to improve quality of life. We had a 217lb 98.6kg patient running 30L in 1.5 hours with a KTV of >3.0. Residual function is the number one goal for dialysis patients by pushing fluids and maintains that output. Make sure they add your 24 hour urine count

Sorry Josh, i’m not sure i understand any of that. I’m in the UK, we don’t operate off KtV calculations here.
My urine output is around 3-4 litres in 24hrs and my weight is very stable at 91kg. I’ve never had issues with overloading, therefore i’ve never seen the need to start removing any fluid if i don’t need it.
I’m only wanting to extend my hours purely to get better solute clearance.

Blessings to Europe for NOT doing ktv. In the states KTv causes unneeded extra dialysis. Our patients feel great, they golf, they do well at BUN less <100. I assume you’re aiming to reduce middle molecule clearance. What is your BUN and Cr on average?

There are many studies that say there isn’t an improvement in reduced mortality associated with longer run times etc. Just genuinely interested if you have a study your physics utilized etc. Always looking to improve our processes

I’m just wondering if theres an argument that an extendeded run at a reduced pump speed would be beneficial. Less organ stress and better solute clearance etc.

My recent labs for Urea nitogen and creatinine were:
Urea Nitrogen: 8.1mmol/L
Creatinine: 509umol/L
I can only access most recent labs at the moment, so i can give you an average sorry.

I first want to say that I’m a social worker, not a nurse or physician. There are multiple studies of nocturnal hemodialysis in PubMed. This 2019 article discusses how frequent nocturnal HD has improved survival, reduced left ventricular hypertrophy and improved LV mass, improved BP, phosphate and mineral metabolism, and sleep apnea. Some studies have shown improvement in kidney domains in a quality of life survey and anemia management. It also mentions risks, including reduction in residual kidney function and access problems with more frequent treatments.

I’ve personally known patients on nocturnal home HD who felt so good they could do more including work and eat a more liberal diet with fewer limits on fluid because they were getting more dialysis and more often. Dietitians have told me that they’ve actually had to tell patients on nocturnal HD in-center and at home to supplement phosphorus or eat more phosphorus!

I suggest you consider joining the Home Dialysis Central FB group. It’s a closed (members only) group of >7,000 members. You can find that group at Home Dialysis Central Discussion Group | Facebook. To join you need to answer 4 simple questions. A number of people in that group are doing longer HD sessions at home or nocturnal home HD while they sleep.

Thanks Beth.
I did look at a few studies which did indeed suggest a reduction in kidney function with longer duration dialysis, but i’m assuming this was in reference to patients who are removing fluid on a regular basis.
It’s difficult to find a study that mirrors my situation, i guess i need to keep digging, hopefully i’ll find something.
I’m already on the fb group, but thanks for the heads up.

Do you mean “justify” in terms of reimbursement purposes? If you’re currently doing 6 hours QOD, and are just increasing your time to 8 hours and lowering the speed, this is the same frequency you’ve previously been approved for. You’re counted when blood hits the dialyzer, not for how long it stays there. Heparin is a necessary medication and should be approved as needed for all dialysis patients. If your fluid removal is solely handled by your residual, make sure your clinic has you do the 24 hour urine test, even if it doesn’t count for Kt/V purposes (which it should, but we shouldn’t be using KtV anyway…that’s a whole other tangent!) so that you KNOW what’s going on. Running treatments in the way you are suggesting (long, low, slow, etc) as you know, will likely preserve that RRF for longer. And that’s a gift. Hope this helps.